Module 6 NUR2214C - Perry EAQ: Chapter 43 The Child With Hematologic or Immunologic Dysfunction

The health care provider orders a transcranial Doppler (TCD) test for a child with sickle cell anemia (SCA). How does the nurse expect the health care provider to explain the reasoning behind ordering the test? 1 "The test will help us know whether the child is at risk for cerebrovascular accident." 2 "The test will help us identify the different types of abnormal hemoglobin." 3 "The test will help us determine whether SCA was inherited by the child." 4 "The test will help us identify whether there are other coexisting conditions."

1 A TCD test is used to identify whether the child with SCA is at risk for cerebrovascular accident. Hemoglobin electrophoresis is a screening test used to identify different types of hemoglobin. SCA is inherited, so the test is not used to verify whether it was inherited. Instead, the test is used to identify the homozygous form and the heterozygous form of the disease. A TCD test is not used to identify other coexisting conditions in a child with SCA.

The nurse finds that a child is pale, gets easily fatigued, and has lack of energy. The nurse asks the parents to get a complete blood count (CBC) test. What does the nurse suspect from these symptoms? 1 Anemia 2 Chest syndrome 3 Sickle cell anemia 4 Splenic sequestration

1 Paleness, fatigue, and lack of energy are the symptoms of anemia that can be confirmed after a CBC test. Sickle cell anemia is diagnosed by chest pain, elevated temperature, painful joints, or hypoxia. Splenic sequestration is a symptom of sickle cell anemia, which causes an enlarged spleen. Chest syndrome is a symptom of sickle cell anemia with signs of hypoxia, chest pain, fever, cough, and wheezing.

The nursing instructor is teaching a student how to administer iron dextran injections to a child with severe anemia. Which instruction does the nurse give after the student administers the injection? 1 "Do not massage the injection site." 2 "Keep the syringe near the child's bed." 3 "Use the same site for the next injection." 4 "Place the child in a semi-Fowler position."

1 The nursing instructor tells the student to avoid massaging the injection site to minimize skin staining and irritation. The nurse places the patient in an appropriate position before administering the injection. It is necessary to rotate sites because of the potential for tissue damage. The nurse disposes of the syringe safely after administering the medication to avoid stick injuries.

The nurse is caring for a child with severe anemia. The child has to undergo several blood tests. What actions does the nurse take to prepare the child for the test? Select all that apply. 1 Describes the test step by step 2 Demonstrates the procedure on a doll 3 Explains why all the tests are necessary 4 Tells the parents to stay out of the laboratory 5 Does not perform the tests if the child is not ready

1,2,3 The child with severe anemia has to undergo several tests sequentially, which is traumatic for the child. So the nurse explains the purpose of each test to provide comfort to the child. The nurse demonstrates the procedure on the doll so that the child gets familiar with the procedure. The nurse describes the test step by step at the level of the child's understanding so that the child gets comfortable with the procedure. The nurse tells the parents to accompany the child during the procedure to make the latter comfortable. The nurse is responsible for preparing the child for the test. Waiting until the child is ready is not an appropriate action at this time.

The nurse is caring for a child with epistaxis. The parent asks how nosebleeds can start. What does the nurse understand about the common causes of epistaxis in children? Select all that apply. 1 They can be caused by nose picking. 2 They can be caused by trauma to the nose. 3 They can be caused by headaches and stress. 4 They can be caused by inflammation from allergies. 5 They can be caused by foreign bodies lodged in the nostrils

1,2,4,5 Epistaxis is common in children because it can be caused by trauma to the nose, nose picking, inflammation from allergies, and foreign bodies lodged in the nostrils. Epistaxis is not commonly caused by headaches and stress.

The parent of a child with immune thrombocytopenia (ITP) asks the nurse what kind of sport activity will be beneficial for the child. How does the nurse respond? 1 "Avoid all kinds of sport activity." 2 "Encourage swimming or walking." 3 "Any kind of indoor activity is good." 4 "Sports such as gymnastics are the best."

2 A child with ITP is at risk for bleeding and easy bruising. Hence, the nurse advises the parents to encourage noncontact sports such as swimming and walking. Gymnastics increase the risk for injury and are avoided. The nurse does not advise to stop all kinds of sport activity because it is not beneficial for the child's physical development. Quiet indoor activities are beneficial for the child; however, any kind of vigorous physical activity indoors may also increase the risk for injury.

The nursing instructor is teaching a group of students about the use of antiretroviral drugs in the therapeutic management of human immunodeficiency virus (HIV) infection. Which statement by the student indicates a need for additional learning? 1 "The drugs prevent further deterioration of the immune system." 2 "The drugs help prevent reproduction of the virus and cure HIV." 3 "The protease inhibitor indinavir (Crixivan) is an antiretroviral drug." 4 "The drugs suppress viral replication and delay disease progression.

2 Antiretroviral drugs prevent the reproduction of the virus but do not cure HIV. The drugs prevent further deterioration of the immune system by slowing the growth of the virus. The protease inhibitor indinavir (Crixivan) belongs to the class of antiretroviral drugs. Antiretroviral drugs suppress viral replication and delay the disease progression, thereby changing HIV from a rapidly fatal illness to a chronic disease.

Which term is used to describe the removal of blood from an individual, separation of the blood into its components, retention of one or more of these components, and reinfusion of the remainder of the blood back into the individual? 1 Epistaxis 2 Apheresis 3 Thrombocytopenia 4 Blood transfusion therapy

2 Apheresis is the term used to describe this procedure. Blood transfusion therapy is a therapeutic process of treating a blood disorder. Epistaxis is a nosebleed. Thrombocytopenia is a disorder characterized by low levels of thrombocytes.

After determining a 7-month-old African-American infant girl has sickle cell anemia and is having a crisis, the health care team begins therapy. What activities would the nurse determine as priorities for this infant? 1 Immobilizing the patient's upper extremities, administering antibiotics, and transfusing blood products 2 Administering pain medication, initiating intravenous (IV) fluids and electrolytes, and administering oxygen 3 Monitoring vital signs, inserting an indwelling urinary catheter, and encouraging activity to promote circulation 4 Preparing the infant for a transcranial Doppler test, administering penicillin, and administering meperidine (Demerol) for pain

2 Because this infant is experiencing a vasoocclusive crisis, IV fluids and electrolytes, oxygen, and pain medication must be administered immediately to decrease the sickling and to decrease the pain. Knowing the triggers for sickling leads to interventions to reduce the sickling. There is no need to immobilize the infant's upper extremities. There may be a need for elbow restraints depending on where the IV site is, but not immobilization. Antibiotics might be administered if infection is expected, but this needs to be determined first. Blood products might be administered to provide blood that is not sickling. A transcranial Doppler test is not indicated at this time because the infant is too young and a cerebrovascular accident (CVA) is not suspected. Penicillin might be the antibiotic used after determining that an infection is present. Demerol is contraindicated because of the side effects it can cause in children with sickle cell anemia. The urine output will be monitored by weighing the diaper without the risk of infection because of an indwelling catheter. Rest is indicated for healing and to conserve energy in this very ill child

A child is prescribed oral iron for iron deficiency anemia. What intervention does the nurse implement to ensure the absorption of iron in the child? 1 Gives milk with medications 2 Gives citrus juice with the oral iron 3 Increases iron-rich foods in the diet 4 Ensures the child drinks adequate fluids

2 Citrus fruits and juices are rich in vitamin C or ascorbic acid, which facilitates the absorption of iron. Consumption of adequate fluids will not ensure iron absorption. Milk is a poor source of iron and will not serve to accomplish iron deficiency. Iron is poorly absorbed from iron-rich foods and does not meet the additional iron requirements of the body.Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

Which statement best describes the onset of clinical manifestations in thalassemia major? 1 Clinical manifestations are usually not identified until adolescence at the earliest. 2 Clinical manifestations may be insidious and not recognized until early toddlerhood. 3 Clinical manifestations are late to form and usually present when the patient is a young adult. 4 Clinical manifestations are delayed for many years, remaining dormant, until mid-adulthood.

2 Clinical manifestations in thalassemia major are not recognized until late infancy or early toddlerhood. They may appear well before adolescence, young adulthood, and middle adulthood.

Which condition in a child indicates a deficiency of one of the factors (proteins) necessary for blood coagulation? 1 Apheresis 2 Hemophilia 3 Aplastic anemia 4 Sickle cell anemia

2 Hemophilia is a group of bleeding disorders in which there is a deficiency of one of the clotting factors necessary for blood coagulation. Aplastic anemia is characterized by anemia, leukopenia, and decreased platelet count. Sickle cell anemia occurs when normal hemoglobin is replaced by abnormal hemoglobin. Apheresis refers to the process of removing blood from a patient, usually before stem cell transplantation or chemotherapy

What is the most important nursing consideration when caring for a child with sickle cell anemia? 1 Refer parents and child for genetic counseling 2 Teach parents and child how to minimize crises 3 Observe for complications of multiple blood transfusions 4 Help the child and family to adjust to a short-term disease

2 Parents need specific instructions about changes in the child's condition that they should watch for, penicillin administration, adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly prepared to care for them

An infant with sickle cell anemia (SCA) is prescribed the hemoglobin electrophoresis test. What is the purpose of this test? 1 To confirm the presence of SCA 2 To rule out disorders other than SCA 3 To detect different types of hemoglobin 4 To identify whether the child is at risk for cerebrovascular accident

3 A hemoglobin electrophoresis test is used to detect different types of hemoglobin in the child. It further helps determine whether the child has SCA, the homozygous form of the disease, or sickle cell C disease, the heterozygous form. A transcranial Doppler (TCD) test is used to identify whether the child with SCA is at risk for cerebrovascular accident. Sickledex is used to confirm the presence of SCA. Hemoglobin electrophoresis test is not used to rule out disorders other than SCA.

The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. In the discussion, what should the nurse include? 1 The virus is easily transmitted. 2 The virus is only transmitted through blood. 3 Intravenous drug users should not share needles. 4 Condoms should be used if adolescents are sexually active and homosexual.

3 Intravenous needles that have been used should not be shared. They may be contaminated with the virus. The virus is not easily transmitted. It requires direct contact with blood and body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Human immunodeficiency virus is spread through blood and body fluids. Condoms should be used for both heterosexual and homosexual sexual activity.

The nurse is reviewing the laboratory results of a 1-year-old child who has been diagnosed with sickle cell anemia (SCA) during infancy and is now presenting with symptoms of the disease. The parent says to the nurse, "I don't understand. My child did not have any symptoms at all up until now." Which is the best response by the nurse? 1 "It's not good to think about the past versus the condition your child is in now." 2 "Your child probably had symptoms this whole time; you just didn't notice them until now." 3 "Infants usually do not have symptoms, but the symptoms become apparent as children get older." 4 "The type of sickle cell anemia your child has determines whether any symptoms will be present."

3 Newborns with SCA are usually asymptomatic because of the protective effect of HbF. However, this rapidly decreases during the first year, and children become at risk for sickle cell-related complications and symptoms. It is not therapeutic to tell the parent not to think about the past versus the present. It is not appropriate to tell the parent that the child probably had symptoms this whole time, as that undermines the parent's intelligence and parenting skills, and it is false. It is inaccurate to say that the type of SCA determines whether symptoms are present or not.

Which symptom is seen in a child with disseminated intravascular coagulation (DIC)? 1 Rickettsial infections 2 Mucosal inflammation 3 Yellow, fatty bone marrow 4 Increased tendency to bleed

4 A child with DIC has an increased tendency to bleed as a result of excess thrombin and destruction of platelets. Rickettsial infections may sometimes cause DIC. It is not a symptom of DIC. Mucosal inflammation is not a symptom of DIC. It is caused by chemotherapy. Yellow, fatty bone marrow indicates the presence of aplastic anemia.

The parent of a 6-month-old infant asks the nurse about the food that can be included in the child's diet. What does the nurse suggest? 1 "Feed breast milk only." 2 "Give carrots and peas." 3 "Provide fresh cow's milk." 4 "Include cereals in the diet."

4 Cereals are the first semisolid foods that should be given to an infant at 6 months of age. This helps the infant accept food other than milk and prevents the risk for anemia. The nurse does not advise feeding only breast milk because it may induce nutritional anemia. Cow's milk puts the child at risk for gastrointestinal blood loss because of the presence of heat-labile protein in the milk. Carrots and peas are solid foods that are not digested by the infants at 6 months.

Antithymocyte globulin (ATG) is administered intravenously to a child with aplastic anemia (AA). The child is susceptible to side effects of ATG, such as fever, chills, and myalgias. Which medication is administered to prevent these side effects? 1 Stavudine (Zerit) 2 Pentam (Pentamidine) 3 Prophylactic antibiotics 4 Methylprednisolone (Medrol)

4 Methylprednisolone (Medrol) is administered to prevent fever, chills, and myalgias in a child who is administered ATG intravenously. Prophylactic antibiotics are administered to prevent infections. Stavudine (Zerit) is a class of antiretroviral drugs used in patients with human immunodeficiency virus (HIV) infection. Pentam (Pentamidine) is used for patients with Pneumocystis carinii pneumonia (PCP).

The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they do what? 1 Make up the liquid portion of blood 2 Help keep germs from causing infection 3 Carry the oxygen that is breathed from the lungs to all parts of the body 4 Help the body stop bleeding by forming a clot (scab) over the hurt area

4 Platelets help the body stop bleeding by forming a clot over the hurt area. Keeping germs from causing infection is the function of white blood cells. The liquid portion of blood is plasma. Carrying oxygen from the lungs to all parts of the body is the function of red blood cells.

The nurse suspects that a child is having an adverse reaction to a blood transfusion. What should be the first action by the nurse? 1 Notify the physician 2 Dilute infusing blood with equal amounts of normal saline 3 Take vital signs and blood pressure and compare them with baseline 4 Stop transfusion and maintain a patent intravenous line with normal saline and new tubing

4 Stopping the transfusion is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying the physician and taking vital signs should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

The parents of a child taking oral iron supplements report that the child's stools are a tarry green color. What is the best response the nurse provides to the parents? 1 "You should avoid giving the dose at night." 2 "Stop the dose immediately. It is a side effect." 3 "It is because of toxicity. You need to lower the dose." 4 "Tarry green color is expected with oral iron supplements."

4 Tarry green stools indicate that the child is taking an adequate doses of oral iron. The symptoms of iron toxicity are stomach pain, nausea, and vomiting. Asking the parents to change the timing of the dose is not appropriate; it must be administered as prescribed. The medication should be stopped immediately if there are any allergic symptoms or toxicity. Tarry green stools is not a side effect of taking oral iron supplements.

The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains the rationale for the nurses' action? 1 "We can give her stronger doses of pain medication less frequently if you prefer." 2 "If we give her larger amounts of medication, she could reach tolerance of the medications much faster." 3 "Because this is the first time she is experiencing a sickle cell crisis, we want to give her as little medication as possible." 4 "We are trying to control her pain by giving her a combination of medications in small, frequent doses so she can still drink her bottle and be awake some of the time."

4 The most common and debilitating symptom experienced by patients with sickle cell disease is a vasoocclusive crisis (VOC), which is accompanied by severe pain. Combinations of medications in smaller, more manageable dosing commonly are used to enhance the pain management effect. Patient-controlled analgesia (PCA) has been used successfully for sickle cell-related pain when the child is able to understand and push the button to receive the medication. It is the health team's responsibility to manage the infant's pain. Tolerance to pain medication does not happen in short-term acute illnesses. It occurs more in chronic conditions.

What is the objective of managing anemia? 1 Preventing bloodborne illnesses 2 Adding more blood back into the body 3 Increasing the amount of white blood cells 4 Reversing it by treating the underlying cause

4 The objective of medical management of anemia is to reverse the disease by treating the underlying cause. Adding more blood, increasing white blood cells, and preventing bloodborne illnesses do not adequately address anemia.