Peds - Chapter 25: Nursing Care of the Child With a Hematologic Disorder SCA

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? a) "Males are much more likely to have the disease than females." b) "The trait or the disease is seen in one generation and skips the next generation." c) "If the trait is inherited from both parents the child will have the disease." d) "The disease is most often seen in individuals of Asian decent."

"If the trait is inherited from both parents the child will have the disease."

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? a) "I put her legs up on pillows when her knees start to hurt." b) "I bought the medication to give to her when she says she is in pain." c) "She has been down, but playing in soccer camp will cheer her up." d) "She loves popsicles, so I'll let her have them as a snack or for dessert."

"She has been down, but playing in soccer camp will cheer her up."

The nurse is caring for a 2-year-old with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to his mother. Which statement by the mother indicates a need for further teaching? a) "Delayed growth and development and delayed puberty are chronic manifestations." b) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." c) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations." d) "The acute manifestations, like splenic sequestration, are most often life-threatening."

"The acute manifestations, like splenic sequestration, are most often life-threatening."

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We must be compliant with vaccinations and prophylactic penicillin." b) "We need to seek medical attention for abdominal pain." c) "We must watch for unusual headache, loss of feeling, or sudden weakness." d) "We should call the doctor for any fever over 100°F."

"We should call the doctor for any fever over 100°F."

The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver's question, the nurse would explain that for the child with sickle cell disease, it is best that the child have: a) 300 to 800 mL of fluid per day b) 2,500 to 3,200 mL of fluid per day c) 1,000 to 1,200 mL of fluid per day d) 1,500 to 2,000 mL of fluid per day

1,500 to 2,000 mL of fluid per day

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? a) 120 mL/kg of fluids per day b) 150 mL/kg of fluids c) 130 mL/kg of fluids per day d) 110 mL/kg of fluids

150 mL/kg of fluids

A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Deficient fluid volume related to clustering of sickled cells b) Acute pain related to effects of sickling c) Ineffective peripheral tissue perfusion related to the effects of sickled cells d) Ineffective coping related to chronic illness

Acute pain related to effects of sickling

A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. 1 Give medications and use distraction. 2 Assess the pain. 3 Believe the child's report of pain. 4 Administer fluids. 5 Provide rest in a quiet area. 6 Look for complications or cause of pain.

Assess the pain. Believe the child's report of pain. Look for complications or cause of pain. Give medications and use distraction. Provide rest in a quiet area. Administer fluids.

The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority? a) Emergent transfusion b) Oxygen administration c) Pain relief d) Antibiotic administration

Emergent transfusion

A child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder? a) Thrombocytes (platelets) b) Leukocytes (white blood cells) c) Plasma d) Hemoglobin

Hemoglobin

A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests? a) Reticulocyte count b) Hemoglobin electrophoresis c) Erythrocyte sedimentation rate d) Peripheral blood smear

Hemoglobin electrophoresis

A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify what as an effect? a) Cholelithiasis b) Pulmonary hypertension c) Chest syndrome d) High urine specific gravity

High urine specific gravity

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Seeing that he ingests a protein-rich diet b) Encouraging him to take deep breaths hourly c) Maintaining a fluid intravenous line d) Beginning active range-of-motion exercises

Maintaining a fluid intravenous line

A child with sickle cell disease is brought to the emergency department by his parents. He is in excruciating pain. A vaso-occlusive crisis is suspected and analgesia is prescribed. What would the nurse expect as least likely to be ordered? a) Morphine b) Meperidine c) Hydromorphone d) Nalbuphine

Meperidine

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority? a) Risk for delayed growth and development b) Risk for infection c) Deficient fluid volume d) Impaired skin integrity

Risk for infection

The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence. 1 Erythropoietin helps the cell turn into a red blood cell. 2 The myeloid cell becomes a megakaryocyte. 3 Thrombopoietin acts on the cell. 4 The bone marrow releases a stem cell.

The bone marrow releases a stem cell. Thrombopoietin acts on the cell. The myeloid cell becomes a megakaryocyte. Erythropoietin helps the cell turn into a red blood cell.

The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? 1. administer pain medication every 3h IV until pain is controlled 2. perform passive range of motion of the arm and leg to maintain function 3. try acetaminophen for pain first, moving up to opioids only if needed 4. use narcotic analgesics and warm compresses as needed to control pain

administer pain medication every 3h IV until pain is controlled

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a) encourage the child to participate in school activities, such as long-distance running. b) administer an iron supplement daily. c) prevent the child from drinking an excess amount of fluids per day. d) notify a health care provider if the child develops an upper respiratory infection.

notify a health care provider if the child develops an upper respiratory infection.

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: a) leg ulcers. b) seizures. c) priapism. d) behavioral addiction.

seizures

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: a) seizures. b) leg ulcers. c) priapism. d) behavioral addiction.

seizures

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects: a) sickle cell disease. b) Cooley anemia. c) idiopathic thrombocytopenic purpura (ITP). d) hemophilia.

sickle cell disease.

You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is: a) depigmented areas on the abdomen. b) increased growth of long bones. c) slightly yellow sclerae. d) enlarged mandibular growth.

slightly yellow sclerae.

The young boy has had his spleen surgically removed. Which statements by the boy's parents prior to discharge indicates that an adequate amount of learning has occurred? a) "He's going to get really good at washing his hands." b) "Before he goes to the dentist, we'll make sure he gets antibiotics." c) "He's going to need several vaccines." d) "If he does get sick, then we'll need to put on his medic alert bracelet." e) "If he gets a fever, I'm going to call our physician right away."

• "If he gets a fever, I'm going to call our physician right away." • "Before he goes to the dentist, we'll make sure he gets antibiotics." • "He's going to need several vaccines." • "He's going to get really good at washing his hands."

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which actions? Select all that apply. a) Preventing injury and bleeding episodes b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Promoting exercise and activity

• Administering oxygen • Maintaining fluid intake • Administering analgesics

A group of nursing students is discussing the diagnosis of iron deficiency anemia, and one of the students asks what foods would be good for this child to eat. Which foods are high in iron? Select all that apply. a) Egg yolks b) Oatmeal c) Raisins d) Cheese e) Peanut butter f) Milk

• Egg yolks • Raisins • Peanut butter • Oatmeal