Ch 44: Nursing Care of a Family when a Child has a Hematologic Disorder

c) "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason" Pg. 1250 Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

7. The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response? a) "ITP is characterized by the loss of surface area on the red blood cell membrane" b) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor" c) "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason" d) "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood"

d) Iliac crest Pg. 1234 The preferred site for bone marrow aspiration in children is the iliac crest. The other sites are not used for a bone marrow aspiration.

10. Which site is most frequently used to perform a bone marrow aspiration? a) Femur b) Rib cage c) Humerus d) Iliac crest

c) Expect menstrual bleeding to be heavy Pg. 1253 Females diagnosed with von Willebrand disease are at risk for menorrhagia. Bruising in the perineal area is not a risk unless there is some sort of trauma at the site. Von Willebrand disease does not cause intermittent periods or shorten the duration of menses.

14. A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client? a) Bruising may occur in the perineal area b) The duration of each period will be short c) Expect menstrual bleeding to be heavy d) Occasional skipped periods can be expected

b) Hemoglobin A Pg. 1232 Three types of normal hemoglobin are present at any given time in the blood: A, F, and A2. By 6 months of age, hemoglobin A is the predominant type. Hemoglobin S is associated with sickle cell disease.

38. When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? a) Hemoglobin A2 b) Hemoglobin A c) Hemoglobin F d) Hemoglobin S

125 mL/hr Pg. 1234 The nurse will use the child's weight in kilograms, and multiply weight by the prescribed milligrams per hour. 25 kg × 5 mL = 125 mL/hour

8. A nurse is providing care to a child who is to receive a blood transfusion. The health care provider has prescribed the infusion to run at a rate of 5 mL/kg/hour. The child weighs 55 lb (25 kg). At what rate should the nurse set the infusion pump? Record your answer using a whole number.

d) Apply heat to the site of bleeding Pg. 1252 Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.

25. A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? a) Administer factor VIII replacement b) Apply direct pressure to the area c) Elevate the injured area such as a leg or arm d) Apply heat to the site of bleeding

d) X-linked recessive inheritance Pg. 1243 G-6-PD deficiency is an X-linked recessive disorder that affects the functioning of the red blood cells. A deficiency in clotting factors is associated with disorders such as idiopathic thrombocytopenic purpura, DIC, or hemophilia. An excess supply of iron refers to hemosiderosis, a complication of thalassemia, an autosomal recessive disorder.

37. A group of students is reviewing information about glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The students demonstrate understanding of the material when they identify what as the cause of the disorder? a) Autosomal recessive inheritance b) An excess supply of iron c) Deficiency in clotting factors d) X-linked recessive inheritance

a) Thrombocytes b) Erythrocytes e) Leukocytes Pg. 1232 The formed elements, the erythrocytes, leukocytes, and thrombocytes are the portions of the blood most commonly affected by hematologic disorders in children. Plasma and whole blood are not major sites of hematologic disease.

15. A nursing instructor is describing childhood hematologic disorders to students. Which would the instructor include as being commonly affected by hematologic disorders? Select all that apply. a) Thrombocytes b) Erythrocytes c) Plasma d) Whole blood e) Leukocytes

d) Pernicious anemia Pg. 1243 Monthly injections of vitamin B12 are used to treat pernicious anemia. Aplastic anemia is characterized by a decrease in all blood cells necessitating a bone marrow transplant. Folic acid deficiency anemia is treated with dietary measures and possible folic acid supplementation. Sickle cell anemia is treated supportively with a focus on preventing sickling crisis, infection, and other complications.

16. A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? a) Sickle cell anemia b) Folic acid anemia c) Aplastic anemia d) Pernicious anemia

a) Iliac crest Pg. 1234 Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

18. A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? a) Iliac crest b) Femur c) Sternum d) Anterior tibia

a) "I mix ferrous sulfate with milk in a bottle" Pg. 1242 Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.

3. The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? a) "I mix ferrous sulfate with milk in a bottle" b) "My child takes ferrous sulfate after meals" c) "My child's stools are darker than usual" d) "I brush my child's teeth once every day"

c) "We will place the liquid in the front of her gums, just below her teeth" Pg. 1241-1242 When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity.

4. A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement by the parents indicates the need for additional teaching? a) "We'll try to get her to drink lots of fluids throughout the day" b) "She needs to eat foods that are high in fiber so she doesn't get constipated" c) "We will place the liquid in the front of her gums, just below her teeth" d) "We need to measure the liquid carefully so that we give her the correct amount"

a) "Milk is a perfect food, and babies should be able to have all the milk they want" Pg. 1240 Babies with an inordinate fondness for milk can take in an astonishing amount and, with their appetites satisfied, may show little interest in solid foods. These babies are prime candidates for iron-deficiency anemia. Many children with iron-deficiency anemia, however, are undernourished because of the family's economic problems. A caregiver's knowledge deficit about nutrition is often present. Because only 10 percent of dietary iron is absorbed, a diet containing 8 to 10 mg of iron is needed for good health. During the first years of life, obtaining this quantity of iron from food is often difficult for a child. If the diet is inadequate, anemia quickly results.

5. In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia? a) "Milk is a perfect food, and babies should be able to have all the milk they want" b) "A family's economic problems are often a cause of malnutrition" c) "Caregivers sometimes don't understand the importance of iron and proper nutrition" d) "Children have a hard time getting enough iron from food during their first few years"

a) The child has mild to moderate iron deficiency Pg. 1242 The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.

33. A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? a) The child has mild to moderate iron deficiency b) The child requires a prophylactic dose of iron c) The child is being prepared for packed red blood cell administration d) The child has severe iron deficiency

d) An enlarged spleen Pg. 1248-1249 The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits, fibrotic scarring in the liver, and the spleen's increased attempts to destroy defective RBCs.

1. An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits? a) An enlarged heart b) Enlarged lymph nodes c) An enlarged thyroid gland d) An enlarged spleen

a) "Our family is taking a fun hiking trip up in the mountains next week" Pg. 1247 High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. Extreme temperatures (hot or cold) are also triggers for a crisis so keeping warm during the winter is important. Dehydration and exposure to infection or other illness are precipitating factors for sickle cell crisis. Adequate hydration and keeping up with immunizations are imperative for health and wellness in a child diagnosed with sickle cell anemia.

11. A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching? a) "Our family is taking a fun hiking trip up in the mountains next week" b) "We always take water along when we are on an outing" c) "I make sure our child is up to date on all immunizations" d) "I make sure my child wears a good warm coat and gloves during winter"

d) "Preterm infants are at risk for iron-deficiency anemia" Pg. 1240 Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.

12. A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? a) "Infants with pyloric stenosis require ferrous sulfate" b) "Your infant may have been having excessive diarrhea" c) "Ferrous sulfate helps improve red blood cell formation" d) "Preterm infants are at risk for iron-deficiency anemia"

b) Risk for infection Pg. 1237 Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection.

13. 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

b) Cheeseburger, broccoli, and fresh strawberries Pg. 1242 Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.

17. The nurse will select which meal as the best choice for a child with iron-deficiency anemia? a) Two slices of pepperoni pizza and a glass of skim milk b) Cheeseburger, broccoli, and fresh strawberries c) Chicken breast, French fries, and sweetened tea d) Peanut butter sandwich, cheese stick, and applesauce

d) Factor VIII Pg. 1252 The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

19. A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor? a) Factor X b) Factor XIII c) Factor V d) Factor VIII

a) Spooned nails Pg. 1241 Spooning or concave shape of the nails suggests iron-deficiency anemia. Other findings would include decreased oxygen saturation levels, tachycardia, and possible splenomegaly.

2. The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? a) Spooned nails b) Oxygen saturation: 99% c) Negative splenomegaly d) Bradycardia

b) Vitamin B12 deficiency Pg. 1243 Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they have a long-term, poorly formulated vegetarian diet, as the vitamin is found primarily in foods of animal origin. Since the client is taking iron, iron deficiency anemia is ruled out. The blood cells in a client with sickle cell anemia are crescent-shaped and do not display the characteristics noted. There are no symptoms of blood loss or acute bleeding, as the client is otherwise healthy.

20. A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider? a) sickle-cell disorder b) Vitamin B12 deficiency c) Iron deficiency d) Acute blood loss

a) Initiate pain assessment with a standardized pain scale Pg. 1245-1247 The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

21. The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? a) Initiate pain assessment with a standardized pain scale b) Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered c) Use guided imagery and therapeutic touch d) Administer meperidine as ordered

a) Prepare to administer factor replacement medication Pg. 1252 Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.

22. A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? a) Prepare to administer factor replacement medication b) Assess the client's urine and stool for blood c) Document the presence of hemarthrosis in the client's chart d) Notify the client's primary health care provider

d) "Sickle cell disease is passed to a fetus when both parents have the gene" Pg. 1243-1244 Sickle cell disease is an inherited disease. The recessive gene is passed from both parents who either have the disease or the trait. There is no need for further testing to determine the cause. There are no other ways to pass the disease other than through genetics. Informing the parents that the gene was passed from both parents is most informative. Sickle cell anemia is not a dominant disease, which is passed when only one parent has the gene, nor is caused by a random mutation.

23. A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? a) "Sickle cell disease can be passed to the fetus in many ways. We will know more at birth" b) "Sickle cell disease is passed to a fetus when one of the parents has the gene" c) "Sickle cell disease occurs from a random genetic mutation" d) "Sickle cell disease is passed to a fetus when both parents have the gene"

b) "If the trait is inherited from both parents the child will have the disease" Pg. 1243-1244 When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in black clients. Either sex can have the trait and disease.

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

b) Giving ferrous sulfate with orange juice between meals Pg. 1242 Treatment for iron-deficiency anemia is the administration of ferrous sulfate for a 13-year-old client with a hemoglobin at 11 g/dL (110 g/L). It should be administered with orange juice, because vitamin C helps absorb iron. It should not be taken with milk. It can cause teeth staining in children and should be given with a straw. Intravenous immunoglobulin would be administered for idiopathic thrombocytopenic purpura. The client's hemoglobin level is not severe enough to warrant blood transfusions at this time. There is also no indication the child is symptomatic. Anemia is generally diagnosed for a hemoglobin less than 12 g/dL (120 g/L) in children 12 to 14 years of age. The normal level for children 12 to 18 years of age is 14 g/dL (140 g/L). While increasing fresh fruits and vegetables is good for the client's overall health, this client needs foods specifically high in iron. These include broccoli, bananas, tomatoes, spinach, liver, nuts, dates, legumes, beef, eggs, and pork.

26. The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? a) Increasing the daily intake of fresh fruits and vegetables b) Giving ferrous sulfate with orange juice between meals c) Providing a high dose of intravenous immunoglobulin weekly d) Packed red blood cell transfusions

c) Provide toys that do not have sharp corners or edges Pg. 1237-1238 For a child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Toys and games with sharp edges/corners may injure the child during play. The low level of platelets would cause bleeding. High-fiber foods would be offered to prevent anal fissures associated with constipation. The child's blood pressure would not be assessed every hour because the inflation of the cuff would cause bruising/injury. Visitors would be limited to avoid exposing the child to visitors who are sick or ill.

27. What nursing action should the nurse take when caring for a child with aplastic anemia? a) Assess the child's blood pressure every hour b) Ensure the child is offered a low-fiber diet c) Provide toys that do not have sharp corners or edges d) Encourage visits from friends and family

c) "He'll need to have those vitamin shots for the rest of his life" Pg. 1243 Monthly injections of vitamin B12 are required for life. Although diet is important, diet alone will not cure the anemia. Iron used to treat iron-deficiency anemia can lead to constipation. Bone marrow transplant is used to treat aplastic anemia.

28. After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state: a) "He needs to eat more green leafy vegetables to cure the anemia" b) "He might get constipated from the supplement" c) "He'll need to have those vitamin shots for the rest of his life" d) "We'll need to plan for a bone marrow transplant soon"

b) Multiple body sites can be affected Pg. 1231 The nurse needs to keep in mind that hematologic alterations can affect multiple body sites, so assessment needs to address all body systems. A child's nutritional status may be helpful in assessing certain hematologic disorders such as iron deficiency anemia, but this information is not the most important to remember. Sequelae commonly occur with hematologic alterations, especially chronic conditions such as hemophilia or sickle cell disease. The child's demographic data are important, because some hematologic diagnoses are more commonly associated with a certain age group, sex, race, or geographic location.

29. When assessing a child for a possible hematologic disorder, which would the nurse need to keep in mind as most important? a) Sequelae are rare with chronic problems b) Multiple body sites can be affected c) Demographic data is of little relevance d) A child's nutritional status is key

d) "We will give the injection once a month for the rest of our child's life" Pg. If the anemia is identified as being caused by a diet deficient in vitamin B12, temporary injections of vitamin B12 will reverse the symptoms. If the anemia is caused by a lack of the intrinsic factor, lifelong monthly intramuscular injections of vitamin B12 may be necessary.

30. A 1-year-old child is diagnosed with pernicious anemia due to lack of intrinsic factor and is prescribed vitamin B12 injections. After teaching the child's parents about this treatment, the nurse determines that the teaching was successful based on which statement? a) "We should give our child the injection daily for one month and then stop it" b) "The injections are a temporary measure until our child outgrows the condition" c) "We must give the injection on the days when our child doesn't eat well" d) "We will give the injection once a month for the rest of our child's life"

d) Packed red blood cells Pg. 1234 Various forms of blood are available, including whole blood, packed red blood cells (RBCs), washed RBCs (as much "foreign" matter is removed as possible to reduce the possibility of blood reaction), plasma, plasma factors, platelets, white blood cells (WBCs), and albumin. Packed RBCs represent the most common form of transfusion used with children because they help minimize the risk of fluid overload.

31. The nurse is developing a plan of care for a child who is to have a transfusion. Which would the nurse expect to administer because it is the most common form of transfusion? a) Washed red blood cells b) Plasma factors c) Whole blood d) Packed red blood cells

c) Infection Pg. 1244 Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.

32. A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? a) Fluid overload b) Pallor c) Infection d) Respiratory distress

c) Widely fluctuating blood pressure Pg. 1253 A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure (such as wide BP fluctuations) or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.

34. A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? a) Equal pupillary response b) Hematuria c) Widely fluctuating blood pressure d) Petechiae

a) Disseminated intravascular coagulation (DIC) Pg. 1253 Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The goal is for the child to maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis. Hemophilia and von Willebrand disorders are genetic and symptoms are caused by a deficiency in a factor needed for clotting. Iron-deficiency anemia occurs when there is not enough iron for adequate hemoglobin capacity in the red blood cells.

35. A nurse caring for an 8-year-old with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a client with: a) Disseminated intravascular coagulation (DIC) b) Hemophilia c) von Willebrand disease d) Iron-deficiency anemia

b) "Will you show me how you walk across the room?" Pg. 1241 Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

36. A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? a) "Open your mouth so I can look inside your cheeks and lips" b) "Will you show me how you walk across the room?" c) "Let me see the palms of your hands and soles of your feet" d) "Do you have any bruises on your feet or shins?"

a) Red meat, eggs, oatmeal, and dried fruit Pg. 1241 Iron-deficiency anemia occurs when the blood does not have enough iron to produce hemoglobin. The anemia can be corrected via iron supplementation, nutrition, and even blood transfusion if the anemia is severe. Foods that have the highest sources of iron include red meat, tuna, eggs, tofu, enriched grains, dried beans and peas, dried fruits, green leafy vegetables and iron-fortified breakfast cereals. The nurse should teach the meal containing red meat, eggs, oatmeal, and dried fruit has the highest amount of iron. Chicken has less iron than red meat, and corn has only a small amount. All the fruits listed have iron, but when dried, the iron levels increase. Pork has a limited amount of iron, and white rice contains almost no iron. Brown rice and whole grains contain higher iron amounts.

6. The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron? a) Red meat, eggs, oatmeal, and dried fruit b) Chicken, corn, brown rice, and oranges c) Pork, broccoli, white rice, and strawberries d) Tuna salad with eggs, whole wheat crackers, and blueberries

c) Allogeneic Pg. 1235 Stem cell transplantation can be allogeneic, syngeneic, or autologous. Allogeneic transplantation is the transfer of stem cells from an immune-compatible (histocompatible) donor, usually a sibling, or from a national cord blood bank or national volunteer donor registry. Syngeneic transplantation (rare) involves a donor and recipient who are genetically identical (are identical twins). Autologous transplantation involves use of the child's own stem cells removed from cord blood banked at the time of the child's birth. Heterologous is not a type of stem cell transplantation.

9. A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is: a) Syngeneic b) Autologous c) Allogeneic d) Heterologous