Chapter 25: Alterations in Hematologic Function

While receiving a transfusion of packed red blood cells, a school-aged child begins to experience itchy skin, hives, and wheezes. What should the nurse do first for this child? A. Stop the transfusion. B. Obtain a blood culture. C. Slow the transfusion rate. D. Provide a diuretic as prescribed.

ANS: A

The mother of Mary Jo, a 10-year-old who had a febrile reaction following a transfusion, asks the nurse: "Why did this happen to my child?" Which response by the nurse would be most appropriate? A. "Mary Jo's blood has developed antibodies to the white blood cells, platelets or plasma protein antigens in the donor blood." B. "Mary Jo's blood was not compatible with the blood product, causing the red blood cells to destruct." C . "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." D. "Too much of the blood product was transfused at too rapid a rate."

ANS: A Rationale: A febrile reaction is not associated with hemolysis and generally occurs when the recipient has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood. In a hemolytic reaction, the blood product is not compatible with the recipient's blood. An allergic reaction is a nonhemolytic reaction that occurs when the donor blood contains plasma proteins or antigens to which the recipient is hypersensitive. Signs of fluid overload would occur if the blood was infused too quickly.

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding? A. Compression B. Heat C. Exercise D. Lowering extremities

ANS: A Rationale: Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition corticosteroids such as prednisone may be used to reduce inflammation in the joint.

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? A. Slightly yellow sclera B. Enlarged mandibular growth C. Increased growth of long bones D. Depigmented areas on the abdomen

ANS: A Rationale: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

A 9-year-old child is diagnosed with von Willebrand's Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand's factor multimers and decreased activity of von Willebrand's factor. The nurse identifies this as which type of vWD as being involved? A. Type I B. Type II C. Type III D. Type IIIB

ANS: A Rationale: Signs of type I von Willebrand's disease include decreased quantities of all sizes of von Willebrand's factor multimers and decreased activity of von Willebrand's factor. Type II involves absence of intermediate-size and large von Willebrand's factor multimers, increased levels of small von Willebrand's factor multimers, and decreased activity of von Willebrand's factor; possibly disproportionate with quantity of von Willebrand's factor. Type III involves the absence (or almost absent) of all sizes of von Willebrand's factor multimers, absent or minimal activity of von Willebrand's factor, and low Factor VIII level.

The nurse preparing a child for diagnostic testing to diagnose disseminated intravascular coagulation (DIC). Which results would the nurse identify as indicating this condition? A. Increased D-Dimer assay B. Increased antithrombin III C. Decreased fibrogen/fibrin degradation products D. Decreased fibrinopeptide A level

ANS: A Rationale: Test results indicative of DIC include: increased D-Dimer assay, decreased antithrombin III, increased fibrogen/fibrin degradation products, and increased fibrinopeptide A level.

A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first? A. Discontinue the transfusion. B. Obtain a blood culture. C. Give an iron-chelating agent. D. Ask the health care provide for a prescription for a diuretic.

ANS: A Rationale: The child is experiencing a transfusion reaction; the first step with any transfusion reaction is to discontinue the transfusion. Oxygen should be given, and the nurse should anticipate the need for an antihistamine to reduce the child's symptoms. An iron-chelating agent would be given for hemosiderosis after repeated transfusions. A blood culture would be obtained if the child developed a fever.

A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy? A. Toxic iron overload B. Fibrin clots C. Chronic idiopathic thrombocytic purpura D. Vaso-occlusive crisis

ANS: A Rationale: The major complication of an ongoing transfusion therapy program is the development of toxic iron overload, which leads to pathologic changes in body systems, including the hepatic, endocrine, and cardiac systems. Fibrin clots, chronic idiopathic thrombocytic purpura or vaso-o

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 g/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: A. removal or covering of flaking paint on the walls of the home B. putting child safety locks on kitchen cabinets C. putting medicine away where children cannot reach it D. placing house plants out of reach of children

ANS: A Rationale: The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries. A child with a blood lead level over 5 g/dL needs to be rescreened to confirm the level and then active interventions begun to prevent further lead exposure, such as removal of the child from the environment containing the lead source or removal of the source of lead from the child's environment. Removal of the lead source is not an easy task in homes because simple repainting or wallpapering does not necessarily remove the source of peeling paint adequately. After some months, the new paint will begin to peel because of the defective paint underneath. The walls must therefore be covered by paneling or dry wall or other solid protective material.

The nurse is reviewing information about hemophilia with an adolescent client. The client demonstrates understanding of the information when identifying hemophilia B as a deficiency of which factor? Select all that apply. A. Christmas factor B. Factor IX C. Stuart's factor D. Antihemophilic factor E. Factor VIII

ANS: A, B Rationale: Factor IX is also known as plasma thromboplastin component or Christmas factor. Factor X is Stuart's factor. Factor VIII is antihemophilic factor and associated with hemophilia A.

A child is receiving antithymocyte globulin for treatment of acquired aplastic anemia. After administering the drug, assessment of which of the following would the nurse identify as a possible adverse reaction? Select all that apply. A. Fever B. Urticaria C. Dyspnea D. Constipation E. Diarrhea

ANS: A, B, C Rationale: Adverse reactions associated with antithymocyte globulin include fever, chills, rash, urticaria, pruritus, dyspnea, chest pain, nausea, vomiting, leukopenia, and thrombocytopenia. Other less frequent side effects that may occur and can be life threatening include hypotension, pulmonary edema, laryngospasm, and anaphylaxis. Serum sickness may also occur.

A nurse performs a focused physical assessment for a child diagnosed with aplastic anemia. Which of the following would the nurse most likely document as a typical characteristic? Select all that apply. A. Epicanthal folds B. Small jaw C. Café-au-lait spots D. Narrow nasal base E. Large eyes

ANS: A, B, C Rationale: Manifestations of aplastic anemia include a broad nasal base, epicanthal folds, small eyes, microdontia, small jaws, and café-au-lait spots

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply. A. Chest pain B. Severe dizziness C. Sudden change in vision D. Constipation E. Irritability

ANS: A, B, C Rationale: The parents should contact the primary health care provider if the child develops a fever, dizziness or severe headaches, severe stomach pain or swelling, sudden changes in vision, weakness, or loss of consciousness. There is no need to notify the primary health care provider if the child develops constipation or irritability.

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply. A. Low back pain B. Fever C. Distended abdomen D. Splenic enlargement E. Increased reticulocyte count

ANS: A, B, C Rationale: Vaso-occlusive crisis is manifested by bone pain, most commonly in the lumbosacral spine, fever, leukocytosis, distended abdomen and acute abdominal pain. Splenic enlargement and increased reticulocyte count suggest acute splenic sequestration.

A child is receiving a blood transfusion. Which of the following would alert the nurse that the child is experiencing a hemolytic reaction? Select all that apply. A. Urticaria B. Respiratory distress C. Diaphoresis D. Lower back pain D. Chills

ANS: A, D, E

The nurse is assessing a child who is experiencing acute splenic sequestration secondary to sickle cell disease. The nurse would identify which of the following as the priority? A. Pain relief B. Emergent transfusion C. Antibiotic administration D. Oxygen administration

ANS: B

A child develops treatment-related thrombocytopenia. When preparing the plan of care for the child, which would the nurse include? Select all that apply. A. Allowing frequent blood-drawing procedures for laboratory testing B. Applying pressure to a puncture site for a full 5 minutes C. Limiting the use of adhesive tape on the child's skin D. Administering medications orally or intravenously E. Obtaining extra amounts of blood just in case when drawing blood

ANS: B, C, D Rationale: With thrombocytopenia, the risk for bleeding is increased. Therefore, the nurse should institute measures to reduce this risk. Measures include limiting the number of blood-drawing procedures, applying pressure to a puncture site for a full 5 minutes, limiting the use of adhesive tape on the child' skin, administering medications orally or intravenously instead of by injection, and not drawing extra amounts of blood just in case.

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. Which of the following would the nurse least likely expect to be ordered? A. Morphine B. Nalbuphine C. Meperidine D. Hydromorphone

ANS: C

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching? A. Suggest the child participate in sports activities without restriction. B. Treat upper respiratory infections with over-the-counter medication. C. Ensure a consistent and daily intake of adequate fluids to prevent dehydration. D. Remind to avoid immunizations to prevent the introduction of bacteria into the body.

ANS: C Rationale: Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine healthcare such as immunization action should be provided in order to prevent common childhood illnesses.

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child? A. Blurred vision B. Nausea and vomiting C. Sudden onset of knee pain D. Bleeding from intravenous sites

ANS: D