Chapter 44 Care of the Child with a Hematologic Disorder

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3 μl (18,000 x 109/L). Which medication would the nurse most likely expect to be ordered? A. Folic acid B. Intravenous immune globulin C. Dimercaprol D. Deferoxamine

B. Intravenous immune globulin

A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? A. Leukocyte level B. Thrombocyte level C. Metabolic screening test D. Hemoglobin level

D. Hemoglobin level

Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be injected: A. intradermally. B. subcutaneously. C. intramuscularly. D. via Z-track technique.

D. via Z-track technique.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? A. Christmas factor B. Proconvertin C. Antihemophilic factor D. Stuart factor

A. Christmas factor

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. Ensure a consistent and daily intake of adequate fluids to prevent dehydration. B. Treat upper respiratory infections with over-the-counter medication. C. Remind parents that the child should avoid immunizations to prevent the introduction of bacteria into the body. D. Suggest the child participate in sports activities without restriction.

A. Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

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. Expect menstrual bleeding to be heavy. B. Bruising may occur in the perineal area. C. The duration of each period will be short. D. Occasional skipped periods can be expected.

A. Expect menstrual bleeding to be heavy.

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

A. Prepare to administer factor replacement medication

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? A. "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." B. "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." C. "I always give the ferrous sulfate with meals." D. "When I give my son ferrous sulfate I know he also needs potassium supplements."

B. "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

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. Bradycardia B. Spooned nails C. Negative splenomegaly D. Oxygen saturation: 99%

B. Spooned nails

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included? A. What foods are high in folic acid B. To use mainly cold water to wash C. To apply a soothing cream to lesions D. Not to pick or irritate the nose

D. Not to pick or irritate the nose

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

B. Slightly yellow sclera

A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily? A. The infant will develop diarrhea. B. The infant will be more irritable than at the last visit. C. The stools will appear black. D. The reticulocyte count will have decreased.

C. The stools will appear black.

The nurse is teaching an in-service 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. "The disease is most often seen in individuals of Asian decent." D. "If the trait is inherited from both parents the child will have the disease."

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

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. "Children have a hard time getting enough iron from food during their first few years." C. "Caregivers sometimes don't understand the importance of iron and proper nutrition." D. "A family's economic problems are often a cause of malnutrition."

A. "Milk is a perfect food, and babies should be able to have all the milk they want."

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with: A. factor VIII. B. factor IX. C. platelets. D. plasmin.

A. factor VIII.

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A. "Our son cannot take any antihistamines." B. "He can resume participation in football in 2 weeks." C. "We should avoid aspirin and drugs like ibuprofen." D. "Swimming would be a great activity."

B. "He can resume participation in football in 2 weeks."

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. A. Administering platelets B. Maintaining fluid intake C. Administering analgesics D. Administering oxygen E. Promoting exercise and activity

B. Maintaining fluid intake C. Administering analgesics D. Administering oxygen

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. peanut butter sandwich, cheese stick, and applesauce C. cheeseburger, broccoli, and fresh strawberries D. chicken breast, French fries, and sweetened tea

C. cheeseburger, broccoli, and fresh strawberries

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. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. B. Administer meperidine as ordered. C. Use guided imagery and therapeutic touch. D. Initiate pain assessment with a standardized pain scale.

D. Initiate pain assessment with a standardized pain scale.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: A. poikilocytosis. B. ecchymosis. C. purpura. D. petechiae.

D. petechiae.

A nurse is teaching parents of a child with iron-deficiency anemia how to administer ferrous sulfate. The nurse determines that the teaching was successful when they make which statements? Select all that apply. A. We'll give him the medicine before he eats his meals." B. "He has to make sure that he brushes his teeth well." C. "He might get constipated, so we'll try to get him to eat some more fiber." D. "We'll have him take the liquid medicine with some orange or pineapple juice." E. "We can mix the liquid form of the drug with milk."

A. We'll give him the medicine before he eats his meals." B. "He has to make sure that he brushes his teeth well." C. "He might get constipated, so we'll try to get him to eat some more fiber." D. "We'll have him take the liquid medicine with some orange or pineapple juice."

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. 1,000 to 1,200 ml of fluid per day. B. 2,500 to 3,200 ml of fluid per day. C. 300 to 800 ml of fluid per day. D. 1,500 to 2,000 ml of fluid per day.

D. 1,500 to 2,000 ml of fluid per day.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? A. A 3-month-old infant who is totally breastfed B. A 7-month-old infant who has started table food C. An 8-year-old child who carries lunch to school D. A 15-year-old adolescent who has heavy menstrual periods

D. A 15-year-old adolescent who has heavy menstrual periods

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. providing a high dose of intravenous immunoglobulin weekly B. increasing the daily intake of fresh fruits and vegetables C. packed red blood cell transfusions D. giving ferrous sulfate with orange juice between meals

D. giving ferrous sulfate with orange juice between meals

A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? A. "The sickle shape of red blood cells decreases oxygen to tissues." B. "This is a hereditary disease that is transmitted by one affected gene." C. "Fluid restriction is necessary to control sickle cell anemia." D. "Sickle cell anemia is common in people of Asian descent.

A. "The sickle shape of red blood cells decreases oxygen to tissues."

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A. "We should administer desmopressin as often as needed." B. "We should be aware that she may suffer from menorrhagia." C. "We understand that she may have frequent nosebleeds." D. "We need to administer Stimate (desmopressin) prior to dental work."

A. "We should administer desmopressin as often as needed."