Hematologic - 25

The nurse treating clients with hemophilia knows that if bleeding is not treated effectively, which body part is at greatest risk for the development of chronic, disabling disease? a. Liver b. Kidneys c. Heart d. Joints

d

The nurse is caring for a 5-year-old client with sickle cell disease who is receiving hydroxyurea therapy. What should the nurse monitor while caring for the client? Select all that apply. a. growth b. vision and hearing c. hemoglobin (Hgb) F levels d. complete blood count (CBC), reticulocyte count, and platelet count e. serum ferritin

c, d

A nurse is providing preoperative care to a child with sickle cell disease. What treatment should the nurse expect to implement prior to surgery? a. deferoxamine administration b. transfusion of fresh frozen plasma (FFP) c. desmopressin administration d. transfusion of packed red blood cells (PRBCs)

d

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. Metabolic screening test b. Leukocyte level c. Hemoglobin level d. Thrombocyte level

c

A child with sickle cell anemia is scheduled for a splenectomy. After the parents receive teaching about the rationale for this surgery, the nurse determines that the teaching was successful when the parents make which statement? a. "It will help to decrease the amount of anemia." b. "The surgery should help prevent any further crisis episodes." c. "The surgery is being done to cure the condition." d. "It will help to reduce the number of infections the child will get."

a

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 is passed to a fetus when both parents have the gene." b. "Sickle cell disease occurs from a random genetic mutation." c. "Sickle cell disease can be passed to the fetus in many ways. We will know more at birth." d. "Sickle cell disease is passed to a fetus when one of the parents has the gene."

a

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. "Fluid restriction is necessary to control sickle cell anemia." c. "This is a hereditary disease that is transmitted by one affected gene." d. "Sickle cell anemia is common in people of Asian descent."

a

A parent calls the pediatric clinic and tells the nurse "I think my child is having a sickle cell crisis. Should I bring the child to the office?" What is the nurse's best response? a. "Tell me about the symptoms your child is experiencing" b. "Take your child to the emergency department now." c. "Call 911 and give the child some water while you wait." d. "What makes you think your child is in crisis?"

a

The nurse cares for a client with hemophilia B. Based on the note (above), what action will the nurse take? CVAD removed but requires another Factor IX treatment a. Achieve venous access with a butterfly needle. b. Administer factor IX treatment per intramuscular (IM) injection. c. Use interventions per the RICE mnemonic until the health care provider clarifies the prescription. d. Contact the health care provider to replace the central venous access device (CVAD).

a

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? a. "These values will help us monitor the disease." b. "These labs are just common labs for children with this disease." c. "I'm really not allowed to discuss these findings with you." d. "The doctor will discuss these findings with you when he comes to the hospital."

a

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

a

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 infection b. Deficient fluid volume c. Impaired skin integrity d. Risk for delayed growth and development

a

The nurse cares for a child with severe hemophilia A with the chart and note above. Based on these notes, what finding(s) indicates that the child has met the expected outcomes for the child's condition? Select all that apply. a. Client demonstrates full range of motion in affected joints. b. Family expresses understanding of risk prevention measures. c. Child engages in developmentally appropriate activities. d. Child is free of signs and symptoms of vaso-occlusive crisis. e. Child's PT, PTT, and coagulation factor levels are within target limits.

a, b, c, e

The nurse is performing pain management interventions for an 8-year-old child with sickle cell disease who is in a vaso-occlusive crisis. What will the nurse include in the plan of care? Select all that apply. a. nonsteroidal anti-inflammatory drugs (NSAIDs) b. warm compresses to the affected area c. restricting fluid intake d. patient-controlled analgesia (PCA) as prescribed e. meperidine

a, b, d

A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition? a. hemophilia b. von Willebrand disease c. disseminated intravascular coagulation d. iron-deficiency anemia

c

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

b

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? a. Ask the parent if he or she has questions about the plan of care. b. Implement strategies to address the child's pain. c. Provide diversional activities for the child. d. Contact the health care provider to meet with the parent.

b

A child is hospitalized with complications related to hemophilia. The health care provider has discussed the child's plan of care with the parents, but they continue to ask questions. What action will the nurse take? a. Encourage the parents to focus their attention on their child. b. Answer the parents' questions as completely as possible. c. Notify the health care provider that the parents still have questions. d. Reassure the parents that they have been fully briefed on their child's treatment.

b

A home care nurse is teaching a parent how to administer a clotting factor infusion to their child. How can the nurse best evaluate the effectiveness of the teaching? a. Give cues as needed while the parent sets up the infusion. b. Observe the parent set up and administer the infusion. c. Ask the parent to repeat the instructions step-by-step. d. Make time for questions at the end of the teaching session.

b

A nurse is preparing a discharge plan for a child diagnosed with Fanconi anemia who has associated congenital defects. What aspect of the plan should the nurse include to address the child's development of orthopedic function? a. medication administration b. occupational therapy c. leukopenia precautions d. home care safety

b

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. plasmin. b. factor VIII. c. factor IX. d. platelets.

b

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 trait or the disease is seen in one generation and skips the next generation." b. "If the trait is inherited from both parents the child will have the disease." c. "The disease is most often seen in individuals of Asian decent." d. "Males are much more likely to have the disease than females."

b

The parents of a 2-month-old infant have learned that their infant has hemophilia. The parents are visibly upset and ask how this could have happened to them. What is the nurse's best response? a. "There is no need to worry. We will teach you how to take care of your child." b. "News like this is difficult to hear. Let's talk about what this means for your child." c. "I understand how you feel. Let's talk about where you go from here." d. "Please do not be upset; it is not your fault. Things like this happen sometimes."

b

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

c

A nurse is administering a blood transfusion to a child diagnosed with a hematologic disorder. Fifteen minutes into the transfusion, the child reports severe headache, nausea, and low back pain. There is no evidence of urticaria and vital signs are unchanged from the baseline. What action should the nurse take next? a. Decrease the transfusion rate. b. Call the health care provider. c. Discontinue the transfusion. d. Administer acetaminophen and antiemetic.

c

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. Apply direct pressure to the area. b. Elevate the injured area such as a leg or arm. c. Apply heat to the site of bleeding. d. Administer factor VIII replacement.

c

A nurse is providing care for a child diagnosed with beta-thalassemia who is receiving a blood transfusion. The child reports being bored and asks to go to the playroom. What is the best action for the nurse to take? a. Accompany the child to the playroom if the child is stable. b. Explain that the child cannot go to the playroom during the transfusion. c. Have a child-life specialist find an appropriate activity to occupy the child during the transfusion. d. Explain the need for quiet rest during a blood transfusion.

c

A nurse is providing teaching on safety to a group of parents whose children are diagnosed with hemophilia. Which statement made by a parent requires follow-up by the nurse? a. "Our child has a medical alert bracelet that is worn at all times." b. "We had a trampoline but got rid of it after our child was diagnosed." c. "Our child always wears a helmet and body padding when playing football." d. "We make sure our toddler wears a helmet and knee pads."

c

A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful? a. Provide written materials to reinforce teaching. b. Provide an opportunity for the adolescent to ask questions. c. Request that the adolescent teach the information to the nurse. d. Ask the adolescent if the teaching was understood.

c

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 V b. Factor X c. Factor VIII d. Factor XIII

c

The nurse is caring for a child with hemophilia. The parents are upset by the possibility that the child will become infected with hepatitis from the clotting factor replacement therapy. Which response by the nurse would be appropriate? a. "There are risks with any treatment including using blood products, but these are very minor." b. "Although factor replacement is expensive, there's more financial strain from missing work if your child has a bleeding episode." c. "The use of dry heat sterilization has proven to inactivate hepatitis virus, resulting to zero factors transfusion-related incidence of hepatitis infection." d. "Parents commonly fear the worst; however, the factor will help your child lead a normal life."

c

The nurse is caring for a client who is in a sickle cell crisis. The child is hospitalized for pain management during the crisis. The parents tell the nurse that they do not think their child needs any pain medication because the child is sleeping a lot. How should the nurse respond? a. "The pain medication is prescribed on a routine basis to keep the pain under control, so I have to give it as prescribed." b. "We need to wait for your child to express the pain level to us before providing medication." c. "I understand why you think your child is not in pain; sleep is often a way for children to cope with pain." d. "I agree. Since your child is sleeping the pain must not be too severe. I will hold his pain medication."

c

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 bought the medication to give to her when she says she is in pain." b. "I put her legs up on pillows when her knees start to hurt." 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."

c

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. "I make sure my child wears a good warm coat and gloves during winter." 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. "Our family is taking a fun hiking trip up in the mountains next week."

d

An 11-year-old child is being prepared for discharge after experiencing a vasoocclusive crisis secondary to sickle cell disease. The child has been prescribed hydroxyurea. After teaching the child and parents about this medication, the nurse determines that the teaching was successful when the parents identify that they will notify the health care provider about which condition? a. Headache b. Constipation c. Gastric upset d. Infection

d

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. behavioral addiction. b. priapism. c. leg ulcers. d. seizures.

d