Hockenberry 24: Hematologic/Immunologic Dysfunction in Children

c

A child has been admitted to the pediatric unit for evaluation of easy bruising. The parents report during the admission assessment that the child has also been experiencing nosebleeds at least once a day; black, tarry stools; and blood in the urine. Lab results indicate a platelet count of 18,000/mm3. Based on the data available, what disorder does the nurse suspect may be responsible for the symptoms? a. Hemophilia b. Sickle cell anemia c. Immune thrombocytopenia d. Human immunodeficiency virus (HIV)

d

A child with sickle cell anemia experiences severe chest pain, fever, a cough, and dyspnea. What is the nurse's priority action? a. Administering 100% oxygen to relieve hypoxia b. Administering pain medication to relieve symptoms c. Notifying the practitioner because the child may be having a stroke d. Notifying the practitioner because the child may be experiencing chest syndrome

c

A child with sickle cell disease is brought to the hospital reporting right knee pain. On examination, the nurse finds localized swelling and immediately applies a cold compress to the right knee, massages the knee, and administers ibuprofen for pain relief. The nurse informs the mother that the child may need a high dose of an opioid if there is no relief from pain. Which of the measures taken by the nurse need to be corrected? a. Massaging the affected area for pain relief b. Giving ibuprofen to the child for pain relief c. Giving cold compression to the affected area d. Informing the parent that the child needs a high dose of an opioid

a

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine therapy. The child's parents ask the nurse what deferoxamine does. What is the most appropriate response by the nurse? a. "The medication helps prevent iron overload." b. "The medication provides vitamin supplementation." c. "The medication stimulates red blood cell production." d. "The medication helps prevent blood transfusion reactions."

a

A nursing student caring for a patient admitted for treatment of a sequestration sickle cell crisis is discussing this type of crisis with the instructor. Which statement by the nursing student indicates proper understanding of this type of crisis? a. "This type of crisis is characterized by pooling of a large amount of blood in the spleen." b. "This crisis is a painful episode characterized by ischemia, which causes mild to severe pain." c. "It is often triggered by a viral infection and is characterized by diminished red blood cell (RBC) production." d. "Anemia, jaundice, and reticulocytosis occur in this type of crisis because of an accelerated rate of red blood cell destruction."

b

A school-age child is admitted in vasoocclusive sickle cell crisis. What should be included in the child's care? a. Correction of acidosis b. Adequate hydration and pain management c. Pain management and administration of heparin d. Adequate oxygenation and replacement of factor VIII

a

A woman is diagnosed with sickle cell anemia (SCA), and her husband does not have the condition. What is the chance of sickle cell anemia in their children? a. 0% chance that their children will have SCA b. 25% chance that male children will have SCA c. 50% chance that female children will have SCA d. 100% chance that their children will have SCA

air embolus

Complication of sudden difficulty in breathing that occurs when a child receives a blood transfusion is an immediate sign or symptom of an ___ ___.

aplastic anemia

In which of the conditions are all the formed elements of the blood simultaneously depressed?

c

Iron dextran is ordered for a young child with severe iron-deficiency anemia. What nursing considerations should be included? a. Administer with meals b. Administer between meals c. Inject deeply into a large muscle d. Massage injection site for 5 minutes after administration of drug

a

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process? a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

c

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

bde

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

be

Parents of an 8-week-old baby with sickle cell disease have come to the hospital for the baby's routine checkup. They tell the nurse that they do not want penicillin prophylaxis for their baby, because the baby is very young. What does the nurse tell them? Select all that apply. a. "Penicillin prophylaxis is not required to be taken by all children with sickle cell disease." b. "Children with sickle cell disease should take penicillin prophylaxis by 2 months of age." c. "Penicillin prophylaxis should not be started before age 2." d. "If a baby is put on penicillin, medical advice is not needed, even if the temperature exceeds 38.3° C." e. "If a baby is put on penicillin, medical advice is needed if the temperature exceeds 38.3° C."

c

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. What should the nurse explain? a. The venipuncture discomfort is very brief b. Only one venipuncture will be needed c. A topical application of local anesthetic can eliminate venipuncture pain d. Most blood tests on children require only a finger puncture because a small amount of blood is needed

b

The family of a child hospitalized for care during a sickle cell crisis calls the nurse into the room because the child is struggling to breathe. Upon assessment, the nurse notes a respiratory rate of 30 and that the child is clutching the abdomen and crying. What does the nurse determine the child may be experiencing? a. Deficient fluid volume b. Acute chest syndrome c. Cerebrovascular accident d. Increasing splenomegaly

badc

The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement sequencing from the highest priority to the lowest. Provide the answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Take the vital signs. b. Stop the transfusion. c. Notify the practitioner. d. Maintain a patent IV line with normal saline.

a

The nurse is conducting a staff in-service on inherited childhood blood disorders. Which statement describes severe combined immunodeficiency syndrome (SCIDS)? a. There is a deficit in both the humoral and cellular immunity with this disease. b. Production of red blood cells is affected with this disease. c. Adult hemoglobin is replaced by abnormal hemoglobin in this disease. d. There is a deficiency of T and B lymphocyte production with this disease.

c

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.

a

The nurse is developing a teaching plan for the family of a toddler recently diagnosed with sickle cell disease. Of which does the nurse include as important for the family to be aware and to report in order to recognize signs of the major cause of death for children under age 5 with sickle cell disease? a. Presence of fever b. Signs and symptoms of stroke c. Presence of respiratory problems

bcd

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells

preventing infection

The nurse is planning care for an adolescent with AIDS. What is the priority nursing goal?

d

The nurse is recommending how to prevent iron-deficiency anemia in a healthy, term, breastfed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

abc

The nurse is teaching a group of parents of children diagnosed with sickle cell anemia. One parent tells the nurse that he or she is so frightened that the child will die and that he or she has heard that certain signs and symptoms can indicate greater likelihood of death if they occur within the first 2 years of life. Which manifestations does the nurse explain can indicate a severe prognosis? Select all that apply. a. Dactylitis b. Severe anemia c. Leukocytosis d. Painful joints e. Chronic anemia

a

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron-deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

c

The nurse is teaching parents of an infant about the causes of iron-deficiency anemia. Which statement best describes iron-deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the preterm addition of solid foods.

a

The nurse is teaching the family of a teenager suffering from a sickle cell crisis about pain management. Which statement by the family would indicate a need for further teaching? a. "Although rates of addiction are high, particularly for teenagers, if we carefully monitor the drug dose it can be avoided." b. "We understand that the pain from the sickle cell crisis will probably require high doses of opioid medications to control it." c. "We need to monitor our teenager for depression or anxiety, because the pain of the crisis can sometimes create fear and anxiety." d. "We will refer to the sickle cell crisis as a pain episode so that it doesn't pick up a negative connotation from the term 'crisis.'"

b

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

b

The transcranial Doppler test results of a child with sickle cell anemia indicate that the child has abnormal intracranial vascular flow. What information does the nurse give to the parents? a. The child may require a splenectomy surgery. b. The child may require multiple blood transfusions. c. The child may require high doses of opioids to prevent pain. d. The child may require oxygen therapy to prevent hypoxia.

bcde

What are some common clinical manifestations of HIV infection in children? Select all that apply. a. Weight gain b. Oral candidiasis c. Chronic diarrhea d. Lymphadenopathy e. Developmental delay

abcd

What are the most common clinical features of sickle cell anemia in children? Select all that apply. a. Gallstones b. Hematuria c. Osteomyelitis d. Hepatomegaly e. Chronic ulcers

bde

What are the most common clinical manifestations of hemophilia? Select all that apply. a. Fever b. Excessive bruising c. Nausea and vomiting d. Hemorrhage from any trauma e. Prolonged bleeding from or in the body

medications

What is a possible cause of acquired aplastic anemia in children?

b

What is the best way to administer parenteral iron preparations? a. Injection into the deltoid muscle followed by gentle massage b. Injection into a large muscle with the use of the Z-track method c. Injection into a large muscle with the use of the air-lock method d. Injection into a ventrogluteal muscle followed by massage

anemia

What is the most common hematologic disorder of infancy and childhood?

d

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

d

Which drug is not recommended for treating pain during sickle cell disease episodes? a. Morphine b. Ketorolac c. Ibuprofen d. Meperidine

b

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)? a. Influenza b. Varicella c. Pneumococcal d. Inactivated poliovirus (IPV)

ace

Which interventions are included in the management of nosebleeds in children? Select all that apply. a. Instruct the child to breathe through the mouth. b. Have the child sit down and tilt the head backward. c. Insert cotton or wadded tissue into each nostril if bleeding persists. d. Apply warm compresses to the bridge of the nose if bleeding is persistent. e. Apply continuous pressure to the nose with thumb and forefinger for at least 10 minutes.

c

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

bce

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

a

Which statement is true regarding human immunodeficiency virus (HIV)-positive children attending schools? a. Parents or legal guardians have the right to decide whether or not to share HIV status with the school. b. By law, schools, daycare facilities, and other settings that provide similar services to children must be notified of HIV status. c. HIV-positive children must receive permission from the school board to participate in contact sports with a high risk for injury. d. Children diagnosed with human immunodeficiency syndrome are legally unable to attend public schools.

d

Which symptom would the nurse recognize as an acquired immunodeficiency syndrome (AIDS)-defining condition in an American child with human immunodeficiency virus (HIV)? a. Parotitis b. Oral candidiasis c. Hepatosplenomegaly d. Cytomegalovirus

chelation

Which therapy does the nurse recognize as the means of eliminating excess iron in a child with ß-thalassemia major?