Peds - Chapter 25: Nursing Care of the Child With a Hematologic Disorder

The parents of a 6-year-old male 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 primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." b) "ITP is characterized by the loss of surface area on the red blood cell membrane." c) "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) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor."

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

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

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

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

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) "When I give my son ferrous sulfate I know he also needs potassium supplements." c) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." d) "I always give the ferrous sulfate with meals."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin 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 put her legs up on pillows when her knees start to hurt." b) "I bought the medication to give to her when she says she is in pain." 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."

"She has been down, but playing in soccer camp will cheer her up."

The nurse is caring for a 2-year-old with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to his mother. Which statement by the mother indicates a need for further teaching? a) "Delayed growth and development and delayed puberty are chronic manifestations." b) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." c) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations." d) "The acute manifestations, like splenic sequestration, are most often life-threatening."

"The acute manifestations, like splenic sequestration, are most often life-threatening."

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) "The doctor will discuss these findings with you when he comes to the hospital." 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) "These values will help us monitor the disease."

"These values will help us monitor the disease."

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We must be compliant with vaccinations and prophylactic penicillin." b) "We need to seek medical attention for abdominal pain." c) "We must watch for unusual headache, loss of feeling, or sudden weakness." d) "We should call the doctor for any fever over 100°F."

"We should call the doctor for any fever over 100°F."

Which assessment below would increase your suspicion that iron-deficiency anemia may be present in a child? a) A 3-month-old boy sucks his thumb b) A 15-year-old girl constantly sucks ice cubes c) A 7-month old boy does not say whole words yet d) An 8-year-old girl is shy and does not participate in class

A 15-year-old girl constantly sucks ice cubes

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 boy who is totally breastfed b) A 7-month-old boy who has started table food c) A 15-year-old girl who has heavy menstrual periods d) An 8-year-old girl who carries her lunch to school

A 15-year-old girl who has heavy menstrual periods

A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Deficient fluid volume related to clustering of sickled cells b) Acute pain related to effects of sickling c) Ineffective peripheral tissue perfusion related to the effects of sickled cells d) Ineffective coping related to chronic illness

Acute pain related to effects of sickling

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) Heterologous b) Autologous c) Allogenic d) Syngeneic

Allogenic

A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. 1 Give medications and use distraction. 2 Assess the pain. 3 Believe the child's report of pain. 4 Administer fluids. 5 Provide rest in a quiet area. 6 Look for complications or cause of pain.

Assess the pain. Believe the child's report of pain. Look for complications or cause of pain. Give medications and use distraction. Provide rest in a quiet area. Administer fluids.

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend? a) Baseball b) Wrestling c) Football d) Soccer

Baseball

In addition to the child's history, symptoms, and blood studies, what information helps to confirm the diagnosis of leukemia? a) Genetic studies b) Bone marrow aspiration c) Modified Jones criteria d) Chest x-rays

Bone marrow aspiration

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) Iron deficiency anemia b) Hemophilia c) von Willebrand disease d) Disseminated intravascular coagulation

Disseminated intravascular coagulation

The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority? a) Emergent transfusion b) Oxygen administration c) Pain relief d) Antibiotic administration

Emergent transfusion

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

Factor VIII

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? a) Providing age appropriate activities b) Grouping nursing care c) Encouraging the child to share feelings d) Following guidelines for protective isolation

Following guidelines for protective isolation

A child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder? a) Thrombocytes (platelets) b) Leukocytes (white blood cells) c) Plasma d) Hemoglobin

Hemoglobin

A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests? a) Reticulocyte count b) Hemoglobin electrophoresis c) Erythrocyte sedimentation rate d) Peripheral blood smear

Hemoglobin electrophoresis

A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily? a) He will develop diarrhea. b) His stools will appear black. c) He will be less irritable than he was at his last visit. d) His reticulocyte count will have decreased.

His stools will appear black.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Risk for infection related to abnormal immune system b) Ineffective breathing pattern related to decreased white blood count c) Ineffective tissue perfusion related to poor platelet formation d) Risk for altered urinary elimination related to kidney impairment

Ineffective tissue perfusion related to poor platelet formation

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Seeing that he ingests a protein-rich diet b) Encouraging him to take deep breaths hourly c) Maintaining a fluid intravenous line d) Beginning active range-of-motion exercises

Maintaining a fluid intravenous line

The nurse is caring for a child with disseminated intravascular coagulation. The nurse notices signs of neurological deficit. Which nursing action is appropriate? a) Notify the physician b) Continue to monitor neurological signs c) Evaluate respiratory status d) Inspect for signs of bleeding

Notify the physician

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

Risk for infection

The nurse is caring for a 3-year-old boy with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis? a) Serum ferritin b) Hemoglobin electrophoresis c) Reticulocyte count d) Iron test

Serum ferritin

For the child diagnosed with iron deficiency anemia, what would the nurse anticipate would be done in treating this disorder? a) The child would be given corticosteroids via a metered-dose inhaler. b) The child would be given a high dose of intravenous immunoglobulin. c) The child would be given enteric-coated aspirin with milk. d) The child would be given ferrous sulfate with orange juice between meals.

The child would be given ferrous sulfate with orange juice between meals.

In von Willebrand's disease, girls exhibit unusually heavy menstrual flow. a) True b) False

True

The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? 1. administer pain medication every 3h IV until pain is controlled 2. perform passive range of motion of the arm and leg to maintain function 3. try acetaminophen for pain first, moving up to opioids only if needed 4. use narcotic analgesics and warm compresses as needed to control pain

administer pain medication every 3h IV until pain is controlled

A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WMC 24,000, and platelets 20,000. What is the priority nursing assessment? 1. assess for pallor, fatigue, and tachycardia 2. monitor for fever 3. assess for bruising or bleeding 4. determine intake and output

assess for bruising or bleeding

In understanding the cardiovascular and hematologic systems of the body it is important to know that the blood is made up of plasma, red blood cells, white blood cells, and platelets. These blood cells are formed in the: a) capillaries. b) bone marrow. c) arteries. d) lymph nodes.

bone marrow.

When planning care for a child with idiopathic thrombocytopenic purpura, the nurse plans to teach her: 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 her nose.

not to pick or irritate her nose.

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

notify a health care provider if the child develops an upper respiratory infection.

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.

petechiae

You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is: a) depigmented areas on the abdomen. b) increased growth of long bones. c) slightly yellow sclerae. d) enlarged mandibular growth.

slightly yellow sclerae.

A 3-year-old female is brought to the ER by her parents and presents with bruising and mucous membrane bleeding from the nose and mouth. The nurse knows that these symptoms are indicative of: a) Disseminated intravascular coagulation b) Hemophilia c) von Willebrand disease d) Chronic iron deficiency anemia

von Willebrand disease

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which actions? Select all that apply. a) Preventing injury and bleeding episodes b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Promoting exercise and activity

• Administering oxygen • Maintaining fluid intake • Administering analgesics

A 5-year-old boy is diagnosed with congenital aplastic anemia. Which symptom should the nurse expect in this child? Select all that apply. a) Cyanosis b) Bradypnea c) Bradycardia d) Fatigue e) Easy bruising f) Pallor

• Pallor • Fatigue • Easy bruising • Cyanosis