Peds Exam 2 Q's: Hematologic & Genetic

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: removal or covering of flaking paint on the walls of the home putting child safety locks on kitchen cabinets putting medicine away where children cannot reach it placing house plants out of reach of children

A

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? Type I Type II Type III Type IIIB

A

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

A

A newborn was screened for hereditary metabolic disorder at 8 hours old. Which action by the nurse is most appropriate? Instruct the parent to have another screening in 1 to 2 weeks No further intervention is needed Repeat screening in 8 hours If the infant is premature, screening needs to be done every 8 hours for 48 hours

A

A nurse is describing the underlying cause of trisomy 21 to a group of parents, integrating knowledge that the disorder is due to: A. nondisjunction. B. deletion. C. duplication. D. translocation.

A

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? Compression Heat Exercise Lowering extremities

A

After teaching a class of students about genetics and inheritance, the instructor determines that the teaching was successful when the students identify this as the basic unit of heredity. A. Gene B. Chromosome C. Allele D. Autosome

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? "Mary Jo's blood has developed antibodies to the white blood cells, platelets or plasma protein antigens in the donor blood." "Mary Jo's blood was not compatible with the blood product, causing the red blood cells to destruct." "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." "Too much of the blood product was transfused at too rapid a rate."

A

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

A

The nurse is assessing an 8-week-old infant in the clinic. The parent states the infant was feeding well and gaining weight until a few weeks ago and now is noted to have lost weight and "isn't doing well" per the parent. What action would the nurse take next? A Assess the infant further for an inborn error of metabolism B Advise the parent to decrease the feedings daily to every 6 hours C Suggest the child be fed in a supine position, using a car seat or carrier D Refer the parents to a dietitian for education on increasing the child's appetite

A

The nurse is assessing the eyes of a 6-month-old and notices that she has wide-spaced eyes and bilateral epicanthal folds. Which condition associated with these findings should also be assessed for in this child? Low-set, malformed ears Amblyopia Strabismus Ptosis

A

The nurse is caring for a 14-year-old client with sickle cell anemia hospitalized for acute splenic sequestration. For which condition should the nurse monitor? Shock Hypoglycemia Hemorrhagic stroke Cardiomegaly

A

The nurse is educating an 18-year-old female client with Turner syndrome. What information will the nurse include in the teaching plan? Resources regarding infertility and family planning Requirements for post secondary educational needs The need to eliminate amino acids from the diet The options for a cure as the client enters adulthood

A

The nurse is performing an assessment on a 14-year-old client with sickle cell anemia during an annual exam. Which finding requires further follow-up by the nurse? The client reports having a difficult time making friends at a new high school. The client has become more distant from the parents. The client pushes the limits of authority. The client feels conflicted about leaving the safety of the home.

A

The nurse is reviewing the dosing instructions for hydroxyurea with a 14-year-old client with sick cell anemia. Which topic should the nurse review with the client to ensure the therapy's effectiveness? Compliance Weight Hydration Hand hygiene

A

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

A

When teaching about Turner's syndrome, what should the nurse include? Timing and use of growth hormone Use of hormone therapy to prevent infertility Long-term effects of decreased intellectual ability Treatment for gynecomastia

A

Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education? "I will need to delay any further immunizations." "Thyroid testing is needed every year." C. "In a couple of years, my child will need an x-ray of the neck." D. "I will watch closely for development of respiratory infection."

A

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? Stop the transfusion. Obtain a blood culture. Slow the transfusion rate. Provide a diuretic as prescribed.

A

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. Christmas factor Factor IX Stuart's factor Antihemophilic factor Factor VIII

A B

The emergency department nurse is assessing a 14-year-old client with sickle cell anemia who presents with symptoms consistent with a sickle cell crisis. Which assessment(s) should the nurse perform immediately? Select all that apply. Breathing effort Mental status Pain Blood pressure Hydration status

AB

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

ABC

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. Low back pain Fever Distended abdomen Splenic enlargement E. Increased reticulocyte count

ABC

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. Epicanthal folds Small jaw Café-au-lait spots Narrow nasal base Large eyes

ABC

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. Chest pain Severe dizziness Sudden change in vision Constipation Irritability

ABC

The nurse is caring for a 14-year-old client with sickle cell anemia experiencing acute chest syndrome. Which goal(s) of care should the nurse anticipate? Select all that apply. Rehydration Pain management Maintain optimal body temperature Promoting peripheral vascular return Maximizing lung capacity

ABC

The nurse is reviewing triggers of sickle cell crisis with a 14-year-old female client with sickle cell anemia. Which statement by the client indicates an understanding of the teaching? Select all that apply. "I have to be very careful to take my medications as directed." "I wash my hands frequently." "Adequate hydration will help me to stay healthy." "I should avoid getting pregnant until I am 21 years old." "Too much sleep can worsen my condition."

ABC

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. Urticaria Respiratory distress C. Diaphoresis Lower back pain Chills

ADE

A nurse is creating a plan of care for a preschool child hospitalized with a diagnosis of leukemia. Which intervention(s) will best help the child adapt to hospitalization? Select all that apply. Provide opportunities for the child to make decisions about care. Discuss the plan of care with parents privately to avoid anxiety in the child. Answer any questions the child may have in generalized terms. Maintain the child's room as a safe space, performing procedures in the treatment room. Encourage the parents to bring the child comfort items such toys and books.

ADE

A 25-year-old client wants to know if her baby boy is at risk for Down syndrome because one of her distant relatives was born with it. Which information would the nurse share with the client while counseling her about Down syndrome? A Instances of Down syndrome in the family greatly increases the risk for the baby also having Down syndrome. B Children with Down syndrome have extra genetic material in the 21 chromosome that occurs during development of the sperm or egg. C Down syndrome occurs only in females, and there is no risk as the baby is male. D Children with Down syndrome are usually born to older mothers.

B

A child with a diagnosis of Down syndrome has had which of the following chromosome abnormalities occur? 1 copy of the chromosome 8 has occurred instead of 2 copies. 3 copies of trisomy 21 has occurred instead of 2 copies. 3 copies of trisomy 18 has occurred instead of 2 copies. 3 copies of trisomy 13 has occurred instead of 2 copies.

B

A nurse is reviewing the laboratory results of a preschool child diagnosed with leukemia. The child is receiving chemotherapy and corticosteroids as part of the treatment regimen. What intervention is most important for the nurse to include in the child's plan of care? Offer mouth care before meals. Assess the temperature every 2 hours. Monitor intake and output. Administer an antiemetic as prescribed.

B

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? Pain relief Emergent transfusion Antibiotic administration Oxygen administration

B

The nurse is caring for a newborn diagnosed with an inborn error of metabolism with several referrals ordered. What referral would the nurse place as the priority for the infant? Spiritual advisor Dietitian Community support group Genetic counseling

B

When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, what would be the priority? Assisting with scheduling follow-up visits Establishing a trusting relationship Teaching the family what to expect Using measures to promote growth and development

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

BCD

The nurse is caring for a 14-year-old client with sickle cell anemia at risk for developing sickle cell crisis. Which sign(s) and symptom(s) requires further follow-up by the nurse? Select all that apply. Dry or oily skin Chest pain Coughing Fever Tachypnea

BCDE

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

C

A nurse is assessing a child with persistent fever, fatigue, and joint pain for 3 days. The parent denies that anyone else in the family is or has been ill, or that the child has been exposed to illness outside the family. Based on this information, what would be an appropriate action for the nurse take next? Notify the health care provider. Document the findings as a viral infection. Assess the child's skin for any rashes or lesions. D. Check the child's immunization schedule.

C

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? Interrupted family process related to the child's diagnosis Deficient knowledge deficit related to the genetic disorder Grieving related to the child's poor prognosis Ineffective coping related to stress of providing care

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

C

The parent of child who has been diagnosed with acute lymphoblastic leukemia (ALL) approaches the nurse's station asking to speak to the child's nurse. The parent is visibly upset and confides in the nurse concerns about the child's condition. What is the best action for the nurse to take? Assure the parent that the child's treatment is going well. Call the health care provider and recommend a family conference. Ask the parent to talk more about his or her concerns about the child's condition. Tell the parent to be careful not to show fear in front of the child.

C

Which of the following women has the greatest risk of having a child with Down syndrome? A. 25-year-old B. 30-year-old C. 42-year-old D. 35-year-old

C

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What would be most important for the nurse to incorporate into the plan of care when working with this family? Gathering information from at least three generations Informing the family of the need for a wide range of information Maintaining the confidentiality of the information Presenting the information in a nondirective manner

D

The nurse is educating a parent after the birth of a newborn who is diagnosed with phenylketonuria (PKU). Which parent statement indicates teaching has been effective? "I will supplement my breast milk with prescribed formula." "Once the baby is on solid foods, the dietary restriction will be gone." "The concern is the baby has an excess of a liver enzyme." "I will not breast feed the baby since breast milk contains phenylalanine."

D

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? Blurred vision Nausea and vomiting Sudden onset of knee pain Bleeding from intravenous sites

D

The parent of an infant born with trisomy 18 says to the nurse, "I am so lost...I can't even think about my baby not being healthy." How should the nurse respond? "I understand...we occasionally see clients with trisomy 18 and it is very sad." "This is a difficult time, but let's talk about the ways your baby will outgrow this." "I would encourage you to talk with the doctor about ways to cure this disorder." "This is a sad time for you. I will sit with you quietly in case you want to talk."

D

The nurse is comforting a family who were just informed by the health care provider that their baby will likely be born with a significant genetic abnormality. What actions by the nurse would be therapeutic? Select all that apply. A Advise the parents to discuss their fears with only each other B Discuss the nurse's personal beliefs regarding genetic abnormalities C Encourage the family to ask questions after they have researched the disorder D Refer the family to appropriate parent group or local family with similar needs E Allow the family to discuss their emotions in an authentic and trusting environment

D E

The parents of a 1-year-old child with Down syndrome are at a follow-up clinic visit for their child. What information would the nurse review with the parents at this time? Select all that apply. A Plan to have the child's vision and hearing tested at the age of 18 months B The child should be consuming added calories now that he is growing more C Dental visits should be scheduled yearly from this age to adolescence D Cervical x-rays need to be scheduled for the next visit in 3 months E Monitor for symptoms of respiratory infections and ear infections F A thyroid test will be scheduled for this visit to monitor for high or low thyroid concerns

EF

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? Discontinue the transfusion. Obtain a blood culture. Give an iron-chelating agent. Ask the health care provide for a prescription for a diuretic.

a

The nurse is caring for a 1-year-old boy with Down syndrome. Which intervention would the nurse be least likely to include in the child's plan of care? Educating parents about how to deal with seizures Explaining developmental milestones to parents Promoting annual vision and hearing tests Describing the importance of a high-fiber diet

a