Peds Final - Hematology

occupational therapy

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?

Apply heat to the site of bleeding.

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?

Administer packed RBC transfusions as ordered. Administer deferoxamine therapy.

The nurse is developing a plan of care for a child with thalassemia. What nursing interventions would the nurse include? Select all that apply.

Implement strategies to address the child's pain.

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?

2.5

A nurse is preparing to administer a blood transfusion of a unit of packed red blood cells (PRBCs) to a child diagnosed with beta-thalassemia. The volume to be infused is 350 ml at a rate of 10 ml/kg/hour. The child weighs 14 kg. Calculate the number of hours the nurse expects it will take for the blood to infuse. Record your answer rounded to the nearest tenth.

Have a child-life specialist find an appropriate activity to occupy the child during the transfusion.

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?

Administer the prescribed antihemophilic agent.

A nurse is providing care to a 2-year-old child who presented to the emergency department with a severe nosebleed, and bleeding of the gums. The nurse reviews the laboratory results (above). Based on this information, which nursing intervention will the nurse implement?

"This is an autosomal recessive genetic disorder that causes aplastic anemia and other congenital disorders."

A parent has just learned that the infant has Fanconi anemia. The parent tells the nurse "I just do not understand how this could happen." How will the nurse respond?

Factor VIII

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?

seizures.

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 referral to an endocrinologist may be needed." "Facial hair may begin to appear in the coming days." "Using safety razors may be necessary for the hair that develops with puberty." "Voice deepening is an expected change."

The nurse cares for a child with for aplastic anemia with the note above. Based on the findings noted, what should the nurse include in the teaching? Select all that apply.

Teach the client to reach for a sticker or other reward on the wall with the affected arm.

The nurse cares for a client with hemophilia A. Based on the note (above), what will the nurse do?

"We should administer desmopressin as often as needed."

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?

slightly yellow sclerae.

The nurse is caring for a 4-year-old with sickle cell anemia. A physical finding the nurse might expect to see in him is:

hemoglobin (Hgb) F levels complete blood count (CBC), reticulocyte count, and platelet count

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.

Hemoglobin Iron level

The nurse is caring for a child diagnosed with thalassemia. What laboratory value(s) would the nurse expect to monitor for this child? Select all that apply.

"The use of dry heat sterilization has proven to inactivate hepatitis virus, resulting to zero factors transfusion-related incidence of hepatitis infection."

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?

Administering oxygen Administering analgesics Maintaining fluid intake

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.

"The leftover blood in the shoulder is causing hemarthrosis."

The parent asks the nurse, "I thought the bleeding was stopped. What is causing this pain?" Based on the note (above), how should the nurse reply?

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

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

Risk for infection

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?

Expect menstrual bleeding to be heavy.

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?

sickle cell disease

A 5-year-old child is brought to the emergency department with reports of generalized pain, especially in the right hand, for several hours. The nurse completes an assessment (above). Which condition is associated with these findings?

Question the parent about the medications the child is taking.

A child, diagnosed with beta-thalassemia major is seen in the pediatric clinic. During the assessment, the nurse notices that the child's skin is darker than it was at the last visit. What action should the nurse take next?

Contact the health care provider to lower the dose.

A health care provider has prescribed hydroxyurea 650 mg for a child diagnosed with sickle cell anemia. The child weighs 65 lb (29.5 kg). The normal recommended dose is 20 mg/kg/day. What action should the nurse take?

Observe the parent set up and administer the infusion.

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?

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

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?

urine output

A nurse is providing care to a child who is receiving desmopressin. At the end of a 12-hour shift, the nurse completes an assessment (above). Which finding requires the nurse's intervention?

Request that the adolescent teach the information to the nurse.

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?

Prepare to administer factor replacement medication

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?

Answer the parents' questions as completely as possible.

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?

Handle the child gently when transferring to a stretcher.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?

"Sickle cell disease is passed to a fetus when both parents have the gene."

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?

disseminated intravascular coagulation

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?

Hemoglobin level of 9 g/dl (90 g/l) or higher is achieved.

A nurse has created a plan of care for a hospitalized child receiving treatment for beta-thalassemia. Which client goal should the nurse prioritize?

sickle cell disease.

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects:

57

A nurse is providing care for a child diagnosed with beta-thalassemia who is to receive a blood transfusion. One unit of packed red blood cells (250 ml) is prescribed at a transfusion rate of 5 ml/kg/hour. The child weighs 11.4 kg. Calculate the rate the nurse will set the infusion pump. Record your answer using a whole number.

Assess whether the family home has live plants.

A nurse is providing care for a child with an absolute neutrophil count (ANC) that is less than 500/µl (0.50 ×109/l). Which action should the nurse take?

asplenia

A nurse is providing care to a child hospitalized for sickle cell anemia. The child begins to exhibit abdominal distension and signs of shock, but reports no pain. For which complication should the nurse assess first?

"Our child always wears a helmet and body padding when playing football."

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?

"Our family is taking a fun hiking trip up in the mountains next week."

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?

Assess for the presence of petechiae.

A nurse is reviewing the laboratory results (above) for a 6-year-old child diagnosed with a hematologic disorder. Which assessment is the nurse's priority?

"Tell me about the symptoms your child is experiencing"

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?

Infection

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?

Maintain adequate hydration. Ensure the ability to obtain medications. Expect to return for follow-up laboratory tests.

Based upon a client's progress note (above), what information will the nurse include in the discharge teaching? Select all that apply.

Ensure neutropenic precautions are in place.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?

Initiate pain assessment with a standardized pain scale.

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?

"These values will help us monitor the disease."

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?

Notify the physician.

The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate?

Maintaining fluids through an intravenous line

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority?

"Would you help me dilute this and mix it up?"

A nurse is caring for a 7-year-old child with hemophilia who requires an infusion of factor VIII. The child is fearful about the process and is resisting treatment. How should the nurse respond?

"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."

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?

Discontinue the transfusion.

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?

hemoglobin level; low 8.8

A nurse is caring for a 4-year-old child diagnosed with a hematologic disorder. The nurse has completed an assessment (above). Which assessment finding has the greatest effect on the child's condition?

Match the unit of blood to the child's identification.

A nurse is preparing to administer a blood transfusion to a child diagnosed with beta-thalassemia. What action should the nurse take first?

factor VIII.

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:

The child's fluid intake will improve.

In caring for a child with sickle cell disease, the highest priority goal is:

"It produces clotting in spite of the factor deficit caused by an immune response."

The nurse is caring for a child with hemophilia A with the note above. The child's parent is present at the bedside and asks, "Why will this new medication be given?" How should the nurse respond?

Give the iron supplement with a liquid or food high in vitamin C (such as orange juice/oranges) Iron supplements may cause dark stools, so monitor for this as an expected finding

The nurse is caring for a toddler diagnosed with iron deficiency anemia and prescribed an iron supplement. What would the nurse include in the educational plan for the parents? Select all that apply.

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

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

Recheck vital signs after the first 15 minutes of the transfusion. Teach the family about the signs and symptoms of a transfusion reaction. Reassess the client at the end of the transfusion. One hour after the transfusion, reassess the client.

The nurse is preparing to administer a blood transfusion for a 10-year-old client with beta-thalassemia. What should the nurse do while administering the transfusion? Select all that apply.

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

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?

transfusion of packed red blood cells (PRBCs)

A nurse is providing preoperative care to a child with sickle cell disease. What treatment should the nurse expect to implement prior to surgery?