Perry, Ch 43 - Hematologic and Immunologic Dysfunction

The health care provider orders a transcranial Doppler (TCD) test for a child with sickle cell anemia (SCA). How does the nurse expect the health care provider to explain the reasoning behind ordering the test? "The test will help us: 1 Know whether the child is at risk for cerebrovascular accident." 2 Identify the different types of abnormal hemoglobin." 3 Determine whether sickle cell anemia was inherited by the child." 4 Identify whether there are other coexisting conditions."

1 A TCD test is used to identify whether the child with SCA is at risk for cerebrovascular accident. Hemoglobin electrophoresis is a screening test used to identify different types of hemoglobin. SCA is inherited, so the test is not used to verify whether it was inherited. Instead, the test is used to identify the homozygous form and the heterozygous form of the disease. A TCD test is not used to identify other coexisting conditions in a child with SCA.

The nurse is assessing a child with immune thrombocytopenia (ITP). The nurse observes that there is no active bleeding in the child. Which medications does the nurse expect in the child's prescription? 1 Anti-D antibody 2 Penicillin prophylaxis 3 Opioids (narcotics) 4 Kytril (Granisetron)

1 Anti-D antibody is administered to a child with ITP for prolonged survival of platelets. The platelet count increases 48 hours after the anti-D antibody is administered. Therefore it is not appropriate for clients with active bleeding. Penicillin prophylaxis is administered to a child to prevent infections after a splenectomy. Opioids (narcotics) are administered to relieve pain in a child with leukemia. Kytril (Granisetron) is used to control nausea and vomiting that may occur after emetogenic chemotherapy and radiotherapy.

After determining a 7-month-old African American infant girl has sickle cell anemia and is having a crisis, the health care team begins therapy. What activities would the nurse determine as priorities for this infant? 1 administering pain medication, initiating intravenous (IV) fluids and electrolytes, and administering oxygen 2 immobilizing the patient's upper extremities, administering antibiotics, and transfusing blood products 3 preparing the infant for a transcranial Doppler test, administering penicillin, and administering meperidine (Demerol) for pain 4 monitoring vital signs, inserting an indwelling urinary catheter, and encouraging activity to promote circulation

1 Because this infant is experiencing a vasoocclusive crisis, IV fluids and electrolytes, oxygen, and pain medication must be administered immediately to decrease the sickling and to decrease the pain. Knowing the triggers for sickling leads to interventions to reduce the sickling. There is no need to immobilize the infant's upper extremities. There may be a need for elbow restraints depending on where the IV site is, but not immobilization. Antibiotics might be administered if infection is expected, but this needs to be determined first. Blood products might be administered to provide blood that is not sickling. A transcranial Doppler test is not indicated at this time because the infant is too young and a cerebrovascular accident (CVA) is not suspected. Penicillin might be the antibiotic used after determining that an infection is present. Demerol is contraindicated because of the side effects it can cause in children with sickle cell anemia. The urine output will be monitored by weighing the diaper without the risk of infection because of an indwelling catheter. Rest is indicated for healing and to conserve energy in this very ill child.

Nursing considerations related to the administration of chemotherapeutic drugs include: 1 many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. 2 good handwashing is essential when handling chemotherapeutic drugs, but gloves are not necessary. 3 infiltration will not occur unless superficial veins are used for the intravenous infusion. 4 anaphylaxis cannot occur because the drugs are considered toxic to normal cells.

1 Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.

The nurse is providing information about the side effect of the prescribed irradiation and chemotherapy to an adolescent with Hodgkin lymphoma (HL). About which side effect does the nurse inform? 1 Infertility 2 Chronic crippling 3 Hemorrhage 4 Myalgias

1 Chemotherapy and irradiation leads to infertility in many adolescent children, because of chemotherapy agents and irradiation to the gonads. Chronic crippling and hemorrhage are seen in children with episodes of joint bleeding caused by hemophilia. Myalgias are a side effect of administering antithymocyte globulin (ATG) for aplastic anemia.

What is the most appropriate action for stopping an occasional episode of epistaxis (nose bleeding)? 1 Have the child sit up and lean forward. 2 Apply ice under the nose and above lip. 3 Have the child lie down quietly with feet elevated. 4 Apply continuous pressure to the nose with thumb and forefinger for at least 1 minute.

1 Having the child sit up and lean forward is the position used to prevent the child from aspirating the blood. Applying pressure is necessary, but not applying ice. Having the child lie down with the feet elevated could lead to aspiration. Continuous pressure for 10 minutes is recommended.

The nurse finds that a child is pale, gets easily fatigued, and has lack of energy. The nurse asks the parents to get a complete blood count (CBC) test. What does the nurse suspect from these symptoms? 1 Anemia 2 Sickle cell anemia 3 Splenic sequestration 4 Chest syndrome

1 Paleness, fatigue, and lack of energy are the symptoms of anemia that can be confirmed after a CBC test. Sickle cell anemia is diagnosed by chest pain, elevated temperature, painful joints, or hypoxia. Splenic sequestration is a symptom of sickle cell anemia, which causes an enlarged spleen. Chest syndrome is a symptom of sickle cell anemia with signs of hypoxia, chest pain, fever, cough, and wheezing.

The most important nursing consideration when caring for a child with sickle cell anemia is to: 1 teach parents and child how to minimize crises. 2 refer parents and child for genetic counseling. 3 help the child and family to adjust to a short-term disease. 4 observe for complications of multiple blood transfusions.

1 Parents need specific instructions about changes in the child's condition that they should watch for, penicillin administration, adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority . Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly prepared to care for them.

What is administered to a child who presents with hemophilia A and is at risk for joint bleeding? 1 Primary prophylaxis 2 Secondary prophylaxis 3 Anti-D antibody 4 Intravenous heparin

1 Primary prophylaxis is administered to prevent bleeding complications in a child with hemophilia A. The child is administered factor VIII concentrate on a regular basis before the joint damage occurs. Secondary prophylaxis involves administering factor VIII concentrate after the child experiences bleeding in a joint. Anti-D antibody is administered to a child with immune thrombocytopenia (ITP) to prevent bleeding. Intravenous heparin is used to inhibit thrombin formation in clients with ITP.

The nurse is assessing a child with short stature and malnutrition. The medical history of the child also indicates oral candidiasis. Which condition does the nurse suspect in the child? 1 Human immunodeficiency virus 2 Non-Hodgkin lymphoma 3 Disseminated intravascular coagulation 4 Immune thrombocytopenia

1 Short stature, malnutrition, and oral candidiasis are the symptoms of human immunodeficiency virus (HIV) infection. Developmental delay and chronic or recurrent diarrhea are the other symptoms associated with HIV. Non-Hodgkin lymphoma is a type of blood cancer characterized by swollen lymph nodes and fever. Disseminated intravascular coagulation is characterized by an increased tendency to bleed resulting from the destruction of platelets. Immune thrombocytopenia is characterized by easy bruising, mucosal bleeding, and petechiae caused by abnormal platelet count.

The parents tell the nurse that their child has frequent nosebleeds that usually stop within 5 to 10 minutes. Which intervention does the nurse suggest to the parents to prevent nosebleeds? 1 "Insert petroleum jelly in the nostril after a nosebleed." 2 "Administer aspirin (Ecotrin) after a bleeding episode." 3 "Decrease the temperature in the child's room." 4 "Administer opioids when the bleeding stops."

1 The nurse advises the parents to insert petroleum jelly in the nostril after a nosebleed to prevent crusting of the old blood. Aspirin increases the chances of nosebleeds and is avoided. Using a cool-mist humidifier in the child's room to alter the household humidity is more beneficial for preventing nosebleeds than decreasing the temperature. Opioids are not administered for nosebleeds; opioids are used to relieve pain.

Jacob is a 2-year-old outpatient with hemophilia A. He will be coming to the emergency department (ED) for an outpatient infusion after a tumble from his high chair. There are a number of bleeding disorders that may require infusion with clotting factors or blood products. Please preview the video and identify which blood component Jacob will need replaced. 1 Factor VIII 2 Factor IX 3 von Willebrand factor 4 Platelets

1 The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates, either synthetically produced or derived from plasma. A synthetic form of

A first-born 7-month-old of African American heritage has a sudden onset of uncontrollable screaming and crying and is brought to the emergency room. The infant and his or her parents are visiting from a country in the Caribbean. After determining that there is no injury present, what actions would the nurse expect to take? 1 Ask the parents if their child had any recent vomiting, diarrhea, or fever recently. 2 Prepare the infant to have arterial blood gases drawn and a chest x-ray. 3 Medicate the infant for an imaging examination and obtain blood laboratory work. 4 Obtain vital signs and vigorously palpate the infant's abdomen.

1 The sickling phenomenon usually is not apparent until later in infancy because of the presence of fetal hemoglobin. This protects the infant from the effects of sickle cell-related complications, but this protection rapidly decreases during the first year. Triggers for a sickle cell crisis can be dehydration, which can occur from vomiting, diarrhea, or fever, as well as from infection. The infant's recent health history and blood work can provide the most information about the presence of sickle cell anemia (SCA). The parents might not have any knowledge that they are carriers of this condition. Newborn screening for SCA is mandatory in most of the United States so that infants can be identified before symptoms occur; most likely this was not done where the child was born.

The nurse is caring for a child with severe anemia. The child has to undergo several blood tests. What actions does the nurse take to prepare the child for the test? Select all that apply. 1 Explains why all the tests are necessary 2 Tells the parents to stay out of the laboratory 3 Demonstrates the procedure on a doll 4 Describes the test step by step 5 Does not perform the tests if the child is not ready

1, 3, 4 The child with severe anemia has to undergo several tests sequentially, which is traumatic for the child. So the nurse explains the purpose of each test to provide comfort to the child. The nurse demonstrates the procedure on the doll so that the child gets familiar with the procedure. The nurse describes the test step by step at the level of the child's understanding so that the child gets comfortable with the procedure. The nurse tells the parents to accompany the child during the procedure to make the latter comfortable. The nurse is responsible for preparing the child for the test.

The nurse is caring for a child with severe anemia. The child has to undergo several blood tests. What actions does the nurse take to prepare the child for the test? Select all that apply. 1 Explains why all the tests are necessary 2 Tells the parents to stay out of the laboratory 3 Demonstrates the procedure on a doll 4 Describes the test step by step 5 Does not perform the tests if the child is not ready

1, 3, 4 The child with severe anemia has to undergo several tests sequentially, which is traumatic for the child. So the nurse explains the purpose of each test to provide comfort to the child. The nurse demonstrates the procedure on the doll so that the child gets familiar with the procedure. The nurse describes the test step by step at the level of the child's understanding so that the child gets comfortable with the procedure. The nurse tells the parents to accompany the child during the procedure to make the latter comfortable. The nurse is responsible for preparing the child for the test.

The nursing instructor is teaching a group of students about hemophilia A. Which statement by the student indicates effective learning? 1 "Hemophilia A does not cause bleeding in the subcutaneous tissue." 2 "This condition occurs as a result of the deficiency of antihemophilic factor." 3 "Hemophilia A gets worse if antihemophilic factor is increased in blood." 4 "Patients with hemophilia A bleed at a faster rate and for longer periods."

2 Antihemophilic factor is necessary for blood coagulation; hence, hemophilia A occurs if there is a deficiency of antihemophilic factor. Hemophilia A causes bleeding in the subcutaneous tissue, intramuscular tissue, and the joint space because of a lack of clotting factor. The disease gets worse if antihemophilic factor is less in the blood. Patients with hemophilia A have two factors (vascular influence and platelets) required for blood coagulation; hence, they bleed for longer periods but not at a faster rate.

The nursing instructor is teaching a group of students about the use of antiretroviral drugs in the therapeutic management of human immunodeficiency virus (HIV) infection. Which statement by the student indicates a need for additional learning? 1 "The drugs prevent further deterioration of the immune system." 2 "The drugs help prevent reproduction of the virus and cure HIV." 3 "The protease inhibitor indinavir (Crixivan) is an antiretroviral drug." 4 "The drugs suppress viral replication and delay disease progression."

2 Antiretroviral drugs prevent the reproduction of the virus but do not cure HIV. The drugs prevent further deterioration of the immune system by slowing the growth of the virus. The protease inhibitor indinavir (Crixivan) belongs to the class of antiretroviral drugs. Antiretroviral drugs suppress viral replication and delay the disease progression, thereby changing HIV from a rapidly fatal illness to a chronic disease.

The parent of a 6-month-old infant asks the nurse about the food that can be included in the child's diet. What does the nurse suggest? 1 "Feed breast milk only." 2 "Include cereals in the diet." 3 "Provide fresh cow's milk." 4 "Give carrots and peas."

2 Cereals are the first semisolid foods that should be given to an infant at 6 months of age. This helps the infant accept food other than milk and prevents the risk for anemia. The nurse does not advise feeding only breast milk because it may induce nutritional anemia. Cow's milk puts the child at risk for gastrointestinal blood loss because of the presence of heat-labile protein in the milk. Carrots and peas are solid foods that are not digested by the infants at 6 months.

A child is prescribed oral iron for iron deficiency anemia. What intervention does the nurse implement to ensure the absorption of iron in the child? 1 Ensures the child drinks adequate fluids 2 Gives citrus juice with the oral iron 3 Gives milk with medications 4 Increases iron rich foods in the diet

2 Citrus fruits and juices are rich in vitamin C or ascorbic acid, which facilitates the absorption of iron. Consumption of adequate fluids will not ensure iron absorption. Milk is a poor source of iron and will not serve to accomplish iron deficiency. Iron is poorly absorbed from iron rich foods and does not meet the additional iron requirements of the body.

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? 1 Lemon glycerin swabs for cleansing 2 Mouthwashes with normal saline 3 Mouthwashes with hydrogen peroxide 4 Local anesthetic such as viscous lidocaine before meals

2 Normal saline mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without risking adverse effects on the mucosa or adverse effects caused by the child swallowing the rinse. Lemon glycerin swabs can irritate eroded tissue and decay teeth. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers because it depresses the gag reflex.

Which is an ideal treatment for a child after splenectomy? 1 Iron dextran injection 2 Prophylactic antibiotics 3 Diphenhydramine (Benadryl) 4 Intravenous heparin

2 Prophylactic antibiotics are administered to the child to prevent the severe infections that the child is at risk for after a splenectomy. Iron dextran injection is used to treat severe anemia. Diphenhydramine (Benadryl) is used to relieve pain in a child with mucosal ulceration. Intravenous heparin is used to inhibit thrombin formation in patients with immune thrombocytopenia (ITP).

A child has acquired mucosal ulceration after chemotherapy, which makes eating uncomfortable. Which intervention does the nurse implement to prevent anorexia in the child? The nurse: 1 Obtains an order for tube feedings. 2 Provides a bland, moist, soft diet. 3 Provides parenteral nutrition. 4 Provides mostly fluids in the diet.

2 The nurse provides a bland, moist, and soft diet so that the child can eat it without any discomfort. Tube feedings and parenteral nutrition are recommended when the child has severe nutritional problems. Providing mostly fluids in the diet will decrease the nutritional value.

The nursing instructor is teaching a student how to administer iron dextran injections to a child with severe anemia. Which instruction does the nurse give after the student administers the injection? 1 "Place the child in a semi-Fowler position." 2 "Do not massage the injection site." 3 "Use the same site for the next injection." 4 "Keep the syringe near the child's bed."

2 The nursing instructor tells the student to avoid massaging the injection site to minimize skin staining and irritation. The nurse places the patient in an appropriate position before administering the injection. It is necessary to rotate sites because of the potential for tissue damage. The nurse disposes of the syringe safely after administering the medication to avoid stick injuries.

The nurse is informing a group of parents in a nursing camp about the importance of genetic counseling. Which parents would need genetic counseling? Select all that apply. Parents of a child with: 1 Leukemia 2 Sickle cell disease 3 Thalassemia 4 Hemophilia A 5 Hodgkin lymphoma

2, 3, 4 There is a 25% possibility of having a child with the disease when both parents carry the trait. Hence genetic counseling is suggested to the parents for prenatal assessment and treatment. Sickle cell disease, thalassemia, and hemophilia A are genetic diseases, and the parents who have children diagnosed with these diseases need genetic counseling. Leukemia and Hodgkin lymphoma are not genetic diseases.

The nurse is instructing about preventing bleeding episodes to the parents of a child with hemophilia. What instructions does the nurse provide? Select all that apply. 1 Restrict sports activity like tennis or golf 2 Encourage participation in swimming 3 Soften toothbrush before brushing 4 Use finger punctures for blood samples 5 Avoid using aspirin for controlling pain

2, 3, 5 The nurse encourages noncontact sports like swimming so that there is no danger of collision and injury. The nurse suggests softening the toothbrush with warm water to prevent trauma to the gums. The nurse also instructs to avoid aspirin or aspirin containing compounds to treat any pain as aspirin worsens bleeding problems. Tennis and golf are noncontact sports and have minimal chances of injury and are not restricted. The nurse can advise to use protective helmets and padding to avoid further injury. Venipunctures are used for blood samples as they cause less bleeding.

An infant with sickle cell anemia (SCA) is prescribed the hemoglobin electrophoresis test. What is the purpose of this test? 1 To identify whether the child is at risk for cerebrovascular accident 2 To confirm the presence of sickle cell anemia 3 To detect different types of hemoglobin 4 To rule out disorders other than sickle cell anemia

3 A hemoglobin electrophoresis test is used to detect different types of hemoglobin in the child. It further helps determine whether the child has SCA, the homozygous form of the disease, or sickle cell C disease, the heterozygous form. A transcranial Doppler (TCD) test is used to identify whether the child with SCA is at risk for cerebrovascular accident. Sickledex is used to confirm the presence of sickle cell anemia. Hemoglobin electrophoresis test is not used to rule out disorders other than SCA.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include: 1 restricting oral fluids. 2 instituting strict isolation. 3 using good handwashing. 4 giving live vaccines appropriate for age.

3 Good handwashing is the most effective means of preventing disease transmission. There is no indication that fluids should be reduced. Strict isolation is not necessary. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine.

The nurse suspects that a child with enlarged lymph nodes and fever has leukemia. Which test does the nurse evaluate to confirm the condition? 1 Peripheral blood smear 2 Lumbar puncture 3 Bone marrow biopsy 4 Tourniquet test

3 Leukemia is confirmed when the bone marrow biopsy indicates that the bone marrow is hypercellular, with primarily blast cells. Peripheral blood smear is not a definite diagnosis of leukemia because it reveals immature forms of leukocytes, frequently combined with low blood counts. Lumbar puncture is performed after a bone marrow biopsy to determine whether there is any involvement of the central nervous system. A tourniquet test helps identify an abnormal platelet count.

Antithymocyte globulin (ATG) is administered intravenously to a child with aplastic anemia (AA). The child is susceptible to side effects of ATG, such as fever, chills, and myalgias. Which medication is administered to prevent these side effects? 1 Prophylactic antibiotics 2 Stavudine (Zerit) 3 Methylprednisolone (Medrol) 4 Pentam (Pentamidine)

3 Methylprednisolone (Medrol) is administered to prevent fever, chills, and myalgias in a child who is administered ATG intravenously. Prophylactic antibiotics are administered to prevent infections. Stavudine (Zerit) is a class of antiretroviral drugs used in patients with human immunodeficiency virus (HIV) infection. Pentam (Pentamidine) is used for patients with Pneumocystis carinii pneumonia (PCP).

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The first action by the nurse is to: 1 administer 100% oxygen to relieve hypoxia. 2 administer meperidine (Demerol) to relieve symptoms. 3 notify the practitioner because chest syndrome is suspected. 4 notify the practitioner because child may be having a stroke.

3 Severe chest pain, fever, cough, and dyspnea are signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Administration of oxygen may be ordered by the practitioner, but the first action is notification. Oxygen therapy is of little therapeutic value unless the patient has hypoxia. Pain medications may be indicated, but evaluation is necessary first. Demerol is not recommended because it produces a metabolite that is a CNS stimulant causing anxiety, tremors, myoclonus, and seizures. A stroke is not indicated.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measure should the nurse do until factor replacement therapy can be instituted? 1 Apply warm, moist compresses. 2 Apply pressure for at least 1 minute. 3 Elevate area above the level of the heart. 4 Begin passive range of motion unless pain is severe.

3 The initial response should include elevation. Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.

The parents of a child with leukemia are worried that chemotherapy will cause alopecia in the child. What does the nurse inform the parents? 1 "Hair loss is seen in children with thin hair." 2 "Your child may feel extremely embarrassed initially." 3 "Hair will regrow 3 to 6 months after the treatment ends." 4 "I think you should not inform the child about the hair loss."

3 The nurse alleviates the parents' anxiety by informing that the child's hair will regrow 3 to 6 months after the treatment ends. Hair loss is seen in most children and not only in children with thin hair, so it is important to let the parents know of this possibility in advance. The nurse should advise the parents about options such as wigs, caps, or head covering for hair loss instead of telling them that it may be embarrassing for the child. The nurse advises the parents to prepare the child for the side effects instead of concealing it from the child.

A child has acquired stomatitis after chemotherapy. The parents are worried and tell the nurse that the child consumes only juices and very few solid foods. What is the nurse's response? 1 "You may ask the primary health care provider for food supplements." 2 "You must persuade the child to eat more solid foods." 3 "The child may eat well after the ulcers heal." 4 "The child may require parenteral nutrition for hydration."

3 The nurse should inform the parents that the child will choose food that is best tolerated. The child can resume good food habits once the ulcers heal. The child may not be able to consume food supplements due to ulcers. Hence the nurse does not advise the parents to try food supplements. The nurse advises the parents to avoid persuading the child to eat solid foods, as the ulcers cause discomfort while eating. Parenteral nutrition is needed in case the child is unable to eat any food and is at risk for dehydration.

The nurse is teaching the parents how to provide care for their child with sickle cell anemia. Which intervention does the nurse include in the teaching? 1 "Enforce bladder control to avoid bedwetting." 2 "Report immediately if the spleen size decreases." 3 "Provide daily fluid intake as specified." 4 "Report fever if more than 100 degrees F."

3 The parents are instructed about the specific fluid intake of the child for adequate hydration to prevent sickling. The nurse informs that enuresis can be a complication of the disease; so the child should not be scolded or enforced for bladder control. Decreasing spleen is an indication of recovery and not an emergency to be reported. The nurse asks the parents to report immediately if the temperature is more than 101.3 degrees F.

The blood report of a 5-year-old child reveals a reduction in hemoglobin below the normal value concentration. Which physiologic defect does the nurse expect in the child? 1 Iron deficiency anemia due to decreased iron 2 Cyanosis due to deoxygenated hemoglobin 3 Reduction in oxygen-carrying capacity of blood 4 Bone marrow failure due to reduction in hemoglobin

3 The reduction in hemoglobin below the normal value indicates anemia. The physiologic defect associated with anemia is a reduction in the oxygen-carrying capacity of the blood. Iron deficiency anemia is found mostly in children between 12 to 36 months. It is caused by the insufficient consumption of foods rich in iron. Cyanosis is caused by deoxygenated hemoglobin in arterial blood. Bone marrow failure is determined only from bone marrow examination.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a/an: 1 symptom of iron-deficiency anemia. 2 adverse effect of the iron preparation. 3 indicator of an iron preparation overdose. 4 normally expected change caused by the iron preparation.

4 An adequate dosage of iron turns the stools a tarry green color. If the stools do not become a tarry green color, it may indicate administration issues.

The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they: 1 help keep germs from causing infection. 2 make up the liquid portion of blood. 3 carry the oxygen that is breathed from the lungs to all parts of the body. 4 help the body stop bleeding by forming a clot (scab) over the hurt area.

4 Platelets help the body stop bleeding by forming a clot over the hurt area. Keeping germs from causing infection is the function of white blood cells. The liquid portion of blood is plasma. Carrying oxygen from the lungs to all parts of the body is the function of red blood cells.

The nurse is assessing an adolescent with hemophilia A, who has also experienced several episodes of joint bleeding. Which condition will be evident in the adolescent? 1 Fanconi syndrome 2 Delayed sexual maturation 3 Visual disturbances 4 Bony changes

4 Several episodes of joint bleeding over several years lead to bony changes and crippling deformities in a child. Fanconi syndrome is a hereditary disorder that causes pancytopenia, hypoplasia of the bone marrow, and patchy brown discoloration of the skin. Delayed sexual maturation is sometimes a side effect of chemotherapy and irradiation. Visual disturbances occur in a child with sickle cell anemia as a result of chronic vasoocclusive phenomena.