Perry/Hockenberry chapter 43. Hematologic and Immunologic Dysfunction

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. 1Describes the test step by step 2Demonstrates the procedure on a doll 3Explains why all the tests are necessary 4Tells the parents to stay out of the laboratory 5Does not perform the tests if the child is not ready

123

The nurse is caring for a child with epistaxis. The parent asks how nosebleeds can start. What does the nurse understand about the common causes of epistaxis in children? Select all that apply. 1They can be caused by nose picking. 2They can be caused by trauma to the nose. 3They can be caused by headaches and stress. 4They can be caused by inflammation from allergies. 5They can be caused by foreign bodies lodged in the nostrils

1245

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? 1Gives milk with medications 2Gives citrus juice with the oral iron 3Increases iron-rich foods in the diet 4Ensures the child drinks adequate fluids

2

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? 1Immobilizing the patient's upper extremities, administering antibiotics, and transfusing blood products 2Administering pain medication, initiating intravenous (IV) fluids and electrolytes, and administering oxygen 3Monitoring vital signs, inserting an indwelling urinary catheter, and encouraging activity to promote circulation 4Preparing the infant for a transcranial Doppler test, administering penicillin, and administering meperidine (Demerol) for pain

2

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

Which condition in a child indicates a deficiency of one of the factors (proteins) necessary for blood coagulation? 1Apheresis 2Hemophilia 3Aplastic anemia 4Sickle cell anemia

2

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

2

Which term is used to describe the removal of blood from an individual, separation of the blood into its components, retention of one or more of these components, and reinfusion of the remainder of the blood back into the individual? 1Epistaxis 2Apheresis 3Thrombocytopenia 4Blood transfusion therapy

2

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: 1Leukemia 2Sickle cell disease 3Thalassemia 4Hemophilia A 5Hodgkin lymphoma

234

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. 1Restrict sports activity like tennis or golf 2Encourage participation in swimming 3Soften toothbrush before brushing 4 Use finger punctures for blood samples 5Avoid using aspirin for controlling pain

235

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

3

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

3

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? 1Iron deficiency anemia due to decreased iron 2Cyanosis due to deoxygenated hemoglobin 3Reduction in oxygen-carrying capacity of blood 4Bone marrow failure due to reduction in hemoglobin

3

When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that: 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. Preparation should be allowed to mix with saliva and bathe the teeth before swallowing

C

Which child should the nurse document as being anemic? A. 7-year-old child with a hemoglobin of 11.5g/dL B. 3-year-old child with a hemoglobin of 12 g/dL C. 14-year-old child with a hemoglobin of 10 g/dL D. 1-year-old child with a hemoglobin of 13 g/dL

C

Which statement most accurately 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 red blood cell destruction occurs

C

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? A. Circulatory collapse B. Cardiomegaly, systolic murmurs C. Hepatomegaly, intrahepatic cholestasis D. Painful swelling of hands and feet, painful joints

D

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? Apply warm, moist compresses Apply pressure for at least 1 minute Elevate area above the level of the heart Begin passive range of motion unless pain is severe

Elevate area above the level of the heart

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

Have child sit up and lean forward.

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: symptom of iron-deficiency anemia. adverse effect of the iron preparation. indicator of an iron preparation overdose. normally expected change caused by the iron preparation.

normally expected change caused by the iron preparation.

The nurse suspects that a child is having an adverse reaction to a blood transfusion. The FIRST action by the nurse should be to: notify the physician. take vital signs and blood pressure and compare them with baseline. dilute infusing blood with equal amounts of normal saline. stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

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

teach parents and child how to minimize crises.

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? 1Ask the parents if their child had any recent vomiting, diarrhea, or fever recently. 2Prepare the infant to have arterial blood gases drawn and a chest x-ray. 3Medicate the infant for an imaging examination and obtain blood laboratory work. 4Obtain vital signs and vigorously palpate the infant's abdomen.

1

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? 1"The test will help us know whether the child is at risk for cerebrovascular accident." 2"The test will help us identify the different types of abnormal hemoglobin." 3"The test will help us determine whether SCA was inherited by the child." 4"The test will help us identify whether there are other coexisting conditions."

1

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? 1Anemia 2Chest syndrome 3Sickle cell anemia 4Splenic sequestration

1

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"Do not massage the injection site." 2"Keep the syringe near the child's bed." 3"Use the same site for the next injection." 4"Place the child in a semi-Fowler position."

1

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

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

1

The nurse is reviewing the laboratory results of a 1-year-old child who has been diagnosed with sickle cell anemia (SCA) during infancy and is now presenting with symptoms of the disease. The parent says to the nurse, "I don't understand. My child did not have any symptoms at all up until now." Which is the best response by the nurse? 1"It's not good to think about the past versus the condition your child is in now." 2"Your child probably had symptoms this whole time; you just didn't notice them until now." 3"Infants usually do not have symptoms, but the symptoms become apparent as children get older." 4"The type of sickle cell anemia your child has determines whether any symptoms will be present."

3

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 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? 1Fanconi syndrome 2Delayed sexual maturation 3Visual disturbances 4Bony changes

4

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"Give carrots and peas." 3"Provide fresh cow's milk." 4"Include cereals in the diet."

4

The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains the rationale for the nurses' action? 1"We can give her stronger doses of pain medication less frequently if you prefer." 2"If we give her larger amounts of medication, she could reach tolerance of the medications much faster." 3"Because this is the first time she is experiencing a sickle cell crisis, we want to give her as little medication as possible." 4"We are trying to control her pain by giving her a combination of medications in small, frequent doses so she can still drink her bottle and be awake some of the time."

4

The parents of a child taking oral iron supplements report that the child's stools are a tarry green color. What is the best response the nurse provides to the parents? 1"You should avoid giving the dose at night." 2"Stop the dose immediately. It is a side effect." 3"It is because of toxicity. You need to lower the dose." 4"Tarry green color is expected with oral iron supplements."

4

What is the objective of managing anemia? 1Preventing bloodborne illnesses 2Adding more blood back into the body 3Increasing the amount of white blood cells 4Reversing it by treating the underlying cause

4

A possible cause of acquired aplastic anemia in children is: A. Drugs B. Injury C. Deficient diet D. Congenital defect

A

In which condition are all the formed elements of the blood simultaneously depressed? A. Aplastic anemia B. Sickle cell anemia C. Thalassemia major D. Iron deficiency anemia

A

The most appropriate nursing diagnosis for a child with anemia is: A. Activity intolerance related to generalized weakness B. Decreased cardiac output related to abnormal hemoglobin C. Risk for injury related to depressed sensorium D. Risk for injury related to dehydration and abnormal hemoglobin

A

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? A. Immobilization and elevation of the affected joint B. Administration of acetaminophen for pain relief C. Assessment of the child's response to hospitalization D. Assessment of the impact of hospitalization on the family system

A

Which statement best 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

A

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. Which priority actions should be taken by the nurse?Select all that apply. Administer 100% oxygen to relieve hypoxia. Administer meperidine (Demerol) to relieve symptoms. Notify the practitioner because chest syndrome is suspected. Notify the practitioner because child may be having a stroke. Administer merperidine (Demerol) orally to relieve pain.

Administer 100% oxygen to relieve hypoxia. Administer meperidine (Demerol) to relieve symptoms.

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is: A. Aplastic anemia B. Sickle cell anemia C. Thalassemia major D. Iron deficiency anemia

B

A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include: 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

B

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that 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 nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? A. Game of "hide and seek" in the children's outdoor play area B. Participation in dance activities in the playroom C. Puppet play in the child's room D. A walk down to the hospital lobby

C

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. Fingersticks for blood work instead of venipunctures B. Avoidance of intramuscular injections C. Acetaminophen for the mild pain control D. Soft toothbrush for dental hygiene E. Administration of packed red blood cells

BCD

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 101.3 or greater occurs C. Give penicillin as prescribed D. Use ice packs to decrease the discomfort of vaso-occlusive pain in the legs E. Notify the health care provider if your child begins to develop symptoms of a cold

BCE

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

BDE

As related to inherited disorders, which statement is descriptive of most cases of hemophilia? A. Autosomal dominant disorder causing deficiency in a factor involved in blood-clotting reaction B. X-linked recessive inherited disorder causing deficiency in 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

C

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include: A. Administering with meals B. Administering between meals C. Injecting deeply into a large muscle D. Massaging injection site for 5 minutes after administration of drug

C

An accurate description of anemia is: A. Increased blood viscosity B. Depressed hematopoietic system C. Presence of abnormal hemoglobin D. Decreased oxygen-carrying capacity of blood

D

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest? A. Iron (ferrous sulfate) drops after age 1 month B. Iron-fortified commercial formula can be used by ages 4 to 6 months C. Iron-fortified infant cereal can be introduced at age 2 months D. Iron- fortified infant cereal can be introduced at approximately 6 months of age

D

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

help your body stop bleeding by forming a clot (scab) over the hurt area.