Sherpath: Disorders of the Red Blood Cells

A parent of a breastfed infant with iron deficiency anemia (IDA) questions the need for iron supplementation. Which response by the nurse is most appropriate? "Children's diets lack iron, so they have to take pills instead." "Your baby's bone marrow function is not fully developed yet." "Because the infant is growing so rapidly, his body needs extra iron." "Other vitamin supplements do not contain iron, so you need special pills instead.

"Because the infant is growing so rapidly, his body needs extra iron."

The nurse suspects that a female adolescent patient has iron deficiency anemia because she complains of weakness, palpitations, and always feeling cold. Which follow-up questions should the nurse ask? Select all that apply. "When was your last bowel movement?" "Have you ever had a blood transfusion?" "How heavy is your monthly period?" "What types of foods do you eat on a typical day?" "How long have you experienced these symptoms?"

"How heavy is your monthly period?" "What types of foods do you eat on a typical day?" "How long have you experienced these symptoms?"

The nurse is educating a parent of a child newly diagnosed with sickle cell anemia. Which statements, made by the parent, indicate teaching was effective? Select all that apply. "My child should avoid range of motion exercises." "I keep bottles of water with me whenever we go out." "I made an appointment for the year 4 immunizations." "I will call our health care provider as soon as I notice any cough or fever." "We only play in the snow for about 20 minutes at a time."

"I keep bottles of water with me whenever we go out." "I made an appointment for the year 4 immunizations." "I will call our health care provider as soon as I notice any cough or fever." "We only play in the snow for about 20 minutes at a time."

A patient with iron deficiency anemia (IDA) is preparing for discharge from the emergency department. During discharge teaching, which statement made by the parent indicates teaching has been effective? "Iron helps my child's red blood cells (RBCs) maintain a normal shape." "Iron helps my child's body make healthy RBCs with hemoglobin." "It's important that I include iron in my child's diet to prevent excessive bleeding." "Even though my child's iron is low now, it will increase with age, and the RBCs will return to normal."

"Iron helps my child's body make healthy RBCs with hemoglobin."

Which statement, made by an infant's parent, would indicate the infant is at risk for having inherited sickle cell anemia? Select all that apply. "My mother had sickle cell disease." "I have cousins with sickle cell disease." "My husband and I are both carriers of the trait." "I have sickle cell disease, but my husband does not and he is not a carrier." "My husband and I are not carriers, but my grandmother and my husband's grandfather both died of sickle cell disease."

"My mother had sickle cell disease." "I have cousins with sickle cell disease." "My husband and I are both carriers of the trait."

The nurse is completing discharge teaching of a patient who originally presented with symptoms of aplastic anemia. Which statement, made by the parents, indicates teaching was effective? "My child is a competitive wrestler." "Our favorite thing to do together is go to the mall." "We don't believe in vaccinations for our children." "We bought a new soft-bristle toothbrush yesterday."

"We bought a new soft-bristle toothbrush yesterday."

A concerned mother brings her 11-year-old in because of repeated nosebleeds. The nurse notes pallor and tachycardia. The child has a platelet count of 45,000/mm3 and a granulocyte count of 750 mm3. After ensuring the child is stable, which questions would be important for the nurse to ask? Select all that apply. "How much water does your child drink on a typical day?" "What new medications has your child recently begun taking?" "Do you have a family history of sickle cell anemia or hemophilia?" "Has your child been exposed to any chemicals recently?" "What other symptoms, such as fever or rashes, have you noticed recently?"

"What new medications has your child recently begun taking?" "Has your child been exposed to any chemicals recently?" "What other symptoms, such as fever or rashes, have you noticed recently?"

A 2-year-old patient diagnosed with beta-thalassemia requires chelation therapy. The child's parents state, "So we bring her here for the needle to be placed for each treatment." Which response by the nurse is most appropriate? "Chelation therapy will be a one-time occurrence." "Your child will be given a tablet four times each day." "You will be taught how to prepare medications for chelation therapy." "Chelation therapy can only be performed during an inpatient hospital visit."

"You will be taught how to prepare medications for chelation therapy."

The nurse receives an intershift report on four assigned patients with iron deficiency anemia (IDA). After a review of each patient's history, combined with the shift report information, which patient should the nurse see first? A 5-year-old with headache and fatigue A 16-year-old who menstruates for an average of 5 days each month A 3-month-old with an intestinal malformation and slight pallor An 11-year-old with joint pain who has grown 4 inches in the past 6 months

A 3-month-old with an intestinal malformation and slight pallor

The clinic nurse wants to develop a teaching program for parents of patients at risk for developing iron deficiency anemia (IDA). Which patient does the nurse correctly identify as being at greatest risk for developing IDA? A 4-year-old child who will only eat cereal A 5-year-old child who lives in a home built in 1942 A 4-year-old child whose father has sickle cell anemia A 6-year-old child whose mother had gestational diabetes

A 5-year-old child who lives in a home built in 1942

A 14-year-old patient with sickle cell disease presents with reports of severe joint, chest, and abdominal pain after having the flu for 3 days. What orders should the nurse anticipate receiving for this patient? Select all that apply. Administer intravenous fluids. Administer the flu vaccine. Have the patient remain in bed. Provide intravenous pain medication. Encourage use of an incentive spirometer. Perform passive range-of-motion exercises with affected joint.

Administer intravenous fluids. Provide intravenous pain medication. Encourage use of an incentive spirometer. Perform passive range-of-motion exercises with affected joint.

The nurse is caring for a child with hepatosplenomegaly related to beta-thalassemia. Which actions should the nurse take to minimize the risks related to this disorder? Select all that apply. Assess for signs of bleeding. Limit the number of visitors. Administer analgesics as ordered. Tell the patient to avoid contact sports. Monitor patient for signs of abdominal trauma.

Assess for signs of bleeding. Tell the patient to avoid contact sports. Monitor patient for signs of abdominal trauma.

A child with sickle cell anemia (SCA) presents with pain and swelling in the right knee and complaints of abdominal pain. The nurse notes abdominal distention. Which action should the nurse take next? Palpate the abdomen. Apply ice to the affected area. Auscultate the patient's lung sounds. Assess vital signs and notify the health care provider.

Assess vital signs and notify the health care provider.

The mother of a 10-month-old reports that the child has been pale, tires quickly, and sometimes has difficulty breathing. Which orders would the nurse anticipate for this patient? Select all that apply. Give an oral iron supplement. Collect blood for complete blood count (CBC). Maintain NPO (nothing by mouth) status for this patient. Prepare the patient for insertion of in intravenous line. Obtain vital signs, including pulse oximetry, and notify the provider of any concerning results.

Collect blood for complete blood count (CBC). Prepare the patient for insertion of in intravenous line. Obtain vital signs, including pulse oximetry, and notify the provider of any concerning results.

A patient with sickle cell anemia presents with pallor, lethargy, headache, and a history of fainting spells. Which provider order would the nurse anticipate? Assess pain level every shift. Assess exertional heart rate on a treadmill. Collect blood for type and cross-matching. Administer 3% saline solution intravenously at a rate of 25 mL/hr.

Collect blood for type and cross-matching.

What causes the facial deformities in children with untreated or inadequately treated beta-thalassemia? Profound tissue hypoxia Abnormal clot formation Extramedullary marrow expansion Decreased red blood cell production

Extramedullary marrow expansion

A 10-year-old patient presents to the pediatric clinic with maxillary hyperplasia, malocclusion, hypochromic anemia, and elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Which additional assessments should the nurse perform? Select all that apply. Administer desferoxamine. Measure oxygen saturation. Perform a complete abdominal assessment. Evaluate peripheral pulses in all extremities. Evaluate parent's understanding of treatment.

Measure oxygen saturation. Perform a complete abdominal assessment. Evaluate peripheral pulses in all extremities. Evaluate parent's understanding of treatment.

A 10-year-old patient with aplastic anemia presents with the following vital signs: blood pressure of 118/70, heart rate of 112, respiratory rate of 28, temperature of 102.3° F. The nurse can anticipate which orders from the provider? Select all that apply. Obtain a blood culture. Collect a stool sample. Administer antibiotics. Administer an antipyretic. Obtain a complete blood count (CBC).

Obtain a blood culture. Administer antibiotics. Administer an antipyretic. Obtain a complete blood count (CBC).

On assessment of a patient with aplastic anemia, the nurse notes peripheral pulses 1+, cool extremities, and capillary refill of 4 seconds. Which actions should the nurse take? Select all that apply. Obtain vital signs. Administer an antibiotic. Administer an analgesic. Notify the health care provider. Complete a neurologic examination.

Obtain vital signs. Notify the health care provider. Complete a neurologic examination

Which physical assessment findings indicate a patient may have decreased hemoglobin? Select all that apply. Pallor Warm skin Weight gain Tachycardia Decreased level of consciousness

Pallor Tachycardia Decreased level of consciousness

Which description represents a common disease presentation for a child with aplastic anemia? Pallor and fatigue Generalized edema Abdominal distention Epistaxis and joint pain

Pallor and fatigue

The nurse notes the vital signs of a patient with sickle cell anemia (SCA) after splenectomy to be as follows: heart rate, 122; respiratory rate, 24; blood pressure, 80/48; and temperature of 100.3° F. The patient appears drowsy but is easy to arouse. Based on this assessment, which initial action should the nurse take? Administer an antipyretic. Auscultate the patient's lung sounds. Contact the health care provider (HCP). Prepare the patient for insertion of an intravenous (IV) line.

Prepare the patient for insertion of an intravenous (IV) line.

The pediatric nurse is caring for a patient with beta-thalassemia who has been transferred to the unit for treatment. Before admission, the patient was experiencing complications of the disorder. Which action should the nurse take in initiating the treatment process? Administer desferoxamine as ordered. Administer prophylactic antibiotics as ordered. Prepare the patient for possible blood transfusion, if ordered. Educate the patient and family about the need for a bone marrow transplant.

Prepare the patient for possible blood transfusion, if ordered.

The nurse in a pediatric hematology unit admits a patient with sickle cell anemia, transferred from the emergency department. Which finding warrants immediate additional assessment by the nurse? Knee pain and a hemoglobin of 10.1 Abdominal pain and serum glucose level of 86 Anorexia and urinalysis that is positive for protein Shortness of breath and a white blood cell (WBC) count of 16,000

Shortness of breath and a white blood cell (WBC) count of 16,000

The nurse understands that which is accurate regarding the necessity of a bone marrow biopsy for the diagnosis of aplastic anemia? To obtain a complete blood count To assess for the presence of microcytic red blood cells To assess for the presence of infection in the blood To assess for the absence of precursors to mature red blood cells

To assess for the absence of precursors to mature red blood cells