Wong's CH 30: End of Chapter NCLEX Review Q's

You are working with a recent graduate on the pediatric unit. You are assigned to take care of an adolescent with β-thalassemia. The nurse needs more information about this disease if she states which of the following? Select all that apply. A. "We need to check the patient's iron level to make sure he is not anemic." B. "I believe this is most common in those of Hispanic descent, although this patient is Mediterranean." C. "The doctor will be prescribing deferasirox (Exjade) or defoxamine (Desferal) for chelation therapy." D. "This patient looks much younger than I would expect. I guess he's just a late bloomer." E. "I think a transfusion will be ordered, since his hemoglobin level is 9.0."

ANS: A, B, D A. "We need to check the patient's iron level to make sure he is not anemic." B. "I believe this is most common in those of Hispanic descent, although this patient is Mediterranean." D. "This patient looks much younger than I would expect. I guess he's just a late bloomer."

You are discharging a patient with hemophilia. Which of the following responses by the parents indicate an understanding of this disorder? Select all that apply. A. "My child should remain active to decrease joint problems, and most children with hemophilia can participate in the same activities as peers." B. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." C. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." D. "If there is bleeding in a joint, elevation, ice, and rest should help and may prevent the need for factor VIII replacement." E. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

ANS: B, C, E B. "Care should be taken to avoid bleeding of gums, and softening the toothbrush in warm water before brushing or using a sponge-tipped disposable toothbrush may be helpful." C. "Signs of internal bleeding should be recognized, such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black, tarry stools (from gastrointestinal bleeding)." E. "All of my son's teachers need to be aware of what to do if he gets a bloody nose."

A child with sickle cell anemia is admitted in a vaso-occlusive crisis. Which of the following interventions should the nurse expect to see ordered? Select all that apply. A. Cold compresses to painful joints B. IV fluids started, and oral fluids encouraged C. Meperidine ordered every 4 hours for pain D. High-calorie, high-protein diet E. Antibiotics ordered for any existing infection

ANS: B, D, E B. IV fluids started, and oral fluids encouraged D. High-calorie, high-protein diet E. Antibiotics ordered for any existing infection

A child is admitted to the pediatric unit. The mother reports that the doctor says her son is anemic. What laboratory findings/manifestations would the nurse expect to see to confirm iron deficiency anemia? A. Cyanosis, due to inadequate oxygen saturation of existing hemoglobin B. A decreased reticulocyte count C. A total iron-binding capacity (TIBC) that is elevated above the normal range D. Decreased blood pressure changes, which are an early sign because of the compensatory mechanisms

ANS: C C. A total iron-binding capacity (TIBC) that is elevated above the normal range

Which is the most accurate genetic explanation for a family with hemophilia? A. It is a Y-linked dominant disorder. B. It is equally distributed among males and females. C. It is an X-linked recessive disorder. D. It is an autosomal recessive disorder.

ANS: C C. It is an X-linked recessive disorder.