341 Ch 24

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? a) "I mix ferrous sulfate with milk in a bottle." b) "I brush my child's teeth once every day." c) "My child's stools are darker than usual." d) "My child takes ferrous sulfate after meals."

"I mix ferrous sulfate with milk in a bottle." Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? a) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." b) "The spinal tap will help relieve pressure and headache for your child." c) "It will help rule out a second malignancy." d) "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration. The other responses are incorrect.

A nurse is caring for a 7-year-old boy with hemophilia who requires an infusion of factor VIII. He is fearful about the process and is resisting treatment. How should the nurse respond? a) "Will you help me apply this band-aid?" b) "Please be brave; we need to stop the bleeding" c) "Would you help me dilute this and mix it up?" d) "Would you like to administer the infusion?"

"Would you help me dilute this and mix it up?" Explanation: The best response for a 7-year-old is to use distraction and involve him in the infusion process in a developmentally appropriate manner. A 7-year-old is old enough to assist with the dilution and mixing of the factor. Asking for help with the band-aid would be best for a younger child. Teens should be taught to administer their own factor infusions. Telling him to be brave is not helpful and does not teach.

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? a) Maintain fluid restriction to below maintenance levels. b) Administer diuretics. c) Monitor serum sodium levels. d) Administer broad-spectrum antibiotics intravenously.

Administer broad-spectrum antibiotics intravenously. Typhlitis (neutropenic enterocolitis) is an inflammatory process of the gastrointestinal tract that occurs with the induction phase of leukemia chemotherapy. The recommended interventions for treatment are to administer broad-spectrum antibiotics or antifungals intravenously, provide supportive care to manage symptoms, and provide IV nutrition. The client should be kept NPO. The nurse should assess for any signs of bowel perforation or shock. Administering diuretics would not be needed and may cause harm. Monitoring sodium levels as well as other electrolytes would be necessary to evaluate IV nutrition.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? a) Palpation of abdomen reveals enlarged liver and spleen b) Observing petechiae, purpura, or unusual bruising c) Child reports facial palsy and vision problems d) Noting adventitious breath sounds during auscultation

Child complains of facial palsy and vision problems The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

A nurse caring for an 8-year-old patient with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a patient with: a) Hemophilia b) Iron deficiency anemia c) Disseminated intravascular coagulation d) von Willebrand disease

Disseminated intravascular coagulation Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this patient is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis

When assessing a child for a possible hematologic disorder, which of the following would the nurse need to keep in mind as most important? a) Sequelae are rare with chronic problems. b) A child's nutritional status is key. c) Demographic data is of little relevance. d) Multiple body sites can be affected.

Multiple body sites can be affected. The nurse needs to keep in mind that hematologic alterations can affect multiple body sites, so assessment needs to address all body systems. A child's nutritional status may be helpful in assessing certain hematologic disorders such as iron deficiency anemia, but this information is not the most important to remember. Sequelae commonly occur with hematologic alterations, especially chronic conditions such as hemophilia or sickle cell disease. The child's demographic data are important, because some hematologic diagnoses are more commonly associated with a certain age group, sex, race, or geographic location.

A hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include? a) Mild analgesics b) Opioids c) Sedatives d) Topical anesthetics

Opioids Chronic or terminal pain may be managed in the home with continuous administration of opioids, orally or intravenously, as a bolus injection or infusion. Both pharmacologic and nonpharmacologic interventions are important in managing pediatric pain. Mild analgesics, topical anesthetics, and opioids can be used to treat pain. Sedatives such as midazolam or anesthetic medications such as ketamine or propofol may be used to assist children undergoing painful procedures that are required routinely during their cancer treatment.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as which of the following? a) Poikilocytosis b) Purpura c) Ecchymosis d) Petechiae

Petechiae Explanation: Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia.

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? a) elevated lymphocytes b) megakaryocyte cells c) Reed-Sternberg cells d) T-lymphocyte surface markers

Reed-Sternberg cells With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.

A nurse is providing care for a child with disseminated intravascular coagulation (DIC). Which of the following would alert the nurse to possible neurologic compromise? a) Widely fluctuating blood pressure b) Petechiae c) Equal pupillary response d) Hematuria

Widely fluctuating blood pressure Explanation: A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure such as wide fluctuations in blood pressure or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin

The nurse identifies the nursing diagnosis of Risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. a) Encouraging frequent close contact with numerous visitors b) Encouraging frequent, thorough handwashing c) Providing a low-carbohydrate, low-protein diet d) Cheering up the environment with fresh flowers and plants e) Having the child sleep in a single bed and room

b) Encouraging frequent, thorough handwashing e) Having the child sleep in a single bed and room

The nurse will select which meal as the best choice for a child with iron-deficiency anemia? a. chicken breast, French fries, and sweetened tea b. two slices of pepperoni pizza and a glass of skim milk c. cheeseburger, broccoli, and fresh strawberries d. peanut butter sandwich, cheese stick, and applesauce

cheeseburger, broccoli, and fresh strawberries Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to a) encourage the child to participate in school activities, such as long-distance running. b) administer an iron supplement daily. c) prevent the child from drinking an excess amount of fluids per day. d) notify a health care provider if the child develops an upper respiratory infection.

d. notify a health care provider if the child develops an upper respiratory infection. Explanation: Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important

A 3-year-old female is brought to the ER by her parents and presents with bruising and mucous membrane bleeding from the nose and mouth. The nurse knows that these symptoms are indicative of: a) Disseminated intravascular coagulation b) von Willebrand disease c) Hemophilia d) Chronic iron deficiency anemia

von Willebrand disease Explanation: The primary clinical manifestations of von Willebrand disease are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract; bleeding may be severe and lead to anemia and shock. Deep bleeding into joints and muscles, like that seen in hemophilia, is rare, except with type III von Willebrand disease.

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. Which of the following would the nurse document as a normal prothrombin finding? a) 16.0 to 18.0 seconds b) 6.0 to 9.0 seconds c) 11.0 to 13.0 seconds d) 21.0 to 35.0 seconds

11.0 to 13.0 seconds Explanation: The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

Which assessment below would increase your suspicion that iron-deficiency anemia may be present in a child? a) A 15-year-old girl constantly sucks ice cubes b) An 8-year-old girl is shy and does not participate in class c) A 3-month-old boy sucks his thumb d) A 7-month old boy does not say whole words yet

A 15-year-old girl constantly sucks ice cubes Explanation: Iron-deficiency anemia is associated with pica, or the eating of nonfood substances

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? a) Temperature of 101° F (38.3° C) or greater b) Blisters, ulcers, or a rash appear c) Difficulty or pain when swallowing d) Earache, stiff neck, or sore throat

A temperature of 101°F (38.3° C) or greater Explanation:The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes, or difficulty or pain when swallowing are reasons to seek medical care, but are not as grave as the risk of infection.

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding? a) Heat b) Lowering extremities c) Compression d) Exercise

Compression Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition corticosteroids such as prednisone may be used to reduce inflammation in the joint.

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition? a) Hodgkin disease b) Non-Hodgkin lymphoma c) Ewing sarcoma d) Neuroblastoma

Ewing sarcoma Radiographs that show lesions on the bone may indicate tumors (e.g. Ewing sarcoma, osteosarcoma) or metastases of tumors warranting further investigation by bone scan, CT or MRI. Positron emission tomography is the most effective test to diagnose neuroblastoma, Hodgkin disease, Non-Hodgkin lymphoma, bone tumors, lung and colon cancers and brain tumors.

Question: A group of nursing students are reviewing the process of blood cell formation. The students demonstrate understanding of this process when they place the following events in the proper sequence

Multipotent stem cell Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte Platelets *There is a picture that shows the process on page 912* Explanation: The process begins with the multipotent stem cell that then becomes a myeloid progenitor, then a megakaryocyte/erythroid progenitor, a megakaryocyte, and finally platelets

A 6-year-old boy visits the doctor's office with his mother. He has a rash on his buttocks, posterior thighs, and the extensor surface of his arms and legs. His joints are tender and swollen. The physician diagnoses him with Henoch-Schönlein syndrome. The nurse should expect which of the following laboratory results in this case? a) Elevated platelet count b) Decreased platelet count c) Decreased white blood cell count d) Normal platelet count

Normal platelet count Explanation: In Henoch-Schönlein syndrome, laboratory studies show a normal platelet count. Sedimentation rate, WBC count, and eosinophil count are elevated

The nurse is caring for a child with DIC. The nurse notices signs of neurological deficit. The appropriate nursing action is to: a) Continue to monitor neurological signs b) Notify the physician c) Inspect for signs of bleeding d) Evaluate respiratory status

Notify the physician Explanation: If neurological deficits are assessed, immediate reporting of the findings is necessary to begin treatment to prevent permanent damage.

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which of the following would the nurse identify as the priority? a) Impaired skin integrity b) Risk for delayed growth and development c) Risk for infection d) Deficient fluid volume

Risk for infection Explanation: Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which of the following disorders? a) Hemophilia b) Kawasaki disease c) Thalassemia d) Sickle cell disease

Thalassemia Explanation: In the child with Thalassemia the skin may appear bronze-colored or jaundiced. The child with hemophilia may have bruised areas on the skin. The skin color in children with sickle cell disease may be pale in color, and with Kawasaki disease the child may have a rash on the trunk and extremities

Question: The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence.

The bone marrow releases a stem cell. Thrombopoietin acts on the cell. The myeloid cell becomes a megakaryocyte. Erythropoietin helps the cell turn into a red blood cell. Explanation: The bone marrow releases a stem cell. Thrombopoietin acts on the cell to help turn it into a myeloid cell. Erythropoietin acts on the cell and it turns into a megakaryocyte. The megakaryocyte becomes an erythrocyte (red blood cell).

For the child diagnosed with iron deficiency anemia which of the following would the nurse anticipate would be done in treating this disorder? a) The child would be given corticosteroids via a metered-dose inhaler. b) The child would be given enteric coated aspirin with milk. c) The child would be given ferrous sulfate with orange juice between meals. d) The child would be given a high dose of intravenous immunoglobulin.

The child would be given ferrous sulfate with orange juice between meals. Explanation: Treatment consists of improved nutrition, with ferrous sulfate administered between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals.

The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority? a) Administer antibiotics intravenously stat. b) Transfuse 1 unit of packed red blood cells. c) Provide the family with preoperative instructions. d) Ask the child to rate pain on a scale 0 to 10.

Transfuse 1 unit of packed red blood cells. In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. The nurse recognizes that which of the following is the likely cause of this type of anemia? a) Sickle-cell disorder b) Vitamin B12 deficiency c) Iron deficiency d) Acute blood loss

Vitamin B12 deficiency Explanation: Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they are ingesting a long-term, poorly formulated vegetarian diet as the vitamin is found primarily in foods of animal origin

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Encouraging him to take deep breaths hourly b) Maintaining a fluid intravenous line c) Beginning active range-of-motion exercises d) Seeing that he ingests a protein-rich diet

b. Maintaining a fluid intravenous line Explanation: Dehydration increases sickling of cells, so maintaining fluid balance is important.

The child has been diagnosed with severe iron deficiency anemia. The child requires 5 mg/kg of elemental iron per day in three equally divided doses. The child weighs 47.3 pounds. How many milligrams of elemental iron should the child receive with each dose? Round to the nearest whole number

36 mg Explanation: 47.3 pounds x 1 kg/2.2 pounds = 21.5 kg 21.5 kg x 5 mg/1 kg = 107.5 mg/day 107.5 mg/3 doses = 35.8333 mg/dose Rounded to the nearest whole number = 36 mg

In addition to the child's history, symptoms, and blood studies, which of the following helps to confirm the diagnosis of leukemia? a) Genetic studies b) Chest x-rays c) Bone marrow aspiration d) Modified Jones criteria

Bone marrow aspiration Explanation: In addition to the his tory, symptoms, and laboratory blood studies, a bone mar row aspiration must be done to confirm the diagnosis of leu kemia. Genetic studies are done for hereditary diseases such as sickle cell anemia and hemophilia. The modified Jones criteria are used as a guide to note the manifestations of rheumatic fever, and chest x-rays help in diagnosing congestive heart failure.

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a) Explain that it develops in nerves outside the brain and spinal cord b) Describe it as a bone tumor c) Indicate that the more commonly used name is Hodgkin lymphoma d) Call it a tumor of muscle tissue

Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect.

Question: A nursing instructor describes what happens to the red blood cell after it disintegrates and how bilirubin is formed. Place the events in the order that the instructor would discuss from first to last.

Degradation of heme portion Conversion to protoporphyrin Break down into indirect bilirubin Conversion to direct bilirubin Excretion in bile Explanation: As the heme portion is degraded, it is converted into protoporphyrin. Protoporphyrin is then further broken down into indirect bilirubin. Indirect bilirubin is fat soluble and cannot be excreted by the kidneys in this state. It is therefore converted by the liver enzyme glucuronyl transferase into direct bilirubin, which is water soluble. This is then excreted in bile.

A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which of the following lab tests: a) Peripheral blood smear b) Hemoglobin electrophoresis c) Erythrocyte sedimentation rate d) Reticulocyte count

Hemoglobin electrophoresis If the screening test result indicates the possibility of SCA or sickle cell trait, hemoglobin (Hgb) electrophoresis is performed promptly to confirm the diagnosis. While Hgb electrophoresis is the only definitive test for diagnosis of the disease, other laboratory testing that assists in the assessment of the disease include reticulocyte count (greatly elevated), peripheral blood smears (presence of sickle-shaped cells and target cells), and erythrocyte sedimentation rate (elevated).

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which of the following sites should she prepare? a) Sternum b) Femur c) Anterior tibia d) Iliac crest

Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Risk for infection related to abnormal immune system b) Risk for altered urinary elimination related to kidney impairment c) Ineffective breathing pattern related to decreased white blood count d) Ineffective tissue perfusion related to poor platelet formation

Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify which of the following as a factor? a) Pallor b) Infection c) Fluid overload d) Respiratory distress

Infection Explanation: Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis

A 15-year-old boy has been diagnosed with an osteogenic sarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area? a) Lungs b) Rib cage c) Heart d) Brain

Lungs Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.

The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which of the following findings would be associated with an elevated mean corpuscular volume (MCV)? a) Hemoglobin (Hgb) of 11.2 g/dL b) Platelet count of 250,000 c) Macrocytic red blood cells (RBCs) d) Decreased white blood cells (WBCs)

Macrocytic red blood cells (RBCs) Explanation: When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? a) Allow the child to play with a doll and syringe. b) Evaluate pain and administer medication. c) Monitor the site dressing and vital signs. d) Educate the family on proper handwashing.

Monitor the site dressing and vital signs. Monitoring vital signs and the dressing for signs of bleeding is a priority after bone marrow aspiration. Although providing pain medication, educating on handwashing, and allowing for therapeutic play are all important, these should only be performed after first stabilizing the child.

The nurse is caring for a 3-year-old boy with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis? a) Hemoglobin electrophoresis b) Reticulocyte count c) Iron test d) Serum ferritin

Serum ferritin Serum ferritin is a measure of ferritin (the major iron storage protein) in the blood. It is the most sensitive test for determination of iron-deficiency anemia. Hemoglobin electrophoresis is indicated for sickle cell anemia and thalassemia and measures the percentage of normal and abnormal hemoglobin in the blood. Reticulocyte count measures the number of immature red blood cells (RBCs) in the blood and indicates the bone marrow's ability to respond to anemia with production of RBCs. The iron test evaluates iron metabolism

Iron-deficiency anemia could be virtually eliminated if all infants were breastfed and those infants who are formula-fed were fed iron-fortified formula for the full first year. a) False b) True

True

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? a) "The disease is most often seen in individuals of Asian decent." b) "The trait or the disease is seen in one generation and skips the next generation." c) "If the trait is inherited from both parents the child will have the disease." d) "Males are much more likely to have the disease than females."

c. "If the trait is inherited from both parents the child will have the disease." Explanation: When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in African Americans. Either sex can have the trait and disease

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to a) encourage the child to participate in school activities, such as long-distance running. b) prevent the child from drinking an excess amount of fluids per day. c) notify a health care provider if the child develops an upper respiratory infection. d) administer an iron supplement daily

notify a health care provider if the child develops an upper respiratory infection. Explanation: Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important

A nurse is teaching a school-aged child with iron-deficiency anemia and her parents about dietary measures to increase iron intake. The nurse determines that the teaching was successful when they state which food is high in iron? Select all that apply. a) Eggs b) Fortified cereal c) Milk d) Citrus fruits e) Green leafy vegetables

• Eggs • Fortified cereal • Green leafy vegetables Explanation: Foods high in iron include meat, cheese, eggs, green leafy vegetables, and fortified cereal. Citrus fruits and milk are not iron-rich foods

The nurse is obtaining a health history on a child diagnosed with idiopathic thrombocytopenic purpura (ITP). After asking about a viral illness, what question should the nurse ask next? a) "Has your child recently had a measles, mumps, rubella (MMR) vaccine?" b) "Has your child had any bloody stools?" c) "Has your child experienced any nose bleeds?" d) "When did the bruising begin?"

"Has your child recently had a measles, mumps, rubella (MMR) vaccine?" Idiopathic thrombocytopenic purpura (ITP) is caused by an immune response following a viral infection. Antiplatelet antibodies cause the development of petechia, purpura, and excessive bruising. Besides a viral infection ITP can follow an MMR immunization or the ingestion of certain drugs. The nurse would first want to know the child's history of illness, MMR immunization or medications before examining the symptoms. Asking about the bruising, blood in the stools, and nose bleeds are all symptoms that need to be explored, because they are part of ITP.

A child abruptly develops miniature petechiae over his legs, along with epistaxis and bleeding into the joints. Laboratory results reveal a platelet count of 20,000/mm3. The child is eventually diagnosed with idiopathic thrombocytopenic purpura. The mother of the child is distraught and asks the nurse what the course of this disorder typically is. Which of the following should the nurse mention? a) 1 to 3 months b) Chronic condition c) 4 to 6 weeks d) Terminal condition

1 to 3 months In most children, ITP runs a limited, 1- to 3-month course. A few children develop chronic ITP

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? a) 110 mL/kg of fluids b) 120 mL/kg of fluids per day c) 150 mL/kg of fluids d) 130 mL/kg of fluids per day

150 mL/kg of fluids Explanation: To promote hemodilution in sickle cell crisis, the nurse would provide 150 mL/kg of fluids per day or as much as double maintenance, either orally or intravenously

In understanding the cardiovascular and hematologic systems of the body it is important to know that the blood is made up of plasma, red blood cells, white blood cells, and platelets. These blood cells are formed in which of the following? a) Capillaries b) Lymph nodes c) Arteries d) Bone marrow

Bone marrow Explanation: Blood is a fluid composed of many elements, including plasma, red blood cells, white blood cells, and platelets. Each of these elements has a different function. These blood cells are formed in the bone marrow. Arteries carry blood away from the heart to the body, and veins collect the blood and return it to the heart. Capillaries are the exchange vessels for the materials that flow through the body. The lymph nodes filter the lymph.

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects? a. Remain in an upright position for at least 15 minutes b. Not eat or drink for one hour c. Brush his or her teeth d. Drink a glass of milk

Brush his or her teeth To prevent staining of the teeth, the child should brush the teeth after administration of iron preparations such as ferrous sulfate. There is no need to remain upright, drink milk or to refrain from eating or drinking for one hour.

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate? a) Chemotherapy affects cancer cells and normal cells that multiply rapidly. b) Hair is exposed to the sun, which increases sensitivity to chemotherapy. c) Hair is not a living tissue, and it is easily damaged by chemotherapy. d) Circulation to the head causes large doses of chemotherapy to reach the scalp.

Chemotherapy affects cancer cells and normal cells that multiply rapidly. Chemotherapy is cytotoxic to rapidly proliferating cells—malignant or normal. Normal cells that turn over rapidly include those of bone marrow, hair, and mucous membranes.

The nurse is caring for a 10-year-old girl with iron toxicity. Which of the following would the nurse expect the physician to order? a) Edentate calcium disodium b) Succimer c) Desferal d) Dimercaprol

Desferal Desferal is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dL. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edentate calcium disodium is indicated for blood lead levels greater than 45 mcg/dL. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dL; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

An 11-year-old male is diagnosed with mild hemophilia. Upon assessment, the nurse documents the following factor level for this category of hemophilia: a) Factor level less than 1% b) Factor level of 1% to 5% c) Factor level of 5% to 50% d) Factor level greater than 50%

Factor level of 5% to 50% Explanation: Mild hemophilia is characterized by a factor level of 5% to 50%. People with mild hemophilia experience prolonged bleeding only when injured. Thus, their condition may not be diagnosed unless they have trauma or surgery.

A child with sickle cell disease is brought to the emergency department by his parents. He is in excruciating pain. A vaso-occlusive crisis is suspected and analgesia is prescribed. Which of the following would the nurse expect as least likely to be ordered? a) Nalbuphine b) Morphine c) Meperidine d) Hydromorphone

Meperidine Explanation: Meperidine is contraindicated for ongoing pain management in a child with vaso-occlusive crisis because it increases the risk for seizures. Analgesics such as morphine, nalbuphine, or hydromorphone are commonly used

The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed? a) The infant always keeps her eyes tightly closed. b) One pupil appears white. c) The infant tugs and pulls at one ear. d) The infant's eye appears to be protruding.

One pupil appears white. On examination, the child's pupil of the affected eye appears white because the red reflex is absent. Some might describe this symptom as a "cat's eye." Ear tugging, eye protrusion, and keeping the eyes closed are not manifestations of retinoblastoma.

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 which of the following? a) Priapism b) Leg ulcers c) Behavioral addiction d) Seizures

Seizures Explanation: Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the narcotic is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which of the following would the nurse expect to find? a) Spooning of nails b) Absence of bruising c) Capillary refill in less than 2 seconds d) Pink palms and nail beds

Spooning of nails Explanation: A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.

The parents of a child with a bleeding disorder ask the nurse about appropriate activities and sports that they should encourage the child to participate in. Which of the following would be the safest for the nurse to suggest? a) Swimming b) Gymnastics c) Rugby d) Soccer

Swimming Explanation: Swimming, a noncontact sport or activity, would be the safest for the nurse to recommend. Soccer and gymnastics may be appropriate; however, these are considered riskier. Rugby would not be recommended because the risks outweigh the benefits.

The nurse is preparing a child for discharge following a sickle cell crisis. The mother makes the following statements to the nurse. Which statement by the mother indicates a need for further teaching? a) "She loves popsicles, so I'll let her have them as a snack or for dessert." b) "I put her legs up on pillows when her knees start to hurt." c) "She has been down, but playing in soccer camp will cheer her up." d) "I bought the medication to give to her when she complains of pain."

c. "She has been down, but playing in soccer camp will cheer her up." Explanation: Following a sickle cell crisis the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.

You are assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a) A 7-month-old boy who has started table food b) A 3-month-old boy who is totally breastfed c) An 8-year-old girl who carries her lunch to school d) A 15-year-old girl who has heavy menstrual periods

d. A 15-year-old girl who has heavy menstrual periods Explanation: Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.

A child with hypoplastic anemia develops hemosiderosis. The therapy for this is a) ferrous sulfate. b) prednisone. c) deferoxamine. d) aspirin.

deferoxamine. Explanation: Hemosiderosis is deposition of iron into tissue. A chelating agent, such as deferoxamine, removes it from tissue.

When planning care for a child with idiopathic thrombocytopenic purpura, you plan to teach her a) not to pick or irritate her nose. b) to apply a soothing cream to lesions. c) to use mainly cold water to wash. d) what foods are high in folic acid.

not to pick or irritate her nose. Explanation: Without adequate platelets, children bleed easily from lesions

A 5-year-old boy is diagnosed with congenital aplastic anemia. Which of the following symptoms should the nurse expect in this child? (Select all that apply.) a) Bradycardia b) Cyanosis c) Pallor d) Bradypnea e) Easy bruising f) Fatigue

• Pallor • Fatigue • Easy bruising • Cyanosis Explanation: When symptoms begin, a child appears pale, fatigues easily, and has anorexia from the lowered RBC count and tissue hypoxia. Because of reduced platelet formation (thrombocytopenia), the child bruises easily or develops petechiae (pinpoint, macular, purplish-red spots caused by intradermal or submucous hemorrhage). A child may have excessive nosebleeds or gastrointestinal bleeding. As a result of a decrease in WBCs (neutropenia) a child may contract an increased number of infections and respond poorly to antibiotic therapy. Observe closely for signs of cardiac decompensation such as tachycardia (not bradycardia), tachypnea (not bradypnea), shortness of breath, or cyanosis from the long-term increased workload of all these effects on the heart.

After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state which of the following? a) "We'll need to plan for a bone marrow transplant soon." b) "He needs to eat more green leafy vegetables to cure the anemia." c) "He'll need to have those vitamin shots for the rest of his life." d) "He might get constipated from the supplement."

"He'll need to have those vitamin shots for the rest of his life." Explanation: Monthly injections of vitamin B12 are required for life. Although diet is important, diet alone will not cure the anemia. Iron used to treat iron-deficiency anemia can lead to constipation. Bone marrow transplant is used to treat aplastic anemia.

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which of the following responses indicates a need for further teaching? a) "He will enjoy tuna casserole and eggs" b) "There are many iron fortified cereals that he likes" c) "Red meat is a good option; he loves the hamburgers from the drive-thru." d) "I must encourage a variety of iron-rich foods that he likes"

"Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive thru as they are also high in fat, fillers, and sodium. The other statements are correct

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We must be compliant with vaccinations and prophylactic penicillin." b) "We need to seek medical attention for abdominal pain." c) "We must watch for unusual headache, loss of feeling, or sudden weakness." d) "We should call the doctor for any fever over 100°F."

"We should call the doctor for any fever over 100°F." Explanation: The nurse must emphasize that ANY febrile illness requires immediate attention. Fever causes dehydration, which can trigger problems in a child with sickle cell anemia. Seeking medical attention for abdominal pain; watching for unusual headache, loss of feeling, or sudden weakness; and compliance with vaccinations are appropriate.

A child with congenital hypoplastic anemia who has been receiving transfusions of packed red blood cells over the long term has developed hemosiderosis. The child is prescribed deferoxamine. After teaching the parents how to administer the drug, the nurse determines that the parents need additional teaching when they make which statement? a) "It would be best to give the drug while our child is sleeping." b) "It will take about 8 hours for the full amount of the drug to be given." c) "We will plan to give the drug on the same day each week." d) "We will give the drug as a subcutaneous infusion."

"We will plan to give the drug on the same day each week." Deferoxamine binds with iron and aids its excretion from the body in urine; it is given 5 or 6 days a week over an 8-hour period. This is one of the few times that an infusion is given subcutaneously. Parents can do this at home after careful instruction, often while their child is asleep at night.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which of the following statements made by the caregivers is correct regarding giving ferrous sulfate? a) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." b) "When I give my son ferrous sulfate I know he also needs potassium supplements." c) "I always give the ferrous sulfate with meals." d) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." Explanation: When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best re sults, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black

A child is to receive oral iron therapy in liquid form three times a day. After teaching the parents about administering the iron, which statement indicates a need for additional teaching? a) "She can drink the medicine from a medicine cup." b) "We will have her drink water or juice with the medicine." c) "Her bowel movements will probably turn very dark." d) "We'll try to give the medicine to her in between milk servings."

"She can drink the medicine from a medicine cup." Explanation: Liquid iron can stain the teeth; therefore, the parents should give the liquid iron through a straw or syringe, placing it toward the back of the child's mouth. Iron turns stools dark. To maximize absorption, it is best to give the iron with water or juice between meals.

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We must be compliant with vaccinations and prophylactic penicillin." b) "We must watch for unusual headache, loss of feeling, or sudden weakness." c) "We should call the doctor for any fever over 100°F." d) "We need to seek medical attention for abdominal pain."

"We should call the doctor for any fever over 100°F." Explanation: The nurse must emphasize that ANY febrile illness requires immediate attention. Fever causes dehydration, which can trigger problems in a child with sickle cell anemia. Seeking medical attention for abdominal pain; watching for unusual headache, loss of feeling, or sudden weakness; and compliance with vaccinations are appropriate.

The nurse is providing teaching about iron supplement administration to the parents of a 10-month-old child. It is critical that the nurse emphasize which of the following teaching points to the parents? a) "Place the liquid behind the teeth; the pigment can cause staining" b) "Please give him plenty of fluids and encourage fiber" c) "You must precisely measure the amount of iron" d) "Your child may become constipated from the iron"

"You must precisely measure the amount of iron" Explanation: The priority is to emphasize to the parents that they precisely measure the amount of iron to be administered in order to avoid overdosing. The other instructions are accurate, but the priority is to emphasize precise measurement.

The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver's question, the nurse would explain that for the child with sickle cell disease, it is best that the child have: a) 1,000 to 1,200 mL of fluid per day b) 2,500 to 3,200 mL of fluid per day c) 1,500 to 2,000 mL of fluid per day d) 300 to 800 mL of fluid per day

1,500 to 2,000 mL of fluid per day Explanation: Prevention of crises is the goal between episodes. Adequate hydration is vital; fluid intake of 1,500 to 2,000 mL daily is desirable for a child weighing 20 kg and should be increased to 3,000 mL during the crisis.

A boy with hemophilia A is scheduled for surgery. Which of the following precautions would you institute with him? a) Do not allow a dressing to be applied postoperatively. b) Caution him not to brush his teeth before surgery. c) Handle him gently when transferring him to a stretcher. d) Mark his chart for him to receive no analgesia

Handle him gently when transferring him to a stretcher. Explanation: Gentle handling can reduce bruising. Analgesia will be needed postoperatively; IM injections are contraindicated because of potential bleeding.

A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? a) Disturbed body image related to loss of hair after chemotherapy b) Compromised family coping related to long-term chemotherapy regimen c) Pain due to neoplastic process in bone d) Risk for imbalanced nutrition, less than body requirements, related to inflammation

Risk for imbalanced nutrition, less than body requirements, related to inflammation Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned.

The health care provider prescribes an alkylating agent as part of a child's chemotherapy regimen. When explaining this classification of drug to the child and parents, which information would the nurse integrate into the explanation? a. They are synthesized naturally by various bacterial and fungal agents b. They are cell cycle-nonspecific destroying both resting and dividing cells c. They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication d. They damage cells by acting as a substitute for a natural metabolite in an important molecule

They are cell cycle-nonspecific destroying both resting and dividing cells Alkylating agents are cell cycle-nonspecific, destroying both resting and dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell are replaced by an alkyl group. This group interferes with DNA replication and RNA transcription.

In hemophilia A, the classic form, only females manifest a bleeding disorder. a) False b) True

a. False Explanation: The classic form of hemophilia is caused by deficiency of the coagulation component factor VIII, the antihemophilic factor, and transmitted as a sex-linked recessive trait. In the United States, the incidence is approximately 1 in 10,000 white males. A female carrier may have slightly lowered but sufficient levels of the factor VIII component so that she does not manifest a bleeding disorder. Males with the disease also have varying levels of factor VIII; their bleeding tendency varies accordingly, from mild to severe.

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend? a) Wrestling b) Football c) Soccer d) Basebal

d. Baseball Explanation: Children with hemophilia should stay active. Good physical activities would be swimming, baseball, basketball, and bicycling (with a helmet). He would still need to be careful about falls and sliding into base. Intense contact sports like football, wrestling, and soccer should be avoided

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? a) mucositis b) infection symptoms c) bleeding d) vital signs

infection symptoms The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/µL (0.50 ×109/L). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants or raw fruits or vegetables would be allowed in the room, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron? a) chicken, corn, brown rice, and oranges b) tuna salad with eggs, whole wheat crackers, and blueberries c) pork, broccoli, white rice, and strawberries d) red meat, eggs, oatmeal, and dried fruit

red meat, eggs, oatmeal, and dried fruit Iron-deficiency anemia occurs when the blood does not have enough iron to produce hemoglobin. The anemia can be corrected via iron supplementation, nutrition, and even blood transfusion if the anemia is severe. Foods that have the highest sources of iron include red meat, tuna, eggs, tofu, enriched grains, dried beans and peas, dried fruits, green leafy vegetables and iron-fortified breakfast cereals. The nurse should teach the meal containing red meat, eggs, oatmeal and dried fruit has the highest amount of iron. Chicken has less iron than red meat, and corn has only a small amount. All the fruits listed have iron, but when dried the iron levels increase. Pork has limited amount of iron, and white rice contains almost no iron. Brown rice and whole grains contain higher iron amounts.

A 3-year old child is brought to the emergency department by the parents. Assessment reveals bruising and bleeding from the nose and mouth. The nurse suspects which condition? a) Hemophilia b) Chronic iron deficiency anemia c) Disseminated intravascular coagulation (DIC) d) von Willebrand disease (vWD)

von Willebrand disease (vWD) The primary clinical manifestations of vWD are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract. Bleeding associated with vWD may be severe and lead to anemia and shock, but deep bleeding into joints and muscles, like that seen in hemophilia, is rare except with type III vWD.

A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply. a) 80,000 per cubic millimeter b) 175,000 per cubic millimeter c) 110,000 per cubic millimeter d) 234,000 per cubic millimeter e) 287,000 per cubic millimeter

• 80,000 per cubic millimeter • 110,000 per cubic millimeter Explanation: Normal thrombocyte level ranges from 150,000 to 300,000 per cubic millimeter. Therefore, a child with a thrombocyte level of 80,000 and 110,000 per cubic millimeter would be at risk for bleeding.

The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation? A) "The MRI uses sound waves to create images that visualize body structures and locate masses." B) "The MRI uses radio waves and magnets to produce a computerized image of the body." C) "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." D) "The MRI uses radiation to examine soft tissue and bony structures of the body."

"The MRI uses radio waves and magnets to produce a computerized image of the body." The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.

The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8 years of age. The nurse would recommend a daily iron intake of which amount? a) 10 mg b) 12 mg c) 6 mg d) 15 mg

10 mg Explanation: The recommended daily dietary iron intake for children 1 to 10 years of age is 10 mg. The recommended daily dietary iron intake for children 0 to 6 months of age is 6 mg. The recommended daily dietary iron intake for boys 11 to 18 years of age is 12 mg. The recommended daily dietary iron intake for girls 11 to 18 years of age is 15 mg.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? a) Stuart factor b) Christmas factor c) Proconvertin d) Antihemophilic factor

Christmas factor Explanation: Factor IX is also known as plasma thromboplastin component or Christmas factor; factor X is Stuart factor; factor VIII is antihemophilic factor; and factor VII is proconvertin.

Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include: a) Compression b) Lowering extremities c) Heat d) Exercise

Compression Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition, corticosteroids such as prednisone may be used to reduce inflammation in the joint.

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 of the following blood factors? a) Factor X b) Factor V c) Factor XIII d) Factor VIII

Factor VIII Explanation: The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) False b) True

False Explanation: The primary intervention for beta-thalassemia is a chronic transfusion program of packed red blood cells with iron chelation. Such a program facilitates adequate oxygenation of body tissues and practically eliminates all symptoms of thalassemia.

Which of the following would the nurse be least likely to assess in a child with a hematologic disorder? a) Anemia b) Fever c) Abnormal hemostasis d) Neutropenia

Fever Explanation: Pediatric hematologic alterations usually are characterized by atypical hemostasis, anemia, and/or neutropenia. Fever suggests infection which may or may not be present with a hematologic disorder.

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of Impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. a) Provide various soft and bland foods to minimize further irritation. b) Apply a lip balm or petroleum jelly to prevent cracking. c) Give the child acidic foods (e.g., orange juice) to cleanse the mouth. d) Vigorously rub the child's gums with gauze to clean them. e) Have the child rinse the mouth with lukewarm water three times a day.

a) Provide various soft and bland foods to minimize further irritation. b) Apply a lip balm or petroleum jelly to prevent cracking. e) Have the child rinse the mouth with lukewarm water three times a day. For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.

The nurse is teaching the parents of a 4-year-old girl with thalassemia about sound nutritional choices. The nurse asks the mother about good snack choices to send to preschool. Which response by the mother would indicate a need for further teaching? a) "She likes string cheese and saltine crackers." b) "She can bring graham crackers and peanut butter." c) "I can send apple slices with yogurt dip." d) "Yogurt and granola is a good choice."

b. "She can bring graham crackers and peanut butter." Explanation: Children with thalassemia should avoid foods that are high in iron. Peanut butter is high in iron and should be avoided. Yogurt, granola, string cheese, saltine crackers, and apples are appropriate choices.

In von Willebrand's disease, girls exhibit unusually heavy menstrual flow. a) False b) True

b. True Explanation: von Willebrand's disease, an inherited autosomal dominant disorder, affects both sexes and is often referred to as angiohemophilia. Along with a factor VIII defect, there is also an inability of the platelets to aggregate and the blood vessels to constrict to aid in coagulation. Bleeding time is prolonged, with most hemorrhages occurring from mucous membrane sites. Epistaxis is a major problem, because all children tend to rub or pick at their nose as a nervous mechanism. In girls, menstrual flow is unusually heavy and may cause embarrassment from stained clothing.

You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is a) increased growth of long bones. b) slightly yellow sclerae. c) enlarged mandibular growth. d) depigmented areas on the abdomen

b. slightly yellow sclerae. Explanation: Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from breakdown of damaged cells.

The child with Thalassemia may be given which of the following classifications of medications to prevent one of the complications frequently seen with the treatment of this disorder. a) Potassium supplements b) Vitamin supplements c) Factor VIII preparations d) Iron-chelating drugs

d. Iron-chelating drugs Explanation: Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate (Desferal) may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? a) nystagmus, ataxia, and seizures b) projectile vomiting, lethargy, and coma c) headache, vision changes, and vomiting d) headache, epistaxis, and dizziness

headache, vision changes, and vomiting Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.

Choice Multiple question - Select all answer choices that apply. The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which of the following. Select all that apply. a) Promoting exercise and activity b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Preventing injury and bleeding episodes

• Administering oxygen • Administering analgesics • Maintaining fluid intake Explanation: Treatment for a crisis is supportive for each presenting symptom, and bed rest is indicated. Oxygen may be administered. Analgesics are given for pain. Dehydration and acidosis are vigorously treated. Prognosis is guarded, depending on the severity of the disease.

Choice Multiple question - Select all answer choices that apply. The nurse is reviewing the laboratory test results of a child with thalassemia. Which result would the nurse expect to find with the hemoglobin electrophoresis? Select all that apply. a) Hemoglobin A2 b) Hemoglobin A c) Hemoglobin F d) Hemoglobin S

• Hemoglobin F • Hemoglobin A2 Explanation: In thalassemia, the hemoglobin electrophoresis would reveal the presence of hemoglobin F and A2 only. Hemoglobin S would be found with sickle cell disease.

The mother of Mary Jo, a 10-year-old who had a febrile reaction following a transfusion, asks the nurse: "Why did this happen to my child?" What is the nurse's best response? a) "Mary Jo's blood was not compatible with the blood product, causing red blood cell destruction." b) "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." c) "Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood." d) "Too much of the blood product was transfused at too rapid a rate."

"Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood." Explanation: A febrile reaction is not associated with hemolysis and generally occurs when the recipient has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood. In a hemolytic reaction, the blood product is not compatible with the recipient's blood. An allergic reaction is a nonhemolytic reaction that occurs when the donor blood contains plasma proteins or antigens to which the recipient is hypersensitive.

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? a) "We always take water along when we are on an outing." b) "Our family is taking a fun hiking trip up in the mountains next week." c) "I make sure our child is up to date on all immunizations." d) "I make sure my child wears a good warm coat and gloves during winter."

"Our family is taking a fun hiking trip up in the mountains next week." High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. Extreme temperatures (hot or cold) are also triggers for a crisis so keeping warm during the winter is important. Dehydration and exposure to infection or other illness are precipitating factors for sickle cell crisis. Adequate hydration and keeping up with immunizations are imperative for health and wellness in a child diagnosed with sickle cell anemia.

The nurse is caring for a 2-year-old with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to his mother. Which statement by the mother indicates a need for further teaching? a) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." b) "Delayed growth and development and delayed puberty are chronic manifestations." c) "The acute manifestations, like splenic sequestration, are most often life-threatening." d) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations.

"The acute manifestations, like splenic sequestration, are most often life-threatening." Splenic sequestration is a life-threatening acute manifestation of sickle cell anemia, but some of the chronic manifestations of the disease, such as pulmonary hypertension and restrictive lung disease, are also often life-threatening. Aplastic crisis is a life-threatening acute manifestation. Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations; delayed growth and development and chronic puberty are chronic manifestations.

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count about 500, platelets over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. The nurse is correct in responding: a) "The doctor will discuss these findings with you when he comes to the hospital." b) "I'm really not allowed to discuss these findings with you. c) "These labs are just common labs for children with this disease." d) "These values will help us monitor the disease."

"These values will help us monitor the disease." Explanation: This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? a) "You'll need to have an incision in your hip area to instill the cells." b) "We'll need to have a match to a donor." c) "The risk for rejection is much less with this type of transplant." d) "You won't need to receive the high doses of chemotherapy before the transplant."

"We'll need to have a match to a donor." An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? a) "You will have to lie on your back and hold your breath." b) "The numbing medicine on your skin will keep you from having pain." c) "You will need to lie still afterward to prevent a headache." d) "You may feel pressure on your hip during the procedure."

"You may feel pressure on your hip during the procedure." The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which of the following would the nurse be least likely to include to manage a bleeding episode? a) Apply direct pressure to the area. b) Administer factor VIII replacement. c) Apply heat to the site of bleeding. d) Elevate the injured area such as a leg or arm.

Apply heat to the site of bleeding. Explanation: Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? a) Administering analgesics for pain b) Preparing the child for amputation c) Avoiding further abdominal palpation d) Performing dressing changes to the affected area

Avoiding further abdominal palpation After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

The nurse is caring for an 18-month-old with suspected iron deficiency anemia. Which of the following lab results confirms the diagnosis? a) Increased serum iron and ferritin levels: decreased FEP level, microcytosis and hypochromia b) Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increase FEP level c) Increased hemoglobin and hematocrit, increased reticulocyte count, microcytosis, and hypochromia d) Increased hemoglobin and hematocrit, increased reticulocyte, microcytosis and hypochromia, increased serum iron and ferritin levels and decreased FEP level

Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increase FEP level Explanation: Laboratory evaluation will reveal decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis and hypochromia, decreased serum iron and ferritin levels, and increase FEP level. The other findings do not point to iron deficiency anemia.

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? a) Expect menstrual bleeding to be heavy. b) Occasional skipped periods can be expected. c) The duration of each period will be short. d) Bruising may occur in the perineal area.

Expect menstrual bleeding to be heavy. Females diagnosed with von Willebrand disease are at risk for menorrhagia. Bruising in the perineal area is not a risk unless there is some sort of trauma at the site. Von Willebrand disease does not cause intermittent periods or shorten the duration of menses.

The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) True b) False

False Explanation: The primary intervention for beta-thalassemia is a chronic transfusion program of packed red blood cells with iron chelation. Such a program facilitates adequate oxygenation of body tissues and practically eliminates all symptoms of thalassemia.

The nurse is caring for a child with leukemia. Which of the following nursing interventions would be the highest priority for this child? a) Encouraging the child to share feelings b) Grouping nursing care c) Following guidelines for protective isolation d) Providing age appropriate activities

Following guidelines for protective isolation Explanation: The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age appropriate activities are important, but psychological issues are a lower priority than physical.

A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action? a) 8 mcg/dL b) 20 mcg/dL c) 14 mcg/dL d) 26 mcg/dL

a. 8 mcg/dL Explanation: A blood lead level less than 10 mcg/dL requires no action. A level of 14 mcg/dL would need to be confirmed with a repeat test in 1 month along with parental education for decreased lead exposure and then a repeat test in 3 months. Levels of 20 mcg/dL and 26 mcg/dL need to be confirmed with a repeat test in 1 week along with parental education and a referral to the local health department for investigation of the home for lead reduction.

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 which of the following? a) Factor VIII b) Plasmin c) Platelets d) Factor IX

a. Factor VIII Explanation: In hemophilia A, the problem is with factor VIII, and in hemophilia B it is factor IX. Platelets are problematic in idiopathic thrombocytopenia purpura. Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation

A child receiving radiation therapy has a nursing diagnosis of Impaired skin integrity related to the effects of radiation therapy as manifested by erythema and dryness of the skin. Which would the nurse include in the child's plan of care? Select all that apply. a) Encourage snug-fitting clothing. b) Expose the skin to air frequently. c) Use mild soap to clean the skin. d) Soak the area in warm water for 30 to 40 minutes frequently. e) Avoid application of creams and lotions.

b) Expose the skin to air frequently. c) Use mild soap to clean the skin. e) Avoid application of creams and lotions. To address skin integrity, the nurse would expose the skin to the air frequently, avoid lengthy soaks in bath water, encourage clothing that fits loosely over the area, avoid creams and lotions, and use mild soap to clean the skin.

A 3-year-old female is brought to the ER by her parents and presents with bruising and mucous membrane bleeding from the nose and mouth. The nurse knows that these symptoms are indicative of: a) Hemophilia b) von Willebrand disease c) Chronic iron deficiency anemia d) Disseminated intravascular coagulation

b. von Willebrand disease Explanation: The primary clinical manifestations of von Willebrand disease are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract; bleeding may be severe and lead to anemia and shock. Deep bleeding into joints and muscles, like that seen in hemophilia, is rare, except with type III von Willebrand disease.

A 4-month-old infant is found to be anemic. Which is the most likely cause of anemia in this child? a) Sickle cell anemia b) Inadequate intake of dietary iron in the infant c) Inadequate intake of dietary iron in the mother during late gestation d) Thalassemia

c) Inadequate intake of dietary iron in the mother during late gestation A newborn usually has enough iron in reserve to last for the first 6 months of life. After that, the infant needs iron incorporated into the diet. Because iron stores are laid down near the end of gestation, women with iron deficiency during pregnancy tend to give birth to iron-deficient babies because the babies do not receive iron stores. At birth, hemoglobin is largely of the infant type (hemoglobin F), which is composed of two alpha and two gamma polypeptide chains. During the first 6 months of life, this infant type is gradually replaced by adult hemoglobin (hemoglobin A), which is composed of two alpha and two beta chains. For this reason, diseases such as sickle-cell anemia or the thalassemias, which are disorders of the beta chains, do not become apparent clinically until this hemoglobin change has occurred (at approximately 6 months of age).

The parents of a 6-year-old male with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response? a) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." b) "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." c) "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." d) "ITP is characterized by the loss of surface area on the red blood cell membrane."

c. "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane

In discussing the causes of iron deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron deficiency anemia? a) "Caregivers sometimes don't understand the importance of iron and proper nutrition." b) "Children have a hard time getting enough iron from food during their first few years." c) "Milk is a perfect food, and babies should be able to have all the milk they want." d) "A family's economic problems are often a cause of malnutrition."

c. "Milk is a perfect food, and babies should be able to have all the milk they want." Explanation: Babies with an inordinate fondness for milk can take in an astonishing amount and, with their appetites satisfied, may show little interest in solid foods. These babies are prime candidates for iron deficiency anemia. Many children with iron deficiency anemia, however, are undernourished because of the family's economic problems. A caregiver knowledge deficit about nutrition is often present. Because only 10 percent of dietary iron is absorbed, a diet containing 8 to 10 mg of iron is needed for good health. During the first years of life, obtaining this quantity of iron from food is often difficult for a child. If the diet is inadequate, anemia quickly results

A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question? a) docusate sodium b) phenytoin c) elevate head of bed 90 degrees d) position on nonsurgical side

elevate head of bed 90 degrees An anticonvulsant such as phenytoin will be prescribed if the child is experiencing seizures or if surgery is apt to induce seizures. A child will usually receive a stool softener such as docusate sodium to prevent straining with bowel movements. In general, a child is positioned on the side opposite the surgical incision. Keep the bed flat or only slightly elevated, again, as prescribed, because this helps to reduce intracranial pressure from accumulation of fluid in the surgical area. Therefore, the nurse would need to question the prescription to elevate the head of bed 90 degrees.

A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? a. lethargy, bruises, and lymphadenopathy b. abdominal pain, nausea, and vomiting c. anorexia and weight loss d. joint pain and swelling

lethargy, bruises, and lymphadenopathy Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.

A 10-month-old has been admitted to the hospital with severe hemolytic anemia and chronic hypoxia. The nurse notes icteral sclerae, jaundice of the skin, and frontal and maxillary bossing. The nurse interprets these findings as most likely indicating which of the following? a) Sickle cell anemia b) β-Thalassemia major c) Hemophilia d) von Willebrand disease

β-Thalassemia major Explanation: Severe hemolytic anemia and chronic hypoxia, icteral sclerae, jaundice of the skin, and frontal and maxillary bossing are signs and symptoms of β-thalassemia major. Hemophilia is manifested by clotting dysfunctions. von Willebrand disease is manifested by abnormal clotting. Sickle cell anemia involves abnormal hemoglobin that leads to significant anemia and acute and chronic symptoms.

The young girl has been diagnosed with a hematologic disorder. Her erythrocyte count is below normal. The mean corpuscular volume is below normal. The girl's mean corpuscular hemoglobin (Hbg) concentration is below normal. Which of the following statements by the girl's nurse is true regarding this girl? Select all that apply. a) "She's anemic." b) "Her red blood cells are smaller than normal." c) "The amount of hemoglobin in her red blood cells is very dilute." d) "Her red blood cells are macrocytic." e) "Her red blood cells are hypochromi"

• "Her red blood cells are smaller than normal." • "The amount of hemoglobin in her red blood cells is very dilute." • "She's anemic." • "Her red blood cells are hypochromi" Explanation: This girl's erythrocyte count is below normal, which indicates she is anemic. The mean corpuscular Hbg concentration is below normal which indicates that her cells are hypochromic with a diluted amount of Hbg available. The mean corpuscular volume of the erythrocytes are decreased which indicates her cells are microcytic or smaller than normal

The child has anemia and iron supplements will be administered by his parents at home. Which of the following statements by the child's parents indicates that further education is required? a) "He may develop diarrhea." b) "If the iron is mixed in a drink, then he should drink it with a straw." c) "His urine may look dark." d) "It's better if I give the iron with orange juice." e) "I can give the iron mixed with chocolate milk."

• "I can give the iron mixed with chocolate milk." • "He may develop diarrhea." Explanation: Iron supplements should not be mixed in milk because it reduces absorption. Iron supplements may make the child constipated. All of the other options are correct

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which of the following interventions would the nurse expect to perform? a) Encouraging fluid intake to increase radionuclide uptake b) Administering a sedative as ordered to keep the child still c) Applying EMLA to the injection site prior to inserting the IV d) Advising the physician that the child is allergic to shellfish

Administering a sedative as ordered to keep the child still The nurse would expect to administer a sedative as ordered to keep the child still because the machine makes a loud thumping noise that could frighten the child. The child must lie without moving while the MRI is being done. Encouraging fluid intake to increase radionuclide uptake is necessary for a bone scan. Advising the physician that the child is allergic to shellfish is an intervention for a computed tomograph (CT) scan with contrast. If the child did not have an IV prior to the MRI and contrast was going to be used, then an IV would need to be inserted for the contrast after the noncontrast MRI was finished. Applying EMLA to an injection site prior to inserting an IV would be appropriate for both the CT and bone scans.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? a) Assessing dietary intake by addressing "picky eating" and "food jags" b) Plotting height and weight on a growth chart c) Administering the measles, mumps, rubella (MMR) vaccined) d) Teaching the importance of taking water safety measures

Administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immune suppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.

An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which of the following symptoms should the nurse most expect as a result of excessive iron deposits? a) An enlarged heart b) An enlarged spleen c) An enlarged thyroid gland d) Enlarged lymph nodes

An enlarged spleen Explanation: The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits and fibrotic scarring in the liver and the spleen's increased attempts to destroy defective RBCs.

A nurse caring for an 8-year-old patient with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a patient with: a) Hemophilia b) von Willebrand disease c) Iron deficiency anemia d) Disseminated intravascular coagulation

Disseminated intravascular coagulation Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this patient is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis.

The child with Thalassemia may be given which of the following classifications of medications to prevent one of the complications frequently seen with the treatment of this disorder. a) Iron-chelating drugs b) Factor VIII preparations c) Potassium supplements d) Vitamin supplements

Iron-chelating drugs Explanation: Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate (Desferal) may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? a) The child has mild to moderate iron deficiency. b) The child requires a prophylactic dose of iron. c) The child has severe iron deficiency. d) The child is being prepared for packed red blood cell administration.

The child has mild to moderate iron deficiency. The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.

In caring for a child with sickle cell disease, the highest priority goal is which of the following? a) The family caregivers' anxiety will be reduced. b) The child's skin integrity will be maintained. c) The family will verbalize understanding of of the disease crisis. d) The child's fluid intake will improve

The child's fluid intake will improve. Explanation: The highest priority goals for this child are maintaining comfort and relieving pain. The child is prone to dehydration because of the kidneys' inability to concentrate urine, so increasing fluid intake is the next highest priority. Other goals include improving physical mobility, maintaining skin integrity, reducing the caregivers' anxiety, and increasing the caregivers' knowledge about the causes of crisis episodes, but these goals are not the highest priority.

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: a) destroy any residual cancer cells. b) kill enough cancerous cells to induce remission. c) destroy any remaining cancer cells. d) follow up for recurrent disease or late effects.

kill enough cancerous cells to induce remission. During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.