Pediatrics Ch. 24

The patient has anemia even after completing an oral iron supplement regimen. Which action by the patient is responsible for this situation?

Taking medication mixed in yogurt

The nurse is assessing the findings of a microscopic study of red blood cell (RBC) morphology. Which assessment finding does the nurse recognize as a sign of sickle cell anemia (SCA)?

Drepanocytes

A 4-year-old child is prescribed liquid iron for iron- deficiency anemia. What instructions are given to the parents of this child? Select all that apply.

Give the iron using a straw. Brush the child's teeth after administration of iron.

Which drug is not recommended for treating pain during sickle cell disease episodes?

Meperidine

Which statement is true regarding human immunodeficiency virus (HIV)-positive children attending schools?

Parents or legal guardians have the right to decide whether or not to share HIV status with the school.

The nurse suspects that a child is having an adverse reaction to blood transfusion. What is the nurse's priority action?

Stopping the transfusion and maintaining a patent intravenous line

The transcranial Doppler test results of a child with sickle cell anemia indicate that the child has abnormal intracranial vascular flow. What information does the nurse give to the parents?

The child may require multiple blood transfusions.

The school nurse is discussing prevention of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIIDS) with some adolescents. Which statement is appropriate to include?

Intravenous drug users should not share needles

What important factor should the nurse consider when administering iron?

Iron should not be given with milk.

What treatment method has greatly improved the prognosis for children with HIV infection?

Combination antiretroviral therapy

Which intervention should be performed first by the nurse during a blood transfusion?

Identify donor and recipient blood types and groups.

The nurse is teaching the family of a teenager suffering from a sickle cell crisis about pain management. Which statement by the family would indicate a need for further teaching?

"Although rates of addiction are high, particularly for teenagers, if we carefully monitor the drug dose it can be avoided."

The nurse is evaluating a family's response to teaching concerning management of sickle cell anemia for their child. Which statement by the family would indicate the need for further teaching?

"At the first sign of infection, we need to get the penicillin prescription filled at the pharmacy."

Parents of an 8-week-old baby with sickle cell disease have come to the hospital for the baby's routine checkup. They tell the nurse that they do not want penicillin prophylaxis for their baby, because the baby is very young. What does the nurse tell them? Select all that apply.

"Children with sickle cell disease should take penicillin prophylaxis by 2 months of age." "If a baby is put on penicillin, medical advice is needed if the temperatue exceeds 38.3° C."

A child with B-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine therapy. The child's parents ask the nurse what deferoxamine does. What is the most appropriate response by the nurse?

"The medication helps prevent iron overload."

The parents of a child with sickle cell anemia are concerned about subsequent children having the disease. Which response by the nurse is most accurate?

"There is a 25% chance of a sibling having sickle cell anemia."

group What ethnic has the highest incidence of sickle cell disease?

African Americans

Which procedure does the nurse recognize as the means of eliminating excess iron in a child with B-thalassemia major?

Chelation therapy

What is the most appropriate way to stop an occasional episode of epistaxis?

Having the child sit up and lean forward

What are some common clinical manifestations of HIV infection in children? Select all that apply.

Oral candidiasis Chronic diarrhea Lymphadenopathy Developmental delay

The nurse is completing an assessment on a child being evaluated for anemia whose parents are Asian. Which question would be most important for the nurse to ask in this situation to help identify the cause of the anemia?

"Does your child have abdominal pain, gas, or diarrhea after drinking milk?"

A nursing student caring for a patient admitted for treatment of a sequestration sickle cell crisis is discussing this type of crisis with the instructor. Which statement by the nursing student indicates proper understanding of this type of crisis?

"This type of crisis is characterized by pooling of a large amount of blood in the spleen."

The family of a toddler recently diagnosed with beta- thalassemia asks the nurse what the main treatment is. Which statement by the nurse provides the most appropriate response to the family's question?

"Transfusions will be required every 3 to 5 weeks to try to keep the hemoglobin at acceptable levels."

A parent of a child with sickle cell disease tells the nurse she is concerned that her child is becoming addicted to opioids. What is the most appropriate response to her concern?

"Very few children who are prescribed opioids for severe pain become behaviorally addicted to the drugs."

A woman is diagnosed with sickle cell anemia (SCA), and her husband does not have the condition. What is the chance of sickle cell anemia in their children?

0% chance that their children will have SCA

The nurse caring for four children with human immunodeficiency virus (HIV) would classify which child as an A2?

Child C

The nurse is caring for four children being treated for anemia. Based on clinical manifestations, which child would the nurse determine has anemia caused by decreased red blood cell (RBC) production?

Child D

The nurse reviews the laboratory reports for a patient. What condition does the nurse suspect most in the patient?

Aplastic anemia

The family of a child hospitalized for care during a sickle cell crisis calls the nurse into the room because the child is struggling to breathe. Upon assessment, the nurse notes a respiratory rate of 30 and that the child is clutching the abdomen and crying. What does the nurse determine the child may be experiencing?

Acute chest syndrome

What serious complication of sickle cell disease is similar to pneumonia?

Acute chest syndrome

A child with sickle cell crisis has been admitted to the pediatric unit for pain management. The nurse is evaluating the child's pain 15 to 20 minutes after an initial dose of morphine. Using the FLACC scale, the nurse notes that the child is sobbing and lying with the legs drawn up. The parents attempt to console the child but have been largely unsuccessful. Based on this assessment, what should the nurse's next action be?

Administer additional morphine per guidelines.

The nurse is teaching the family of a child diagnosed with iron-deficiency anemia about the proper administration of iron supplements. Which points should the nurse include in the education session? Select all that apply.

Administer in two divided doses between meals. Use a straw to administer the iron if it is in liquid form. Administer with citrus fruits or juices to increase absorption.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. What is the nurse's best explanation?

An expected change caused by the iron preparation

What is the most common hematologic disorder of infancy and childhood?

Anemia

A 2-month-old formula-fed baby is brought in for a routine checkup. The parent of the baby tells the nurse that a friend has advised her to give fresh cow's milk to the baby instead of formula milk, because it has high nutritional value. What does the nurse tell the parent?

Cow's milk should be avoided before 12 months of age, because it may cause iron-deficiency anemia.

Which symptom would the nurse recognize as an acquired immunodeficiency syndrome (AIDS)- defining condition in an American child with human immunodeficiency virus (HIV)?

Cytomegalovirus

The nurse is teaching a group of parents of children diagnosed with sickle cell anemia. One parent tells the nurse that he or she is so frightened that the child will die and that he or she has heard that certain signs and symptoms can indicate greater likelihood of death if they occur within the first 2 years of life. Which manifestations does the nurse explain can indicate a severe prognosis? Select all that apply.

Dactylitis Severe anemia Leukocytosis

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

Elevating the area above the level of the heart

What are the most common clinical manifestations of hemophilia? Select all that apply.

Excessive bruising Hemorrhage from any trauma Prolonged bleeding from or in the body

What are the most common clinical features of sickle cell anemia in children? Select all that apply.

Gallstones Hematuria Osteomyelitis Hepatomegaly

The nurse is teaching a group of student nurses about the parenteral administration of iron dextran. What instructions does the nurse include in the teaching? Select all that apply.

Give a maximum dose of 1 mL IM at one site to a child. Do not massage the injection site after administration of iron dextran. Administer it deeply into a large muscle mass using the Z-track technique.

A child with sickle cell anemia is brought to the hospital with pain in the lower limbs. On examination the child's skin and tongue are pale and the PaO 2 is 98%. What measure should the nurse take to prevent sickling of red blood cells in this patient?

Give intravenous fluids.

A child is diagnosed with iron-deficiency anemia and is treated with iron supplements. The child starts vomiting after ingestion of iron tablets. What instructions does the nurse give to the parent and the child? Select all that apply.

Give iron supplements with meals. Decrease dose and then increase to ordered dose as tolerated.

A child with sickle cell disease is brought to the hospital reporting right knee pain. On examination, the nurse finds localized swelling and immediately applies a cold compress to the right knee, massages the knee, and administers ibuprofen for pain relief. The nurse informs the mother that the child may need a high dose of an opioid if there is no relief from pain. Which of the measures taken by the nurse need to be corrected?

Giving cold compression to the affected area

The nurse is explaining blood components to an 8-year-old child. The nurse, drawing on knowledge of child development, understands that the most appropriate description of platelets is that they do what?

Help the body stop bleeding by forming a clot (scab) over the hurt area

After 30 minutes of a blood transfusion the child complains of a sudden severe headache. What does this symptom suggest?

Hemolytic reaction to the blood transfusion

A child has been admitted to the pediatric unit for evaluation of easy bruising. The parents report during the admission assessment that the child has also been experiencing nosebleeds at least once a day; black, tarry stools; and blood in the urine. Lab results indicate a platelet count of 18,000/mm 3. Based on the data available, what disorder does the nurse suspect may be responsible for the symptoms?

Immune thrombocytopenia

What is the best way to administer parenteral iron preparations?

Injection into a large muscle with the use of the Z-track method

Which interventions are included in the management of nosebleeds in children? Select all that apply.

Instruct the child to breathe through the mouth. Insert cotton or wadded tissue into each nostril if bleeding persists. Apply continuous pressure to the nose with thumb and forefinger for at least 10 minutes.

When developing a plan of care for a child diagnosed with anemia, which activity is important for the nurse to complete in order to determine how to minimize tissue oxygen needs?

Measure the child's vital signs and observe behavior during periods of rest to establish a baseline for nonexertion energy expenditure.

A child with sickle cell anemia experiences severe chest pain, fever, a cough, and dyspnea. What is the nurse's priority action?

O Notifying the practitioner because the child may be experiencing chest syndrome

Which complete blood count (CBC) test value would the nurse consider outside normal range?

Platelet count 430 x 10 ³/mm 3

The nurse is developing a teaching plan for the family of a toddler recently diagnosed with sickle cell disease. Of which does the nurse include as important for the family to be aware and to report in order to recognize signs of the major cause of death for children under 5 with sickle cell disease? age

Presence of fever

What is the primary treatment for hemophilia?

Replacement of missing clotting factor

The nurse is administering a blood transfusion to a child for treatment of hemophilia. Upon assessment, the nurse notes that the child is cyanotic, has difficulty breathing, and has rales upon inspiration throughout the lung fields. What is the nurse's best response to these findings?

Stop the transfusion immediately.

A nurse suspects that a child receiving a blood transfusion is experiencing an adverse reaction. What is the nurse's priority action?

Stopping the transfusion

What does the nurse recognize as the most important nursing consideration in the care of a child with sickle cell anemia?

Teaching the parents and child how to recognize signs and symptoms of crisis

A health care provider informs the nurse that the complete blood count of a child shows shift to the left and instructs the nurse to explain this to the parents of the child. What does the nurse tell them?

The child most likely has bacterial infection.

While reviewing the laboratory reports of a patient with hemophilia, the nurse finds that the patient has passed black, tarry stools. What should the nurse interpret from these findings?

The patient has gastrointestinal bleeding.

During a blood transfusion, a child reports mild precordial pain. What is the most appropriate action of the nurse?

Transfuse the blood slower.

The nurse is caring for a 10-year-old child whose white blood cell count is high. The child asks the nurse about the significance of white blood cells. of the nurse? What is the most appropriate response

White blood cells help keep germs from causing infections.