CH 25
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) "A family's economic problems are often a cause of malnutrition." b) "Caregivers sometimes don't understand the importance of iron and proper nutrition." c) "Milk is a perfect food, and babies should be able to have all the milk they want." d) "Children have a hard time getting enough iron from food during their first few years."
"Milk is a perfect food, and babies should be able to have all the milk they want." Correct 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.
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) "When I give my son ferrous sulfate I know he also needs potassium supplements." b) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." c) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." d) "I always give the ferrous sulfate with meals."
"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 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) "There are many iron fortified cereals that he likes" b) "Red meat is a good option; he loves the hamburgers from the drive-thru." c) "I must encourage a variety of iron-rich foods that he likes" d) "He will enjoy tuna casserole and eggs"
"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.
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) "Her bowel movements will probably turn very dark." b) "She can drink the medicine from a medicine cup." c) "We'll try to give the medicine to her in between milk servings." d) "We will have her drink water or juice with the medicine."
"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 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) 15 mg c) 6 mg d) 12 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.
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) 6.0 to 9.0 seconds b) 16.0 to 18.0 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.
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 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
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) 14 mcg/dL b) 20 mcg/dL c) 26 mcg/dL d) 8 mcg/dL
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.
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
A 15-year-old girl who has heavy menstrual periods Correct Explanation: Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.
A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Deficient fluid volume related to clustering of sickled cells b) Ineffective coping related to chronic illness c) Acute pain related to effects of sickling d) Ineffective peripheral tissue perfusion related to the effects of sickled cells
Acute pain related to effects of sickling Explanation: Although ineffective peripheral tissue perfusion and deficient fluid volume would apply, acute pain would be the priority. Once pain is relieved, the child is able to relax, thus reducing the metabolic demand for oxygen and helping to end the sickling. There is no information to correlate with a nursing diagnosis of ineffective coping.
A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is which of the following? a) Allogenic b) Heterologous c) Syngeneic d) Autologous
Allogenic Explanation: Stem cell transplantation can be allogeneic, syngeneic, or autologous. Allogeneic transplantation is the transfer of stem cells from an immune-compatible (histocompatible) donor, usually a sibling, or from a national cord blood bank or national volunteer donor registry. Syngeneic transplantation (rare) involves a donor and recipient who are genetically identical (are identical twins). Autologous transplantation involves use of the child's own stem cells removed from cord blood banked at the time of the child's birth. Heterologous is not a type of stem cell transplantation.
In a child diagnosed with sickle cell disease, which of the following clinical manifestations would the nurse most likely see? a) Hyperactive bowel sounds b) Decreased hemoglobin level c) Strawberry colored tongue d) Increased appetite
Decreased hemoglobin level Explanation: Sickle cell disease causes chronic anemia, with a hemoglobin level of 6 to 9 g/dL (the normal level in an infant is 11 to 15 g/dL). The chronic anemia causes the child to have a poor appetite and severe, acute abdominal pain (caused by sludging, which leads to enlargement of the spleen) and an absence of bowel sounds. A strawberry colored tongue is seen in the diagnosis of Kawasaki disease.
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) Disseminated intravascular coagulation b) Hemophilia c) Iron deficiency anemia 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.
A group of nursing students is discussing the diagnosis of iron deficiency anemia, and one of the students asks what foods would be good for this child to eat. Which of the following foods are high in iron? (select all that apply) a) Oatmeal b) Cheese c) Milk d) Peanut butter e) Raisins f) Egg yolks
Egg yolks • Raisins • Peanut butter • Oatmeal Explanation: Egg yolks, raisins, peanut butter and oatmeal are food sources high in iron. Milk and cheese are not food sources that are high in iron.
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) Plasmin b) Factor IX c) Platelets d) Factor VIII
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 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 XIII c) Factor VIII d) Factor V
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.
In hemophilia A, the classic form, only females manifest a bleeding disorder. a) True b) False
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 child with leukemia. Which of the following nursing interventions would be the highest priority for this child? a) Providing age appropriate activities b) Grouping nursing care c) Encouraging the child to share feelings d) Following guidelines for protective isolation
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 child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder? a) Thrombocytes (platelets) b) Plasma c) Hemoglobin d) Leukocytes (white blood cells)
Hemoglobin Explanation: The component of RBCs that allows them to carry out the transport of oxygen is hemoglobin, composed of globin, a protein, and heme, an iron-containing pigment. Fetal hemoglobin differs from adult hemoglobin; 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).
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) Erythrocyte sedimentation rate c) Reticulocyte count d) Hemoglobin electrophoresis
Hemoglobin electrophoresis Explanation: 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).
The nurse treating patients with hemophilia knows that if bleeding is not treated effectively, the following body part is at greatest risk for the development of chronic, disabling disease: a) Liver b) Kidneys c) Joints d) Heart
Joints Explanation: Regardless of the type, if bleeding is not treated effectively, target joints are particularly at risk for deterioration and the development of chronic, disabling hemophilic arthropathy (joint disease).
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) Hydromorphone b) Morphine c) Nalbuphine d) Meperidine
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.
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 Platelets Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte
Multipotent stem cell Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte Platelets 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.
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) Evaluate respiratory status c) Inspect for signs of bleeding d) Notify the physician
Notify the physician Explanation: If neurological deficits are assessed, immediate reporting of the findings is necessary to begin treatment to prevent permanent damage.
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 characterized by the loss of surface area on the red blood cell membrane." b) "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." c) "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." d) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor."
"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.
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) "She has been down, but playing in soccer camp will cheer her up." c) "I put her legs up on pillows when her knees start to hurt." d) "I bought the medication to give to her when she complains of pain."
"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.
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) Dimercaprol b) Succimer c) Edentate calcium disodium d) Desferal
Desferal Explanation: 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.
A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify which of the following as an effect? a) Pulmonary hypertension b) Chest syndrome c) Cholelithiasis d) High urine specific gravity
High urine specific gravity Explanation: Low urine specific gravity (hyposthenuria) occurs with sickle cell anemia. Chest syndrome is an acute manifestation of sickle cell anemia. Pulmonary hypertension is a chronic manifestation of sickle cell anemia. Cholelithiasis is a chronic manifestation of sickle cell anemia.
A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which of the following assessments would best help you determine that he is actually taking it daily? a) His reticulocyte count will have decreased. b) He will be less irritable than he was at his last visit. c) His stools will appear black. d) He will develop diarrhea.
His stools will appear black. Explanation: A side effect of ferrous sulfate therapy is to color stools black.
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) Vitamin supplements b) Iron-chelating drugs c) Potassium supplements d) Factor VIII preparations
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-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Beginning active range-of-motion exercises b) Encouraging him to take deep breaths hourly c) Maintaining a fluid intravenous line d) Seeing that he ingests a protein-rich diet
Maintaining a fluid intravenous line Explanation: Dehydration increases sickling of cells, so maintaining fluid balance is important.
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) Ecchymosis b) Petechiae c) Purpura d) Poikilocytosis
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.
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) Gymnastics b) Rugby c) Soccer d) Swimming
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.
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) Iron deficiency c) Vitamin B12 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.
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) "He might get constipated from the supplement." 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) "We'll need to plan for a bone marrow transplant soon."
"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.
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) "Males are much more likely to have the disease than females." 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) "The disease is most often seen in individuals of Asian decent."
"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.
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) "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." b) "Too much of the blood product was transfused at too rapid a rate." c) "Mary Jo's blood was not compatible with the blood product, causing red blood cell destruction." d) "Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood."
"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.
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 should call the doctor for any fever over 100°F." 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 must be compliant with vaccinations and prophylactic penicillin."
"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 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) "Would you help me dilute this and mix it up?" b) "Would you like to administer the infusion?" c) "Please be brave; we need to stop the bleeding" d) "Will you help me apply this band-aid?"
"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.
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 thyroid gland c) An enlarged spleen d) Enlarged lymph nodes
An enlarged spleen Correct 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 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 heat to the site of bleeding. b) Elevate the injured area such as a leg or arm. c) Administer factor VIII replacement. d) Apply direct pressure to the area.
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.
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) Football b) Wrestling c) Baseball d) Soccer
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.
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) Lowering extremities b) Exercise c) Heat d) Compression
Compression Explanation: 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 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.
A boy with hemophilia A is scheduled for surgery. Which of the following precautions would you institute with him? a) Mark his chart for him to receive no analgesia. b) Caution him not to brush his teeth before surgery. c) Do not allow a dressing to be applied postoperatively. d) Handle him gently when transferring him to a stretcher.
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 nurse is preparing a 7-year-old girl for bone marrow aspiration. Which of the following sites should she prepare? a) Femur b) Sternum c) Iliac crest d) Anterior tibia
Iliac crest Explanation: 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) Ineffective tissue perfusion related to poor platelet formation b) Risk for infection related to abnormal immune system c) Risk for altered urinary elimination related to kidney impairment d) Ineffective breathing pattern related to decreased white blood count
Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur.
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) A child's nutritional status is key. b) Sequelae are rare with chronic problems. c) Demographic data is of little relevance. d) Multiple body sites can be affected.
Multiple body sites can be affected. Explanation: 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.
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) Seizures b) Leg ulcers c) Behavioral addiction d) Priapism
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.
A child is diagnosed with iron deficiency anemia. Which diagnostic test would the nurse suspect as being altered? a) Serum iron level b) Total iron binding capacity c) Transferrin saturation d) Serum ferritin
Serum ferritin Explanation: During the first stage of iron deficiency, the depletion of iron stores is most commonly identified by a decrease in serum ferritin. During the second stage, the lack of transport iron is identified primarily by a decrease in transferrin saturation. A decrease in serum iron and an increase in total iron-binding capacity are likely to be evident as well. (less)
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
In von Willebrand's disease, girls exhibit unusually heavy menstrual flow. a) False b) True
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.
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) Petechiae b) Equal pupillary response c) Widely fluctuating blood pressure 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.
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) what foods are high in folic acid. d) to use mainly cold water to wash.
not to pick or irritate her nose. Explanation: Without adequate platelets, children bleed easily from lesions.
To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to a) notify a health care provider if the child develops an upper respiratory infection. b) encourage the child to participate in school activities, such as long-distance running. c) prevent the child from drinking an excess amount of fluids per day. 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.
You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is a) enlarged mandibular growth. b) slightly yellow sclerae. c) increased growth of long bones. d) depigmented areas on the abdomen.
slightly yellow sclerae. Explanation: Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from breakdown of damaged cells.
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 F b) Hemoglobin A c) Hemoglobin A2 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 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) Sickle cell disease c) Kawasaki disease d) Thalassemia
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.
The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence. 1. Thrombopoietin acts on the cell. 2. The bone marrow releases a stem cell. 3. The myeloid cell becomes a megakaryocyte. 4. Erythropoietin helps the cell turn into a red blood cell. Incorrect
1. The bone marrow releases a stem cell. 2. Thrombopoietin acts on the cell. 3. The myeloid cell becomes a megakaryocyte. 4. 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).
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) Fluid overload b) Pallor c) Respiratory distress d) Infection
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 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) Decreased white blood cell count b) Normal platelet count c) Decreased platelet count d) Elevated 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.
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) Deficient fluid volume c) Risk for infection d) Risk for delayed growth and development
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.
Which of the following statements is most accurate related to sickle cell disease? a) Sickle cell disease is genetically inherited. b) Sickle cell disease is confirmed by doing chest X-rays. c) Sickle cell disease is evaluated using the modified Jones criteria. d) Sickle cell disease is treated by using preparations of factor VIII.
Sickle cell disease is genetically inherited. Explanation: Sickle cell disease is a hereditary trait occurring most commonly in African Americans.
In caring for a child with sickle cell disease, the highest priority goal is which of the following? a) The child's skin integrity will be maintained. b) The family caregivers' anxiety will be reduced. c) The child's fluid intake will improve. d) The family will verbalize understanding of of the disease crisis.
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.