CH. 44 MATERNAL PREP U

A nurse is providing care to a child who is to receive a blood transfusion. The health care provider has prescribed the infusion to run at a rate of 5 ml/kg/hour. The child weighs 55 lb (25 kg). At what rate should the nurse set the infusion pump? Record your answer using a whole number.

125 The nurse will use the child's weight in kilograms, and multiply weight by the prescribed milligrams per hour. 25 kg × 5 ml = 125 ml/hour

The nurse is providing care to a child with disseminated intravascular coagulation and is preparing to administer heparin. The parent asks why the heparin is being given. Which response by the nurse would be most appropriate? "Heparin provides a stimulus for clotting factor production." "It helps to counteract the clotting cascader." "It reduces the risk for significant hemorrhage." "Heparin helps to reduce the consumption of platelets."

Correct response: "Heparin helps to reduce the consumption of platelets." Explanation: Heparin reduces platelet consumption, thereby resulting in improved platelet counts. It does not counteract the clotting cascade. It is an anticoagulant and, as such, increases the risk for bleeding and hemorrhage. Heparin does not stimulate clotting factor production.

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

Correct response: "I mix ferrous sulfate with milk in a bottle." Explanation: 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.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition? "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." "The trait or the disease is seen in one generation and skips the next generation." "Males are much more likely to have the disease than females."

Correct response: "If the trait is inherited from both parents the child will have the disease."

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? "Infants with pyloric stenosis require ferrous sulfate." "Preterm infants are at risk for iron-deficiency anemia." "Ferrous sulfate helps improve red blood cell formation." "Your infant may have been having excessive diarrhea."

Correct response: "Preterm infants are at risk for iron-deficiency anemia." Explanation: Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth." "Sickle cell disease occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when one of the parents has the gene."

Correct response: "Sickle cell disease is passed to a fetus when both parents have the gene."

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement by the parents indicates the need for additional teaching? "We need to measure the liquid carefully so that we give her the correct amount." "We will place the liquid in the front of her gums, just below her teeth." "We'll try to get her to drink lots of fluids throughout the day." "She needs to eat foods that are high in fiber so she doesn't get constipated."

Correct response: "We will place the liquid in the front of her gums, just below her teeth."

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? "Do you have any bruises on your feet or shins?" "Let me see the palms of your hands and soles of your feet." "Will you show me how you walk across the room?" "Open your mouth so I can look inside your cheeks and lips."

Correct response: "Will you show me how you walk across the room?" Explanation: Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

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 symptom should the nurse most expect as a result of excessive iron deposits? An enlarged thyroid gland An enlarged spleen Enlarged lymph nodes An enlarged heart

Correct response: An enlarged spleen

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

Correct response: 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? Wrestling Soccer Football Baseball

Correct response: Baseball

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? Not eat or drink for one hour Remain in an upright position for at least 15 minutes Drink a glass of milk Brush his or her teeth

Correct response: Brush his or her teeth

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Ensure neutropenic precautions are in place. Monitor daily complete blood count (CBC). Remind parents to contact the child's school. Encourage therapeutic play activities.

Correct response: Ensure neutropenic precautions are in place. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.

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 blood factor? Factor XIII Factor V Factor X Factor VIII

Correct response: 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.

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? Hemoglobin F Hemoglobin A Hemoglobin A2 Hemoglobin S

Correct response: Hemoglobin A Explanation: Three types of normal hemoglobin are present at any given time in the blood: A, F, and A2. By 6 months of age, hemoglobin A is the predominant type. Hemoglobin S is associated with sickle cell disease.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Femur Anterior tibia

Correct response: Iliac crest

Which site is most frequently used to perform a bone marrow aspiration? Iliac crest Humerus Femur Rib cage

Correct response: Iliac crest

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

Correct response: 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 developing a plan of care for a child who is to have a transfusion. Which would the nurse expect to administer because it is the most common form of transfusion? Packed red blood cells Plasma factors Washed red blood cells Whole blood

Correct response: Packed red blood cells

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Notify the client's primary health care provider Document the presence of hemarthrosis in the client's chart Assess the client's urine and stool for blood Prepare to administer factor replacement medication

Correct response: Prepare to administer factor replacement medication Explanation: Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? Bradycardia Negative splenomegaly Oxygen saturation: 99% Spooned nails

Correct response: Spooned nails Explanation: Spooning or concave shape of the nails suggests iron-deficiency anemia. Other findings would include decreased oxygen saturation levels, tachycardia, and possible splenomegaly.

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? Transfuse 1 unit of packed red blood cells. Administer antibiotics intravenously stat. Ask the child to rate pain on a scale 0 to 10. Provide the family with preoperative instructions.

Correct response: Transfuse 1 unit of packed red blood cells. Explanation: 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.

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

Correct response: cheeseburger, broccoli, and fresh strawberries Explanation: 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.

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: ecchymosis. poikilocytosis. petechiae. purpura.

Correct response: petechiae.

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? chicken, corn, brown rice, and oranges red meat, eggs, oatmeal, and dried fruit pork, broccoli, white rice, and strawberries tuna salad with eggs, whole wheat crackers, and blueberries

Correct response: red meat, eggs, oatmeal, and dried fruit Explanation: 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 a limited amount of iron, and white rice contains almost no iron. Brown rice and whole grains

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? "The iron you give him before birth is different from what he needs once he is born." "If the baby didn't use up what you gave him before birth, he excretes it soon after birth." "Because the baby grows rapidly during the first months, he uses up what you gave him." "You give the baby some iron, but it is not enough to sustain him after birth."

Correct response: "Because the baby grows rapidly during the first months, he uses up what you gave him."

The parents of a 6-year-old child 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? "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is characterized by the loss of surface area on the red blood cell membrane." "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."

Correct response: "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason."

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

Correct response: "She has been down, but playing in soccer camp will cheer her up."

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? Ask the parent if he or she has questions about the plan of care. Provide diversional activities for the child. Implement strategies to address the child's pain. Contact the health care provider to meet with the parent.

Correct response: Implement strategies to address the child's pain. Explanation: In this case, the nurse's priority is to address the child's pain. The child is already receiving IV fluids and oxygen. That, in combination with analgesia, will assist in resolving the crisis. Asking the parent if he or she has questions, asking the health care provider to meet with the parent, and providing distraction for the child are all appropriate interventions, but the priority is to address the child's pain.

What nursing action should the nurse take when caring for a child with aplastic anemia? provide toys that do not have sharp corners or edges encourage visits from friends and family assess the child's blood pressure every hour assure the child is offered a low-fiber diet

Correct response: • provide toys that do not have sharp corners or edges Explanation: For a child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Toys and games with sharp edges/corners may injure the child during play. The low level of platelets would cause bleeding. High-fiber foods would be offered to prevent anal fissures associated with constipation. The child's blood pressure would not be assessed every hour because the inflation of the cuff would cause bruising/injury. Visitors would be limited to avoid exposing the child to visitors who are sick or ill.

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 blood factor? Factor X Factor XIII Factor VIII Factor V

Factor VIII

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 statement made by the caregivers is correct regarding giving ferrous sulfate? "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." "When I give my son ferrous sulfate I know he also needs potassium supplements." "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 results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.