Chapter 46-Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

25. An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL

8250ml

10. The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching?

A) "I can have the nurse administer the chelation therapy if I am uncomfortable."

24. The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply.

A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis

12. When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type?

A) Hemoglobin A

26. The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply.

A) Packed RBC transfusions B) Deferoxamine therapy

1. The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 μg/dL. Which action would the nurse expect to happen next?

A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered

14. When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority?

A) Risk for injury

19. 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?

A) Spooned nails

20. The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply.

A) Tuna B) Salmon C) Tofu E) Dried fruits

27. A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following?

A) X-linked recessive inheritance

22. 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?

B) "Because the baby grows rapidly during the first months, he uses up what you gave him."

3. The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?

B) "He can resume participation in football in 2 weeks."

18. A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results?

B) Blood transfusion 1 month ago

4. The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess?

B) Frontal bossing

16. A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered?

B) Intravenous immune globulin

21. A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?

B) Pernicious anemia

13. The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned?

B) RBC: 2.8 × 106/mm3

9. A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following?

B) The child has mild to moderate iron deficiency. administration.

6. The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching?

C) "We should administer desmopressin as often as needed."

23. 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 indicates the need for additional teaching?

C) "We will place the liquid in the front of her gums, just below her teeth."

2. A nurse is conducting a physical examination of a 5-year-old with suspected irondeficiency anemia. How would the nurse evaluate for changes in neurologic functioning?

C) "Will you show me how you walk across the room?"

17. The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned?

C) Eosinophils: 10%

15. The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder?

C) Positive fibrin split products

11. The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting?

C) Thrombocytes

5. The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching?

D) "My son can never take penicillin for an infection."

8. The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate?

D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

7. The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management?

D) Initiate pain assessment with a standardized pain scale.