Pediatric Hematologic Disorders (Practice Questions)

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? "We should administer desmopressin as often as needed." "We should be aware that she may suffer from menorrhagia." "We need to administer Stimate (desmopressin) prior to dental work." "We understand that she may have frequent nosebleeds."

"We should administer desmopressin as often as needed." Explanation: The parents need to know that desmopressin spray Stimate is used for controlling bleeding; the other brands are used for homeostasis and enuresis. Additionally, Stimate should only be used for 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.

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

-Expect menstrual bleeding to be heavy. Explanation: 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.

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: -factor IX. -platelets. -factor VIII. -plasmin.

-factor VIII. Explanation: In hemophilia A, the problem is with factor VIII, and in hemophilia B the problem lies with factor IX. Platelets are problematic in idiopathic thrombocytopenic purpura (ITP). Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.

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? -"Swimming would be a great activity." -"He can resume participation in football in 2 weeks." -"We should avoid aspirin and drugs like ibuprofen." -"Our son cannot take any antihistamines."

-"He can resume participation in football in 2 weeks." Explanation: The nurse must emphasize to the parents that they need to prevent trauma to their son by avoiding activities that may cause injury. Participation in contact sports like football is not recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be avoided because they could precipitate anemia. Swimming, a noncontact sport, is an appropriate choice.

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 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." -"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 primarily an autoimmune disease in which 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. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. 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 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." -"Males are much more likely to have the disease than females." -"The trait or the disease is seen in one generation and skips the next generation." -"If the trait is inherited from both parents the child will have the disease."

-"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 black clients. Either sex can have the trait and disease.

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

-"Our family is taking a fun hiking trip up in the mountains next week." Explanation: 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 preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? -"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 put her legs up on pillows when her knees start to hurt." -"I bought the medication to give to her when she says she is in 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.

A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? -"The sickle shape of red blood cells decreases oxygen to tissues." -"This is a hereditary disease that is transmitted by one affected gene." -"Fluid restriction is necessary to control sickle cell anemia." -"Sickle cell anemia is common in people of Asian descent."

-"The sickle shape of red blood cells decreases oxygen to tissues." Explanation: The sickle shape of the red blood cells impedes the flow of blood through the vessels, thus causing hypoxia to the tissues. Sickle cell anemia is a hereditary disease but it is autosomal recessive, meaning it requires two genes in order for the disease to be transmitted. Sickle cell anemia is common in people of African, Mediterranean, and Indian descent. Hydration is important to controlling sickle cell anemia. Dehydration is a trigger for sickle cell crisis.

A nurse is reviewing the above laboratory results for a 6-year-old child during a pediatric clinic visit. Based on the laboratory results, what question is most appropriate for the nurse to ask the parents? -"Has your child been exposed to any illnesses lately?" -"Have you noticed any unexplained bruising on your child?" -"What has your child's activity level been like recently?" -"Have you noticed any color changes in your child's bowel movements?"

-"What has your child's activity level been like recently?" Explanation: The hemoglobin/hematocrit levels and red blood cell count indicate anemia. Anemia can cause fatigue, hence the most appropriate question would be to ask about the child's activity level. If the white blood cell count was high, that might indicate infection. Unexplained bruising would be reflected in a low platelet count (178 ×103/μL; 178 ×109/L is the low end of normal).

The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air. The nurse receives orders for the child. Click to highlight the order(s) that needs to be implemented immediately. Orders: -Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). -Administer oxygen to maintain oxygen saturation greater than 95%. -Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. -Administer 100 mcg/kg morphine IV for pain prn q4 hours. -Initiate a regular diet as tolerated.

-Administer oxygen to maintain oxygen saturation greater than 95%. -Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. -Administer 100 mcg/kg morphine IV for pain prn q4 hours. Explanation: Nursing interventions should always be prioritized according to the ABCs (airway, breathing, circulation). Because the child's oxygen saturation is only 92% on room air, the nurse should apply oxygen to achieve an oxygen saturation of 95% or greater. After implementing measures to ensure a patent airway, the nurse should address circulation. In sickle cell crisis, the red blood cells (RBCs) clump together blocking microcirculation, which causes pain due to ischemia. The nurse should start intravenous (IV) fluids to prevent clumping of the RBCs to improve circulation. The child is reporting pain that is a 10 out of 10. The child will require an intravenous (IV) opioid analgesic such as morphine. The child's temperature is slightly elevated at 99.8°F (37.6°C). This is most likely due to dehydration (water is cooling, and less water in the body will increase the temperature slightly). Therefore, acetaminophen does not need to be administered. Initiating a regular diet at this time is not a priority. The child's respiratory rate of 18 breaths/min are within normal limits.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. -Promoting exercise and activity -Administering analgesics -Administering oxygen -Administering platelets -Maintaining fluid intake

-Administering analgesics -Administering oxygen -Maintaining fluid intake Explanation: A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system. Platelet administration is not indicated as part of the treatment. Children and adults experiencing a sickle cell crisis experience a high degree of pain, so exercise and activity is postponed until the crisis is over. Activity is encouraged when the child is not in crisis as it promotes growth and a positive self-image.

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? -Apply direct pressure to the area. -Apply heat to the site of bleeding. -Administer factor VIII replacement. -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.

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching? -Ensure a consistent and daily intake of adequate fluids to prevent dehydration. -Suggest the child participate in sports activities without restriction. -Remind parents that the child should avoid immunizations to prevent the introduction of bacteria into the body. -Treat upper respiratory infections with over-the-counter medication.

-Ensure a consistent and daily intake of adequate fluids to prevent dehydration. Explanation: Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine health care such as immunizations should be provided in order to prevent common childhood illnesses.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client? -Handle the child gently when transferring to a stretcher. -Mark the client's chart to receive no analgesia. -Do not allow a dressing to be applied postoperatively. -Caution the child not to brush the teeth before surgery.

-Handle the child gently when transferring to a stretcher. Explanation: Hemophilia is a group of X-linked recessive disorders that prevent clot formation. The best care for the child is to prevent any bruising or bleeding so gentle handling when moving the child from the stretcher is necessary. Because the child is having surgery, infusion of clotting agents will be necessary. Analgesia will be needed postoperatively as will surgical dressings. IM injections are contraindicated because of potential bleeding. Brushing the teeth is part of normal daily hygiene.

A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? -Metabolic screening test -Hemoglobin level -Leukocyte level -Thrombocyte level

-Hemoglobin level Explanation: The component of red blood cells (RBCs) that allows them to carry out the transport of oxygen is hemoglobin, composed of the protein globin 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 clinically apparent until this hemoglobin change has occurred (at approximately 6 months of age). Leukocyte and thrombocyte levels are not typically tested in clients with sickle cell anemia. Metabolic screening is a test completed on newborns to assess for common metabolic disorders, such as sickle cell anemia, hypothyroidism, and phenylketonuria (PKU). However, this test is used to diagnose, not determine symptom severity or prognosis.

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? -Contact the health care provider to meet with the parent. -Implement strategies to address the child's pain. -Provide diversional activities for the child. -Ask the parent if he or she has questions about the plan of care.

-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.

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

-Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura (ITP) results from an immune response following a viral infection that produces antiplatelet antibodies. These antibodies destroy the platelets which cause petechiae, purpura, and excessive bleeding. ITP does not affect the kidneys. Breathing difficulties would not occur with decreased white blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than other children who are healthy.

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 what as a factor? -Respiratory distress -Infection -Pallor -Fluid overload

-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.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? -Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. -Use guided imagery and therapeutic touch. -Initiate pain assessment with a standardized pain scale. -Administer meperidine as ordered.

-Initiate pain assessment with a standardized pain scale. Explanation: The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3 μl (18,000 x 109/L). Which medication would the nurse most likely expect to be ordered? -Dimercaprol -Folic acid -Intravenous immune globulin -Deferoxamine

-Intravenous immune globulin Explanation: Intravenous immune globulin would be used to treat idiopathic thrombocytopenic purpura. Folic acid is used to treat folic acid deficiency anemia. Dimercaprol is used to remove lead from the soft tissue and bone to allow for excretion by the kidneys. Deferoxamine is used to treat iron toxicity.

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority? -Maintaining fluids through an intravenous line -Encouraging the child to take deep breaths hourly -Seeing that the child ingests a protein-rich diet -Beginning active range-of-motion exercises

-Maintaining fluids through an intravenous line Explanation: Sickle cells clump together and prevent normal blood flow. This leads to tissue hypoxia. With a vaso-occlusive crisis, the cells are clumped together and prevent blood flow to the joint or organ. The blood with the clumped sickled cells is very viscous. Adequate hydration is crucial in relieving the problems of a vaso-occlusive crisis. The hydration dilutes the blood and decreases the viscosity. During a crisis the recommended fluid intake (IV and PO) is 150 ml/kg/day. During a vaso-occlusive crisis, the child has severe pain. The goal is to get the pain under control and increase blood flow. Range-of-motion exercises will add to the increased pain during this period of time, so should not be started until crisis in under control. The diet and hourly deep breaths are important, but they are not crucial to correcting the crisis.

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included? -Not to pick or irritate the nose -To apply a soothing cream to lesions -What foods are high in folic acid -To use mainly cold water to wash

-Not to pick or irritate the nose Explanation: Idiopathic thrombocytopenic purpura (ITP) occurs as an immune response following a viral infection. It produces antiplatelet antibodies that destroy platelets. This leads to the classic symptoms of petechiae, purpura, and excessive bruising. Without adequate platelets, children bleed easily from lesions. If the child "picks" the nose, an area could be opened and bleeding could occur. Folic acid will have no effect on the disease process. The lesions are not itchy and are open or draining, so cold water washing and soothing lotions are not required.

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

-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.

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? -Ineffective breathing pattern related to decreased white blood count -Risk for bleeding related to insufficient platelet formation -Risk for altered urinary elimination related to kidney impairment -Risk for infection related to abnormal immune system

-Risk for bleeding related to insufficient platelet formation Explanation: Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.

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

-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 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. What activity would be the safest for the nurse to suggest? -Swimming -Rugby -Gymnastics -Soccer

-Swimming Explanation: Swimming, a noncontact 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.

In caring for a child with sickle cell disease, the highest priority goal is: -the family will verbalize understanding of the disease crisis. -the child's skin integrity will be maintained. -The child's fluid intake will improve. -the caregiver's anxiety will be reduced.

-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 caregiver's anxiety, and increasing the caregiver's knowledge about the causes of crisis episodes — but these goals are not the highest priority.

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? -lowering extremities -exercise -heat -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.

A child has a history of sickle cell anemia, and is brought to the emergency department with reports of generalized pain for several hours. The nurse completes an assessment with the above results. The nurse suspects the child is experiencing a vaso-occlusive crisis. Which assessment finding best supports the nurse's suspicion? -temperature -dactylitis -oxygen saturation -pale mucous membranes

-dactylitis Explanation: A hallmark of a vaso-occlusive crisis is dactylitis, which results from the sickled red cells and increased blood viscosity. This process prevents blood flow to the hands or feet resulting in swelling and pain. The increased temperature due to an infection is a probable trigger to the crisis. Pale mucous membranes are the result of decreased hemoglobin level. The oxygen saturation is just under the desired threshold (93%) and is also due to decreased hemoglobin.

The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority? -antibiotic administration -pain relief -oxygen administration -emergent transfusion

-emergent transfusion Explanation: Acute splenic sequestration can rapidly progress to cardiovascular collapse and death. Prepare the child for emergent transfusion with packed red blood cells. Pain relief would be a priority for a vaso-occlusive crisis. Antibiotic administration would be a priority for a febrile child with sickle cell disease. Oxygen administration would be a priority for a child with acute chest syndrome (a vaso-occlusive crisis).

When caring for a 7-year-old client diagnosed with sickle cell anemia, which clinical manifestation will the nurse report to the health care provider first? -respiratory rate 23 breaths/min -facial droop -hemoglobin level of 10 g/dl (100 g/L) -dactylitis of the hands and feet

-facial droop Explanation: The nurse would first report any signs or symptoms that can indicate a life-threatening situation is occurring. A facial droop is a potential sign of a stroke or silent cerebral ischemia, which is life-threatening and requires emergent care. Sickle cell disease causes chronic anemia, with a hemoglobin level of 6 to 9 g/dl (60 to 90 g/L) with a normal level in a child at 11 to 13 g/dl (110 to 130 g/L). 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), swelling of the hands and feet (dactylitis), and increased respirations.

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 lab tests? -hemoglobin electrophoresis -peripheral blood smear -erythrocyte sedimentation rate -reticulocyte count

-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).

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

-notify a health care provider if the child develops an upper respiratory infection. Explanation: Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron will not correct the anemia.

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply. -severe dizziness -constipation -chest pain -sudden change in vision -irritability

-severe dizziness -chest pain -sudden change in vision Explanation: The parents should contact the primary health care provider if the child develops a fever, dizziness or severe headaches, severe stomach pain or swelling, sudden changes in vision, weakness, or loss of consciousness. There is no need to notify the primary health care provider if the child develops constipation or irritability.

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects: -sickle cell disease. -idiopathic thrombocytopenic purpura (ITP). -Cooley anemia. -hemophilia.

-sickle cell disease. Explanation: Symmetrical swelling of the hands and feet in the infant or toddler is termed dactylitis; aseptic infarction occurs in the metacarpals and metatarsals and is often the first vaso-occlusive event seen with sickle cell disease. Symmetrical swelling of the hands and feet are not typically seen with the other conditions listed.

A child diagnosed with idiopathic thrombocytopenic purpura (ITP) is scheduled to receive an infusion of intravenous immunoglobulin (IVIG) due to low platelet counts. Prior to the infusion, the nurse administers acetaminophen to the child. The nurse would explain to the parents that acetaminophen is administered to obtain which expected outcome? -to decrease fever produced from the medication -to reduce any pain at infusion site -to relax the child during drug infusion -to prevent chills from developing

-to decrease fever produced from the medication Explanation: For the child with ITP, the administration of IVIG is warranted, if the platelet counts decrease below 10,000 mm3 (10 ×109/L). IVIG produces large amounts of antibodies and will improve the platelet count. IVIG is considered a blood product. During administration, antipyretics may be given to reduce fever and pain from the flulike symptoms that can develop. Antihistamines are given to prevent or reduce chills. The nurse would monitor fever, vital signs, and any other adverse reactions that could occur from this medication or any blood product.

The nurse is caring for a child with idiopathic thrombocytopenic purpura (ITP). Which assessment finding requires immediate notification of the health care provider? Select all that apply. -vomiting -petechiae -lethargy -purpura -headache

-vomiting -lethargy -headache Explanation: The child with idiopathic thrombocytopenic purpura (ITP) is expected to have petechiae and purpura (bruising), which would not require notification of the health care provider. Headache, vomiting, and lethargy indicate possible intracranial hemorrhage and should be reported to the health care provider.