Pediatrics Quiz 3

Laboratory studies are performed for a child suspected to have IDA. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? a. Elevated hemoglobin level. b. Decreased reticulocyte count. c. Elevated red blood cell count. d. Red blood cells that are microcytic and hypochromic.

Answer: d. Rationale: The results of a CBC in children with IDA show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's records should the nurse question? Select all that apply. 1. Restrict fluid intake. 2. Position for comfort. 3. Avoid strain on painful joints. 4. Apply nasal oxygen at 2 L/minute. 5. Provide a high calorie, high-protein diet. 6. Give meperidine 25 mg IV q 4 hours prn pain.

Answer: 1, 6 Rationale: Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine is a CNS stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Positioning for comfort, avoiding strain on painful joints, oxygen and a high-calorie and high-protein diet are also important parts of the treatment plan.

The nursing student is presenting a clinical conference and discusses the cause of B-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these? a. A child of Mexican descent. b. A child of Mediterranean descent. c. A child whose intake of iron is extremely poor. d. A breast-fed child of a mother with chronic anemia.

Answer: b. Rationale: B-Thalassemia is an autosomal recessive disorder characterized by the reduced production of 1 of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with B-thalassemia major). This disorder is found primarily in individuals of Mediterranean descent.

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? a. Administer iron at mealtimes. b. Administer the iron through a straw. c. Mix the iron with cereal to administer. d. Add the iron to formula for easy administration.

Answer: b. Rationale: In IDA, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at that back of the mouth because the iron stains the teeth. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not added to formula or mixed with cereal or other food items.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? a. Stress. b. Trauma c. Infection. d. Fluid overload.

Answer: d Rationale: Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1-1/2 to 2 times the daily requirement to prevent dehydration.

What is the most striking laboratory finding in diagnosing Beta-thalassemia?

Extremely low hematocrit, which can fall to less than 10% of normal if not treated with transfusions.

What is the relationship of HgbF (fetal hgb) and HgbS (sickle hgb)?

Fetal hemoglobin (HgbF) is present for the first 6 months of life and does not sickle. After that, the infant acquires sickled hemoglobin (HgbS).

What is pancytopenia?

Pancytopenia is a deficiency of all three cellular components of the blood (red cells, white cells & platelets).

A child with B-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? a. Fragmin. b. Meropenem. c. Metoprolol. d. Deferoxamine.

Answer: d. Rationale: The major complication of long-term transfusion therapy is hemosiderosis. To prevent organ damage from too much iron, chelation therapy with either Exjade or deferoxamine may be prescribed. Deferoxamine is classified as an antidote for acute iron toxicity. Fragmin is an anticoagulant used as prophylaxis for DVT. Meropenem is an antibiotic. Metoprolol is a beta blocker used to treat HTN.