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ANS: B Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

1. When teaching the parents of a young child about iron deficiency anemia, the nurse would tell them that a rich source of iron is: a. an egg white. b. cream of Wheat. c. a banana. d. a carrot.

ANS: electrophoresis

32. The nurse confirms that sickle cell trait can be distinguished from sickle cell disease by a lab test called ________________.

ANS: B A soft toothbrush reduces capillary damage and mucous membrane breakdown, and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

16. The nurse would include in a teaching plan about mouth care of a child receiving chemotherapy to: a. use commercial mouthwash. b. clean teeth with a soft toothbrush. c. avoid use of a Water-Pik. d. inspect the mouth weekly for ulcerations.

ANS: C Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

10. A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. The nurse recognizes that the type of crisis the child is most likely experiencing is: a. aplastic. b. hyperhemolytic. c. vaso-occlusive. d. splenic sequestration.

ANS: B Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

11. The statement made by a parent indicating understanding of health maintenance of a child with sickle cell disease is: a. "I should give my child a daily iron supplement." b. "It is important for my child to drink plenty of fluids." c. "He needs to wear protective equipment if he plays contact sports." d. "He shouldn't receive any immunizations until he is older."

ANS: A This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification.

17. A 6-year-old with leukemia asks, "Who will take care of me in heaven?" The best response for the nurse to make is: a. "Who do you think will take care of you?" b. "Your grandparents and God will take care of you." c. "Your mom will know more about that than I do." d. "Why are you asking me that?"

ANS: C The preschooler views death as reversible and temporary.

18. When dealing with a preschool-age child with a life-threatening illness, the nurse should remember that at this age the child's concept of death includes: a. that it is final. b. only a fear of separation from her parents. c. that a person becomes alive again soon after death. d. an understanding based on simple logic.

ANS: A, B, D, E The COPP medical regimen includes the combination of cyclophosphamide, vincristine (Oncovin), prednisone, and procarbazine hydrochloride.

30. The nurse explains that the COPP medical regimen for the treatment of Hodgkin's disease uses a combination of which drugs? Select all that apply. a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride

ANS: A When bleeding occurs, the traditional approach is to follow RICE—rest, ice, compression, and elevation.

5. A 2-year-old child has been diagnosed with hemophilia A. The information the nurse would include in a teaching plan about home care would be: a. if bleeding occurs, apply pressure, ice, elevate, and rest the extremity. b. children's aspirin in lowered doses may be given for joint discomfort. c. a firm, dry toothbrush should be used to clean teeth at least twice a day. d. do not permit interactive play with other children.

ANS: B Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

6. The nurse would teach the parents of a child with a low platelet count to avoid: a. ibuprofen. b. aspirin. c. caffeine. d. prednisone.

ANS: A The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

7. A child who is receiving a transfusion should be closely assessed for: a. fever. b. lethargy. c. jaundice. d. bradycardia.

ANS: C The sickle cell gene is inherited from both parents; therefore each offspring has a one in four chance of inheriting the disease.

12. A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease? a. Every fourth child will have the disease; two others will be carriers. b. All of their children will be carriers, just as they are. c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier. d. The risk levels of their children cannot be determined by this information.

ANS: D As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

13. A child with thalassemia major receives blood transfusions frequently. The nurse is aware that a complication of repeated blood transfusions is: a. hemarthrosis. b. hematuria. c. hemoptysis. d. hemosiderosis.

ANS: cardiac arrhythmias Cold blood entering the heart via a central line can trigger an irregular heartbeat.

33. To prevent ________________ ________________ the nurse warms the blood that is to be given as a transfusion through a central line.

ANS: D Christmas disease, or hemophilia B, is caused by the deficiency of factor IX.

4. The nurse clarifies that the deficiency of factor IX results in: a. thalassemia. b. idiopathic thrombocytopenic purpura. c. hemophilia A. d. Christmas disease.

ANS: D An overproduction of immature white blood cells increases the child's susceptibility to infection.

14. A child has just been diagnosed with acute lymphoblastic leukemia. The nurse is aware that the result of an overproduction of immature white blood cells in the bone marrow is: a. decreased T-cell production. b. decreased hemoglobin. c. increased blood clotting. d. increased susceptibility to infection.

ANS: D If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

15. When the child receiving a transfusion complains of back pain and itching, the nurse's initial action would be to: a. notify the charge nurse. b. disconnect intravenous lines immediately. c. give diphenhydramine (Benadryl). d. clamp off blood and keep line open with normal saline.

ANS: A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

19. The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. The lab value that would be consistent with these symptoms is: a. platelet count of 25,000/mm3. b. hemoglobin level of 8 g/dL. c. hematocrit level of 36%. d. leukocyte count of 14,000/mm3.

ANS: A Because cow's milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

2. The statement by a mother that may indicate a cause for her 9-month-old having iron deficiency anemia is: a. "Formula is so expensive. We switched to regular milk right away." b. "She almost never drinks water." c. "She doesn't really like peaches or pears, so we stick to bananas for fruit." d. "I give her a piece of bread now and then. She likes to chew on it."

ANS: A Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

20. The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. Also, there is no record of a bowel movement for the last 2 days. These assessment findings suggest the possibility of: a. peripheral neuropathy. b. stomatitis. c. myelosuppression. d. hemorrhage.

ANS: D The nurse should encourage the adolescent to express her feelings and concerns.

21. The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." The most appropriate nursing response to this comment is: a. "I understand how you must feel." b. "You shouldn't feel that way." c. "Is this the strongest feeling you've had today?" d. "Tell me what's got you scared."

ANS: A The child with neutropenia is at risk for infection.

22. The most recent blood count for a child who received chemotherapy last week shows neutropenia. The priority nursing diagnosis for this child is: a. risk for infection. b. risk for hemorrhage. c. altered skin integrity. d. disturbance in body image.

ANS: C Hearing is intact even when there is a loss of consciousness.

23. The nurse takes into consideration an important focus of nursing care for the dying child and the family, which is that: a. nursing care should be organized to minimize contact with the child. b. adequate oral intake is crucial to the dying child. c. families should be made aware that hearing is the last sense to stop functioning before death. d. it is best for the family if the nursing staff provides all of the child's care.

ANS: B Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.

24. The nurse takes into consideration that hemophilia A is a congenital disorder that is: a. seen in males and females equally. b. transmitted by symptom-free females. c. a sex-linked dominant trait. d. a defective gene located on the Y chromosome.

ANS: A, B, C, D, E All options are potential benefits to including the sibling in the care of a dying child.

25. Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? Select all that apply. a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel less helpless. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.

ANS: A, B, C, D Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.

26. What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease? Select all that apply. a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development

ANS: A, B, C, D, E All of the options are classic signs of thalassemia major.

27. What are the classic symptoms of thalassemia major (Cooley's anemia)? Select all that apply. a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Cardiac failure

ANS: A, B, D, E The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.

28. How has synthetic recombinant antihemophilic factor improved the management of hemophilia? Select all that apply. a. Eliminates the need for frequent transfusions b. Can be administered by family at home c. Prevents hemorrhage d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission

ANS: A, B, C, E Support groups are helpful for emotional support and realistic tips on care. The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization.

29. The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the child's care? Select all that apply. a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases

ANS: B Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

3. The nurse would instruct the parent to give ferrous sulfate drops to the child: a. with milk. b. with orange juice. c. with water. d. on a full stomach.

ANS: hemoglobin S Hemoglobin S is the abnormal hemoglobin that makes red blood cells fragile and causes the walls of the cells to collapse, giving them the characteristic sickle shape.

31. The nurse shows slides of red blood cells from a child with sickle cell disease, noting that in addition to their sickle shape, the cells contain the abnormal element of ______________ _____.

ANS: A When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

8. On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. The priority nursing intervention is: a. assessing neurological status. b. inserting an intravenous line. c. monitoring vital signs during platelet transfusions. d. providing family education about how to prevent bleeding.

ANS: C Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkin's disease.

9. An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. The disease is in stage: a. I. b. II. c. III. d. IV.