PEDs Chapt 25 Nursing Care of the Child with a Hematologic Disorder
Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? a) Proconvertin b) Christmas factor c) Antihemophilic factor d) Stuart factor
Christmas factor Correct Explanation: Factor IX is also known as plasma thromboplastin component or Christmas factor; factor X is Stuart factor; factor VIII is antihemophilic factor; and factor VII is proconvertin.
The nurse is caring for a 10-year-old girl with iron toxicity. Which of the following would the nurse expect the physician to order? a) Succimer b) Desferal c) Dimercaprol d) Edentate calcium disodium
Desferal Correct Explanation: Desferal is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dL. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edentate calcium disodium is indicated for blood lead levels greater than 45 mcg/dL. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dL; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.
The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. Which of the following would be a priority? a) Emergent transfusion b) Antibiotic administration c) Oxygen administration d) Pain relief
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).
An 11-year-old male is diagnosed with mild hemophilia. Upon assessment, the nurse documents the following factor level for this category of hemophilia: a) Factor level greater than 50% b) Factor level of 1% to 5% c) Factor level of 5% to 50% d) Factor level less than 1%
Factor level of 5% to 50% Correct Explanation: Mild hemophilia is characterized by a factor level of 5% to 50%. People with mild hemophilia experience prolonged bleeding only when injured. Thus, their condition may not be diagnosed unless they have trauma or surgery.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Ineffective breathing pattern related to decreased white blood count b) Risk for infection related to abnormal immune system c) Ineffective tissue perfusion related to poor platelet formation d) Risk for altered urinary elimination related to kidney impairment
Ineffective tissue perfusion related to poor platelet formation Correct Explanation: Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur.
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for which of the following? a) Priapism b) Seizures c) Leg ulcers d) Behavioral addiction
Seizures Correct Explanation: Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the narcotic is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.
The nurse is teaching an in service program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? a) "If the trait is inherited from both parents the child will have the disease." b) "The trait or the disease is seen in one generation and skips the next generation." c) "Males are much more likely to have the disease than females." d) "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." Correct 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 African Americans. Either sex can have the trait and disease.
The child has been diagnosed with severe iron deficiency anemia. The child requires 5 mg/kg of elemental iron per day in three equally divided doses. The child weighs 47.3 pounds. How many milligrams of elemental iron should the child receive with each dose? Round to the nearest whole number. ______ mg
36 Correct Explanation: 47.3 pounds x 1 kg/2.2 pounds = 21.5 kg 21.5 kg x 5 mg/1 kg = 107.5 mg/day 107.5 mg/3 doses = 35.8333 mg/dose Rounded to the nearest whole number = 36 mg
A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is which of the following? a) Autologous b) Allogenic c) Syngeneic d) Heterologous
Allogenic Explanation: Stem cell transplantation can be allogeneic, syngeneic, or autologous. Allogeneic transplantation is the transfer of stem cells from an immune-compatible (histocompatible) donor, usually a sibling, or from a national cord blood bank or national volunteer donor registry. Syngeneic transplantation (rare) involves a donor and recipient who are genetically identical (are identical twins). Autologous transplantation involves use of the child's own stem cells removed from cord blood banked at the time of the child's birth. Heterologous is not a type of stem cell transplantation.
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which of the following would the nurse be least likely to include to manage a bleeding episode? a) Give Factor VIII replacement b) Apply heat to the site of bleeding c) Apply direct pressure until the bleeding stops d) Elevate injured extremities
Apply heat to the site of bleeding. Correct 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? a) Football b) Baseball c) Wrestling d) Soccer
Baseball Correct Explanation: Children with hemophilia should stay active. Good physical activities would be swimming, baseball, basketball, and bicycling (with a helmet). He would still need to be careful about falls and sliding into base. Intense contact sports like football, wrestling, and soccer should be avoided.
Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include: a) Heat b) Lowering extremities c) Compression d) Exercise
Compression Correct 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.
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 which of the following? a) Plasmin b) Factor IX c) Platelets d) Factor VIII
Factor VIII Correct Explanation: In hemophilia A, the problem is with factor VIII, and in hemophilia B it is factor IX. Platelets are problematic in idiopathic thrombocytopenia purpura. Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.
In hemophilia A, the classic form, only females manifest a bleeding disorder. a) False b) True
False Correct Explanation: The classic form of hemophilia is caused by deficiency of the coagulation component factor VIII, the antihemophilic factor, and transmitted as a sex-linked recessive trait. In the United States, the incidence is approximately 1 in 10,000 white males. A female carrier may have slightly lowered but sufficient levels of the factor VIII component so that she does not manifest a bleeding disorder. Males with the disease also have varying levels of factor VIII; their bleeding tendency varies accordingly, from mild to severe.
A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which of the following assessments would best help you determine that he is actually taking it daily? a) His reticulocyte count will have decreased. b) He will develop diarrhea. c) He will be less irritable than he was at his last visit. d) His stools will appear black.
His stools will appear black. Explanation: A side effect of ferrous sulfate therapy is to color stools black.
The child with Thalassemia may be given which of the following classifications of medications to prevent one of the complications frequently seen with the treatment of this disorder. a) Potassium supplements b) Factor VIII preparations c) Iron-chelating drugs d) Vitamin supplements
Iron-chelating drugs Correct Explanation: Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate (Desferal) may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.
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 which of the following? a) Poikilocytosis b) Purpura c) Petechiae d) Ecchymosis
Petechiae Correct Explanation: Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia.
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. Which of the following would be the safest for the nurse to suggest? a) Rugby b) Swimming c) Gymnastics d) Soccer
Swimming Correct Explanation: Swimming, a noncontact sport or 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.
The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which of the following disorders? a) Sickle cell disease b) Hemophilia c) Kawasaki disease d) Thalassemia
Thalassemia Explanation: In the child with Thalassemia the skin may appear bronze-colored or jaundiced. The child with hemophilia may have bruised areas on the skin. The skin color in children with sickle cell disease may be pale in color, and with Kawasaki disease the child may have a rash on the trunk and extremities.
A child who weighs 22 pounds is to receive a blood transfusion. The nurse would expect to administer _____ of the blood transfusion in an hour? _____ milliliters
The child weighs 22 pounds, which is equivalent to 10 kg. The recommended rate of infusion is 10 mL/kg/hour. A child who weighs 10 kg would receive 100 mL in an hour.
A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. The nurse recognizes that which of the following is the likely cause of this type of anemia? a) Sickle-cell disorder b) Vitamin B12 deficiency c) Acute blood loss d) Iron deficiency
Vitamin B12 deficiency Explanation: Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they are ingesting a long-term, poorly formulated vegetarian diet as the vitamin is found primarily in foods of animal origin.
A child with hypoplastic anemia develops hemosiderosis. The therapy for this is a) ferrous sulfate. b) deferoxamine. c) aspirin. d) prednisone.
deferoxamine. Correct Explanation: Hemosiderosis is deposition of iron into tissue. A chelating agent, such as deferoxamine, removes it from tissue.
When planning care for a child with idiopathic thrombocytopenic purpura, you plan to teach her a) to apply a soothing cream to lesions. b) to use mainly cold water to wash. c) not to pick or irritate her nose. d) what foods are high in folic acid.
not to pick or irritate her nose. Correct Explanation: Without adequate platelets, children bleed easily from lesions.
A boy with hemophilia A is scheduled for surgery. Which of the following precautions would you institute with him? a) Caution him not to brush his teeth before surgery. b) Mark his chart for him to receive no analgesia. c) Do not allow a dressing to be applied postoperatively. d) Handle him gently when transferring him to a stretcher.
Handle him gently when transferring him to a stretcher. Correct Explanation: Gentle handling can reduce bruising. Analgesia will be needed postoperatively; IM injections are contraindicated because of potential bleeding.
When assessing a child for a possible hematologic disorder, which of the following would the nurse need to keep in mind as most important? a) Multiple body sites can be affected. b) A child's nutritional status is key. c) Demographic data is of little relevance. d) Sequelae are rare with chronic problems.
Multiple body sites can be affected. Correct 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.
In caring for a child with sickle cell disease, the highest priority goal is which of the following? a) The child's fluid intake will improve. b) The child's skin integrity will be maintained. c) The family caregivers' anxiety will be reduced. d) The family will verbalize understanding of of the disease crisis.
The child's fluid intake will improve. Correct 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 caregivers' anxiety, and increasing the caregivers' knowledge about the causes of crisis episodes, but these goals are not the highest priority.
You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is a) slightly yellow sclerae. b) increased growth of long bones. c) enlarged mandibular growth. d) depigmented areas on the abdomen.
slightly yellow sclerae. Correct Explanation: Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from breakdown of damaged cells.
The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver's question, the nurse would explain that for the child with sickle cell disease, it is best that the child have: a) 1,500 to 2,000 mL of fluid per day b) 300 to 800 mL of fluid per day c) 1,000 to 1,200 mL of fluid per day d) 2,500 to 3,200 mL of fluid per day
1,500 to 2,000 mL of fluid per day Correct Explanation: Prevention of crises is the goal between episodes. Adequate hydration is vital; fluid intake of 1,500 to 2,000 mL daily is desirable for a child weighing 20 kg and should be increased to 3,000 mL during the crisis.
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 of the following symptoms should the nurse most expect as a result of excessive iron deposits? a) An enlarged heart b) An enlarged spleen c) Enlarged lymph nodes d) An enlarged thyroid gland
An enlarged spleen Correct Explanation: The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits and fibrotic scarring in the liver and the spleen's increased attempts to destroy defective RBCs.
Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include: a) Heat b) Lowering extremities c) Exercise d) Compression
Compression Correct 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 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 of the following blood factors? a) Factor V b) Factor VIII c) Factor XIII d) Factor X
Factor VIII Correct 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.
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Seeing that he ingests a protein-rich diet b) Beginning active range-of-motion exercises c) Maintaining a fluid intravenous line d) Encouraging him to take deep breaths hourly
Maintaining a fluid intravenous line Correct Explanation: Dehydration increases sickling of cells, so maintaining fluid balance is important.
When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which of the following would the nurse identify as the priority? a) Risk for delayed growth and development b) Deficient fluid volume c) Risk for infection d) Impaired skin integrity
Risk for infection Correct 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 nurse is caring for a 3-year-old boy with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis? a) Serum ferritin b) Hemoglobin electrophoresis c) Reticulocyte count d) Iron test
Serum ferritin Correct Explanation: Serum ferritin is a measure of ferritin (the major iron storage protein) in the blood. It is the most sensitive test for determination of iron-deficiency anemia. Hemoglobin electrophoresis is indicated for sickle cell anemia and thalassemia and measures the percentage of normal and abnormal hemoglobin in the blood. Reticulocyte count measures the number of immature red blood cells (RBCs) in the blood and indicates the bone marrow's ability to respond to anemia with production of RBCs. The iron test evaluates iron metabolism.
A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action? a) 8 mcg/dL b) 14 mcg/dL c) 20 mcg/dL d) 26 mcg/dL
8 mcg/dL Correct Explanation: A blood lead level less than 10 mcg/dL requires no action. A level of 14 mcg/dL would need to be confirmed with a repeat test in 1 month along with parental education for decreased lead exposure and then a repeat test in 3 months. Levels of 20 mcg/dL and 26 mcg/dL need to be confirmed with a repeat test in 1 week along with parental education and a referral to the local health department for investigation of the home for lead reduction.
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). Which of the following would alert the nurse to possible neurologic compromise? a) Widely fluctuating blood pressure b) Equal pupillary response c) Hematuria d) Petechiae
Widely fluctuating blood pressure Explanation: A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure such as wide fluctuations in blood pressure or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.
After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state which of the following? a) "He'll need to have those vitamin shots for the rest of his life." b) "He needs to eat more green leafy vegetables to cure the anemia." c) "He might get constipated from the supplement." d) "We'll need to plan for a bone marrow transplant soon."
"He'll need to have those vitamin shots for the rest of his life." Correct Explanation: Monthly injections of vitamin B12 are required for life. Although diet is important, diet alone will not cure the anemia. Iron used to treat iron-deficiency anemia can lead to constipation. Bone marrow transplant is used to treat aplastic anemia.
The parents of a 6-year-old male 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? a) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." b) "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." c) "ITP is characterized by the loss of surface area on the red blood cell membrane." d) "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 primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Correct 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. 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 mother of Mary Jo, a 10-year-old who had a febrile reaction following a transfusion, asks the nurse: "Why did this happen to my child?" What is the nurse's best response? a) "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." b) "Too much of the blood product was transfused at too rapid a rate." c) "Mary Jo's blood was not compatible with the blood product, causing red blood cell destruction." d) "Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood."
"Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood." Correct Explanation: A febrile reaction is not associated with hemolysis and generally occurs when the recipient has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood. In a hemolytic reaction, the blood product is not compatible with the recipient's blood. An allergic reaction is a nonhemolytic reaction that occurs when the donor blood contains plasma proteins or antigens to which the recipient is hypersensitive.
In discussing the causes of iron deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron deficiency anemia? a) "A family's economic problems are often a cause of malnutrition." b) "Caregivers sometimes don't understand the importance of iron and proper nutrition." c) "Milk is a perfect food, and babies should be able to have all the milk they want." d) "Children have a hard time getting enough iron from food during their first few years."
"Milk is a perfect food, and babies should be able to have all the milk they want." Correct Explanation: Babies with an inordinate fondness for milk can take in an astonishing amount and, with their appetites satisfied, may show little interest in solid foods. These babies are prime candidates for iron deficiency anemia. Many children with iron deficiency anemia, however, are undernourished because of the family's economic problems. A caregiver knowledge deficit about nutrition is often present. Because only 10 percent of dietary iron is absorbed, a diet containing 8 to 10 mg of iron is needed for good health. During the first years of life, obtaining this quantity of iron from food is often difficult for a child. If the diet is inadequate, anemia quickly results.
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 of the following statements made by the caregivers is correct regarding giving ferrous sulfate? a) "I always give the ferrous sulfate with meals." b) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." c) "When I give my son ferrous sulfate I know he also needs potassium supplements." d) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."
"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 re sults, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black
The nurse is teaching the parents of a 4-year-old girl with thalassemia about sound nutritional choices. The nurse asks the mother about good snack choices to send to preschool. Which response by the mother would indicate a need for further teaching? a) "She likes string cheese and saltine crackers." b) "She can bring graham crackers and peanut butter." c) "I can send apple slices with yogurt dip." d) "Yogurt and granola is a good choice."
"She can bring graham crackers and peanut butter." Explanation: Children with thalassemia should avoid foods that are high in iron. Peanut butter is high in iron and should be avoided. Yogurt, granola, string cheese, saltine crackers, and apples are appropriate choices.
A child is to receive oral iron therapy in liquid form three times a day. After teaching the parents about administering the iron, which statement indicates a need for additional teaching? a) "Her bowel movements will probably turn very dark." b) "She can drink the medicine from a medicine cup." c) "We will have her drink water or juice with the medicine." d) "We'll try to give the medicine to her in between milk servings."
"She can drink the medicine from a medicine cup." Explanation: Liquid iron can stain the teeth; therefore, the parents should give the liquid iron through a straw or syringe, placing it toward the back of the child's mouth. Iron turns stools dark. To maximize absorption, it is best to give the iron with water or juice between meals.
The nurse is preparing a child for discharge following a sickle cell crisis. The mother makes the following statements to the nurse. Which statement by the mother indicates a need for further teaching? a) "She has been down, but playing in soccer camp will cheer her up." b) "I put her legs up on pillows when her knees start to hurt." c) "She loves popsicles, so I'll let her have them as a snack or for dessert." d) "I bought the medication to give to her when she complains of pain."
"She has been down, but playing in soccer camp will cheer her up." Correct 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.
The nurse is caring for a 2-year-old with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to his mother. Which statement by the mother indicates a need for further teaching? a) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations." b) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." c) "Delayed growth and development and delayed puberty are chronic manifestations." d) "The acute manifestations, like splenic sequestration, are most often life-threatening."
"The acute manifestations, like splenic sequestration, are most often life-threatening." Explanation: Splenic sequestration is a life-threatening acute manifestation of sickle cell anemia, but some of the chronic manifestations of the disease, such as pulmonary hypertension and restrictive lung disease, are also often life-threatening. Aplastic crisis is a life-threatening acute manifestation. Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations; delayed growth and development and chronic puberty are chronic manifestations.
The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8 years of age. The nurse would recommend a daily iron intake of which amount? a) 6 mg b) 15 mg c) 12 mg d) 10 mg
10 mg Explanation: The recommended daily dietary iron intake for children 1 to 10 years of age is 10 mg. The recommended daily dietary iron intake for children 0 to 6 months of age is 6 mg. The recommended daily dietary iron intake for boys 11 to 18 years of age is 12 mg. The recommended daily dietary iron intake for girls 11 to 18 years of age is 15 mg.
The nurse is reviewing the results of a clotting study for a healthy 6-year-old. Which of the following would the nurse document as a normal prothrombin finding? a) 16.0 to 18.0 seconds b) 21.0 to 35.0 seconds c) 6.0 to 9.0 seconds d) 11.0 to 13.0 seconds
11.0 to 13.0 seconds Correct Explanation: The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.
You are assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a) A 15-year-old girl who has heavy menstrual periods b) An 8-year-old girl who carries her lunch to school c) A 7-month-old boy who has started table food d) A 3-month-old boy who is totally breastfed
A 15-year-old girl who has heavy menstrual periods Correct Explanation: Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.
A nursing instructor describes what happens to the red blood cell after it disintegrates and how bilirubin is formed. Place the events in the order that the instructor would discuss from first to last. Conversion to direct bilirubin Conversion to protoporphyrin Break down into indirect bilirubin Degradation of heme portion Excretion in bile
Degradation of heme portion Conversion to protoporphyrin Break down into indirect bilirubin Conversion to direct bilirubin Excretion in bile Explanation: As the heme portion is degraded, it is converted into protoporphyrin. Protoporphyrin is then further broken down into indirect bilirubin. Indirect bilirubin is fat soluble and cannot be excreted by the kidneys in this state. It is therefore converted by the liver enzyme glucuronyl transferase into direct bilirubin, which is water soluble. This is then excreted in bile.
A nurse caring for an 8-year-old patient with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a patient with: a) Iron deficiency anemia b) von Willebrand disease c) Disseminated intravascular coagulation d) Hemophilia
Disseminated intravascular coagulation Correct Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this patient is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis.
The nurse is caring for a child with leukemia. Which of the following nursing interventions would be the highest priority for this child? a) Following guidelines for protective isolation b) Providing age appropriate activities c) Grouping nursing care d) Encouraging the child to share feelings
Following guidelines for protective isolation Explanation: The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age appropriate activities are important, but psychological issues are a lower priority than physical.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which of the following sites should she prepare? a) Iliac crest b) Sternum c) Femur d) Anterior tibia
Iliac crest Correct Explanation: Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.
The nurse preparing a patient for diagnostic testing for disseminated intravascular coagulation knows that the following is a result indicative of this disease: a) Increased antithrombin III b) Decreased fibrogen/fibrin degradation products c) Increased D-dimer assay d) Decreased fibrinopeptide A level
Increased D-dimer assay Correct Explanation: Results indicative of disseminated intravascular coagulation include: increased D-dimer assay, decreased antithrombin III, increased fibrogen/fibrin degradation products, and increased fibrinopeptide A level.
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 which of the following as a factor? a) Fluid overload b) Respiratory distress c) Infection d) Pallor
Infection Correct 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.
To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to a) prevent the child from drinking an excess amount of fluids per day. b) notify a health care provider if the child develops an upper respiratory infection. c) administer an iron supplement daily. d) encourage the child to participate in school activities, such as long-distance running.
notify a health care provider if the child develops an upper respiratory infection. Correct Explanation: Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important.
The nurse is reviewing the laboratory test results of a child with thalassemia. Which result would the nurse expect to find with the hemoglobin electrophoresis? Select all that apply. a) Hemoglobin F b) Hemoglobin A2 c) Hemoglobin A d) Hemoglobin S
• Hemoglobin F • Hemoglobin A2 Explanation: In thalassemia, the hemoglobin electrophoresis would reveal the presence of hemoglobin F and A2 only. Hemoglobin S would be found with sickle cell disease.