Quiz: Chapter 43, The Child With Hematologic or Immunologic Dysfunction

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measure should the nurse do until factor replacement therapy can be instituted?

Elevate area above the level of the heart

Mucosal inflammation is not a symptom of DIC. It is caused by _______________

chemotherapy

Sickle cell anemia is diagnosed by ______________, elevated temperature, painful joints, or hypoxia.

chest pain

Hemoglobin _______________________ is a screening test used to identify whether the child has SCA, the homozygous form of the disease, or sickle cell C disease, the heterozygous form.

electrophoresis

Splenic sequestration is a symptom of sickle cell anemia, which causes an __________________________

enlarged spleen.

Partial thromboplastin time test is used to detect

hemophilia.

Western blot immunoassay and HIV enzyme-linked immunosorbent assay are used in detecting HIV in ____________ who are aged 18 months or older.

infants

Diphenhydramine (Benadryl) is used to relieve pain in a child with ______________ ___________________

mucosal ulceration.

Influenza vaccine would____________________________ in immunodeficiency disease because of the possibility of acquiring severe influenza

not be recommended

Apheresis refers to the process of __________________ from a patient, usually before stem cell transplantation or chemotherapy.

removing blood

Iron dextran injection is used to treat ______________ _____________

severe anemia.

Chest syndrome is a symptom of ______________ anemia with signs of hypoxia, chest pain, fever, cough, and wheezing.

sickle cell

The symptoms of iron toxicity are __________________, ____________, and _________. Asking the parents to change the timing of the dose is not appropriate; it must be administered as prescribed.

stomach pain, nausea, and vomiting.

Intravenous heparin is used to inhibit _______________ _______________ in patients with immune thrombocytopenia (ITP).

thrombin formation

Pneumocystis carinii pneumonia (PCP) prophylaxis and intravenous immunoglobulin are used to improve humoral immunity in the child until the______________________ is performed..

transplant

Which approaches can be used to classify anemia? Select all that apply.

Etiology Morphology rational: Etiology (or physiology) and morphology are the two approaches to classifying anemia. Epistemology is the branch of science that deals with studying the theory of knowledge. Epidemiology is the branch of science that deals with studying patterns and causes of health issues. Fetology is the branch of science that deals with studying prenatal development.

A child is prescribed oral iron for iron deficiency anemia. What intervention does the nurse implement to ensure the absorption of iron in the child?

Gives citrus juice with the oral iron

A 5-month-old infant born to a mother with human immunodeficiency virus (HIV) infection needs to be tested for HIV. Which test will be used for an accurate diagnosis of HIV in the child?

HIV polymerase chain reaction (PCR)

"Provide daily fluid intake as specified."

Have the child sit up and lean forward

The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they do what?

Help the body stop bleeding by forming a clot (scab) over the hurt area

The parents of a child with leukemia are anxious during a nose bleeding episode and request platelet transfusions for the child. What action does the nurse take?

Tries to stop the bleeding by applying pressure at the site

The nursing instructor is teaching a student how to administer iron dextran injections to a child with severe anemia. Which instruction does the nurse give after the student administers the injection?

"Do not massage the injection site." Rational The nursing instructor tells the student to avoid massaging the injection site to minimize skin staining and irritation. The nurse places the patient in an appropriate position before administering the injection. It is necessary to rotate sites because of the potential for tissue damage. The nurse disposes of the syringe safely after administering the medication to avoid stick injuries.

The parent of a 6-month-old infant asks the nurse about the food that can be included in the child's diet. What does the nurse suggest?

"Include cereals in the diet." Rational Cereals are the first semisolid foods that should be given to an infant at 6 months of age. This helps the infant accept food other than milk and prevents the risk for anemia. The nurse does not advise feeding only breast milk because it may induce nutritional anemia. Cow's milk puts the child at risk for gastrointestinal blood loss because of the presence of heat-labile protein in the milk. Carrots and peas are solid foods that are not digested by the infants at 6 months.

The nurse is reviewing the laboratory results of a 1-year-old child who has been diagnosed with sickle cell anemia (SCA) during infancy and is now presenting with symptoms of the disease. The parent says to the nurse, "I don't understand. My child did not have any symptoms at all up until now." Which is the best response by the nurse?

"Infants usually do not have symptoms, but the symptoms become apparent as children get older."

The nurse is teaching the parents how to provide care for their child with sickle cell anemia. Which intervention does the nurse include in the teaching?

"Provide daily fluid intake as specified."

The nurse is monitoring a child during a blood transfusion procedure. What precautions does the nurse take? Select all that apply.

Uses an appropriate filter for administering blood Administers the first 50 mL of blood volume slowly Stops the transfusion if there is any reaction in the child Takes vital signs before, after, and during the blood transfusion

__________________________________ is a symptom of sickle cell anemia, which causes painful joints. Big and swollen spleen develops due to pooling of large amount of blood in the spleen. Chest pain is accompanied by fever and hypoxia, which indicates sickle cell anemia.

Vasoocclusive crisis

Sickle cell anemia occurs when normal hemoglobin is replaced by

abnormal hemoglobin.

Aplastic anemia is characterized by

anemia, leukopenia, and decreased platelet count.

Packed RBCs at ___________________mL/kg should be used with a child, so the dosage is too high. . Whole blood is not used because it could increase the chance of circulatory overload.

2 to 3

The parents of a child taking oral iron supplements report that the child's stools are a tarry green color. What is the best response the nurse provides to the parents?

"Tarry green color is expected with oral iron supplements." Rational: "Tarry green color is expected with oral iron supplements."Tarry green stools indicate that the child is taking an adequate doses of oral iron. The medication should be stopped immediately if there are any allergic symptoms or toxicity. Tarry green stools is not a side effect of taking oral iron supplements.

The health care provider orders a transcranial Doppler (TCD) test for a child with sickle cell anemia (SCA). How does the nurse expect the health care provider to explain the reasoning behind ordering the test?

"The test will help us know whether the child is at risk for cerebrovascular accident."

The nursing instructor is teaching a group of students about hemophilia A. Which statement by the student indicates effective learning?

"This condition occurs as a result of the deficiency of antihemophilic factor."

HIV polymerase chain reaction (PCR) is used for detecting proviral DNA in infants betwee ___________ and _______________months of age

1 and 6

Anti-D antibody is administered to a child with ITP for prolonged survival of platelets. The platelet count increases _________ hours after the anti-D antibody is administered. Therefore it is not appropriate for clients with active bleeding.

48

The nurse finds that a child is pale, gets easily fatigued, and has lack of energy. The nurse asks the parents to get a complete blood count (CBC) test. What does the nurse suspect from these symptoms?

Anemia Rational: Paleness, fatigue, and lack of energy are the symptoms of anemia that can be confirmed after a CBC test. Splenic sequestration is a symptom of sickle cell anemia, which causes an enlarged spleen. Chest syndrome is a symptom of sickle cell anemia with signs of hypoxia, chest pain, fever, cough, and wheezing.

The nurse is assessing a child with immune thrombocytopenia (ITP). The nurse observes that there is no active bleeding in the child. Which medications does the nurse expect in the child's prescription?

Anti-D antibody

The nurse is caring for a child with sickle cell anemia (SCA). The child has acute chest syndrome and has also experienced a cerebrovascular accident (CVA). Which is the most effective treatment for the child?

Chronic transfusion therapy

Which statement best describes the onset of clinical manifestations in thalassemia major?

Clinical manifestations may be insidious and not recognized until early toddlerhood. Rational Clinical manifestations in thalassemia major are not recognized until late infancy or early toddlerhood. They may appear well before adolescence, young adulthood, and middle adulthood.

Which condition in a child indicates a deficiency of one of the factors (proteins) necessary for blood coagulation?

Hemophilia Rational Hemophilia is a group of bleeding disorders in which there is a deficiency of one of the clotting factors necessary for blood coagulation. Aplastic anemia is characterized by anemia, leukopenia, and decreased platelet count. Sickle cell anemia occurs when normal hemoglobin is replaced by abnormal hemoglobin. Apheresis refers to the process of removing blood from a patient, usually before stem cell transplantation or chemotherapy.

_________________________ causes bleeding in the subcutaneous tissue, intramuscular tissue, and the joint space because of a lack of clotting factor. The disease gets worse if antihemophilic factor is less in the blood. Patients with____________________ have two factors (vascular influence and platelets) required for blood coagulation; hence, they bleed for longer periods but not at a faster rate.

Hemophilia A

The nurse is educating the parents of a child about the symptoms that would indicate sickle cell anemia. Which symptoms does the nurse describe? Select all that apply.

Hypoxia Chest pain Painful joints Big and swollen spleen

Which symptom is seen in a child with disseminated intravascular coagulation (DIC)?

Increased tendency to bleed Rational: A child with DIC has an increased tendency to bleed as a result of excess thrombin and destruction of platelets. Rickettsial infections may sometimes cause DIC. It is not a symptom of DIC.

The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. In the discussion, what should the nurse include?

Intravenous drug users should not share needles.

A child is prescribed hematopoietic stem cell transplantation for severe combined immunodeficiency disease. What is administered to the child to improve the humoral immunity until the transplant is performed? Select all that apply.

Intravenous immunoglobulin Pneumocystis carinii pneumonia (PCP) prophylaxis

Antithymocyte globulin (ATG) is administered intravenously to a child with aplastic anemia (AA). The child is susceptible to side effects of ATG, such as fever, chills, and myalgias. Which medication is administered to prevent these side effects?

Methylprednisolone (Medrol)

The nurse assesses an infant with sickle cell anemia (SCA). Which clinical manifestations alert the nurse that the patient may be experiencing a vaso-occlusive crisis? Select all that apply.

Painful joints Visual disturbances Swollen hands and feet

What is administered to a child who presents with hemophilia A and is at risk for joint bleeding?

Primary prophylaxis

Which is an ideal treatment for a child after splenectomy?

Prophylactic antibiotics Rational: Prophylactic antibiotics are administered to the child to prevent the severe infections that the child is at risk for after a splenectomy. Intravenous heparin is used to inhibit thrombin formation in patients with immune thrombocytopenia (ITP).

The blood report of a 5-year-old child reveals a reduction in hemoglobin below the normal value concentration. Which physiologic defect does the nurse expect in the child?

Reduction in oxygen-carrying capacity of blood

What is the objective of managing anemia?

Reversing it by treating the underlying cause

Chronic transfusion therapy is used for children with ______________to treat CVA and prevent repeated CVAs

SCA

The nurse is instructing about preventing bleeding episodes to the parents of a child with hemophilia. What instructions does the nurse provide? Select all that apply.

Soften toothbrush before brushing Encourage participation in swimming Avoid using aspirin for controlling pain

___________________ (Zerit) is a class of antiretroviral drugs used in patients with human immunodeficiency virus (HIV) infection.

Stavudine

The nurse suspects that a child is having an adverse reaction to a blood transfusion. What should be the first action by the nurse?

Stop transfusion and maintain a patent intravenous line with normal saline and new tubing Rational Stopping the transfusion is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused. Notifying the physician and taking vital signs should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

What is the most common manifestation of severe combined immunodeficiency disease (SCID)?

Susceptibility to infection Rational Susceptibility to infection early in life is the most common manifestation of SCID. Bloody stools, chronic nosebleeds, and skin rashes are not as common.

how to administer blood

The nurse takes vital signs before the blood transfusion to establish baseline data for intratransfusion. Vital signs are taken hourly while the blood is infusing and taken post-transfusion to check for any adverse reactions. The nurse administers the first 50 mL of the blood volume slowly to prevent any abnormalities in the blood pressure and assess for adverse reactions. If there is any reaction in the child, the nurse stops the transfusion, takes vital signs, and maintains a patent IV line with normal saline and new tubing. The nurse then informs the primary health care provider. The nurse uses an appropriate filter for administering blood to eliminate any particles in the blood. The nurse uses the blood within 30 minutes of its arrival from the blood bank so that the blood properties do not change.

The nurse prepares to administer a blood transfusion to a 7-year-old child with severe anemia with mild tissue hypoxia. The prescription reads that packed red blood cells (RBCs) are to be administered at 4 mL/kg. Why does this cause the nurse to contact the prescriber?

The ordered amount for packed RBCs is too high.

The nurse is caring for a child with epistaxis. The parent asks how nosebleeds can start. What does the nurse understand about the common causes of epistaxis in children? Select all that apply.

They can be caused by nose picking. They can be caused by trauma to the nose. They can be caused by inflammation from allergies. They can be caused by foreign bodies lodged in the nostrils

Yellow, fatty bone marrow indicates the presence of ____________ anemia

aplastic