Ch. 43 Hematologic and Immunologic Dysfunction

Which home care instructions should the nurse provide tot he parents of a child with (AIDS)?

- Give supplemental vitamins as prescribed. - Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. - Notify the physician if the child develops a cough or congestion.

Which should the nurse teach about prevention of sickle cell crisis to parents of a preschool child with sickle cell disease?

- Notify the HCP if a fever of 101.3 or greater occurs. - Give penicillin as prescribed. - Notify the HCP if your child begins to develop symptoms of a cold.

Which child should the nurse document as being anemic?

14-year old child with a hemoglobin of 10 g/dL

The nurse is planning care for a school age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child?

- Avoidance of IM injections. - Acetaminophen for mild pain control - Soft toothbrush for dental hygiene.

The nurse is preparing to give oral care to a school age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child?

- Chlorhexidine gluconate (Peridex) - Antifungal troches (lozenges) - Lip balm (Aquaphor)

The nurse is caring for a child with aplastic anemia. Which nursing diagnoses are appropriate?

- Risk for Infection related to inadequate secondary defenses or immunosuppression. - Ineffective Protection related to thrombocytopenia. - Ineffective Tissue Perfusion related to anemia.

A boy with leukemia screams whenever he needs to be turned or moved. The most probable cause of this pain is:

Bone involvement.

The school nurse is informed that a child with HIV will be attending school soon. Which is an important nursing intervention?

Carefully follow universal precautions.

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent:

Central nervous system disease.

An 8 year old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of:

Circulatory overload.

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an:

Decrease in blood platelets.

The parents of a child with cancer tell the nurse that a bone marrow transplant may be necessary. What should the nurse recognize as important when discussing this with the family?

Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

Children receiving long-term systemic corticosteroid therapy are most at risk for:

Growth delays.

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include:

Injecting deeply into a large muscle.

An adolescent will receive a bone marrow transplant. The nurse should explain that the bone marrow will be administered by which route?

Intravenous infusion

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she suggest?

Iron-fortified infant cereal can be introduced at approximately 6 months of age.

Which immunization should not be given to a child receiving chemotherapy for cancer?

MMR

Which statement best explains why iron deficiency anemia is common during toddlerhood?

Milk is a poor source of iron.

What is the most common mode of transmission of HIV in the pediatric population?

Perinatal transmission.

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?

Stop drug infusion immediately.

Which statement best describes thalassemia major (Cooley's anemia)?

Increased incidence occurs in families of Mediterranean extraction.

Which statement most accurately describes the pathologic changes of sickle cell anemia?

Increased red blood cell destruction occurs.

A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include:

Adequate hydration and pain management.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to:

Administer an antiemetic before chemotherapy begins.

Which condition is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T-cells?

Acquired immunodeficiency syndrome (AIDS)

The most appropriate nursing diagnosis for a child with anemia is:

Activity Intolerance related to generalized weakness.

When teaching the mother of a 9 month old infant about administering liquid iron preparations, the nurse should include that:

Adequate dosage will turn the stools a tarry green color.

A young boy will receive a bone marrow transplant. This is possible because one of his older siblings is a histocompatible donor.This type of BMT is termed:

Allogeneic.

In which condition are all the formed elements of the blood simultaneously depressed?

Aplastic anemia.

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?

Immobilization and elevation of the affected joint.

An accurate description of anemia is:

Decreased oxygen-carrying capacity of blood

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to:

Delay disease progression

A possible cause of acquired aplastic anemia in children is:

Drugs

Chelation therapy is begun on a child with thalassemia major. The purpose of this therapy is to:

Eliminate excess iron.

A common clinical manifestation of Hodgkin's disease is:

Enlarged, firm, nontender lymph nodes.

The nurse is preparing a child for possible alopecia from chemotherapy. Which suggestion should be included in the teaching?

Explaining to the child that, when hair regrows, it may have a slightly different color or texture.

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is:

Idiopathic thrombocytopenic purpura

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?

Painful swelling of hands and feet, painful joints.

The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to:

Prevent infection.

The nurse is planning activity for a 4 year old child with anemia. Which activity should the nurse plan for this child?

Puppet play in the child's room.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics:

Rarely cause addiction because they are medically indicated.

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention?

Relax any eating pressures

An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is:

Severe combined immunodeficiency syndrome (SCIDS).

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:

Sickle cell anemia

Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is:

Sudden difficulty in breathing.

Parents of a school age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend?

Swimming Golf Bowling

Several blood tests are ordered for a preschool child with severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago. The nurse should explain that:

Topical application of local anesthetic can eliminate venipuncture pain.

What is most descriptive of the pathophysiology of leukemia?

Unrestricted proliferation of immature white blood cells occurs.

Which immunization should be given with caution to children infected with HIV?

Varicella

As related to inherited disorders, which statement is descriptive of most cases of hemophilia?

X-linked recessive inherited disorder in which a blood-clotting factor is deficient.