Chapter 44

The nurse is caring for a 13-year-old girl with von Wilebrand disease. After teaching the adolescent and her parents about this disorder and care, what response by the parents indicates a need for further teaching?

"We should administer desmopression as often as needed."

The nurse is providing care to a child with DIC and is preparing to administer heparin. A nursing student who is shadowing the nurse asks why the heparin is being given. What response by the nurse would be most appropriate?

"Heparin helps to reduce the consumption of platelets."

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?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with sickle cell anemia. What statement is most accurate regarding sickle cell anemia?

"If the trait in inherited from both parents the child will have the disease."

The nurse is reinforcing teaching with a group of caregives of children diagnosed with iron def anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." What statement made by the caregivers is correct regarding giving ferrous sulfate?

"My husband gives our daughter OJ when she takes her ferrous sulfate, so she gets VIt C"

The nurse is caring for a child recently diagnosed with G6PD deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. What response indicates a need for further teaching?

"My son can never take penicillin for an infection."

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. What response by a family member indicates a need for further teaching?

"We should call the doctor for any fever over 100F"

After teaching a group of students about hemophilia, the instructor determine that the students have understood the information when they identify hemophilia A as involving a problem with what?

... Factor VII

What is the recommended rate of infusion of blood cells?

10mL/kg/hr

The nurse is working with a child who is in sickle cell crisis. Treatment & Nursing care for this child includes what?

Administering Oxygen Administering analgesics Maintaining fluid intake

Nursing students are reviewing blood coagulation and the factors involved in the extrinisic and intrinsic pathways. The students demonstrate understanding of the information when they identify what factors as part of the intrinsic pathway?

Antihemophilic factor Christmas factor Hageman factor

Following the administration of liquid ferrous sulfate, the most important action for the child to be encouraged to dO is what?

Brush his or her teeth

Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include:

Compression

A nursing instructor describes what happens to the RBC after it disintegrates and how bilirubin is formed. Place the events in order that the instructor would discuss from first to last.

Degradation of heme portion Conversion to protoporphyrin Break down into indirect bilirubin Conversion to direct bilirubin Excretion in bile

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?

Desferal

While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. The nurse documents these as what?

Ecchymoses

The nurse is assessing a child who is experiencing an acute splenic sequestration s/t sickle cell disease. What would be a priority?

Emergent transfusion

The primary intervention for beta-thalassemia is chronic transfusion program of packed WBCs with iron chelation.

False

What would the nurse be least likely to assess in a child with a hematologic disorder?

Fever

A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate the need for additional study when they identify what as an effect?

High urine specific gravity

What site is most frequently used to perform a bone marrow aspiration?

Iliac crest

The nurse is preparing a patient for diagnostic testing for DIC knows that the following is a result indicative of this disease:

Increased D-dimer assay

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 determine that the teaching was successful when the parents identify what as a factor?

Infection

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

Initiate pain assessment with a standardized pain scale.

The nurse treating patients with hemophilia knows that if bleeding is not treated effectively, the following body part is a greatest risk for the development of chronic, disabling disease.

Joints

A nurse assessing a 3-year-old brought to the clinic by her parents for a check up notes the following symptoms: pallor, irritability, poor feeding, and developmental delay. The parents tell that nurse that they are vegetarians and serve only vegetarian meals. Based on this criterion the nurse would be correct to suspect:

Megaloblastic anemia

A nurse is assessing a child with Fanconi anemia. What would the nurse expect to assess?

Microcephaly Skin hyper pigmentation Small eyes Epicanthal folds

A nurse is preparing a teaching plan for the parents of a child scheduled to have a stem cell transplant. What would the nurse expect to include in the teaching plan?

Monitoring of HR and rhythm during the infusion Need for strict hand washing to reduce the risk for infection Daily measurements of WBC counts

When assessing a child for a possible hematologic disorder, what would the nurse keep in mind as most important?

Multiple body sites can be affected

The nurse is reviewing the lab test results of a child diagnosed with DIC. What would the nurse interpret as indicative of the disorder?

Positive fibrin split products

When developing the post of plan of care for a child with sickle cell anemia who has undergone a splenectomy, what would the nurse identify as priority?

Risk for Infection

When providing care to a child with aplastic anemia, what nsg diagnosis would most likely be priority?

Risk for Injury

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in 2 divided doses. The nurse interprets this order as indicating what?

The child has mild to moderate iron deficiency

Franconi anemia (FA) is a rare, inherited form of aplastic anemia that is associated with an autosomal recessive inheritance pattern.

True

The nurse is developing a plan of care for a child with thalassemia. What would the nurse expect to include?

Packed RBC transfusions Deferoxamine therapy

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 what?

Petechiae

A nsg instructor is describing childhood hematologic disorders to students. What would the instructor include as being most commonly affected by hematologic disorders?

Erythocytes Leukocytes Thrombocytes

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 & notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. The child most likely has a deficiency of what blood factor?

Factor VII