Peds - Chapter 25: Nursing Care of the Child With a Hematologic Disorder
For the child diagnosed with iron deficiency anemia, what would the nurse anticipate would be done in treating this disorder? a) The child would be given corticosteroids via a metered-dose inhaler. b) The child would be given a high dose of intravenous immunoglobulin. c) The child would be given enteric-coated aspirin with milk. d) The child would be given ferrous sulfate with orange juice between meals.
The child would be given ferrous sulfate with orange juice between meals.
In von Willebrand's disease, girls exhibit unusually heavy menstrual flow. a) True b) False
True
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? a) Widely fluctuating blood pressure b) Petechiae c) Hematuria d) Equal pupillary response
Widely fluctuating blood pressure
A 14 y/o with thalassemia asks for your assistance in choosing her afternoon snack. Which choice is the most appropriate? 1. peanut butter with rice cake 2. small spinach salad 3. apple slices with cheddar cheese 4. small burger on wheat bun
apple slices with cheddar cheese
In understanding the cardiovascular and hematologic systems of the body it is important to know that the blood is made up of plasma, red blood cells, white blood cells, and platelets. These blood cells are formed in the: a) capillaries. b) bone marrow. c) arteries. d) lymph nodes.
bone marrow.
A 5-year-old boy is diagnosed with congenital aplastic anemia. Which symptom should the nurse expect in this child? Select all that apply. a) Cyanosis b) Bradypnea c) Bradycardia d) Fatigue e) Easy bruising f) Pallor
• Pallor • Fatigue • Easy bruising • Cyanosis
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 primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." b) "ITP is characterized by the loss of surface area on the red blood cell membrane." c) "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." d) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor."
"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 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."
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: a) Heterologous b) Autologous c) Allogenic d) Syngeneic
Allogenic
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 symptom should the nurse most expect as a result of excessive iron deposits? a) Enlarged lymph nodes b) An enlarged heart c) An enlarged thyroid gland d) An enlarged spleen
An enlarged spleen
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) Christmas factor b) Antihemophilic factor c) Stuart factor d) Proconvertin
Christmas factor
The nurse is caring for an 18-month-old with suspected iron deficiency anemia. Which lab results confirm the diagnosis? a) Increased serum iron and ferritin levels, decreased FEP level, microcytosis and hypochromia b) Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increased FEP level c) Increased hemoglobin and hematocrit, increased reticulocyte count, microcytosis, and hypochromia d) Increased hemoglobin and hematocrit, increased reticulocyte, microcytosis and hypochromia, increased serum iron and ferritin levels, and decreased FEP level
Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increased FEP level
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? a) Deferasirox b) Succimer c) Dimercaprol d) Edentate calcium disodium
Deferasirox
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 less than 1% c) Factor level of 5% to 50% d) Factor level of 1% to 5%
Factor level of 5% to 50%
In hemophilia A, the classic form, only females manifest a bleeding disorder. a) True b) False
False
Which of the following would the nurse be least likely to assess in a child with a hematologic disorder? a) Abnormal hemostasis b) Neutropenia c) Anemia d) Fever
Fever
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Risk for infection related to abnormal immune system b) Ineffective breathing pattern related to decreased white blood count 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
A child is diagnosed with iron deficiency anemia. Which diagnostic test would the nurse suspect as being the most sensitive test for determining this disorder? a) Hemoglobin electrophoresis b) Serum iron level c) Reticulocyte count d) Serum ferritin
Serum ferritin
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
The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence. 1 Erythropoietin helps the cell turn into a red blood cell. 2 The myeloid cell becomes a megakaryocyte. 3 Thrombopoietin acts on the cell. 4 The bone marrow releases a stem cell.
The bone marrow releases a stem cell. Thrombopoietin acts on the cell. The myeloid cell becomes a megakaryocyte. Erythropoietin helps the cell turn into a red blood cell.
The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a) A 3-month-old boy who is totally breastfed b) A 7-month-old boy who has started table food c) A 15-year-old girl who has heavy menstrual periods d) An 8-year-old girl who carries her lunch to school
A 15-year-old girl who has heavy menstrual periods
The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority? a) Emergent transfusion b) Oxygen administration c) Pain relief d) Antibiotic administration
Emergent transfusion
Iron-deficiency anemia could be virtually eliminated if all infants were breastfed and those infants who are formula-fed were fed iron-fortified formula for the full first year. a) False b) True
True
The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which actions? Select all that apply. a) Preventing injury and bleeding episodes b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Promoting exercise and activity
• Administering oxygen • Maintaining fluid intake • Administering analgesics
The nurse is providing teaching about iron supplement administration to the parents of a 10-month-old child. It is critical that the nurse emphasize which teaching point to the parents? a) "Please give him plenty of fluids and encourage fiber." b) "Place the liquid behind the teeth; the pigment can cause staining." c) "Your child may become constipated from the iron." d) "You must precisely measure the amount of iron."
"You must precisely measure the amount of iron."
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) 12 mg b) 10 mg c) 15 mg d) 6 mg
10 mg
The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding? a) 11.0 to 13.0 seconds b) 21.0 to 35.0 seconds c) 6.0 to 9.0 seconds d) 16.0 to 18.0 seconds
11.0 to 13.0 seconds
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) 26 mcg/dL c) 14 mcg/dL d) 20 mcg/dL
8 mcg/dL
A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Deficient fluid volume related to clustering of sickled cells b) Acute pain related to effects of sickling c) Ineffective peripheral tissue perfusion related to the effects of sickled cells d) Ineffective coping related to chronic illness
Acute pain related to effects of sickling
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) Baseball b) Wrestling c) Football d) Soccer
Baseball
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. Degradation of heme portion Conversion to protoporphyrin Conversion to direct bilirubin Break down into indirect bilirubin Excretion in bile
Correct response: Degradation of heme portion Conversion to protoporphyrin Break down into indirect bilirubin Conversion to direct bilirubin Excretion in bile
A nurse caring for an 8-year-old 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 client with: a) Iron deficiency anemia b) Hemophilia c) von Willebrand disease d) Disseminated intravascular coagulation
Disseminated intravascular coagulation
The nurse is reviewing the laboratory test results of a child with thalassemia. Which results would the nurse expect to find with the hemoglobin electrophoresis? Select all that apply. a) Hemoglobin A2 b) Hemoglobin A c) Hemoglobin S d) Hemoglobin F
Hemoglobin A2 Hemoglobin F
The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder? a) Iron-chelating drugs b) Vitamin supplements c) Potassium supplements d) Factor VIII preparations
Iron-chelating drugs
The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)? a) Macrocytic red blood cells (RBCs) b) Hemoglobin (Hgb) of 11.2 g/dL c) Decreased white blood cells (WBCs) d) Platelet count of 250,000
Macrocytic red blood cells (RBCs)
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) Demographic data is of little relevance. c) A child's nutritional status is key. d) Sequelae are rare with chronic problems.
Multiple body sites can be affected.
A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: a) Placing house plants out of reach of children b) Putting child safety locks on kitchen cabinets c) Removal or covering of flaking paint on the walls of the home d) Putting medicine away where children cannot reach it
Removal or covering of flaking paint on the walls of the home
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 disorder? a) Sickle cell disease b) Kawasaki disease c) Hemophilia d) Thalassemia
Thalassemia
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 this is the likely cause of this type of anemia: a) Vitamin B12 deficiency b) Iron deficiency c) Acute blood loss d) Sickle-cell disorder
Vitamin B12 deficiency
A child with hypoplastic anemia develops hemosiderosis. The therapy for this is: a) prednisone. b) aspirin. c) deferoxamine. d) ferrous sulfate.
deferoxamine
When planning care for a child with idiopathic thrombocytopenic purpura, the nurse plans to teach her: a) what foods are high in folic acid. b) to use mainly cold water to wash. c) to apply a soothing cream to lesions. d) not to pick or irritate her nose.
not to pick or irritate her nose.
To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a) encourage the child to participate in school activities, such as long-distance running. b) administer an iron supplement daily. c) prevent the child from drinking an excess amount of fluids per day. d) notify a health care provider if the child develops an upper respiratory infection.
notify a health care provider if the child develops an upper respiratory infection.
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: a) poikilocytosis. b) ecchymosis. c) purpura. d) petechiae.
petechiae
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: a) leg ulcers. b) seizures. c) priapism. d) behavioral addiction.
seizures
A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects: a) sickle cell disease. b) Cooley anemia. c) idiopathic thrombocytopenic purpura (ITP). d) hemophilia.
sickle cell disease.
A 3-year-old female is brought to the ER by her parents and presents with bruising and mucous membrane bleeding from the nose and mouth. The nurse knows that these symptoms are indicative of: a) Disseminated intravascular coagulation b) Hemophilia c) von Willebrand disease d) Chronic iron deficiency anemia
von Willebrand disease
The young boy has had his spleen surgically removed. Which statements by the boy's parents prior to discharge indicates that an adequate amount of learning has occurred? a) "He's going to get really good at washing his hands." b) "Before he goes to the dentist, we'll make sure he gets antibiotics." c) "He's going to need several vaccines." d) "If he does get sick, then we'll need to put on his medic alert bracelet." e) "If he gets a fever, I'm going to call our physician right away."
• "If he gets a fever, I'm going to call our physician right away." • "Before he goes to the dentist, we'll make sure he gets antibiotics." • "He's going to need several vaccines." • "He's going to get really good at washing his hands."
A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply. a) 110,000 per cubic millimeter b) 234,000 per cubic millimeter c) 80,000 per cubic millimeter d) 175,000 per cubic millimeter e) 287,000 per cubic millimeter
• 80,000 per cubic millimeter • 110,000 per cubic millimeter
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? a) "I put her legs up on pillows when her knees start to hurt." b) "I bought the medication to give to her when she says she is in pain." c) "She has been down, but playing in soccer camp will cheer her up." d) "She loves popsicles, so I'll let her have them as a snack or for dessert."
"She has been down, but playing in soccer camp will cheer her up."
In addition to the child's history, symptoms, and blood studies, what information helps to confirm the diagnosis of leukemia? a) Genetic studies b) Bone marrow aspiration c) Modified Jones criteria d) Chest x-rays
Bone marrow aspiration
The nurse is caring for a child with disseminated intravascular coagulation. The nurse notices signs of neurological deficit. Which nursing action is appropriate? a) Notify the physician b) Continue to monitor neurological signs c) Evaluate respiratory status d) Inspect for signs of bleeding
Notify the physician
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: a) seizures. b) leg ulcers. c) priapism. d) behavioral addiction.
seizures
A group of nursing students is discussing the diagnosis of iron deficiency anemia, and one of the students asks what foods would be good for this child to eat. Which foods are high in iron? Select all that apply. a) Egg yolks b) Oatmeal c) Raisins d) Cheese e) Peanut butter f) Milk
• Egg yolks • Raisins • Peanut butter • Oatmeal
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) "Milk is a perfect food, and babies should be able to have all the milk they want." b) "Caregivers sometimes don't understand the importance of iron and proper nutrition." c) "Children have a hard time getting enough iron from food during their first few years." d) "A family's economic problems are often a cause of malnutrition."
"Milk is a perfect food, and babies should be able to have all the milk they want."
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) "Delayed growth and development and delayed puberty are chronic manifestations." b) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." c) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations." d) "The acute manifestations, like splenic sequestration, are most often life-threatening."
"The acute manifestations, like splenic sequestration, are most often life-threatening."
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? a) "The doctor will discuss these findings with you when he comes to the hospital." b) "These labs are just common labs for children with this disease." c) "I'm really not allowed to discuss these findings with you." d) "These values will help us monitor the disease."
"These values will help us monitor the disease."
The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We must be compliant with vaccinations and prophylactic penicillin." b) "We need to seek medical attention for abdominal pain." c) "We must watch for unusual headache, loss of feeling, or sudden weakness." d) "We should call the doctor for any fever over 100°F."
"We should call the doctor for any fever over 100°F."
The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? 1. administer pain medication every 3h IV until pain is controlled 2. perform passive range of motion of the arm and leg to maintain function 3. try acetaminophen for pain first, moving up to opioids only if needed 4. use narcotic analgesics and warm compresses as needed to control pain
administer pain medication every 3h IV until pain is controlled
A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. 1 Give medications and use distraction. 2 Assess the pain. 3 Believe the child's report of pain. 4 Administer fluids. 5 Provide rest in a quiet area. 6 Look for complications or cause of pain.
Assess the pain. Believe the child's report of pain. Look for complications or cause of pain. Give medications and use distraction. Provide rest in a quiet area. Administer fluids.
The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? a) 120 mL/kg of fluids per day b) 150 mL/kg of fluids c) 130 mL/kg of fluids per day d) 110 mL/kg of fluids
150 mL/kg of fluids
The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) False b) True
False
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) Encouraging him to take deep breaths hourly c) Maintaining a fluid intravenous line d) Beginning active range-of-motion exercises
Maintaining a fluid intravenous line
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 statement made by the caregivers is correct regarding giving ferrous sulfate? a) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." b) "When I give my son ferrous sulfate I know he also needs potassium supplements." c) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." d) "I always give the ferrous sulfate with meals."
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."
The nurse is teaching an inservice 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) "Males are much more likely to have the disease than females." b) "The trait or the disease is seen in one generation and skips the next generation." c) "If the trait is inherited from both parents the child will have the disease." 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."
A child abruptly develops miniature petechiae over his legs, along with epistaxis and bleeding into the joints. Laboratory results reveal a platelet count of 20,000/mm3. The child is eventually diagnosed with idiopathic thrombocytopenic purpura (ITP). The mother of the child is distraught and asks the nurse what the course of this disorder typically is. What should the nurse tell the mother? a) 1 to 3 months b) 4 to 6 weeks c) Terminal condition d) Chronic condition
1 to 3 months
A nurse is caring for a 7-year-old boy with hemophilia who requires an infusion of factor VIII. He is fearful about the process and is resisting treatment. How should the nurse respond? a) "Would you help me dilute this and mix it up?" b) "Will you help me apply this band-aid?" c) "Would you like to administer the infusion?" d) "Please be brave; we need to stop the bleeding"
"Would you help me dilute this and mix it up?"
The mother of a 10-year-old who had a febrile reaction following a transfusion, asks the nurse: "Why did this happen to my child?" What response by the nurse is best? a) "Too much of the blood product was transfused at too rapid a rate." b) "Your child's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood." c) "The donor blood contained plasma proteins or other antigens to which your child was hypersensitive." d) "Your child's blood was not compatible with the blood product, causing red blood cell destruction."
"Your child's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood."
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) 300 to 800 mL of fluid per day b) 2,500 to 3,200 mL of fluid per day c) 1,000 to 1,200 mL of fluid per day d) 1,500 to 2,000 mL of fluid per day
1,500 to 2,000 mL of fluid per day
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 lb (21.5 kg). How many milligrams of elemental iron should the child receive with each dose? Record your answer using a whole number. __________ mg
36 mg
Which assessment below would increase your suspicion that iron-deficiency anemia may be present in a child? a) A 3-month-old boy sucks his thumb b) A 15-year-old girl constantly sucks ice cubes c) A 7-month old boy does not say whole words yet d) An 8-year-old girl is shy and does not participate in class
A 15-year-old girl constantly sucks ice cubes
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 blood factor? a) Factor XIII b) Factor VIII c) Factor X d) Factor V
Factor VIII
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? a) Providing age appropriate activities b) Grouping nursing care c) Encouraging the child to share feelings d) Following guidelines for protective isolation
Following guidelines for protective isolation
A child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder? a) Thrombocytes (platelets) b) Leukocytes (white blood cells) c) Plasma d) Hemoglobin
Hemoglobin
A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests? a) Reticulocyte count b) Hemoglobin electrophoresis c) Erythrocyte sedimentation rate d) Peripheral blood smear
Hemoglobin electrophoresis
A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify what as an effect? a) Cholelithiasis b) Pulmonary hypertension c) Chest syndrome d) High urine specific gravity
High urine specific gravity
A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily? a) He will develop diarrhea. b) His stools will appear black. c) He will be less irritable than he was at his last visit. d) His reticulocyte count will have decreased.
His stools will appear black.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? a) Iliac crest b) Anterior tibia c) Sternum d) Femur
Iliac crest
The nurse preparing a client for diagnostic testing for disseminated intravascular coagulation knows this is a result indicative of this disease: a) Increased antithrombin III b) Decreased fibrogen/fibrin degradation products c) Decreased fibrinopeptide A level d) Increased D-dimer assay
Increased D-dimer assay
A child with sickle cell disease is brought to the emergency department by his parents. He is in excruciating pain. A vaso-occlusive crisis is suspected and analgesia is prescribed. What would the nurse expect as least likely to be ordered? a) Morphine b) Meperidine c) Hydromorphone d) Nalbuphine
Meperidine
Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: A group of nursing students are reviewing the process of blood cell formation. The students demonstrate understanding of this process when they place the formation events in their proper sequence. What is the proper sequence? 1 Multipotent stem cell 2 Megakaryocyte 3 Myeloid progenitor 4 Megakaryocyte/erythroid progenitor 5 Platelets
Multipotent stem cell Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte Platelets
A 6-year-old boy visits the doctor's office with his mother. He has a rash on his buttocks, posterior thighs, and the extensor surface of his arms and legs. His joints are tender and swollen. The physician diagnoses him with Henoch-Schönlein syndrome. The nurse should expect what laboratory results in this case? a) Normal platelet count b) Elevated platelet count c) Decreased platelet count d) Decreased white blood cell count
Normal platelet count
When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority? a) Risk for delayed growth and development b) Risk for infection c) Deficient fluid volume d) Impaired skin integrity
Risk for infection
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? a) Capillary refill in less than 2 seconds b) Spooning of nails c) Pink palms and nail beds d) Absence of bruising
Spooning of nails
A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WMC 24,000, and platelets 20,000. What is the priority nursing assessment? 1. assess for pallor, fatigue, and tachycardia 2. monitor for fever 3. assess for bruising or bleeding 4. determine intake and output
assess for bruising or bleeding
A child with hemophilia fell while riding his bicycle. He was wearing a helmet and did not lose consciousness. He has a mild abrasion on his knee that is not oosing. He is complaining of abdominal pain. What is the priority nursing assessment? 1. perform neurologic checks 2. assess ability to void frequently 3. carefully assess his abdomen 4. examine his knee frequently
carefully assess his abdomen
You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is: a) depigmented areas on the abdomen. b) increased growth of long bones. c) slightly yellow sclerae. d) enlarged mandibular growth.
slightly yellow sclerae.
