Peds PrepU: Chapter 25
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which of the following would the nurse expect to find? a) Spooning of nails b) Absence of bruising c) Capillary refill in less than 2 seconds d) Pink palms and nail beds
Spooning of nails Explanation: A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.
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) Swimming b) Gymnastics c) Rugby d) Soccer
Swimming 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.
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) Petechiae c) Equal pupillary response d) Hematuria
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
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) 20 mcg/dL c) 14 mcg/dL d) 26 mcg/dL
a. 8 mcg/dL 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.
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) Factor VIII b) Plasmin c) Platelets d) Factor IX
a. Factor VIII 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
a. False 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.
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."
b. "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.
You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is a) increased growth of long bones. b) slightly yellow sclerae. c) enlarged mandibular growth. d) depigmented areas on the abdomen
b. slightly yellow sclerae. Explanation: Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from breakdown of damaged cells.
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) Hemophilia b) von Willebrand disease c) Chronic iron deficiency anemia d) Disseminated intravascular coagulation
b. von Willebrand disease Explanation: The primary clinical manifestations of von Willebrand disease are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract; bleeding may be severe and lead to anemia and shock. Deep bleeding into joints and muscles, like that seen in hemophilia, is rare, except with type III von Willebrand disease.
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) "The disease is most often seen in individuals of Asian decent." 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) "Males are much more likely to have the disease than females."
c. "If the trait is inherited from both parents the child will have the disease." 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
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which of the following responses indicates a need for further teaching? a) "He will enjoy tuna casserole and eggs" b) "There are many iron fortified cereals that he likes" c) "Red meat is a good option; he loves the hamburgers from the drive-thru." d) "I must encourage a variety of iron-rich foods that he likes"
"Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive thru as they are also high in fat, fillers, and sodium. The other statements are correct
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) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." b) "Delayed growth and development and delayed puberty are chronic manifestations." c) "The acute manifestations, like splenic sequestration, are most often life-threatening." d) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations.
"The acute manifestations, like splenic sequestration, are most often life-threatening." 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 caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count about 500, platelets over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. The nurse is correct in responding: a) "The doctor will discuss these findings with you when he comes to the hospital." b) "I'm really not allowed to discuss these findings with you. c) "These labs are just common labs for children with this disease." d) "These values will help us monitor the disease."
"These values will help us monitor the disease." Explanation: This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.
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 must watch for unusual headache, loss of feeling, or sudden weakness." c) "We should call the doctor for any fever over 100°F." d) "We need to seek medical attention for abdominal pain."
"We should call the doctor for any fever over 100°F." Explanation: The nurse must emphasize that ANY febrile illness requires immediate attention. Fever causes dehydration, which can trigger problems in a child with sickle cell anemia. Seeking medical attention for abdominal pain; watching for unusual headache, loss of feeling, or sudden weakness; and compliance with vaccinations are appropriate.
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) "Will you help me apply this band-aid?" b) "Please be brave; we need to stop the bleeding" c) "Would you help me dilute this and mix it up?" d) "Would you like to administer the infusion?"
"Would you help me dilute this and mix it up?" Explanation: The best response for a 7-year-old is to use distraction and involve him in the infusion process in a developmentally appropriate manner. A 7-year-old is old enough to assist with the dilution and mixing of the factor. Asking for help with the band-aid would be best for a younger child. Teens should be taught to administer their own factor infusions. Telling him to be brave is not helpful and does not teach.
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 of the following teaching points to the parents? a) "Place the liquid behind the teeth; the pigment can cause staining" b) "Please give him plenty of fluids and encourage fiber" c) "You must precisely measure the amount of iron" d) "Your child may become constipated from the iron"
"You must precisely measure the amount of iron" Explanation: The priority is to emphasize to the parents that they precisely measure the amount of iron to be administered in order to avoid overdosing. The other instructions are accurate, but the priority is to emphasize precise measurement.
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. The mother of the child is distraught and asks the nurse what the course of this disorder typically is. Which of the following should the nurse mention? a) 1 to 3 months b) Chronic condition c) 4 to 6 weeks d) Terminal condition
1 to 3 months In most children, ITP runs a limited, 1- to 3-month course. A few children develop chronic ITP
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) 10 mg b) 12 mg c) 6 mg d) 15 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) 6.0 to 9.0 seconds c) 11.0 to 13.0 seconds d) 21.0 to 35.0 seconds
11.0 to 13.0 seconds 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.
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) 110 mL/kg of fluids b) 120 mL/kg of fluids per day c) 150 mL/kg of fluids d) 130 mL/kg of fluids per day
150 mL/kg of fluids Explanation: To promote hemodilution in sickle cell crisis, the nurse would provide 150 mL/kg of fluids per day or as much as double maintenance, either orally or intravenously
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
36 mg 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
Which assessment below would increase your suspicion that iron-deficiency anemia may be present in a child? a) A 15-year-old girl constantly sucks ice cubes b) An 8-year-old girl is shy and does not participate in class c) A 3-month-old boy sucks his thumb d) A 7-month old boy does not say whole words yet
A 15-year-old girl constantly sucks ice cubes Explanation: Iron-deficiency anemia is associated with pica, or the eating of nonfood substances
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) Apply direct pressure to the area. b) Administer factor VIII replacement. c) Apply heat to the site of bleeding. d) Elevate the injured area such as a leg or arm.
Apply heat to the site of bleeding. 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.
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 which of the following? a) Capillaries b) Lymph nodes c) Arteries d) Bone marrow
Bone marrow Explanation: Blood is a fluid composed of many elements, including plasma, red blood cells, white blood cells, and platelets. Each of these elements has a different function. These blood cells are formed in the bone marrow. Arteries carry blood away from the heart to the body, and veins collect the blood and return it to the heart. Capillaries are the exchange vessels for the materials that flow through the body. The lymph nodes filter the lymph.
In addition to the child's history, symptoms, and blood studies, which of the following helps to confirm the diagnosis of leukemia? a) Genetic studies b) Chest x-rays c) Bone marrow aspiration d) Modified Jones criteria
Bone marrow aspiration Explanation: In addition to the his tory, symptoms, and laboratory blood studies, a bone mar row aspiration must be done to confirm the diagnosis of leu kemia. Genetic studies are done for hereditary diseases such as sickle cell anemia and hemophilia. The modified Jones criteria are used as a guide to note the manifestations of rheumatic fever, and chest x-rays help in diagnosing congestive heart failure.
Question: 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 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) Hemophilia b) Iron deficiency anemia c) Disseminated intravascular coagulation d) von Willebrand disease
Disseminated intravascular coagulation 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
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 X b) Factor V c) Factor XIII d) Factor VIII
Factor VIII 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.
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 less than 1% b) Factor level of 1% to 5% c) Factor level of 5% to 50% d) Factor level greater than 50%
Factor level of 5% to 50% 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.
The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) True b) False
False Explanation: The primary intervention for beta-thalassemia is a chronic transfusion program of packed red blood cells with iron chelation. Such a program facilitates adequate oxygenation of body tissues and practically eliminates all symptoms of thalassemia.
Which of the following would the nurse be least likely to assess in a child with a hematologic disorder? a) Anemia b) Fever c) Abnormal hemostasis d) Neutropenia
Fever Explanation: Pediatric hematologic alterations usually are characterized by atypical hemostasis, anemia, and/or neutropenia. Fever suggests infection which may or may not be present with a hematologic disorder.
The nurse is caring for a child with leukemia. Which of the following nursing interventions would be the highest priority for this child? a) Encouraging the child to share feelings b) Grouping nursing care c) Following guidelines for protective isolation d) Providing age appropriate activities
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 boy with hemophilia A is scheduled for surgery. Which of the following precautions would you institute with him? a) Do not allow a dressing to be applied postoperatively. b) Caution him not to brush his teeth before surgery. c) Handle him gently when transferring him to a stretcher. d) Mark his chart for him to receive no analgesia
Handle him gently when transferring him to a stretcher. Explanation: Gentle handling can reduce bruising. Analgesia will be needed postoperatively; IM injections are contraindicated because of potential bleeding.
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) Pallor b) Infection c) Fluid overload d) Respiratory distress
Infection 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
The nurse is caring for a child with DIC. The nurse notices signs of neurological deficit. The appropriate nursing action is to: a) Continue to monitor neurological signs b) Notify the physician c) Inspect for signs of bleeding d) Evaluate respiratory status
Notify the physician Explanation: If neurological deficits are assessed, immediate reporting of the findings is necessary to begin treatment to prevent permanent damage.
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) Ecchymosis d) Petechiae
Petechiae 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 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) Leg ulcers c) Behavioral addiction d) Seizures
Seizures 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 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) Hemoglobin electrophoresis b) Reticulocyte count c) Iron test d) Serum ferritin
Serum ferritin 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
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) "We'll need to plan for a bone marrow transplant soon." b) "He needs to eat more green leafy vegetables to cure the anemia." c) "He'll need to have those vitamin shots for the rest of his life." d) "He might get constipated from the supplement."
"He'll need to have those vitamin shots for the rest of his life." 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.
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) Stuart factor b) Christmas factor c) Proconvertin d) Antihemophilic factor
Christmas factor 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 evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which of the following findings would be associated with an elevated mean corpuscular volume (MCV)? a) Hemoglobin (Hgb) of 11.2 g/dL b) Platelet count of 250,000 c) Macrocytic red blood cells (RBCs) d) Decreased white blood cells (WBCs)
Macrocytic red blood cells (RBCs) Explanation: When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.
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. Which of the following would the nurse expect as least likely to be ordered? a) Nalbuphine b) Morphine c) Meperidine d) Hydromorphone
Meperidine Explanation: Meperidine is contraindicated for ongoing pain management in a child with vaso-occlusive crisis because it increases the risk for seizures. Analgesics such as morphine, nalbuphine, or hydromorphone are commonly used
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) Sequelae are rare with chronic problems. b) A child's nutritional status is key. c) Demographic data is of little relevance. d) Multiple body sites can be affected.
Multiple body sites can be affected. 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.
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) Hemophilia b) Kawasaki disease c) Thalassemia d) Sickle cell disease
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
For the child diagnosed with iron deficiency anemia which of the following 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 enteric coated aspirin with milk. c) The child would be given ferrous sulfate with orange juice between meals. d) The child would be given a high dose of intravenous immunoglobulin.
The child would be given ferrous sulfate with orange juice between meals. Explanation: Treatment consists of improved nutrition, with ferrous sulfate administered between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals.
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
You are assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a) A 7-month-old boy who has started table food b) A 3-month-old boy who is totally breastfed c) An 8-year-old girl who carries her lunch to school d) A 15-year-old girl who has heavy menstrual periods
d. A 15-year-old girl who has heavy menstrual periods Explanation: Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.
A child with hypoplastic anemia develops hemosiderosis. The therapy for this is a) ferrous sulfate. b) prednisone. c) deferoxamine. d) aspirin.
deferoxamine. 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) not to pick or irritate her nose. b) to apply a soothing cream to lesions. c) to use mainly cold water to wash. d) what foods are high in folic acid.
not to pick or irritate her nose. Explanation: Without adequate platelets, children bleed easily from lesions
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) prevent the child from drinking an excess amount of fluids per day. c) notify a health care provider if the child develops an upper respiratory infection. d) administer an iron supplement daily
notify a health care provider if the child develops an upper respiratory infection. Explanation: Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important
A nurse is teaching a school-aged child with iron-deficiency anemia and her parents about dietary measures to increase iron intake. The nurse determines that the teaching was successful when they state which food is high in iron? Select all that apply. a) Eggs b) Fortified cereal c) Milk d) Citrus fruits e) Green leafy vegetables
• Eggs • Fortified cereal • Green leafy vegetables Explanation: Foods high in iron include meat, cheese, eggs, green leafy vegetables, and fortified cereal. Citrus fruits and milk are not iron-rich foods
Choice Multiple question - Select all answer choices that apply. 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 A2 b) Hemoglobin A c) Hemoglobin F 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.
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) "She can drink the medicine from a medicine cup." b) "We will have her drink water or juice with the medicine." c) "Her bowel movements will probably turn very dark." 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.
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) An enlarged thyroid gland d) Enlarged lymph nodes
An enlarged spleen 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.
The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) False b) True
False Explanation: The primary intervention for beta-thalassemia is a chronic transfusion program of packed red blood cells with iron chelation. Such a program facilitates adequate oxygenation of body tissues and practically eliminates all symptoms of thalassemia.
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) Iron-chelating drugs b) Factor VIII preparations c) Potassium supplements d) Vitamin supplements
Iron-chelating drugs 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.
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 following events in the proper sequence
Multipotent stem cell Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte Platelets *There is a picture that shows the process on page 912* Explanation: The process begins with the multipotent stem cell that then becomes a myeloid progenitor, then a megakaryocyte/erythroid progenitor, a megakaryocyte, and finally platelets
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) Impaired skin integrity b) Risk for delayed growth and development c) Risk for infection d) Deficient fluid volume
Risk for infection 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
In von Willebrand's disease, girls exhibit unusually heavy menstrual flow. a) False b) True
b. True Explanation: von Willebrand's disease, an inherited autosomal dominant disorder, affects both sexes and is often referred to as angiohemophilia. Along with a factor VIII defect, there is also an inability of the platelets to aggregate and the blood vessels to constrict to aid in coagulation. Bleeding time is prolonged, with most hemorrhages occurring from mucous membrane sites. Epistaxis is a major problem, because all children tend to rub or pick at their nose as a nervous mechanism. In girls, menstrual flow is unusually heavy and may cause embarrassment from stained clothing.
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) Wrestling b) Football c) Soccer d) Basebal
d. Baseball 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
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 loves popsicles, so I'll let her have them as a snack or for dessert." b) "I put her legs up on pillows when her knees start to hurt." c) "She has been down, but playing in soccer camp will cheer her up." d) "I bought the medication to give to her when she complains of pain."
c. "She has been down, but playing in soccer camp will cheer her up." 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 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) Vitamin supplements c) Factor VIII preparations d) Iron-chelating drugs
d. Iron-chelating drugs 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 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) "Mary Jo's blood was not compatible with the blood product, causing red blood cell destruction." b) "The donor blood contained plasma proteins or other antigens to which Mary Joe was hypersensitive." c) "Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood." d) "Too much of the blood product was transfused at too rapid a rate."
"Mary Jo's blood has developed antibodies to leukocyte, platelet, or plasma protein antigens in the donor blood." 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.
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) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." b) "When I give my son ferrous sulfate I know he also needs potassium supplements." c) "I always give the ferrous sulfate with meals." d) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."
"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
A 5-year-old boy is diagnosed with congenital aplastic anemia. Which of the following symptoms should the nurse expect in this child? (Select all that apply.) a) Bradycardia b) Cyanosis c) Pallor d) Bradypnea e) Easy bruising f) Fatigue
• Pallor • Fatigue • Easy bruising • Cyanosis Explanation: When symptoms begin, a child appears pale, fatigues easily, and has anorexia from the lowered RBC count and tissue hypoxia. Because of reduced platelet formation (thrombocytopenia), the child bruises easily or develops petechiae (pinpoint, macular, purplish-red spots caused by intradermal or submucous hemorrhage). A child may have excessive nosebleeds or gastrointestinal bleeding. As a result of a decrease in WBCs (neutropenia) a child may contract an increased number of infections and respond poorly to antibiotic therapy. Observe closely for signs of cardiac decompensation such as tachycardia (not bradycardia), tachypnea (not bradypnea), shortness of breath, or cyanosis from the long-term increased workload of all these effects on the heart.
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) Iron deficiency d) Acute blood loss
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
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.
d. notify a health care provider if the child develops an upper respiratory infection. Explanation: Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important
A 10-month-old has been admitted to the hospital with severe hemolytic anemia and chronic hypoxia. The nurse notes icteral sclerae, jaundice of the skin, and frontal and maxillary bossing. The nurse interprets these findings as most likely indicating which of the following? a) Sickle cell anemia b) β-Thalassemia major c) Hemophilia d) von Willebrand disease
β-Thalassemia major Explanation: Severe hemolytic anemia and chronic hypoxia, icteral sclerae, jaundice of the skin, and frontal and maxillary bossing are signs and symptoms of β-thalassemia major. Hemophilia is manifested by clotting dysfunctions. von Willebrand disease is manifested by abnormal clotting. Sickle cell anemia involves abnormal hemoglobin that leads to significant anemia and acute and chronic symptoms.
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) "Caregivers sometimes don't understand the importance of iron and proper nutrition." b) "Children have a hard time getting enough iron from food during their first few years." c) "Milk is a perfect food, and babies should be able to have all the milk they want." d) "A family's economic problems are often a cause of malnutrition."
c. "Milk is a perfect food, and babies should be able to have all the milk they want." 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 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." Explanation: The nurse must emphasize that ANY febrile illness requires immediate attention. Fever causes dehydration, which can trigger problems in a child with sickle cell anemia. Seeking medical attention for abdominal pain; watching for unusual headache, loss of feeling, or sudden weakness; and compliance with vaccinations are appropriate.
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) 1,000 to 1,200 mL of fluid per day b) 2,500 to 3,200 mL of fluid per day c) 1,500 to 2,000 mL of fluid per day d) 300 to 800 mL of fluid per day
1,500 to 2,000 mL of fluid per day 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.
Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include: a) Compression b) Lowering extremities c) Heat d) Exercise
Compression 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.
The nurse is caring for an 18-month-old with suspected iron deficiency anemia. Which of the following lab results confirms 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 increase 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 increase FEP level Explanation: Laboratory evaluation will reveal decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis and hypochromia, decreased serum iron and ferritin levels, and increase FEP level. The other findings do not point to iron deficiency anemia.
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) Edentate calcium disodium b) Succimer c) Desferal d) Dimercaprol
Desferal 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.
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) Hemophilia b) von Willebrand disease c) Iron deficiency anemia d) Disseminated intravascular coagulation
Disseminated intravascular coagulation 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.
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 of the following lab tests: a) Peripheral blood smear b) Hemoglobin electrophoresis c) Erythrocyte sedimentation rate d) Reticulocyte count
Hemoglobin electrophoresis If the screening test result indicates the possibility of SCA or sickle cell trait, hemoglobin (Hgb) electrophoresis is performed promptly to confirm the diagnosis. While Hgb electrophoresis is the only definitive test for diagnosis of the disease, other laboratory testing that assists in the assessment of the disease include reticulocyte count (greatly elevated), peripheral blood smears (presence of sickle-shaped cells and target cells), and erythrocyte sedimentation rate (elevated).
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which of the following sites should she prepare? a) Sternum b) Femur c) Anterior tibia d) Iliac crest
Iliac crest 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.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Risk for infection related to abnormal immune system b) Risk for altered urinary elimination related to kidney impairment c) Ineffective breathing pattern related to decreased white blood count d) Ineffective tissue perfusion related to poor platelet formation
Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur
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 which of the following laboratory results in this case? a) Elevated platelet count b) Decreased platelet count c) Decreased white blood cell count d) Normal platelet count
Normal platelet count Explanation: In Henoch-Schönlein syndrome, laboratory studies show a normal platelet count. Sedimentation rate, WBC count, and eosinophil count are elevated
Question: The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence.
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. Explanation: The bone marrow releases a stem cell. Thrombopoietin acts on the cell to help turn it into a myeloid cell. Erythropoietin acts on the cell and it turns into a megakaryocyte. The megakaryocyte becomes an erythrocyte (red blood cell).
In caring for a child with sickle cell disease, the highest priority goal is which of the following? a) The family caregivers' anxiety will be reduced. b) The child's skin integrity will be maintained. c) The family will verbalize understanding of of the disease crisis. d) The child's fluid intake will improve
The child's fluid intake will improve. 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.
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) Encouraging him to take deep breaths hourly b) Maintaining a fluid intravenous line c) Beginning active range-of-motion exercises d) Seeing that he ingests a protein-rich diet
b. Maintaining a fluid intravenous line Explanation: Dehydration increases sickling of cells, so maintaining fluid balance is important.
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 occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." c) "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." d) "ITP is characterized by the loss of surface area on the red blood cell membrane."
c. "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." 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
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) von Willebrand disease c) Hemophilia d) Chronic iron deficiency anemia
von Willebrand disease Explanation: The primary clinical manifestations of von Willebrand disease are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract; bleeding may be severe and lead to anemia and shock. Deep bleeding into joints and muscles, like that seen in hemophilia, is rare, except with type III von Willebrand disease.
The young girl has been diagnosed with a hematologic disorder. Her erythrocyte count is below normal. The mean corpuscular volume is below normal. The girl's mean corpuscular hemoglobin (Hbg) concentration is below normal. Which of the following statements by the girl's nurse is true regarding this girl? Select all that apply. a) "She's anemic." b) "Her red blood cells are smaller than normal." c) "The amount of hemoglobin in her red blood cells is very dilute." d) "Her red blood cells are macrocytic." e) "Her red blood cells are hypochromi"
• "Her red blood cells are smaller than normal." • "The amount of hemoglobin in her red blood cells is very dilute." • "She's anemic." • "Her red blood cells are hypochromi" Explanation: This girl's erythrocyte count is below normal, which indicates she is anemic. The mean corpuscular Hbg concentration is below normal which indicates that her cells are hypochromic with a diluted amount of Hbg available. The mean corpuscular volume of the erythrocytes are decreased which indicates her cells are microcytic or smaller than normal
The child has anemia and iron supplements will be administered by his parents at home. Which of the following statements by the child's parents indicates that further education is required? a) "He may develop diarrhea." b) "If the iron is mixed in a drink, then he should drink it with a straw." c) "His urine may look dark." d) "It's better if I give the iron with orange juice." e) "I can give the iron mixed with chocolate milk."
• "I can give the iron mixed with chocolate milk." • "He may develop diarrhea." Explanation: Iron supplements should not be mixed in milk because it reduces absorption. Iron supplements may make the child constipated. All of the other options are correct
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) 80,000 per cubic millimeter b) 175,000 per cubic millimeter c) 110,000 per cubic millimeter d) 234,000 per cubic millimeter e) 287,000 per cubic millimeter
• 80,000 per cubic millimeter • 110,000 per cubic millimeter Explanation: Normal thrombocyte level ranges from 150,000 to 300,000 per cubic millimeter. Therefore, a child with a thrombocyte level of 80,000 and 110,000 per cubic millimeter would be at risk for bleeding.
Choice Multiple question - Select all answer choices that apply. The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which of the following. Select all that apply. a) Promoting exercise and activity b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Preventing injury and bleeding episodes
• Administering oxygen • Administering analgesics • Maintaining fluid intake Explanation: Treatment for a crisis is supportive for each presenting symptom, and bed rest is indicated. Oxygen may be administered. Analgesics are given for pain. Dehydration and acidosis are vigorously treated. Prognosis is guarded, depending on the severity of the disease.