Deck 30: The Child with Hematologic or Immunologic Dysfunction

Question 1

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason?

A) Allow her parents to come visit her.
B) Fight the infection that she now has.
C) Increase her energy so she will not be so tired.
D) Help her body stop bleeding by forming a clot (scab).

Answer 1

Increase her energy so she will not be so tired.

Question 2

What statement best describes b-thalassemia major (Cooley anemia)?

A) It is an acquired hemolytic anemia.
B) Inadequate numbers of red blood cells (RBCs) are present.
C) Increased incidence occurs in families of Mediterranean extraction.
D) It commonly occurs in individuals from West Africa.

Answer 2

Increased incidence occurs in families of Mediterranean extraction.

Question 3

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA?

A) SCA is not inherited.
B) All siblings will have SCA.
C) Each sibling has a 25% chance of having SCA.
D) There is a 50% chance of siblings having SCA.

Answer 3

Each sibling has a 25% chance of having SCA.

Question 4

What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin?

A) Aplastic anemia
B) Sickle cell anemia
C) Thalassemia major
D) Iron deficiency anemia

Question 5

What physiologic defect is responsible for causing anemia?

A) Increased blood viscosity
B) Depressed hematopoietic system
C) Presence of abnormal hemoglobin
D) Decreased oxygen-carrying capacity of blood

Question 6

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child's care should include which therapeutic interventions?

A) Hydration and pain management
B) Oxygenation and factor VIII replacement
C) Electrolyte replacement and administration of heparin
D) Correction of alkalosis and reduction of energy expenditure

Question 7

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

A) Air embolism
B) Allergic reaction
C) Hemolytic reaction
D) Circulatory overload

Question 8

What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?

A) Give with meals.
B) Stop immediately if nausea and vomiting occur.
C) Adequate dosage will turn the stools a tarry green color.
D) Allow preparation to mix with saliva and bathe the teeth before swallowing.

Question 9

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

A) Aplastic anemia
B) Sickle cell anemia
C) Thalassemia major
D) Iron deficiency anemia

Question 10

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxia-ischemia cycle. What information should the nurse share with parents in a teaching plan?

A) Encourage drinking.
B) Keep accurate records of output.
C) Check for moist mucous membranes.
D) Monitor the concentration of the child's urine.

Question 11

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration?

A) Decreased blood viscosity
B) Deficiency in coagulation
C) Increased red blood cell (RBC) destruction
D) Greater affinity for oxygen

Question 12

Therapeutic management of a 6-year-old child with hereditary spherocytosis (HS) should include which therapeutic intervention?

A) Perform a splenectomy.
B) Supplement the diet with calcium.
C) Institute a maintenance transfusion program.
D) Increase intake of iron-rich foods such as meat.

Question 13

The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor?

A) Hemoglobin
B) Tissue hypoxia
C) Reticulocyte count
D) Number of RBCs

Question 14

What therapeutic intervention is most appropriate for a child with b-thalassemia major?

A) Oxygen therapy
B) Supplemental iron
C) Adequate hydration
D) Frequent blood transfusions

Question 15

For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention?

A) Antibiotics
B) Antiretroviral drugs
C) Iron supplementation
D) Immunosuppressive therapy

Question 16

What explanation provides the rationale for why iron-deficiency anemia is common during infancy?

A) Cow's milk is a poor source of iron.
B) Iron cannot be stored during fetal development.
C) Fetal iron stores are depleted by 1 month of age.
D) Dietary iron cannot be started until 12 months of age.

Question 17

Iron overload is a side effect of chronic transfusion therapy. What treatment assists in minimizing this complication?

A) Magnetic therapy
B) Infusion of deferoxamine
C) Hemoglobin electrophoresis
D) Washing red blood cells (RBCs) to reduce iron

Question 18

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next?

A) Reduce environmental stimulation to prevent seizures.
B) Have the laboratory repeat the analysis with a new specimen.
C) Minimize energy expenditure to decrease cardiac workload.
D) Administer intravenous fluids to correct the dehydration.

Question 19

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse?

A) Administer 100% oxygen to relieve hypoxia.
B) Notify the practitioner because chest syndrome is suspected.
C) Infuse intravenous antibiotics as soon as cultures are obtained.
D) Give ordered pain medication to relieve symptoms of pain episode.

Question 20

What statement best describes iron deficiency anemia in infants?

A) It is caused by depression of the hematopoietic system.
B) Diagnosis is easily made because of the infant's emaciated appearance.
C) It results from a decreased intake of milk and the premature addition of solid foods.
D) Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.

Question 21

A toddler is diagnosed with chronic benign neutropenia. The parents are being taught about caring for their child. What information is important to include?

A) Avoid large indoor crowds and people who are ill.
B) Parenteral antibiotics are necessary to control disease.
C) Frequent rest periods are needed during the daytime.
D) List the side effects of corticosteroids used to decrease inflammation.

Question 22

The nurse is caring for a child with hemophilia A. The child's activity is as tolerated. What activity is contraindicated for this child?

A) Ambulating to the cafeteria
B) Active range of motion
C) Ambulating to the playroom
D) Passive range of motion exercises

Question 23

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs?

A) Cure the disease.
B) Delay disease progression.
C) Prevent spread of infection.
D) Treat Pneumocystis carinii pneumonia.

Question 24

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. What is the priority nursing goal?

A) Prevent infection.
B) Prevent secondary cancers.
C) Identify source of infection.
D) Restore immunologic defenses.

Question 25

What condition is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity?

A) Fanconi syndrome
B) Wiskott-Aldrich syndrome
C) Acquired immunodeficiency syndrome (AIDS)
D) Severe combined immunodeficiency syndrome (SCIDS)

Question 26

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement?

A) Notify the health care provider.
B) Place the child on bed rest.
C) Administer a dose of hydrocodone (Vicodin).
D) Start O2 per the hospital's protocol.

Question 27

The school nurse is informed that a child with human immunodeficiency virus (HIV) infection will be attending school soon. What is an important nursing intervention to include in the plan of care?

A) Carefully follow universal precautions.
B) Inform the parents of the other children.
C) Determine how the child became infected.
D) Reassure other children that they will not become infected.

Question 28

A child with hemophilia A will have which abnormal laboratory result?

A) PT (ProTime)
B) Platelet count
C) Fibrinogen level
D) PTT (partial thromboplastin time)

Question 29

The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means?

A) Through sexual contact
B) From a blood transfusion
C) By using intravenous (IV) drugs
D) Perinatally from their mothers

Question 30

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury?

A) Administer nonsteroidal anti-inflammatory drugs (NSAIDs).
B) Administer DDAVP (synthetic vasopressin).
C) Provide intravenous (IV) infusion of factor VIII concentrates.
D) Encourage elevation and application of ice to the involved joint.

Question 31

What condition precipitates polycythemia?

A) Dehydration
B) Severe infections
C) Immunosuppression
D) Prolonged tissue hypoxia

Question 32

In anticipation of the admission of a child with hereditary spherocytosis (HS) who is experiencing an aplastic crisis, what action should the nurse plan?

A) Secure an isolation room.
B) Prepare for a transfusion of packed red blood cells.
C) Anticipate preoperative preparation for a splenectomy.
D) Gather equipment and medication for treatment of shock.

Question 33

What statement is descriptive of most cases of hemophilia?

A) X-linked recessive deficiency of platelets causing prolonged bleeding
B) X-linked recessive inherited disorder in which a blood clotting factor is deficient
C) Autosomal dominant deficiency of a factor involved in the blood-clotting reaction
D) Y-linked recessive inherited disorder in which the red blood cells become moon shaped

Question 34

The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program?

A) Whole milk can be introduced into the infant's diet in small amounts at 6 months.
B) Iron supplements cannot be given until the infant is older than 1 year of age.
C) Iron-fortified cereal should be introduced to the infant at 2 months of age.
D) Breast milk or iron-fortified formula should be used for the first 12 months.

Question 35

A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child?

A) Handle the child gently when transferring to a cart.
B) Caution the child not to brush his teeth before surgery.
C) Use tape sparingly on postoperative dressings.
D) Do not administer analgesics before surgery.

Question 36

Nursing strategies to improve the growth and development of the child with human immunodeficiency virus (HIV) infection should include what?

A) Provide only those foods that the child feels like eating.
B) Fortify foods with nutritional supplements to maximize quality of intake.
C) Weigh the child and measure height and muscle mass on a daily basis.
D) Provide high-fat and high-calorie meals and snacks to meet body requirements for growth.

Question 37

What pain medication is contraindicated in children with sickle cell disease (SCD)?

A) Meperidine (Demerol)
B) Hydrocodone (Vicodin)
C) Morphine sulfate
D) Ketorolac (Toradol)

Question 38

Care for the child with acute idiopathic thrombocytopenic purpura (ITP) includes which therapeutic intervention?

A) Splenectomy
B) Intravenous administration of anti-D antibody
C) Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
D) Helping child participate in sports

Question 39

What medication is classified as an antiretroviral?

A) Dapsone (Aczone)
B) Pentamidine (Pentam)
C) Didanosine (Videx)
D) Trimethoprim-sulfamethoxazole (Bactrim)

Question 40

What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets?

A) Aplastic anemia
B) Thalassemia major
C) Idiopathic thrombocytopenic purpura
D) Disseminated intravascular coagulation

Question 41

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood?

A) Take the vital signs every 15 minutes while blood is infusing.
B) Use blood within 1 hour of its arrival from the blood bank.
C) Administer the blood with 5% glucose in a piggyback setup.
D) Administer the first 50 ml of blood slowly and stay with the child.

Question 42

The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease). What clinical features of severe congenital neutropenia should the nurse recognize? (Select all that apply.)

A) Anemia is present.
B) Neutropenia is present.
C) The illness is severe.
D) It has a dominant inheritance pattern.
E) There are decreased eosinophils in the bone marrow.

Question 43

The health care provider has prescribed a unit of packed red blood cells to be administered over 3 hours to a child with sickle cell disease. The unit from the blood bank totals 240 ml. What milliliters per hour should the nurse set the infusion pump to deliver the packed red blood cells? Fill in the blank and record your answer in a whole number.
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Question 44

The nurse is caring for a 12-year-old child with b-thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Anorexia
B) Unexplained fever
C) Enlarged spleen or liver
D) Bronzed, freckled complexion
E) Precocious sexual development

Question 45

The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child?

A) Playing a musical instrument
B) Playing board or card games
C) Participating in a game of table tennis
D) Participating in decorating the hospital room

Question 46

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.)

A) Prematurity
B) Slow growth rate
C) Excessive milk intake
D) Severe iron deficiency in the mother
E) Exclusive breastfeeding of infant from birth to 3 months

Question 47

The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range?

A) 9 g/dl
B) 10 g/dl
C) 11 g/dl
D) 12 g/dl

Question 48

The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection. What should the nurse include in the teaching session? (Select all that apply.)

A) Avoid obtaining the pneumococcal vaccination for the child.
B) Avoid obtaining the meningococcal vaccination for the child.
C) The child should receive prophylactic penicillin for certain procedures.
D) Have the child immunized with the Haemophilus influenzae type b vaccination.
E) Notify the health care provider if your child develops a fever of 38.5° C (101.3° F).

Question 49

The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range?

A) 30%
B) 40%
C) 50%
D) 60%

Question 50

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.)

A) Gastric acidity
B) Chronic diarrhea
C) Lactose intolerance
D) Absence of phosphates
E) Inflammatory bowel disease

Question 51

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan?

A) Exercise as a distraction
B) Heat to the affected area
C) Elevation of the extremity
D) Cold compresses to the affected area

Question 52

A health care provider prescribes morphine sulfate, 0.2 mg/kg IV every 2 to 4 hours as needed for pain for a child with sickle cell disease. The child weighs 20 kg. The medication label states: "Morphine sulfate 5 mg/ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 53

What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.)

A) Golf
B) Soccer
C) Rugby
D) Jogging
E) Swimming

Question 54

The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Petechiae
B) Chronic diarrhea
C) Hepatosplenomegaly
D) Bleeding from openings in the skin
E) Hypotension
F) Purpura

Question 55

The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia. What clinical features of chronic benign neutropenia should the nurse recognize? (Select all that apply.)

A) Gingivitis is present.
B) Anemia is not present.
C) Monocytosis is present.
D) It has an autosomal recessive pattern.
E) Treatment is by bone marrow transplantation.

Question 56

What are signs and symptoms of anemia? (Select all that apply.)

A) Pallor
B) Fatigue
C) Dilute urine
D) Bradycardia
E) Muscle weakness

Question 57

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia?

A) Prolonged use of oxygen can decrease erythropoiesis.
B) Prolonged use of oxygen can interfere with iron production.
C) Prolonged use of oxygen interferes with a child's appetite.
D) Prolonged use of oxygen can affect the synthesis of hemoglobin.

Question 58

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent?

A) 500 ml
B) 750 ml
C) 1000 ml
D) 1250 ml

Question 59

The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.)

A) Chills
B) Shaking
C) Flank pain
D) Hypothermia
E) Sudden severe headache

Question 60

What immunoglobulin pattern does the nurse expect in a child recently diagnosed with Wiskott-Aldrich syndrome?

A) Diminished levels of IgG
B) Diminished levels of IgA
C) Diminished levels of IgM
D) Diminished levels of IgE

Question 61

A health care provider prescribes OxyContin (Oxycodone), 7.5 mg PO every 4 to 6 hours as needed for pain for a child with sickle cell disease. The medication label states: "OxyContin 5 mg/1 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 62

A health care provider prescribes ibuprofen (Motrin), 5 mg/kg PO every 6 to 8 hours as needed for pain for a child with sickle cell disease. The child weighs 16 kg. The medication label states: "Ibuprofen 100 mg/5 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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Question 63

A health care provider prescribes iron (Niferex) elixir, 2 mg/kg orally daily for a preterm infant. The infant weighs 4 kg. The medication label states: "Niferex 100 mg/5 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 64

The child with sickle cell disease requires 150% of the 24-hour fluid maintenance. Calculate the 24-hour maintenance fluid requirement (ml/day) for a child with sickle cell disease weighing 12 kg. Fill in the blank. Record your answer in a whole number.
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Question 65

A health care provider prescribes Kytril (granisetron), 10 mcg/kg IV every 4 to 6 hours as needed for nausea for a child who had a reaction to a blood transfusion. The medication label states: "Kytril 100 mcg/1 ml." The child weighs 20 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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