Question 1

Several complications can occur when a child receives a blood transfusion.Which is an immediate sign or symptom of an air embolus?
A)Chills and shaking
B)Nausea and vomiting
C)Irregular heart rate
D)Sudden difficulty in breathing

Accepted Answer

Signs of air embolism are sudden difficulty breathing,sharp pain in the chest,and apprehension.Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient.Chills,shaking,nausea,and vomiting are associated with hemolytic reactions.Irregular heart rate is associated with electrolyte disturbances and hypothermia.

Question 2

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:
A)air emboli.
B)allergic reaction.
C)hemolytic reaction.
D)circulatory overload.

Accepted Answer

The signs of circulatory overload include distended neck veins,hypertension,crackles,dry cough,cyanosis,and precordial pain.Signs of air embolism are sudden difficulty breathing,sharp pain in the chest,and apprehension.Allergic reactions are manifested by urticaria,pruritus,flushing,asthmatic wheezing,and laryngeal edema.Hemolytic reactions are characterized by chills,shaking,fever,pain at infusion site,nausea,vomiting,tightness in chest,flank pain,red or black urine,and progressive signs of shock and renal failure.

Question 3

A toddler with leukemia is on intravenous chemotherapy treatments.The toddler's lab results are WBC: 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%.What is this child's absolute neutrophil count (ANC)? (Record your answer in a whole number.)

Accepted Answer

The answer of A toddler with leukemia is on intravenous...

Question 4

Parents of a school-age child with hemophilia ask the nurse,"Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.)
A)Soccer
B)Swimming
C)Basketball
D)Golf
E)Bowling

Accepted Answer

Because almost all persons with hemophilia are boys,the physical limitations in regard to active sports may be a difficult adjustment,and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs.Use of protective equipment,such as padding and helmets,is particularly important,and noncontact sports,especially swimming,walking,jogging,tennis,golf,fishing,and bowling,are encouraged.Contact sport such as soccer and basketball are not recommended.

Question 5

The nurse is planning care for a school-age child admitted to the hospital with hemophilia.Which interventions should the nurse plan to implement for this child? (Select all that apply.)
A)Finger sticks for blood work instead of venipunctures
B)Avoidance of IM injections
C)Acetaminophen (Tylenol) for mild pain control
D)Soft tooth brush for dental hygiene
E)Administration of packed red blood cells

Accepted Answer

Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding,such as IM injections.The subcutaneous route is substituted for IM injections whenever possible.Venipunctures for blood samples are usually preferred for these children.There is usually less bleeding after the venipuncture than after finger or heel punctures.Neither aspirin nor any aspirin-containing compound should be used.Acetaminophen is a suitable aspirin substitute,especially for controlling mild pain.A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums.Packed red blood cells are not administered.The primary therapy for hemophilia is replacement of the missing clotting factor.The products available are factor VIII concentrates.

Question 6

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.)
A)Limit fluids at bedtime.
B)Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs.
C)Give penicillin as prescribed.
D)Use ice packs to decrease the discomfort of vasoocclusive pain in the legs.
E)Notify the health care provider if your child begins to develop symptoms of a cold.

Accepted Answer

The most important issues to teach the family of a child with sickle cell anemia are to (1)seek early intervention for problems,such as a fever of 38.5° C (101.3° F)or greater; (2)give penicillin as ordered; (3)recognize signs and symptoms of splenic sequestration,as well as respiratory problems that can lead to hypoxia; and (4)treat the child normally.The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle.It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required.Many foods are also a source of fluid,particularly soups,flavored ice pops,ice cream,sherbet,gelatin,and puddings.Increased fluids combined with impaired kidney function result in the problem of enuresis.Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting,such as limiting fluids at night.Enuresis is treated as a complication of the disease,such as joint pain or some other symptom,to alleviate parental pressure on the child.Ice should not be used during a vasoocclusive pain crisis because it vasoconstricts and impairs circulation even more.

Question 7

An adolescent will receive a bone marrow transplant (BMT).The nurse should explain that the bone marrow will be administered by which route?
A)Bone grafting
B)Bone marrow injection
C)IV infusion
D)Intra-abdominal infusion

Accepted Answer

Bone marrow from a donor is infused intravenously,and the transfused stem cells will repopulate the marrow.Because the stem cells migrate to the recipient's marrow when given intravenously,this is the method of administration.

Question 8

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia.Which preparations should the nurse use for oral care on this child? (Select all that apply.)
A)Chlorhexidine gluconate (Peridex)
B)Lemon glycerin swabs
C)Antifungal troches (lozenges)
D)Lip balm (Aquaphor)
E)Hydrogen peroxide

Accepted Answer

Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex)because of its dual effectiveness against candidal and bacterial infections,antifungal troches (lozenges)or mouthwash,and lip balm (e.g.,Aquaphor)to keep the lips moist.Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth),hydrogen peroxide (delays healing by breaking down protein),and milk of magnesia (dries mucosa).

Question 9

The nurse has initiated a blood transfusion on a preschool child.The child begins to exhibit signs of a transfusion reaction.Place in order the interventions the nurse should implement sequencing from the highest priority to the lowest.Provide answer using lowercase letters separated by commas (e.g.,a,b,c,d).
a. Take the vital signs.
b. Stop the transfusion.
c. Notify the practitioner.
d. Maintain a patent IV line with normal saline.

Accepted Answer

The answer of The nurse has initiated a blood transfusion...

Question 10

The nurse is reviewing first aid with a group of school nurses.Which statement made by a participant indicates a correct understanding of the information?
A)"If a child loses a tooth due to injury, I should place the tooth in warm milk."
B)"If a child has recurrent abdominal pain, I should send him or her back to class until the end of the day."
C)"If a child has a chemical burn to the eye, I should irrigate the eye with normal saline."
D)"If a child has a nosebleed, I should have the child sit up and lean forward."

Accepted Answer

If a child has a nosebleed,the child should lean forward,not lie down.A tooth should be placed in cold milk or saliva for transporting to a dentist.Recurrent abdominal pain is a physiologic problem and requires further evaluation.If a chemical burn occurs in the eye,the eye should be irrigated with water for 20 minutes.

Quiz 26: The Child with Hematologic or Immunologic Dysfunction

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

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:

A toddler with leukemia is on intravenous chemotherapy treatments.The toddler's lab results are WBC: 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%.What is this child's absolute neutrophil count (ANC)? (Record your answer in a whole number.)

Parents of a school-age child with hemophilia ask the nurse,"Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.)

The nurse is planning care for a school-age child admitted to the hospital with hemophilia.Which interventions should the nurse plan to implement for this child? (Select all that apply.)

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.)

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

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

The nurse is reviewing first aid with a group of school nurses.Which statement made by a participant indicates a correct understanding of the information?