Question 1

What is the most appropriate nursing diagnosis for a child with anemia?

Accepted Answer

The basic pathology in anemia is the decreased oxygen-carrying capacity of the blood.The nurse must assess the child's activity level (response to the physiological state),and the nursing diagnosis would reflect activity intolerance.In generalized anemia,no abnormal hemoglobin may be present-only at a level of very severe anemia is cardiac output altered.No decreased sensorium exists until profound anemia occurs.Dehydration and abnormal hemoglobin are not usually part of anemia.

Question 2

Several blood tests are ordered for a preschool child with severe anemia.She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago.What should the nurse explain to the child?

Accepted Answer

Preschool children are very concerned about both pain and loss of blood.When preparing the child for venipuncture,a topical anaesthetic should be used to eliminate any pain and a bandage should be applied afterward.This is a very traumatic experience for preschool children because they are concerned about their bodily integrity.The nurse should not promise that only one venipuncture will be needed in case multiple attempts are required.Both finger punctures and venipunctures are traumatic for children,so both require preparation.

Question 3

What is the name of the condition in which the normal,adult hemoglobin is partly or completely replaced by abnormal hemoglobin?

Accepted Answer

Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies,which replace normal adult hemoglobin with abnormal hemoglobin.Aplastic anemia is caused by a lack of production of cellular elements.Hemophilia refers to a group of bleeding disorders where there is a deficiency of one of the factors necessary for coagulation.Iron-deficiency anemia is caused by factors that decrease the supply of iron,impair its' absorption,increase its' consumption or affect the synthesis of HgB but the HgB is not replaced by abnormal HgB.

Question 4

What is one possible cause of acquired aplastic anemia in children?

Accepted Answer

Drugs such as chemotherapeutic agents and several antibiotics such as chloramphenicol can cause aplastic anemia.Fanconi syndrome is a primary form of the disorder,which is congenital and not acquired after birth.Deficient diet and congenital defects are not causative agents in acquired aplastic anemia.

Question 5

Which of the following statements best describes the pathological changes of sickle cell anemia?

Accepted Answer

The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells.Sickled red cells have decreased oxygen-carrying capacity and trAnswerform into the sickle shape in conditions of low oxygen tension.When the sickle cells change shape,they increase the viscosity in the area where they are involved in microcirculation.

Question 6

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

Accepted Answer

The nurse should prepare the mother for the anticipated change in the child's stools.If the iron dose is adequate,the stools will be a tarry green colour.The lack of the colour change may indicate insufficient iron.The iron should be given in two divided doses between meals,when the presence of free hydrochloric acid is greatest because iron is absorbed best in an acidic environment.Vomiting and diarrhea may occur with iron administration.If these occur,iron should be given with meals at a reduced dosage,and gradually increased as the child develops tolerance.Liquid preparations of iron stain the teeth,so they should be administered through a straw,and the mouth rinsed after administration.

Question 7

Which age group is most at risk for iron-deficiency anemia?

Accepted Answer

Adolescents are the most at risk because of their rapid growth rate combined with poor eating habits.Preterm infants,not term infants,are especially at risk because of their reduced fetal iron supply.Healthy school-aged children and young adults are not at high risk.

Question 8

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

Accepted Answer

Aplastic anemia refers to a condition caused by abnormal bone marrow function in which the formed elements of the blood are simultaneously depressed.Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin.Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains.Iron-deficiency anemia results in a decreased amount of circulating red cells.

Question 9

Which of the following is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets?

Accepted Answer

Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by the excessive destruction of platelets,discolorations caused by petechiae beneath the skin,and a normal bone marrow.Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed.Thalassemia major is a group of blood disorders characterized by a deficiency in the production rate of specific hemoglobin globin chains.Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature,consumption of coagulation factors,and endogenous generation of thrombin and plasma.

Question 10

Why is iron-deficiency anemia common during toddlerhood?

Accepted Answer

Children between the ages of 12 to 36 months are at risk for anemia because cow's milk is a major component of their diet,and it is a poor source of iron.Iron is stored during fetal development,but the amount stored depends on maternal iron stores.Fetal iron stores are usually depleted by age 5 to 6 months.Dietary iron can be introduced by breastfeeding,iron-fortified formula,and cereals during the first 12 months of life.

Question 11

The nurse is recommending how to prevent iron-deficiency anemia in a healthy term breastfed infant.What should she tell the parents?

Accepted Answer

Breast milk supplies inadequate iron for growth and development after age 5 to 6 months,so supplementation is necessary after this time.Iron supplementation,or the introduction of solid foods to a breastfed baby is not indicated.Introducing iron-fortified infant cereal at 2 months should not be done.

Question 12

A boy with leukemia screams whenever he needs to be turned or moved.What is the most probable cause of his pain?

Accepted Answer

The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures.As leukemic cells invade the periosteum,increasing pressure causes severe pain.Edema,petechial hemorrhages,and muscular changes would not cause severe pain.

Question 13

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?

Accepted Answer

A vaso-occlusive crisis is characterized by severe pain in the area of involvement.If in the extremities,painful swelling of the hands and feet is seen; if in the abdomen,severe pain resembles that of acute surgical pain in the abdomen; and if in the head,stroke and visual disturbances occur.Circulatory collapse results from sequestration crises.Cardiomegaly,systolic murmurs,hepatomegaly,and intrahepatic cholestasis result from chronic vaso-occlusive phenomena.

Question 14

Which statement best describes b-thalassemia major ( Cooley's anemia )?

Accepted Answer

Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia,which causes an overproduction of red blood cells.Although numerous,the red cells are relatively unstable.Sickle cell disease is common in blacks of West African descent.

Question 15

What is the purpose of initiating chelation therapy on a child with b-thalassemia major?

Accepted Answer

A complication of the frequent blood trAnswerfusions in thalassemia is iron overload.Chelation therapy with deferoxamine (an iron-chelating agent)is given with oral supplements of vitamin C to increase iron excretion.Chelation therapy treats the adverse effects of disease management.Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

Question 16

Which of the following sentences is most descriptive of the pathophysiology of leukemia?

Accepted Answer

Leukemia is a group of malignant disorders of the bone marrow and the lymphatic system.It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body.Increased blood viscosity may occur secondary to the increased number of WBCs.Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow.The coagulation process is unaffected by leukemia.

Question 17

A school-age child is admitted in vaso-occlusive sickle cell crisis.What should the child's care include?

Accepted Answer

The management of crises includes adequate hydration,minimizing energy expenditures,pain management,electrolyte replacement,and blood component therapy if indicated.The acidosis will be corrected as the crisis is treated.Heparin and factor VIII are not indicated in the treatment of a vaso-occlusive sickle cell crisis.Oxygen may prevent further sickling,but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

Question 18

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction.What should the nurse explain about narcotic analgesics?

Accepted Answer

The pain of sickle cell anemia is best treated using a multidisciplinary approach.Mild to moderate pain can be controlled by ibuprofen and acetaminophen.When narcotics are indicated,they are titrated to effect and given around the clock.Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with it.Few if any patients who receive opioids for severe pain become behaviourally addicted to the drug.Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis.Ice is contraindicated because of its vasoconstrictive effects.

Question 19

Which of the following statements accurately describes most cases of hemophilia?

Accepted Answer

The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive.The two most common forms of the disorder are factor VIII deficiency,hemophilia A (known as classic hemophilia),and factor IX deficiency,hemophilia B (known as Christmas disease).The disorder involves coagulation factors,not platelets.The disorder does not involve red blood cells or the Y chromosome.

Question 20

Which one of the following statements accurately describes anemia?

Accepted Answer

Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age.This results in blood having a decreased oxygen-carrying capacity.Increased blood viscosity is usually a function of too many cells or dehydration,not anemia.A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia,but the definition depends on the deceased oxygen-carrying capacity of the blood.

Quiz 49: Hematological and Immunological Dysfunction