Question 1

A child who has beta-thalassemia is receiving numerous blood transfusions. The child is also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which rationale does the nurse use when responding to the parents?

Accepted Answer

Deferoxamine (Desferal) chelates excess iron that accumulates in the body as a result of frequent blood transfusions, preventing iron overload and associated complications.

Question 2

The nurse is caring for the 5-year-old just diagnosed with von Willebrand disease after a tooth extraction with increased bleeding. The family asks the nurse how the signs and symptoms of von Willebrand disease are manifested. What will the nurse tell the family? Select all that apply.

Accepted Answer

Von Willebrand disease is a bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor. The signs and symptoms of von Willebrand disease include frequent nosebleeds, bleeding from mucous membranes (such as gums), and easy bruising. The partial thromboplastin time may be normal or prolonged, but it is not decreased. Factor VI deficiency is not associated with von Willebrand disease, so B is incorrect. Therefore, the best choices are C, D, and E.

Question 3

The nurse is providing care for an adolescent client who is experiencing pain related to a sickle cell crisis. Which medication does the nurse prepare to administer to this client?

Accepted Answer

Morphine sulfate is the preferred opioid for adolescents experiencing severe pain related to sickle cell crisis, as it provides potent pain relief and is less likely to cause adverse effects such as seizures compared to meperidine. Acetaminophen and ibuprofen are not strong enough to manage severe pain associated with sickle cell crisis.

Question 4

A child recently diagnosed with aplastic anemia is being prepared for discharge. When planning support for the family, which service should the nurse plan to include in the discharge plan?

Accepted Answer

Referrals to support groups and social services can provide ongoing emotional and financial support for the family as they manage the child's condition. Short-term support may not be sufficient for a chronic condition like aplastic anemia. While genetic counseling may be appropriate in some cases, it is not necessarily required for all children with aplastic anemia. Nutrition counseling may be helpful, but it is not the priority in the discharge plan.

Question 5

The adolescent is admitted to the hospital in sickle cell crisis with a pain level of 10/10. The physician orders:
Morphine sulfate 5 mg IV q 2 hr prn
Medication on hand: morphine sulfate 10 mg/mL
Calculate how many ml of morphine sulfate will be given IV.

Accepted Answer

The answer of The adolescent is admitted to the hospital...

Question 6

The nurse is providing care to a school-age client with neutropenia. Which clinical manifestations does the nurse anticipate when assessing this client? Select all that apply.

Accepted Answer

Neutropenia, a condition characterized by an abnormally low number of neutrophils, increases the risk of infections. Fever is a common sign of infection in neutropenic patients. Fatigue can result from the body's increased metabolic demand during infection. Tachycardia and tachypnea may occur as the body attempts to meet the oxygen demands during an infection or inflammatory process. Hypertension is not typically associated with neutropenia or its direct clinical manifestations.

Question 7

The nurse is providing an educational session for parents with children diagnosed with iron deficiency anemia. Which statements will the nurse include educate about the normal functions of RBCs? Select all that apply.

Accepted Answer

RBCs transport oxygen from the lungs to the tissue and transport carbon dioxide to the lungs. C and D are functions of platelets, not RBCs, and E is not a function of either RBCs or platelets.

Question 8

The nurse is providing care to a school-age client diagnosed with idiopathic thrombocytopenic purpura (ITP). Which nursing diagnosis is the priority for this client?

Accepted Answer

The priority nursing diagnosis for a client with ITP is Risk for Injury related to decreased platelet count and potential bleeding, including intracranial bleeding.

Question 9

A school-age child with hemophilia falls on the playground and goes to the nurse's office with superficial bleeding above the knee. Which action by the nurse is the most appropriate?

Accepted Answer

Applying pressure to the affected area for at least 15 minutes is the most appropriate action, as it helps to control bleeding in children with hemophilia. Warm, moist packs or passive range of motion could exacerbate bleeding, and keeping the affected extremity in a dependent position could increase the risk of bleeding as well.

Question 10

A child with meningococcemia is being admitted to the pediatric intensive-care unit. Which room assignment is the most appropriate for this child?

Accepted Answer

Meningococcemia, caused by Neisseria meningitidis, can lead to meningitis and is highly contagious through respiratory droplets. Therefore, a private room in respiratory isolation is most appropriate to prevent the spread of infection.

Question 11

The nurse is caring for a child who is in a sickle cell crisis and has severe pain. Which nursing intervention is the most appropriate for this child?

Accepted Answer

Pain medication will provide the most direct relief for the child's severe pain during a sickle cell crisis. Comfort measures and diversional activities may provide some distraction or relaxation, but will not address the root cause of the pain. Preparing the child for painful procedures may be necessary, but it is not the most appropriate intervention for managing the current pain crisis.

Question 12

A child diagnosed with hemophilia plans on participating in a bicycling club. Which recommendation by the nurse is the most appropriate?

Accepted Answer

The child should wear kneepads, elbow pads, and a helmet while bicycling to prevent injury and bleeding due to hemophilia. While choosing a different activity or only participating in social activities may also be options, these limit the child's opportunities for physical activity and socialization. Completely prohibiting the child from joining the club may also be overly restrictive, as long as appropriate safety measures are taken.

Question 13

A child who has undergone a hematopoietic stem cell transplantation (HSCT) is ready for discharge. Which items will the nurse include in the discharge teaching for this child and family? Select all that apply.

Accepted Answer

A) It is important for the child and family to recognize signs of graft-versus-host disease as early identification and treatment can improve outcomes.
C) Good handwashing is important to decrease the risk of infection post-HSCT.
E) Fresh vegetables and live plants carry a higher risk of infection, and hence should be avoided post-HSCT. 
B) The child may not be ready to return to school within six weeks due to the risk of infection. This decision should be made by the healthcare team in consultation with the family.
D) Influenza vaccination is important to decrease the risk of infection post-HSCT; however, the child should receive a killed virus vaccine rather than a live vaccine.

Question 14

The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle cell disease. Which precipitating factors to a sickle cell crisis will the nurse include in the explanation? Select all that apply.

Accepted Answer

Fever, dehydration, and high altitude can all precipitate a sickle cell crisis. Fever and dehydration can lead to increased blood viscosity, promoting sickling of red blood cells. High altitude can induce hypoxia, which also promotes sickling. Regular exercise, when not excessive, and increased fluid intake are generally recommended to maintain health and prevent crises.

Question 15

The nurse is evaluating the activity tolerance of a 9-month-old with iron deficiency anemia. Which finding indicates that the infant is not tolerating activity?

Accepted Answer

Muscle weakness indicates that the infant's activity tolerance is limited and not normal for their age. A heart rate of 138 may be within a normal range for the infant's activity level, increased alertness may indicate that the infant is able to tolerate activity well, and a respiratory rate less than 40 with activity may also be within a normal range for the infant's age.

Question 16

The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which nursing intervention is a priority for this child?

Accepted Answer

The priority intervention for a child with DIC is maintenance of skin integrity due to the risk of bleeding and development of pressure ulcers. Frequent ambulation, monitoring of fluid restriction, and preparation for x-ray procedures may also be necessary interventions, but they are not the priority in this situation.

Question 17

A child is diagnosed with sickle cell disease. The parents are unsure how their child contracted the disease. Which explanation by the nurse is the most appropriate?

Accepted Answer

Sickle cell disease is an autosomal recessive genetic disorder, meaning that it requires two copies of the abnormal gene to be present for the disease to develop. A person who inherits one copy of the abnormal gene and one normal gene is said to have sickle cell trait, which usually does not cause symptoms. Therefore, both the mother and the father must have at least one copy of the abnormal gene to pass it on to their child, resulting in sickle cell disease.

Question 18

Which action by the parents demonstrates an understanding of the nurse's teaching with regard to prevention of iron-deficient anemia?

Accepted Answer

Starting iron-fortified infant cereal at 4 to 6 months of age is the best choice because introducing iron-rich foods at this age can prevent iron-deficient anemia. The other options are incorrect as feeding an infant with a formula that is not iron fortified, introducing cow's milk at 6 months of age, and limiting vitamin C consumption after 1 year of age can all increase the risk of iron-deficient anemia.

Question 19

The nurse is administering packed RBCs to a child with sickle cell disease (SCD). The nurse is monitoring for a transfusion reaction and knows it is most likely to occur during which time frame?

Accepted Answer

Transfusion reactions are most likely to occur within the first 20 minutes of the administration of the transfusion. However, the nurse should continue to monitor for signs and symptoms of a reaction throughout the entire transfusion and for a period of time after the transfusion is completed.

Question 20

The charge nurse on a pediatric unit is making a room assignment for a school-age child diagnosed with sickle cell disease, who is in splenic sequestration crisis. Which room assignment is most appropriate for this client?

Accepted Answer

A private room would be the most appropriate to help protect the child from infections, which can cause further complications during a splenic sequestration crisis. The child's condition requires close monitoring and specialized care, which would not be possible in a semiprivate or isolation room.

Quiz 23: Alterations in Hematologic Function