Deck 26: The Child With Hematologic or Immunologic Dysfunction

Question 1

Which of the following is the most appropriate nursing diagnosis for a child with anemia?

A)Activity intolerance related to generalized weakness
B)Alteration in cardiac output related to abnormal hemoglobin
C)Potential for injury related to depressed sensorium
D)Potential for injury related to dehydration and abnormal hemoglobin

Answer 1

Activity intolerance related to generalized weakness

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. The nurse should explain that:

A)Venipuncture discomfort is very brief.
B)Only one venipuncture will be needed.
C)Topical application of local anesthetic can eliminate venipuncture pain.
D)Most blood tests on children require only a finger puncture because a small amount of blood is needed.

Answer 2

Topical application of local anesthetic can eliminate venipuncture pain.

Question 3

Which of the following is an accurate description of anemia?

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

Answer 3

Decreased oxygen-carrying capacity of blood

Question 4

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

A)Are often ordered but not usually needed.
B)Rarely cause addiction because they are medically indicated.
C)Are given as a last resort because of the threat of addiction.
D)Are used only if other measures, such as ice packs, are ineffective.

Question 5

Meperidine (Demerol) is not recommended for children in sickle cell crisis because it:

A)May induce seizures.
B)Is easily addictive.
C)Is not adequate for pain relief.
D)Is given by intramuscular injection.

Question 6

Chelation therapy is begun on a child with $\beta$ -thalassemia major. The purpose of this therapy is to do which of the following?

A)Treat the disease
B)Eliminate excess iron
C)Decrease risk of hypoxia
D)Manage nausea and vomiting

Question 7

When both parents have sickle cell trait, what is the chance their children will have sickle cell anemia?

A)25%
B)50%
C)75%
D)100%

Question 8

Which of the following describes the pathologic changes of sickle cell anemia?

A)Sickle-shaped cells carry excess oxygen.
B)Sickle-shaped cells decrease blood viscosity.
C)Increased red blood cell destruction occurs.
D)Decreased red blood cell destruction occurs.

Question 9

A possible cause of acquired aplastic anemia in children is which of the following?

A)Drugs
B)Injury
C)Deficient diet
D)Congenital defect

Question 10

Iron dextran is ordered for a young child with severe iron-deficiency anemia. Nursing considerations include which of the following?

A)Administer with meals.
B)Administer between meals.
C)Inject deeply into a large muscle.
D)Massage injection site for 5 minutes after administration of drug.

Question 11

Which of the following explains why iron-deficiency anemia is common during toddlerhood?

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

Question 12

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

A)They should be given with meals.
B)They should be stopped 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 13

The therapeutic management of children with $\beta$ -thalassemia major consists primarily of which of the following?

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

Question 14

Which of the following is a condition in which 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 15

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

A)Circulatory collapse
B)Cardiomegaly, systolic murmurs
C)Hepatomegaly, intrahepatic cholestasis
D)Painful swelling of hands and feet, painful joints

Question 16

In which of the following conditions 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 17

The nurse is recommending how to prevent iron-deficiency anemia in a healthy, term, breast-fed infant. Which of the following should be suggested?

A)Iron (ferrous sulfate) drops after age 1 month
B)Iron-fortified commercial formula by age 4 to 6 months
C)Iron-fortified infant cereal by age 2 months
D)Iron-fortified infant cereal by age 4 to 6 months

Question 18

Which of the following statements best describes iron-deficiency anemia in infants?

A)It is caused by depression of the hematopoietic system.
B)It is easily diagnosed because of infant's emaciated appearance.
C)Clinical manifestations are similar regardless of the cause of the anemia.
D)Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.

Question 19

Which of the following statements best describes $\beta$ -thalassemia major (Cooley anemia)?

A)All formed elements of the blood are depressed.
B)Inadequate numbers of red blood cells are present.
C)Increased incidence occurs in families of Mediterranean extraction.
D)Increased incidence occurs in blacks of West African descent.

Question 20

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

A)Correction of acidosis
B)Adequate hydration, pain management
C)Pain management, administration of heparin
D)Adequate oxygenation, replacement of factor VIII

Question 21

Which of the following is often administered to prevent or control hemorrhage in a child with cancer?

A)Nitrosoureas
B)Platelets
C)Whole blood
D)Corticosteroids

Question 22

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

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

Question 23

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

A)Increased blood viscosity occurs.
B)Thrombocytopenia (excessive destruction of platelets) occurs.
C)Unrestricted proliferation of immature white blood cells (WBCs) occurs.
D)First stage of coagulation process is abnormally stimulated.

Question 24

A young child with HIV is receiving several antiretroviral drugs. The purpose of these drugs is to:

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

Question 25

The nurse is preparing a child for possible alopecia from chemotherapy. Which of the following should be included?

A)Explain to child that hair usually regrows in 1 year.
B)Advise child to expose head to sunlight to minimize alopecia.
C)Explain to child that wearing a hat/scarf is preferable to wearing a wig.
D)Explain to child that when hair regrows, it may have a slightly different color or texture.

Question 26

Which of the following immunizations should not be given to a child receiving chemotherapy for cancer?

A)Tetanus vaccine
B)Inactivated poliovirus vaccine
C)Diphtheria, pertussis, tetanus (DPT)
D)Measles, rubella, mumps

Question 27

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which of the following is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

A)Encourage drinking large amounts of favorite fluids.
B)Encourage to remain nothing-by-mouth (NPO) until nausea and vomiting subside.
C)Administer an antiemetic before chemotherapy begins.
D)Administer an antiemetic as soon as child has nausea.

Question 28

Which of the following is the most effective pain-management approach for a child who is having a bone marrow aspiration?

A)Relaxation techniques
B)Administration of an opioid
C)EMLA cream applied over site
D)Conscious or unconscious sedation

Question 29

The nurse is planning care for an adolescent with acquired immune deficiency syndrome (AIDS). Which of the following is the priority nursing goal?

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

Question 30

Which of the following immunizations should be given with caution to children infected with HIV?

A)Influenza
B)Varicella
C)Pneumococcal
D)Inactivated poliovirus (IPV)

Question 31

Which of the following is a common clinical manifestation of Hodgkin disease?

A)Petechiae
B)Bone and joint pain
C)Painful, enlarged lymph nodes
D)Enlarged, firm, nontender lymph nodes

Question 32

Which of the following is descriptive of most cases of hemophilia?

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

Question 33

Which of the following is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD₄⁺ T cells?

A)Wiskott-Aldrich syndrome
B)Idiopathic thrombocytopenic purpura
C)Acquired immunodeficiency syndrome
D)Severe combined immunodeficiency disease

Question 34

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent:

A)Infection.
B)Brain tumor.
C)Drug side effects.
D)Central nervous system (CNS) disease.

Question 35

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of what?

A)Decrease in leukocytes
B)Increase in lymphocytes
C)Vitamin C deficiency
D)Decrease in blood platelets

Question 36

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

A)Edema
B)Bone involvement
C)Petechial hemorrhages
D)Changes within the muscles

Question 37

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which of the following?

A)Relax any eating pressures.
B)Firmly insist that child eat normally.
C)Begin gavage feedings to supplement diet.
D)Serve foods that are either hot or cold.

Question 38

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which of the following is the most appropriate nursing action?

A)Stop drug infusion immediately.
B)Recheck rate of drug infusion.
C)Observe child closely for next 10 minutes.
D)Explain to child that this is an expected side effect.

Question 39

A young boy will receive a bone marrow transplant. This is possible because one of his older siblings is a histocompatible donor. What is this type of bone marrow transplant called?

A)Syngeneic
B)Allogeneic
C)Monoclonal
D)Autologous

Question 40

A common side effect of corticosteroid (Prednisone) therapy is:

A)Alopecia.
B)Anorexia.
C)Nausea and vomiting.
D)Susceptibility to infection.

Question 41

Which of the following is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity?

A)Severe combined immunodeficiency disease
B)AIDS
C)Wiskott-Aldrich syndrome
D)Fanconi syndrome

Question 42

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

A)Chills and shaking
B)Nausea and vomiting
C)Irregular heart rate
D)Sudden difficulty in breathing

Question 43

The school nurse is informed that a child with HIV will be attending school soon. Which of the following is an important nursing intervention?

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

Question 44

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. Which of the following should the nurse recognize as important when discussing this with the family?

A)BMT should be done at time of diagnosis.
B)Parents and siblings of child have a 25% chance of being a suitable donor.
C)Finding a suitable donor involves matching antigens from the human leukocyte antigen system.
D)If BMT fails, chemotherapy or radiotherapy must be continued.

Question 45

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 which of the following complications?

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

Question 46

An adolescent will receive a BMT. The nurse should explain that the bone marrow will be administered by which of the following?

A)Bone grafting
B)Bone marrow injection
C)Intravenous infusion
D)Intraabdominal infusion