Deck 27: Hematologic Disorders

Question 1

A toddler who presents with anemia and reticulocytopenia has a history of a
gradual decrease in energy and increase in pallor beginning after a recent viral infection. How will the primary care pediatric nurse practitioner treat this child?
A. Closely observe the child's symptoms and lab values.
B. Consult with a pediatric hematologist.
C. Prescribe supplemental iron for 4 to 6 months.
D. Refer for transfusions to correct the anemia.

Answer 1

Closely observe the child's symptoms and lab values.

Question 2

A complete blood count on a 12­month­old infant reveals microcytic, hypochromic
anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects
A. hereditary spherocytosis.
B. iron­deficiency anemia.
C. lead intoxication.
D. sickle­cell anemia.

Answer 2

iron­deficiency anemia.

Question 3

The primary care pediatric nurse practitioner is performing a well child
examination on a school­age child who has a history of cancer treated with cranial irradiation. What will the nurse practitioner monitor in this child?
A. Cardiomyopathy and arrhythmias
B. Leukoencephalopathy
C. Obesity and gonadal dysfunction
D. Peripheral neuropathy and hearing loss

Answer 3

Leukoencephalopathy

Question 4

The primary care pediatric nurse practitioner is managing care for a child
diagnosed with iron­deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child's current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient?
A. Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months.
B. Discontinue the supplemental iron and encourage an iron­enriched diet.
C. Increase the ferrous sulfate dose to 4 to 6 mg/kg/day of elemental iron.
D. Refer the child to a pediatric hematologist to further evaluate the anemia.

Question 5

The primary care pediatric nurse practitioner performs a well baby examination
on a 4­month­old infant who is exclusively breastfed and whose mother plans to introduce only
small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the nurse practitioner recommend?
A. Elemental iron supplementation of 1 mg/kg/day until cereals are added
B. Elemental iron supplementation of 3 mg/kg/day for the duration of breastfeeding
C. Monitoring the infant's hemoglobin and hematocrit at every well­baby checkup
D. Offering iron­fortified formula to ensure adequate iron intake

Question 6

The primary care pediatric nurse practitioner is examining a 5­year­old child who
has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to a specialist for
A. bone marrow biopsy.
B. corticosteroids and IVIG.
C. hemoglobin electrophoresis.
D. immunoglobulin testing.

Question 7

The primary care pediatric nurse practitioner reviews hematology reports on a
child with beta­thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do?
A. Evaluate serum ferritin.
B. Order Hgb electrophoresis.
C. Prescribe supplemental iron.
D. Refer for RBC transfusions.

Question 8

The primary care pediatric nurse practitioner evaluates a 5­year­old child who
presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?
A. Prescribe elemental iron and recheck labs in 1 month.
B. Reassure the parent that this represents mild anemia.
C. Recommend a diet high in iron­rich foods.
D. Refer to a hematologist for further evaluation.

Question 9

A school­age child comes to the clinic for evaluation of excessive bruising. The
primary care pediatric nurse practitioner notes a history of an upper respiratory infection 2 weeks prior. The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work reveals a platelet count of 60,000/mm3 with normal PT and aPTT. How will the nurse practitioner manage this child's condition?
A. Admit to the hospital for IVIG therapy.
B. Begin a short course of corticosteroid therapy.
C. Refer to a pediatric hematologist.
D. Teach to avoid NSAIDs and contact sports.

Question 10

The primary care pediatric nurse practitioner reviews a child's complete blood
count with differential white blood cell values and recognizes a "left shift" because of
A. a decreased eosinophil count.
B. a decreased lymphocyte count.
C. an elevated monocyte count.
D. an elevated neutrophil count.

Question 11

The primary care pediatric nurse practitioner sees a 12­month­old infant who is
being fed goat's milk and a vegetarian diet. The child is pale and has a beefy­red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child's condition?
A. Hemoglobin electrophoresis
B. RBC folate, iron, and B12 levels
C. Reticulocyte levels
D. Serum lead levels

Question 12

The pediatric nurse practitioner provides primary care for a 30­month­old child
who has sickle cell anemia who has had one dose of 23­valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child?
A. Administer an initial meningococcal vaccine.
B. Begin folic acid dietary supplementation.
C. Decrease the dose of penicillin V prophylaxis.
D. Give a second dose of 23­valent pneumococcal vaccine.