Deck 26: The Child With a Condition of the Blood, Blood-Forming Organs, or Lymphatic System

Question 1

A child with thalassemia major receives blood transfusions frequently. The nurse is aware that a complication of repeated blood transfusions is:

A) Hemarthrosis
B) Hematuria
C) Hemoptysis
D) Hemosiderosis

Answer 1

Hemosiderosis

Question 2

The nurse would ask the patient with hemophilia A to reconsider a vacation he has planned to:

A) The Caribbean for a cruise
B) Denver for skiing
C) Canada for a rail tour
D) New England for a bus tour

Answer 2

Denver for skiing

Question 3

The statement made by a parent indicating understanding of health maintenance of a child with sickle cell anemia is:

A) "I should give my child a daily iron supplement."
B) "It is important for my child to drink plenty of fluids."
C) "He needs to wear protective equipment if he plays contact sports."
D) "He shouldn't receive any immunizations until he is older."

Answer 3

"It is important for my child to drink plenty of fluids."

Question 4

When dealing with a preschool-age child with a life-threatening illness, the nurse should remember that at this age the child's concept of death includes:

A) That it is final
B) Only a fear of separation from her parents
C) That a person becomes alive again soon after death
D) An understanding based on simple logic

Question 5

A child who is receiving a transfusion should be closely assessed for:

A) Fever
B) Lethargy
C) Jaundice
D) Bradycardia

Question 6

A child has just been diagnosed with acute lymphoblastic leukemia. The nurse is aware that the result of an overproduction of immature white blood cells in the bone marrow is:

A) Decreased T-cell production
B) Decreased hemoglobin
C) Increased blood clotting
D) Increased susceptibility to infection

Question 7

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm³. The priority nursing intervention is:

A) Assessing neurological status
B) Inserting an intravenous line
C) Monitoring vital signs during platelet transfusions
D) Providing family education about how to prevent bleeding

Question 8

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain their children's risk of inheriting this disease?

A) Every fourth child will have the disease; two others will be carriers.
B) All of their children will be carriers, just as they are.
C) Each child has a one-in-four chance of having the disease and a two-in-four chance of being a carrier.
D) The risk levels of their children cannot be determined by this information.

Question 9

The nurse would teach the parents of a child with a low platelet count to avoid:

A) Ibuprofen
B) Aspirin
C) Caffeine
D) Prednisone

Question 10

The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. Also, there is no record of a bowel movement for the last 2 days. These assessment findings suggest the possibility of:

A) Peripheral neuropathy
B) Stomatitis
C) Myelosuppression
D) Hemorrhage

Question 11

An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. The disease is in:

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Question 12

The nurse would instruct the parent to give ferrous sulfate drops to the child:

A) With milk
B) With orange juice
C) With water
D) On a full stomach

Question 13

The nurse would include in a teaching plan about mouth care of a child receiving chemotherapy to:

A) Use commercial mouthwash
B) Clean teeth with a soft toothbrush
C) Avoid use of a Waterpik
D) Inspect the mouth weekly for ulcerations

Question 14

A 2-year-old child has been diagnosed with hemophilia A. The information the nurse would include in a teaching plan about home care would be:

A) If bleeding occurs, apply pressure, ice, elevate, and rest the extremity.
B) Children's aspirin in lowered doses may be given for joint discomfort.
C) A firm, dry toothbrush should be used to clean teeth at least twice a day.
D) Do not permit interactive play with other children.

Question 15

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis for severe abdominal pain. The nurse recognizes that the type of crisis the child is most likely experiencing is:

A) Aplastic
B) Hyperhemolytic
C) Vaso-occlusive
D) Splenic sequestration

Question 16

The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. The lab value that would be consistent with these symptoms is:

A) Platelet count of 25,000/mm3
B) Hemoglobin level of 8 g/dl
C) Hematocrit level of 36%
D) Leukocyte count of 14,000/mm3

Question 17

The statement by a mother that may indicate a cause for her 9-month-old having iron deficiency anemia is:

A) "Formula is so expensive. We switched to regular milk right away."
B) "She almost never drinks water."
C) "She doesn't really like peaches or pears, so we stick to bananas for fruit."
D) "I give her a piece of bread now and then. She likes to chew on it."

Question 18

When the child receiving a transfusion complains of back pain and itching, the nurse's initial action would be to:

A) Notify the charge nurse
B) Disconnect IV lines immediately
C) Give Benadryl
D) Clamp off blood and keep line open with NS

Question 19

When teaching the mother of a young child about iron deficiency anemia, the nurse would tell her that a rich source of iron is:

A) Egg whites
B) Cream of wheat
C) Bananas
D) Carrots

Question 20

A 6-year-old with leukemia asks, "Who will take care of me in heaven?" The best response for the nurse to make is:

A) "Who do you think will take care of you?"
B) "Your grandparents and God will take care of you."
C) "Your mom will know more about that than I do."
D) "Why are you asking me that?"

Question 21

The nurse reviews the classic symptoms of thalassemia major (Cooley's anemia), such as: Select all that apply.

A) Hepatomegaly
B) Jaundice
C) Protruding teeth
D) Pathological fractures
E) Cardiac failure
F) None of the above

Question 22

The family of a child receiving chemotherapy for leukemia should be taught to focus on the child's care in regard to the need to: Select all that apply.

A) Use a support group
B) Stimulate appetite
C) Maintain adequate hydration
D) Delay immunizations
E) Report exposure to infectious diseases
F) None of the above

Question 23

The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." The most appropriate nursing response to this comment is:

A) "I understand how you must feel."
B) "You shouldn't feel that way."
C) "Is this the strongest feeling you've had today?"
D) "Tell me what's got you scared."

Question 24

The nurse shows slides of red blood cells from a child with sickle cell anemia, noting that in addition to their sickle shape, the cells contain the abnormal element of ________ ______.

Question 25

The nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease, should include: Select all that apply.

A) Application of sunblock to the skin to prevent burning
B) Appetite stimulation
C) Conservation of energy
D) Provision for expressions of anger
E) Preparation for delay in sexual development
F) None of the above

Question 26

The nurse reviews for a family how the development of synthetic recombinant antihemophilic factor has improved the management of hemophilia, because this drug: Select all that apply.

A) Eliminates the need for frequent transfusions
B) Can be administered by family at home
C) Prevents hemorrhage
D) Reduces cost of care of the hemophiliac
E) Reduces risk of HIV and hepatitis A and B transmission

Question 27

The nurse takes into consideration an important focus of nursing care for the dying child and his/her family, which is:

A) Nursing care should be organized to minimize contact with the child.
B) Adequate oral intake is crucial to the dying child.
C) Families should be made aware that hearing is the last sense to stop functioning before death.
D) It is best for the family if the nursing staff provides all of the child's care.

Question 28

The most recent blood count for a child who received chemotherapy last week shows neutropenia. The priority nursing diagnosis for this child is:

A) Risk for infection
B) Risk for hemorrhage
C) Altered skin integrity
D) Disturbance in body image