Deck 24: The Child with Hematologic or Immunologic Dysfunction

Question 1

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

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

Answer 1

Drugs

Question 2

Iron dextran is ordered for a young child with severe iron-deficiency anemia. What nursing considerations should be included?

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

Answer 2

Inject deeply into a large muscle

Question 3

In which of the 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

Answer 3

Aplastic anemia

Question 4

The nurse is recommending how to prevent iron-deficiency anemia in a healthy, term, breastfed infant. Which 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 5

The nurse is teaching parents about the importance of iron in a toddler's diet. Which 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 6

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about 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 7

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child?

A) Game of "hide and seek" in the children's outdoor play area
B) Participation in dance activities in the playroom
C) Puppet play in the child's room
D) A walk down to the hospital lobby

Question 8

Chelation therapy is begun on a child with b-thalassemia major. What is the purpose of this therapy?

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

Question 9

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?

A) Normal adult hemoglobin is replaced by abnormal hemoglobin.
B) There is a lack of cellular hemoglobin being produced.
C) There is a deficiency in the production of globulin chains.
D) The size and depth of the hemoglobin are affected.

Question 10

Which statement best describes b-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 persons of West African descent.

Question 11

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse 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 12

A school-age child is admitted in vasoocclusive sickle cell crisis. What should be included in the child's care?

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

Question 13

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

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

Question 14

The nurse is conducting a staff in-service on sickle cell anemia. Which 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 adhesion of sickle-shaped cells occurs.

Question 15

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

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

Question 16

Why is meperidine (Demerol) not recommended for children in sickle cell crisis?

A) May induce seizures
B) Is easily addictive
C) Not adequate for pain relief
D) Given by intramuscular injection

Question 17

Which 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 18

Which child should the nurse document as being anemic?

A) 7-year-old child with a hemoglobin of 11.5 g/dl
B) 3-year-old child with a hemoglobin of 12 g/dl
C) 14-year-old child with a hemoglobin of 10 g/dl
D) 1-year-old child with a hemoglobin of 13 g/dl

Question 19

The nurse is teaching parents of an infant about the causes of iron-deficiency anemia. Which statement best describes iron-deficiency anemia in infants?

A) It is caused by depression of the hematopoietic system.
B) It is easily diagnosed because of an 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 preterm addition of solid foods.

Question 20

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

A) The venipuncture discomfort is very brief
B) Only one venipuncture will be needed
C) A 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

Question 21

Which 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 (AIDS)
D) Severe combined immunodeficiency disease

Question 22

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which 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 23

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura?

A) Bone marrow failure in which all elements are suppressed
B) Deficiency in the production rate of globin chains
C) Diffuse fibrin deposition in the microvasculature
D) An excessive destruction of platelets

Question 24

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.)

A) Finger sticks for blood work instead of venipunctures
B) Avoidance of IM injections
C) Acetaminophen (Tylenol) for mild pain control
D) Soft tooth brush for dental hygiene
E) Administration of packed red blood cells

Question 25

The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement sequencing from the highest priority to the lowest. Provide the answer using lowercase letters separated by commas (e.g., a, b, c, d).

A) Take the vital signs.
B) Stop the transfusion.
C) Notify the practitioner.
D) Maintain a patent IV line with normal saline.

Question 26

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

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

Question 27

The nurse is reviewing first aid with a group of school nurses. Which statement made by a participant indicates a correct understanding of the information?

A) "If a child loses a tooth due to injury, I should place the tooth in warm milk."
B) "If a child has recurrent abdominal pain, I should send him or her back to class until the end of the day."
C) "If a child has a chemical burn to the eye, I should irrigate the eye with normal saline."
D) "If a child has a nosebleed, I should have the child sit up and lean forward."

Question 28

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.)

A) Soccer
B) Swimming
C) Basketball
D) Golf
E) Bowling

Question 29

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)?

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

Question 30

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. Of what are these manifestations most suggestive?

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

Question 31

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs?

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

Question 32

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.)

A) Limit fluids at bedtime.
B) Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs.
C) Give penicillin as prescribed.
D) Use ice packs to decrease the discomfort of vasoocclusive pain in the legs.
E) Notify the health care provider if your child begins to develop symptoms of a cold.

Question 33

The nurse is conducting a staff in-service on inherited childhood blood disorders. Which statement describes severe combined immunodeficiency syndrome (SCIDS)?

A) There is a deficit in both the humoral and cellular immunity with this disease.
B) Production of red blood cells is affected with this disease.
C) Adult hemoglobin is replaced by abnormal hemoglobin in this disease.
D) There is a deficiency of T and B lymphocyte production with this disease.

Question 34

The nurse is planning care for an adolescent with AIDS. Which is the priority nursing goal?

A) Preventing infection
B) Preventing secondary cancers
C) Restoring immunologic defenses
D) Identifying source of infection