Deck 47: The Child with a Hematologic Alteration

Question 1

The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia.What is the best response to this question?

A) "Hemophilia is a lifelong blood disorder."
B) "There is a 25% chance that your child will have spontaneous remission."
C) "Treatment continues until after the toddler years."
D) "Since your first child did not have hemophilia, treatment for this child is temporary."

Answer 1

"Hemophilia is a lifelong blood disorder."

Question 2

Which statement 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 persons of West African descent.

Answer 2

Increased incidence occurs in families of Mediterranean extraction.

Question 3

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?

A) Immobilization and elevation of the affected joint
B) Administration of acetaminophen for pain relief
C) Assessment of the child's response to hospitalization
D) Assessment of the impact of hospitalization on the family system

Answer 3

Immobilization and elevation of the affected joint

Question 4

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is known as

A) aplastic anemia.
B) sickle cell anemia.
C) thalassemia major.
D) iron-deficiency anemia.

Question 5

What is the best response to a parent who asks the nurse whether her 5-month-old infant can have cow's milk?

A) "You need to wait until she is 8 months old and eating solids well."
B) "Yes, if you think that she will eat enough meat to get the iron she needs."
C) "Infants younger than 12 months need iron-rich formula to get the iron they need."
D) "Try it and see how she tolerates it."

Question 6

What is true about the genetic transmission of sickle cell disease?

A) Both parents must carry the sickle cell trait.
B) Both parents must have sickle cell disease.
C) One parent must have the sickle cell trait.
D) Sickle cell disease has no known pattern of inheritance.

Question 7

What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis?

A) Administration of antibiotics and nebulizer treatments
B) Hydration and pain management
C) Blood transfusions and an increased calorie diet
D) School work and diversion

Question 8

A nurse is evaluating parents' knowledge about caring for their child who has iron-deficiency anemia.Which action shows the parents need further education?

A) Decreasing the infant's daily milk intake to 24 oz or less
B) Giving oral iron supplements between meals with orange juice
C) Including apricots, dark-green leafy vegetables, and egg yolk in the infant's diet
D) Allowing the infant to drink the iron supplement from a small medicine cup

Question 9

Which clinical manifestation 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 10

In teaching family members about their child's von Willebrand disease,what is the priority outcome for the child that the nurse should discuss?

A) Prevention of injury
B) Maintaining adequate hydration
C) Compliance with chronic transfusion therapy
D) Prevention of respiratory infections

Question 11

What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)?

A) Teaching the parents to report excessive fatigue to the physician
B) Monitoring the child's hemoglobin level every 2 weeks
C) Providing a diet that contains iron-rich foods
D) Establishing a safe, age-appropriate home environment

Question 12

A child has beta-thalassemia and is receiving deferoxamine.The parent asks what the purpose of this medication is.Which response by the nurse is best?

A) "To improve the anemia"
B) "To decrease liver and spleen swelling"
C) "To eliminate excessive iron being stored in the organs"
D) "To prepare your child for a bone marrow transplant"

Question 13

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

Question 14

What 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 15

A child who has been in good health has a platelet count of 45,000/mm³,petechiae,and excessive bruising that covers the body.The nurse is aware that these signs are clinical manifestations of which disease?

A) Erythroblastopenia
B) von Willebrand disease
C) Hemophilia
D) Immune thrombocytopenic purpura (ITP)

Question 16

An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is

A) lethargic, pale, and irritable.
B) thin, energetic, and sleeps little.
C) anorexic, vomiting, and has watery stools.
D) flushed, fussy, and tired.

Question 17

What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)?

A) Hospitalization at the first sign of bleeding
B) Teaching the child relaxation techniques for pain control
C) Management in the intensive care unit
D) Provision of adequate hydration to prevent complications

Question 18

What is the nurse's best response to parents with questions about how her child's blood disorder will be treated?

A) "Your child may be able to receive home care."
B) "What did the provider tell you?"
C) "Blood diseases are transient, so there is no need to worry."
D) "Your child will be tired for a while and then be back to normal."

Question 19

What 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 20

What should the discharge plan for a school-age child with sickle cell disease include?

A) Restricting the child's participation in outside activities
B) Administering aspirin for pain or fever
C) Limiting the child's interaction with peers
D) Administering penicillin daily as ordered

Question 21

A nurse is teaching home care instructions to parents of a child with sickle cell disease.Which instructions should the nurse include? (Select all that apply.)

A) Limit fluid intake.
B) Administer aspirin for fever.
C) Administer penicillin as ordered.
D) Avoid cold and extreme heat.
E) Provide for adequate rest periods.

Question 22

The nurse assesses the lab values of a child hospitalized with DIC.What findings are consistent for this disorder? (Select all that apply.)

A) Decreased platelet count
B) Increased hemoglobin
C) Prolonged prothrombin time
D) Elevated D-dimer
E) Pancytopenia

Question 23

The nurse is caring for a child with iron-deficiency anemia.What should the nurse expect to find when reviewing the results of the complete blood count (CBC)? (Select all that apply.)

A) Low hemoglobin levels
B) Elevated red blood cell (RBC) levels
C) Elevated mean cell volume (MCV) levels
D) Low reticulocyte count
E) Decreased MCV levels

Question 24

The nurse is caring for a child with aplastic anemia.What nursing diagnoses are appropriate? (Select all that apply.)

A) Acute Pain related to vaso-occlusion
B) Risk for Infection related to inadequate secondary defenses or immunosuppression
C) Ineffective Protection related to thrombocytopenia
D) Ineffective Tissue Perfusion related to anemia
E) Ineffective Protection related to abnormal clotting

Question 25

The nurse is caring for a child who has beta-thalassemia.What unique facial features does the nurse assess in this child? (Select all that apply.)

A) Frontal bossing
B) Strabismus
C) Wide-set eyes
D) Maxillary prominence
E) Distinct overbite