Deck 26: Hematological Alterations

Question 1

Where are blood cells produced during fetal development?

A) bone marrow
B) stem cells
C) liver and spleen
D) heart and lungs

Answer 1

liver and spleen

Question 2

What features of red blood cells (RBCs) allow them to reach all the tissues of the body?

A) shape, size, and structure
B) gelatinous quality
C) propulsive DNA energy
D) compacting of various cells

Answer 2

shape, size, and structure

Question 3

The primary function of white blood cells (WBCs) is to guard against microorganisms and to do which of the following?

A) produce erythrocytes
B) remove debris
C) disperse platelets
D) boost antibiotics

Answer 3

remove debris

Question 4

What is the main function of platelets?

A) to wall off foreign proteins, preventing infection
B) to carry nutrients to tissues throughout the body
C) to be involved in the recovery process in infection
D) to facilitate blood coagulation to control bleeding

Question 5

The pediatric nurse doing assessments on infants and young children is aware that the most common blood disorder in children is:

A) leukemia
B) anemia
C) thalassemia minor
D) von Willebrand's disease

Question 6

Which of the following types of anemia would the nurse most expect to find in infants and toddlers?

A) iron deficiency
B) aplastic
C) sickle cell
D) decreased production

Question 7

Parents ask the nurse why their adolescent daughter and several of her friends tend to be anemic. Which of the following is the nurse's best response?

A) "There is decreased production of red blood cells (RBCs) during adolescence as the body focuses on growth in other areas."
B) "Some adolescent girls are anemic because of pregnancy and others because the body is preparing for pregnancy."
C) "This is a time when girls have a very heavy menstrual flow, which reduces the amount of hemoglobin."
D) "While there are several causes of anemia, teenage girls tend to make poor dietary choices at a time when they are growing."

Question 8

When a child progresses to moderate iron-deficiency anemia, the caregivers or the nurse will notice which of the following signs?

A) yellow color of skin, fatigue, and increased aggressiveness
B) mottling of skin, joint pain, and muscular weakness
C) general irritability, weakness, and lack of interest in play
D) respiratory distress, cardiac irregularities, seizures

Question 9

As iron-deficiency anemia progresses beyond the moderate stage, the nurse assessing the child will most likely find which of the following signs?

A) decreased reticulocytes and increased serum ferritin
B) systolic murmurs, hair falling out, brittle nails, and enlarged spleen
C) elevated blood pressure and pulse
D) seizures and loss of consciousness

Question 10

The nurse is assessing a child who has anemia. The child has a yellowish skin color. This skin color is most likely indicative of which of the following conditions associated with severe anemia?

A) increased destruction of red blood cells (RBCs)
B) compensatory polycythemia
C) increased melatonin
D) liver disease

Question 11

Why are premature infants more at risk for iron-deficiency anemia than full-term infants?

A) They do not nurse or take formula as well as full-term infants, so their intake of iron is considerably less.
B) Their liver and spleen are smaller and functionally less well-developed than full-term infants.
C) Premature infants use up their stores of hemosiderin within 6 to 8 weeks compared to approximately 20 weeks for full-term infants.
D) The bone marrow production of iron is depressed and does not come up to the production level of full-term infants for several months.

Question 12

The nurse is working with a mother who is breastfeeding her 2-month-old infant with blood-loss anemia. The blood loss has been stopped, and efforts are made to increase the infant's supply of iron. The nurse will advise the mother to:

A) switch to a formula high in iron
B) feed half formula with iron and half breast milk
C) feed formula with iron and iron-fortified cereal
D) give only mother's breast milk

Question 13

The school nurse is working with a pregnant adolescent. The nurse will advise the young woman to eat foods high in iron and also high in which of the following vitamins to increase the absorption of iron?

A) the B vitamins
B) vitamin E
C) vitamin C
D) vitamin D

Question 14

A parent calls the nurse and frantically reports that a child has gotten into the mother's ferrous sulfate pills and ingested a number of these pills. The child is vomiting, has bloody diarrhea, and is complaining of abdominal pain. The nurse will tell the mother to:

A) call the poison control center
B) administer syrup of ipecac
C) call emergency medical services (EMS) and get the child to the emergency room
D) relax because these symptoms will pass and the child will be fine

Question 15

What is the primary focus of nursing intervention when the child has iron-deficiency anemia?

A) caregiver education
B) reduction of episodes of constipation
C) control of acute pain
D) reduction of febrile episodes

Question 16

The nurse is doing discharge teaching with caregivers who will be giving their toddler a liquid iron supplement. The nurse will teach the parents to administer the liquid iron supplement in which of the following ways?

A) mixed half and half with water
B) through a straw, a medicine dropper, or a syringe in the back part of the mouth
C) with food such as eggs, milk, cheese, or a slice of toasted whole grain bread with butter
D) mixed with antacids

Question 17

The nurse is talking to the working parents of a child with sickle cell anemia. The nurse explores the feelings of the parents and finds that both parents are admitting to feeling guilty a lot of the time. Which of the following causes will the nurse most likely find as the greatest contributor or cause of this guilt?

A) Both parents are carrying at least one recessive gene for sickle cell anemia.
B) Both parents are working and cannot spend as much time with the child as they would like.
C) The parents are not able to help their child more, and they fear that the child is suffering a great amount of the time.
D) The child wants more and more things that cost more and more money, and the parents can't comply because of hospital bills.

Question 18

In talking with parents about the life expectancy of children who have the sickle cell trait, the nurse will share with the parents whose children with the sickle cell trait:

A) often live only into their 20s or early 30s
B) usually die at about age 45
C) most often do not live past age 55
D) do not have a decreased life expectancy

Question 19

When sickle cells are not able to pass through the microcirculation, which of the following signs or symptoms will the nurse find on assessment of a child with sickle cell anemia?

A) edema
B) pain
C) fever
D) dizziness

Question 20

The nurse is working with a child who has vaso-occlusive crisis. The nurse is aware that if this vaso-occlusive crisis is not resolved, the most likely result will be:

A) priapism
B) bleeding into the surrounding tissues
C) bruising
D) infarction of the distal tissues

Question 21

The school nurse will educate teachers of children with a diagnosis of sickle cell anemia that when these children have a deterioration in school performance or a severe headache, this can be followed by which of the following problems?

A) cerebral vascular accident (CVA)
B) petit mal seizure
C) loss of consciousness
D) migraine or cluster headaches

Question 22

Parents of children with sickle cell anemia need to know the risks of various activities. The nurse will teach the parents of a child with sickle cell anemia that on rare occasions children who have the sickle cell trait can have vaso-occlusive episodes and severe crisis caused by which of the following activities?

A) being in very hot water (e.g., in a bathtub or a hot tub) that is 40.5 degrees C (105 degrees F) or higher
B) failure to take rest periods morning and afternoon and to get 9 hours sleep daily
C) flying at high altitudes in depressurized aircraft, exercising at high altitudes, or using anesthesia
D) doubling up on medication either on purpose or by accident, then forgetting that the medicine was already been taken

Question 23

When the nurse realizes that a child is in sequestration crisis, the nurse will assess for and most likely need to initiate interventions for:

A) shock
B) bleeding
C) breathing difficulty
D) cardiac arrest

Question 24

Which of the following precipitates 80% of the cases of aplastic crisis?

A) pneumococcal infection
B) human parvovirus B-19
C) staphylococcus
D) streptococcus

Question 25

Parents of a child with anemia of unknown cause learn that their child will be tested for sickle cell anemia. The parents ask the nurse to explain why after having a sickle solubility test the child is now going to have a hemoglobin electrophoresis. Which of the following explanations by the nurse would be most accurate?

A) The physician has to verify the results of the first test and doesn't like to base a diagnosis on just one test.
B) The solubility has to do with the sickle cell and the electrophoresis with the severity of the anemia.
C) The solubility test has to do with what solutions will dissolve a sickle cell and the electrophoresis with determining the electrical charge.
D) The solubility test is to detect the presence of hemoglobin S(Hb S), while the hemoglobin electrophoresis is to determine the amount of Hb S in the blood.

Question 26

Parents with sickle cell anemia in their families ask the nurse to tell them which test for sickle cell anemia can be done the earliest in the prenatal period. The nurse will respond that prenatal diagnosis for sickle cell anemia can be conducted as early as 8 to 10 weeks with which of the following tests?

A) chorionic villi sampling
B) amnionic fluid analysis
C) sickle cell solubility tests
D) hemoglobin electrophoresis

Question 27

The nurse is giving parents discharge instructions for the care of their child with sickle cell anemia. The nurse explains that the child will be maintained on prophylactic oral penicillin until age 5 and tells the parents that the rationale for this antibiotic is:

A) because of the increased risk for infection
B) to prevent the destruction of red blood cells (RBCs)
C) to prevent vegetation on the mitral valve
D) antibiotics alter the shape of the sickle cell

Question 28

The school nurse will need to know and share with teachers and caregivers that a child with a diagnosis of sickle cell anemia must avoid:

A) diets high in sugar, cola drinks, and classroom treats that are high in sugar content
B) homework assignments that require loss of sleep to be completed on time
C) fever, infection, dehydration, constricting clothing, and exposure to cold
D) playing with other children, small group projects, and paired projects

Question 29

Which of the following approaches to pain treatment would be best for a child with a diagnosis of sickle cell anemia who is having pain related to a vaso-occlusive crisis?

A) pain medication every 3 to 4 hours as necessary
B) pain medication every 3 to 4 hours around the clock
C) each pain medication dose ordered specifically by the physician in response to the nurse calling the doctor
D) as little pain medication as possible by using some alternative comforting methods

Question 30

The nurse reporting on duty is assigned to care for a child with a diagnosis of sickle cell anemia. In the report the nurse hears that this child is "clock watching" in regard to pain medication and sometimes asks for pain medication before it is time. The nurse suspects which of the following as the most likely cause of the child's behavior in regard to pain medication?

A) The child is drug addicted.
B) The child is on the way to being drug addicted.
C) The child's pain is undermedicated.
D) The child is over-medicated and needs to be weaned downward.

Question 31

Which of the following statements about thalassemia is true?

A) It involves the inheritance of dominant genes from both parents.
B) It is characterized by an impaired rate of hemoglobin chain synthesis.
C) It always involves early death.
D) It involve years of transfusions, which cause few side effects if any.

Question 32

If a child with thalassemia major is not treated, death will most likely occur by which of the following ages?

A) 3 to 4 years
B) 5 to 6 years
C) 8 to 9 years
D) 11 to 12 years

Question 33

The parents ask the nurse if there is anything that can be done to reduce or eliminate the need for transfusions every 2 to 3 weeks for their child who has thalassemia. Which one of the following treatments will the nurse report as one that will decrease the child's need for frequent transfusions?

A) beta cell transplantation
B) liver and pancreatic transplantation
C) splenectomy or bone marrow transplantation
D) allergy testing and serum treatment of allergies

Question 34

The nurse is assigned to a child with hemosiderosis. The nurse will most expect to give which of the following ordered medications to reduce hemosiderosis?

A) naloxone hydrochloride (Narcan)
B) deferoxamine (Desferal)
C) ferrous sulfate
D) a daily vitamin with minerals

Question 35

When the nurse learns that the assigned clients include a child with aplastic anemia, the nurse knows that this is a condition involving:

A) production of an inadequate number of erythrocytes
B) lack of, or deficiency in, factor V
C) circulation of highly moldable platelets
D) production of inadequate amounts of hemoglobin

Question 36

The father of a newborn has sickle cell anemia and the mother of a newborn is a carrier for sickle cell disease. There is a ____________________% chance that the child conceived will have the disease.

Question 37

Which of the following drugs might a nurse find in the doctor's orders for clients with mild hemophilia A? Select all that apply.

A) desmopressin
B) third-generation cephalosporin drug
C) meperidine (Demerol)
D) factor VIII concentrates

Question 38

When a child has hemophilia, which of the following conditions are present? Select all that apply.

A) The child has either a missing or a deficient clotting factor.
B) There is a deficiency in the production of platelets.
C) The prothrombin time will be within normal limits.
D) The child has an allergic reaction to his or her own body proteins.