Deck 32: Caring for the Child With a Hematological Condition

Question 1

A couple who recently married and want to have children ask the nurse what the chances are that their children will inherit thalassemia from them,as they both are carriers.What information from the nurse is most accurate?

A) All of your children will inherit it.
B) Each child has a 25% chance of inheriting it.
C) None of your children will inherit it.
D) Only the boys will inherit it.

Answer 1

Each child has a 25% chance of inheriting it.

Question 2

Which health promotion measure does the nurse teach as being most important for the child with sickle cell disease?

A) Adequate nutrition
B) Ensured rest periods
C) Plenty of fluids
D) Routine vaccinations

Answer 2

Routine vaccinations

Question 3

A child presents to the emergency department with sickle cell crisis.Which intervention does the nurse perform first?

A) Administer oxygen.
B) Assess and treat pain.
C) Provide warm blankets.
D) Start IV fluids.

Answer 3

Administer oxygen.

Question 4

An acutely ill,anemic child's peripheral blood smear shows small,dense,spherical RBCs.What action by the nurse takes priority?

A) Assess and treat the child's pain adequately.
B) Discuss the option of a bone marrow transplant.
C) Obtain informed consent for blood transfusions.
D) Prepare the family for chelation therapy.

Question 5

A 2-year-old child's hemoglobin is 8.2 g/dL.What action by the nurse is best?

A) Ask the parents about activity level.
B) Document findings in the chart.
C) Notify the provider immediately.
D) Schedule a re-draw of blood in 6 months.

Question 6

A nurse is assessing an infant for the most common type of anemia worldwide.What action by the nurse is most helpful?

A) Assess if formula is iron-fortified.
B) Determine family history of anemia.
C) Look at mucous membranes for pallor.
D) Perform range of motion on the hips.

Question 7

A child with sickle cell disease is receiving hypertransfusion therapy,and the current serum ferritin level is 1,035 µg/L.What medication does the nurse prepare to administer?

A) Deferoxamine (Desferal)
B) Elemental iron
C) Furosemide (Lasix)
D) Morphine sulfate (Duramorph)

Question 8

A nurse working in pediatrics learns that the normal hemoglobin value for an infant is high at birth,then decreases by 2 months of age before increasing again as the child grows.The nurse knows the reason for this shift is which of the following?

A) Hemodilution from starting oral nutrition
B) Lower available oxygen while in utero
C) Rapid hemoglobin destruction at birth
D) Slower hemoglobin production after birth

Question 9

A nursing student asks the instructor why he was marked off on his care plan when explaining a low hemoglobin level as being caused by "anemia." What response by the instructor is best?

A) Anemia is a symptom, not a disease.
B) Anemia only refers to a low red blood cell count.
C) Hemoglobin and anemia are unrelated.
D) The hemoglobin must not be too low.

Question 10

An adolescent has been taught to administer replacement factors for bleeding episodes related to hemophilia.What action by the teen indicates that further instruction is needed?

A) Disposes of sharps in an approved container
B) Reconstitutes the medication with sterile water
C) Selects the appropriate needle for an IM injection
D) Washes hands prior to working with the drug

Question 11

A child is taking desmopressin acetate (DDAVP)for von Willebrand's disease.What teaching about this medication does the nurse provide?

A) Avoid products with aspirin (salicylate) in them.
B) Get a new needle for each injection.
C) Monitor your child's weight and report a gain.
D) Use ice packs and pressure for epistaxis.

Question 12

The parents of an 8-year-old child with sickle cell anemia call the clinic to report that the child developed chest pain after playing soccer.What advice from the nurse is most appropriate?

A) "Go to the nearest emergency department."
B) "Have him rest and take Tylenol (acetaminophen)."
C) "If he doesn't improve, bring him in to the clinic."
D) "Try a warm pack on his chest for 10 minutes."

Question 13

A child with chronic immune thrombocytopenia presents to the emergency department,where the parents report a 3-day history of severe headache and recent change in mental status.What diagnostic test does the nurse prepare to facilitate as the priority?

A) CT of the head
B) Lumbar puncture
C) Platelet count
D) White blood cell count

Question 14

A child has been hospitalized with a sickle cell crisis and given morphine sulfate (Duramorph)for severe pain.On assessment 45 minutes later,the child appears to be sleeping quietly with a respiratory rate of 6 breaths/minute.What action by the nurse is most appropriate?

A) Document findings and let the child sleep.
B) Plan to hold the next dose of morphine.
C) Prepare to administer naloxone (Narcan).
D) Wake the child up to take deep breaths.

Question 15

A teenager is hospitalized with sickle cell disease and vaso-occlusive crisis.What pain medication regimen does the nurse assist the patient with?

A) Acetaminophen (children's Tylenol)
B) Ketorolac (Toradol) orally
C) Meperidine (Demerol), given intravenously
D) PCA pump with morphine (Duramorph)

Question 16

The nurse working in the pediatric intensive care unit understands that the priority for treating disseminated intravascular coagulation (DIC)is to do which of the following?

A) Administer antibiotics.
B) Discuss organ donation.
C) Provide massive transfusions.
D) Treat the underlying cause.

Question 17

A child has mild anemia and the parent asks why this makes the child have difficulty concentrating.What response by the nurse is best?

A) "All sick children have trouble concentrating."
B) "Her anemia makes her too tired to think."
C) "She may have another problem with her brain."
D) "The brain isn't getting enough oxygen."

Question 18

A toddler had a minor fall and now has a swollen,bruised,painful knee.What diagnostic test is most important for the nurse to educate the parents about?

A) Complete blood count
B) Plasma factor assay
C) Plasma ferritin level
D) Platelet count

Question 19

A nurse is assessing a child who presents to the pediatric clinic,where the parent reports new bruising and petechiae.What question asked by the nurse would elicit the most helpful information?

A) "Do bleeding disorders run in your family?"
B) "Does your child have arthritis symptoms?"
C) "Has your child had a recent viral infection?"
D) "Has your child been exposed to heavy metals?"

Question 20

The nurse has educated parents on administration of iron to their child.What statement by the parents indicates a need for further instruction?

A) "I will call the doctor right away if my child has black, tarry stools."
B) "It is best if the iron is taken on an empty stomach or with orange juice."
C) "Rinsing the mouth after taking iron will prevent staining the teeth."
D) "We will have our child drink the iron preparation through a straw."

Question 21

A child with pancytopenia is getting a blood transfusion and it is time to administer her IV antibiotic.The child has only one IV line.What action by the nurse is most appropriate?

A) Administer the antibiotic with the blood.
B) Obtain an order for an oral antibiotic.
C) Start a new peripheral IV in another site.
D) Stop the blood to give the antibiotic.

Question 22

A child is hospitalized with the following laboratory values: WBCs,2,100 mm³; segs,48%; and bands,2%.What action by the nurse is best?

A) Move the child to a laminar airflow room.
B) Place the child on strict protective isolation.
C) Use good hand hygiene measures consistently.
D) Wear a mask when entering the child's room.

Question 23

The nurse administering a blood transfusion is aware that which of the following is the most important nursing action to prevent a transfusion reaction?

A) Checking the provider's orders for transfusion
B) Identifying the patient with two unique identifiers
C) Monitoring vital signs per protocol
D) Staying with patient for the first 15 minutes

Question 24

A child is on IV heparin.Which laboratory value does the nurse analyze to determine if the dose is therapeutic?

A) Platelet count
B) PT
C) PTT
D) Red blood cell count

Question 25

In preparing a patient to receive an autologous bone marrow transplantation,which action by the nurse is best?

A) Ensure HLA typing has been done.
B) Limit visitors to one per shift.
C) Place the child in protective isolation.
D) Teach about long-term complications.

Question 26

An 8-year-old child had a hematopoietic stem cell transplant 10 months ago.The father brings her to the clinic,where the child reports "I just don't feel well." Dad relates that the child has been lethargic and sleeping a lot.The child's vital signs are within normal range for age.What action by the nurse is best?

A) Explain that growth spurts can cause fatigue.
B) Prepare the family for a "fever" workup.
C) Provide reassurance to the father and child.
D) Review side effects of immunosuppressants.

Question 27

A child is hospitalized with immune thrombocytopenia (ITP).What treatment options does the nurse prepare to answer questions about?

A) Anti-D antibody (WinRho)
B) IV immune gamma globulin
C) Platelet transfusions
D) Steroid administration
E) Whole blood transfusion

Question 28

A hospitalized child is receiving antithymocyte globulin (ATG)for aplastic anemia.What action by the nurse is most important?

A) Assess the IV site for good blood return.
B) Ensure emergency equipment is nearby.
C) Obtain informed consent for each dose.
D) Pad side rails and institute seizure precautions.

Question 29

A child is receiving a blood transfusion.On assessment,the nurse finds the child short of breath,febrile,and hypotensive.After stopping the transfusion,what action by the nurse takes priority?

A) Document the findings.
B) Obtain oxygen saturation.
C) Prepare fluid resuscitation.
D) Sit the child upright in bed.

Question 30

The pediatric nurse is aware that the most common type of transfusion reaction is which of the following?

A) Acute hemolytic reaction
B) Allergic reaction
C) Circulatory overload
D) Febrile reaction

Question 31

The pediatric nurse understands blood types.Which of the following donor/recipient matches are suitable?

A) Donor: A⁺ Recipient: A⁺
B) Donor: B⁺ Recipient: B^-
C) Donor: AB⁺Recipient: Anyone
D) Donor: O^- Recipient: Anyone
E) Donor: A^- Recipient: A^-, A⁺

Question 32

A child has a disease involving an antigen-antibody complex disorder.What treatment regimen does the nurse prepare the family for?

A) Apheresis
B) Erythrocytaphoresis
C) Leukapheresis
D) Plasmapheresis

Question 33

A school-age child is scheduled to have a bone marrow biopsy.What action by the nurse takes priority?

A) Ensure informed consent is on the chart.
B) Help position the child to facilitate the sample.
C) Provide developmentally appropriate teaching.
D) Use distraction techniques during the procedure.

Question 34

A faculty member is reviewing guidelines for blood transfusions with a student whose patient is to receive 2 units of packed red blood cells.Which of the following does the student know about transfusions?

A) Do not obtain the unit of blood more than 30 minutes before starting it.
B) Obtain a baseline set of vital signs prior to starting the transfusion.
C) Run the blood transfusion at a slow rate for the first 15 minutes.
D) The transfusion of 1 unit of blood must be completed within 6 hours.
E) Two appropriate health-care providers must check the blood at the bedside.

Question 35

A child is receiving a dose of filgrastim (Neupogen).The parent asks the nurse what this medication is for.What response by the nurse is best?

A) Causes bones that don't usually make blood cells to create them
B) Results in white blood cells being able to live longer
C) Stimulates bone marrow to make more red blood cells
D) Stimulates bone marrow to make more white blood cells

Question 36

A child is suspected of having aplastic anemia.What physical assessment should the nurse perform to correlate with this condition?

A) Abdominal palpation
B) Lung auscultation
C) Oral assessment
D) Skin inspection

Question 37

The student studying pediatric hematological disorders learns that anemia can occur in several ways,including which of the following?

A) Acute or chronic blood loss
B) Altered shape of RBCs
C) Decreased RBC production
D) Increased RBC destruction
E) Lack of functional RBCs

Question 38

A child has mild anemia.Parents learn to assess for signs of worsening anemia,including which of the following?

A) Decreased activity
B) Irritability
C) Listlessness
D) Pale skin
E) Rapid heart rate

Question 39

The pediatric nurse knows that which of the following might be included in the collaborative care of children with mild to moderate anemia?

A) Administration of epopoietin alfa (Epogen)
B) Blood product transfusions
C) Bone marrow transplantation
D) Routine laboratory analysis
E) Supplements and iron-rich diet

Question 40

A child is in the pediatric intensive care unit with disseminated intravascular coagulation (DIC).What laboratory findings correlate with this condition?

A) Decreased PTT
B) Increased D-dimer
C) Increased fibrinogen
D) Low platelet count
E) Normal white blood cell count

Question 41

A 2-year-old child is starting enoxaparin (Lovenox)to treat a thrombosis.The child weighs 32 lb.According to your calculation,the dose to be given twice a day is ____________________ mg,for each of the two doses.

Question 42

A child has an order for ketorolac (Toradol)IV push once.The child weighs 78 lb.According to your calculation,the one-time dose would be ____________________mg.

Question 43

A child weighing 32 kg (74.4 lb)is taking iron.By your calculation,the daily dose of the drug for this child would be____________________ mg/day,in two divided doses.

Question 44

A pediatric intensive care nurse understands that which of the following are complications of apheresis procedures?

A) Air embolism
B) Bleeding
C) Hypercalcemia
D) Hyperthermia
E) Hypotension

Question 45

A child who weighs 32 kg (74.4 lb)is hospitalized with a sickle cell crisis.By your calculation,this child's 24-hour fluid requirement would be ____________________ mL/24 hours.