Deck 43: Hematologic and Immunologic Dysfunction

Question 1

A possible cause of acquired aplastic anemia in children is:

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

Answer 1

Drugs.

Question 2

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction.The nurse should explain that 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.

Answer 2

Rarely cause addiction because they are medically indicated.

Question 3

A school-age child is admitted in vaso-occlusive sickle cell crisis.The child's care should include:

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.

Answer 3

Adequate hydration and pain management.

Question 4

Several blood tests are ordered for a preschool child with severe anemia.She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago.The nurse should explain that:

A)Venipuncture discomfort is very brief.
B)Only one venipuncture will be needed.
C)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 5

Which statement most accurately 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 6

Which statement best 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 7

What is most descriptive of the pathophysiology of leukemia?

A)Increased blood viscosity occurs.
B)Thrombocytopenia (excessive destruction of platelets) occurs.
C)Unrestricted proliferation of immature white blood cells (WBCs) occurs.
D)The first stage of the coagulation process is abnormally stimulated.

Question 8

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is:

A)Aplastic anemia.
B)Thalassemia major.
C)Disseminated intravascular coagulation.
D)Idiopathic thrombocytopenic purpura.

Question 9

An accurate description of anemia is:

A)Increased blood viscosity.
B)Depressed hematopoietic system.
C)Presence of abnormal hemoglobin.
D)Decreased oxygen-carrying capacity of blood.

Question 10

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 11

Which statement best describes b-thalassemia major (Cooley's 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 12

A boy with leukemia screams whenever he needs to be turned or moved.The most probable cause of this pain is:

A)Edema.
B)Bone involvement.
C)Petechial hemorrhages.
D)Changes within the muscles.

Question 13

When teaching the mother of a 9-month-old infant about administering liquid iron preparations,the nurse should include that:

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)Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.

Question 14

Chelation therapy is begun on a child with b-thalassemia major.The purpose of this therapy is to:

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

Question 15

In which condition are all the formed elements of the blood simultaneously depressed?

A)Aplastic anemia
B)Sickle cell anemia
C)Thalassemia major
D)Iron deficiency anemia

Question 16

As related to inherited disorders,which statement 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 17

Iron dextran is ordered for a young child with severe iron deficiency anemia.Nursing considerations include:

A)Administering with meals.
B)Administering between meals.
C)Injecting deeply into a large muscle.
D)Massaging injection site for 5 minutes after administration of drug.

Question 18

The nurse is recommending how to prevent iron deficiency anemia in a healthy,term,breastfed infant.What should she or he suggest?

A)Iron (ferrous sulfate) drops after age 1 month.
B)Iron-fortified commercial formula can be used by ages 4 to 6 months.
C)Iron-fortified infant cereal can be introduced at age 2 months.
D)Iron-fortified infant cereal can be introduced at approximately 6 months of age.

Question 19

The most appropriate nursing diagnosis for a child with anemia is:

A)Activity Intolerance related to generalized weakness.
B)Decreased Cardiac Output related to abnormal hemoglobin.
C)Risk for Injury related to depressed sensorium.
D)Risk for Injury related to dehydration and abnormal hemoglobin.

Question 20

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

A)Aplastic anemia.
B)Sickle cell anemia.
C)Thalassemia major.
D)Iron deficiency anemia.

Question 21

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT)may be necessary.What should the nurse recognize as important when discussing this with the family?

A)BMT should be done at time of diagnosis.
B)Parents and siblings of child have a 25% chance of being a suitable donor.
C)Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
D)If BMT fails, chemotherapy or radiotherapy must be continued.

Question 22

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.These manifestations are most suggestive of:

A)Air embolism.
B)Allergic reaction.
C)Hemolytic reaction.
D)Circulatory overload.

Question 23

Which immunization should not be given to a child receiving chemotherapy for cancer?

A)Tetanus vaccine
B)Inactivated poliovirus vaccine
C)Diphtheria, pertussis, tetanus (DPT)
D)Measles, rubella, mumps

Question 24

What is the most common mode of transmission of human immunodeficiency virus (HIV)in the pediatric population?

A)Perinatal transmission
B)Sexual abuse
C)Blood transfusions
D)Poor hand washing

Question 25

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 26

Children receiving long-term systemic corticosteroid therapy are most at risk for:

A)Hypotension.
B)Dilation of blood vessels in the cheeks.
C)Growth delays.
D)Decreased appetite and weight loss.

Question 27

A young child with human immunodeficiency virus is receiving several antiretroviral drugs.The purpose of these drugs is to:

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

Question 28

A young boy will receive a bone marrow transplant (BMT).This is possible because one of his older siblings is a histocompatible donor.This type of BMT is termed:

A)Syngeneic.
B)Allogeneic.
C)Monoclonal.
D)Autologous.

Question 29

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time.The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to:

A)Encourage drinking large amounts of favorite fluids.
B)Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside.
C)Administer an antiemetic before chemotherapy begins.
D)Administer an antiemetic as soon as child has nausea.

Question 30

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate,cytarabine,and hydrocortisone.The purpose of this is to prevent:

A)Infection.
B)Brain tumor.
C)Drug side effects.
D)Central nervous system (CNS) disease.

Question 31

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome.The priority nursing goal is to:

A)Prevent infection.
B)Prevent secondary cancers.
C)Restore immunologic defenses.
D)Identify source of infection.

Question 32

Which condition 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 (ITP)
C)Acquired immunodeficiency syndrome (AIDS)
D)Severe combined immunodeficiency disease

Question 33

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 34

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an:

A)Decrease in leukocytes.
B)Increase in lymphocytes.
C)Vitamin C deficiency.
D)Decrease in blood platelets.

Question 35

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

Question 36

The nurse is preparing a child for possible alopecia from chemotherapy.Which suggestion should be included in the teaching?

A)Explaining to the child that hair usually regrows in 1 year.
B)Advising the child to expose the head to sunlight to minimize alopecia.
C)Explaining to the child that wearing a hat or scarf is preferable to wearing a wig.
D)Explaining to the child that, when hair regrows, it may have a slightly different color or texture.

Question 37

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

A)Influenza
B)Varicella
C)Pneumococcus
D)Inactivated poliovirus

Question 38

An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is:

A)Severe combined immunodeficiency syndrome (SCIDS).
B)Acquired immunodeficiency syndrome.
C)Wiskott-Aldrich syndrome.
D)Fanconi syndrome.

Question 39

A common clinical manifestation of Hodgkin's disease is:

A)Petechiae.
B)Bone and joint pain.
C)Painful, enlarged lymph nodes.
D)Enlarged, firm, nontender lymph nodes.

Question 40

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

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

Question 41

An adolescent will receive a bone marrow transplant (BMT).The nurse should explain that the bone marrow will be administered by which route?

A)Bone grafting
B)Bone marrow injection
C)Intravenous infusion
D)Intraabdominal infusion

Question 42

The nurse is caring for a child with aplastic anemia.Which 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 43

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.

Second priority

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

Question 44

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 45

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 46

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.

Fourth priority

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

Question 47

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.

First priority

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

Question 48

A toddler with leukemia is on intravenous chemotherapy treatments.The toddler's lab results are white blood cell count (WBC): 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%.What is this child's absolute neutrophil count (ANC)? _____ Record your answer as a whole number.

Question 49

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 vaso-occlusive pain in the legs.
E)Notify the health care provider if your child begins to develop symptoms of a cold.

Question 50

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia.The child suddenly begins to wheeze and have severe urticaria.Which is the most appropriate nursing action?

A)Stop drug infusion immediately.
B)Recheck rate of drug infusion.
C)Observe child closely for next 10 minutes.
D)Explain to child that this is an expected side effect.

Question 51

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.

Third priority

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

Question 52

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)(Select all that apply)?

A)Give supplemental vitamins as prescribed.
B)Yearly influenza vaccination should be avoided.
C)Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed.
D)Notify the physician if the child develops a cough or congestion.
E)Missed doses of antiretroviral medication do not need to be recorded.

Question 53

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia.Which preparations should the nurse use for oral care on this child (Select all that apply)?

A)Chlorhexidine gluconate (Peridex)
B)Lemon glycerin swabs
C)Antifungal troches (lozenges)
D)Lip balm (Aquaphor)
E)Hydrogen peroxide

Question 54

A young child with leukemia has anorexia and severe stomatitis.The nurse should suggest that the parents try which intervention?

A)Relax any eating pressures.
B)Firmly insist that child eat normally.
C)Begin gavage feedings to supplement diet.
D)Serve foods that are either hot or cold.

Question 55

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)Fingersticks for blood work instead of venipunctures
B)Avoidance of intramuscular (IM) injections
C)Acetaminophen (Tylenol) for mild pain control
D)Soft toothbrush for dental hygiene
E)Administration of packed red blood cells