Deck 49: Hematological and Immunological Dysfunction

Question 1

What is the most appropriate nursing diagnosis for a child with anemia?

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

Answer 1

Activity intolerance related to generalized weakness

Question 2

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.What should the nurse explain to the child?

A) Venipuncture discomfort is very brief.
B) Only one venipuncture will be needed.
C) Topical application of local anaesthetic can eliminate venipuncture pain.
D) Most blood tests on children require only a finger puncture because a small amount of blood is needed.

Answer 2

Topical application of local anaesthetic can eliminate venipuncture pain.

Question 3

What is the name of the condition in which the normal,adult hemoglobin is partly or completely replaced by abnormal hemoglobin?

A) Aplastic anemia
B) Sickle cell anemia
C) Hemophilia
D) Iron-deficiency anemia

Answer 3

Sickle cell anemia

Question 4

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

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

Question 5

Which of the following statements best describes the pathological 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

What information 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 colour.
D) The preparation should be allowed to mix with saliva and bathe the teeth before swallowing.

Question 7

Which age group is most at risk for iron-deficiency anemia?

A) Term infant
B) School-aged children
C) Adolescent
D) Young adult

Question 8

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 9

Which of the following is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets?

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

Question 10

Why is iron-deficiency anemia 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 11

The nurse is recommending how to prevent iron-deficiency anemia in a healthy term breastfed infant.What should she tell the parents?

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

Question 12

A boy with leukemia screams whenever he needs to be turned or moved.What is the most probable cause of his pain?

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

Question 13

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 14

Which statement best describes b-thalassemia major ( Cooley's anemia )?

A) All formed elements of the blood are depressed.
B) An inadequate number of red blood cells are present.
C) Increased incidence occurs in families of Mediterranean extraction.
D) Increased incidence occurs in families of West African descent.

Question 15

What is the purpose of initiating chelation therapy on a child with b-thalassemia major?

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

Question 16

Which of the following sentences 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 17

A school-age child is admitted in vaso-occlusive sickle cell crisis.What should the child's care 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

Question 18

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

A) They are often ordered but not usually needed.
B) They rarely cause addiction because they are medically indicated.
C) They are given as a last resort because of the threat of addiction.
D) They are used only if other measures, such as ice packs, are ineffective.

Question 19

Which of the following statements accurately describes 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

Which one of the following statements accurately describes anemia?

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

Question 21

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.What are these manifestations most suggestive of?

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

Question 22

Which of the following is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity?

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

Question 23

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome.What is the priority nursing goal?

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

Question 24

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) The BMT should be done at the time of diagnosis.
B) The parents and siblings of the 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 the BMT fails, chemotherapy or radiotherapy must be continued.

Question 25

Several complications can occur when a child receives a blood transfusion.What is one 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 26

What is often administered to prevent or control hemorrhage in a child with cancer?

A) Nitrosoureas
B) Platelets
C) Whole blood
D) Corticosteroids

Question 27

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

A) Encourage the child to drink large amounts of his favourite fluids.
B) Encourage the 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 28

The nurse is preparing a child for possible alopecia from chemotherapy.What information should he include?

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

Question 29

What is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4⁺ cells?

A) Wiskott-Aldrich syndrome
B) Idiopathic thrombocytopenic purpura (ITP)
C) Acquired immunodeficiency syndrome (AIDS)
D) Severe combined immunodeficiency disease

Question 30

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

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

Question 31

A young boy will receive a bone marrow transplant (BMT),which is possible because one of his older siblings is a histocompatible donor.What is the term for this type of BMT?

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

Question 32

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

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

Question 33

Which of the following sentences is a good explanation for teaching children about white blood cells?

A) They carry the oxygen you breathe from your lungs to parts of your body.
B) They help to keep germs from causing infections.
C) They are small parts of cells that make bleeding stop.
D) They are the liquid portion of your blood.

Question 34

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of which of the following?

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

Question 35

What is one common clinical manifestation of Hodgkin's disease?

A) Petechiae
B) Bone and joint pain
C) Painful, enlarged lymph nodes
D) Enlarged, firm, non-tender lymph nodes