Deck 43: The Child With Hematologic or Immunologic Dysfunction

Question 1

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.

Answer 1

Milk is a poor source of iron.

Question 2

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

Answer 2

X-linked recessive inherited disorder in which a blood-clotting factor is deficient

Question 3

What is the primary result of anemia?

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

Answer 3

Decreased oxygen-carrying capacity of blood.

Question 4

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

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 5

What name is given to identify an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets?

A) Aplastic anemia
B) Thalassemia major
C) Disseminated intravascular coagulation
D) Immune thrombocytopenia

Question 6

A young child with human immunodeficiency virus is receiving several antiretroviral drugs.What is the expected outcome of these drug therapies?

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

Question 7

What is the most appropriate nursing diagnosis for a child diagnosed with moderate 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

Question 8

Which statement correctly 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 9

Chelation therapy is begun on a child with b-thalassemia major with what expected result?

A) Treatment of the disease.
B) Elimination of excess iron.
C) Decreasing the risk of hypoxia.
D) Managing nausea and vomiting.

Question 10

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 11

What intervention should the nurse share with parents on how to prevent iron deficiency anemia in a healthy,term,breastfed infant?

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 solid foods are introduced at 3 months
D) Iron-fortified infant cereal can be introduced at approximately 6 months of age

Question 12

Iron dextran is ordered for a young child with severe iron deficiency anemia.What nursing consideration should be considered?

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 13

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

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

Question 14

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 15

Which clinical manifestation should the nurse expect when a child diagnosed 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 16

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 17

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 provide what explanation in response to the parent's concern?

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

Question 18

What term is used to identify the condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin?

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

Question 19

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 what associated adverse reaction?

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

Question 20

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 21

The parents of a child diagnosed with aplastic anemia 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

MATCHING
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 23

MATCHING
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 24

A school-age child is admitted in vaso-occlusive sickle cell crisis.The child's care should include which intervention? (Select all that apply.)

A) Correction of acidosis
B) Adequate hydration
C) Pain management
D) Administration of heparin
E) Replacement of factor VIII

Question 25

MATCHING
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 26

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 27

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 28

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 cold.

Question 29

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 30

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 31

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 for mild pain control
D) Soft toothbrush for dental hygiene
E) Administration of packed red blood cells

Question 32

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 33

MATCHING
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