Deck 49: Hematologic and Immunologic Dysfunction

Question 1

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.

Answer 1

Sickle cell anemia.

Question 2

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.

Answer 2

Injecting deeply into a large muscle.

Question 3

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.

Answer 3

Topical application of local anesthetic can eliminate venipuncture pain.

Question 4

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 5

The nurse is recommending how to prevent iron deficiency anemia in a healthy,term,breastfed infant. What should he or she 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 used by age 2 months.
D)Iron-fortified infant cereal can be used at approximately 6 months of age.

Question 6

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 7

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 8

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.

Question 9

What 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 10

What 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 11

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 12

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 13

What 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 14

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 15

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 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

A possible cause of acquired aplastic anemia in children is:

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

Question 18

A school-age child is admitted in vasoocclusive 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.

Question 19

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis?

A)Circulatory collapse
B)Cardiomegaly,systolic murmurs
C)Hepatomegaly,intrahepatic cholestasis
D)Painful swelling of hands and feet,painful joints

Question 20

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 coagulation process is abnormally stimulated.

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. These manifestations are most suggestive of:

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

Question 22

The nurse is preparing a child for possible alopecia from chemotherapy. What should be included?

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 23

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 24

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 carinii pneumonia.

Question 25

What 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 26

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 27

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 28

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 29

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

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

Question 30

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

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

Question 31

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 32

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 33

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 34

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 35

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 36

Nose bleeding,also known as __________________,is common in childhood. The bleeding ordinarily stops spontaneously or with minimal pressure.