Question 1

Which statement best explains why iron deficiency anemia is common during toddlerhood?

Accepted Answer

Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet,and it is a poor source of iron.Iron is stored during fetal development,but the amount stored depends on maternal iron stores.Fetal iron stores are usually depleted by age 5 to 6 months.Dietary iron can be introduced by breastfeeding,iron-fortified formula,and cereals during the first 12 months of life.

Question 2

As related to inherited disorders,which statement is descriptive of most cases of hemophilia?

Accepted Answer

The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive.The two most common forms of the disorder are factor VIII deficiency (hemophilia A or classic hemophilia),and factor IX deficiency (hemophilia B or Christmas disease).The disorder involves coagulation factors,not platelets.The disorder does not involve red cells or the Y chromosome.

Question 3

What is the primary result of anemia?

Accepted Answer

Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age.This results in a decreased oxygen-carrying capacity of blood.Increased blood viscosity is usually a function of too many cells or of dehydration,not of anemia.A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia,but the definition depends on the deceased oxygen-carrying capacity of the blood.

Question 4

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

Accepted Answer

The nurse should prepare the mother for the anticipated change in the child's stools.If the iron dose is adequate,the stools will become a tarry green color.The lack of the color change may indicate insufficient iron.The iron should be given in two divided doses between meals,when the presence of free hydrochloric acid is greatest.Iron is absorbed best in an acidic environment.Vomiting and diarrhea may occur with iron administration.If these occur,the iron should be given with meals,and the dosage reduced and gradually increased as the child develops tolerance.Liquid preparations of iron stain the teeth.They should be administered through a straw,and the mouth rinsed after administration.

Question 5

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

Accepted Answer

Immune thrombocytopenia is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets,discolorations caused by petechiae beneath the skin,and a normal bone marrow.Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed.Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains.Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature,consumption of coagulation factors,and endogenous generation of thrombin and plasma.

Question 6

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

Accepted Answer

Although not a cure,these antiviral drugs can suppress viral replication,preventing further deterioration of the immune system,and delay disease progression.At this time cure is not possible.These drugs do not prevent the spread of the disease.Pneumocystis jiroveci prophylaxis is accomplished with antibiotics.

Question 7

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

Accepted Answer

The basic pathology in anemia is the decreased oxygen-carrying capacity of the blood.The nurse must assess the child's activity level (response to the physiologic state).The nursing diagnosis would reflect the activity intolerance.In generalized anemia no abnormal hemoglobin may be present.Only at a level of very severe anemia does cardiac output become altered.No decreased sensorium exists until profound anemia occurs.Dehydration and abnormal hemoglobin are not usually part of anemia.

Question 8

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

Accepted Answer

Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia.An overproduction of red cells occurs.Although numerous,the red cells are relatively unstable.Sickle cell disease is common in blacks of West African descent.

Question 9

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

Accepted Answer

A complication of the frequent blood transfusions in thalassemia is iron overload.Chelation therapy with deferoxamine (an iron-chelating agent)is given with oral supplements of vitamin C to increase iron excretion.Chelation therapy treats the side effects of disease management.Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

Question 10

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

Accepted Answer

AIDS is caused by the human immunodeficiency virus,which primarily attacks the CD4⁺ T-cells.Wiskott-Aldrich syndrome,ITP,and severe combined immunodeficiency disease are not viral illnesses.

Question 11

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

Accepted Answer

Breast milk supplies inadequate iron for growth and development after age 5 months.Supplementation is necessary at this time.Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated.Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue breastfeeding.

Question 12

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

Accepted Answer

Iron dextran is a parenteral form of iron.When administered intramuscularly,it must be injected into a large muscle using the Z-track method.Iron dextran is for intramuscular or intravenous administration; it is not taken orally.The site should not be massaged to prevent leakage,potential irritation,and staining of the skin.The administration has no relationship to food since it is not being given orally.

Question 13

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

Accepted Answer

The children should be carefully evaluated before giving live viral vaccines such as varicella,measles,mumps,and rubella.The child must be immunocompetent and not have contact with other severely immunocompromised individuals.Influenza,pneumococcus,and inactivated poliovirus are not live vaccines.

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:

Accepted Answer

Preschool children are very concerned about both pain and the loss of blood.When preparing the child for venipuncture,a topical anesthetic will be used to eliminate any pain.This is a very traumatic experience for preschool children.They are concerned about their bodily integrity.A local anesthetic should be used,and a bandage should be applied to maintain bodily integrity.A promise that only one venipuncture will be needed should not be made in case multiple attempts are required.Both finger punctures and venipunctures are traumatic for children.Both require preparation.

Question 15

Which clinical manifestation should the nurse expect when a child diagnosed with sickle cell anemia experiences an acute vaso-occlusive crisis?

Accepted Answer

A vaso-occlusive crisis is characterized by severe pain in the area of involvement.If in the extremities,painful swelling of the hands and feet is seen; if in the abdomen,severe pain resembles that of acute surgical abdomen; and if in the head,stroke and visual disturbances occur.Circulatory collapse results from sequestration crises.Cardiomegaly,systolic murmurs,hepatomegaly,and intrahepatic cholestasis result from chronic vaso-occlusive phenomena.

Question 16

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

Accepted Answer

Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed.Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin.Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains.Iron deficiency anemia results in a decreased amount of circulating red cells.

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?

Accepted Answer

The pain of sickle cell anemia is best treated by a multidisciplinary approach.Mild-to-moderate pain can be controlled by ibuprofen and acetaminophen.When narcotics are indicated,they are titrated to effect and given around the clock.Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain.Few if any patients who receive opioids for severe pain become behaviorally addicted to the drug.Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis.Ice is contraindicated because of its vasoconstrictive effects.

Question 18

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

Accepted Answer

Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies,in which normal adult hemoglobin is replaced by abnormal hemoglobin.Aplastic anemia is a lack of cellular elements being produced.Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation.Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal hemoglobin.

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?

Accepted Answer

The signs of circulatory overload include distended neck veins,hypertension,crackles,dry cough,cyanosis,and precordial pain.Signs of air embolism are sudden difficulty breathing,sharp pain in the chest,and apprehension.Allergic reactions are manifested by urticaria,pruritus,flushing,asthmatic wheezing,and laryngeal edema.Hemolytic reactions are characterized by chills,shaking,fever,pain at infusion site,nausea,vomiting,tightness in chest,flank pain,red or black urine,and progressive signs of shock and renal failure.

Question 20

Which statement most accurately describes the pathologic changes of sickle cell anemia?

Accepted Answer

The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells.Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension.When the sickle cells change shape,they increase the viscosity in the area where they are involved in the microcirculation.

Quiz 43: The Child With Hematologic or Immunologic Dysfunction

Which statement best explains why iron deficiency anemia is common during toddlerhood?

As related to inherited disorders,which statement is descriptive of most cases of hemophilia?

What is the primary result of anemia?

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

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

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

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

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

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

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

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

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

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

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:

Which clinical manifestation should the nurse expect when a child diagnosed with sickle cell anemia experiences an acute vaso-occlusive crisis?

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

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?

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

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?

Which statement most accurately describes the pathologic changes of sickle cell anemia?

Quiz 43: The Child With Hematologic or Immunologic Dysfunction

Which statement best explains why iron deficiency anemia is common during toddlerhood?

As related to inherited disorders,which statement is descriptive of most cases of hemophilia?

What is the primary result of anemia?

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

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

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

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

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

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

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

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

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

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

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:

Which clinical manifestation should the nurse expect when a child diagnosed with sickle cell anemia experiences an acute vaso-occlusive crisis?

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

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?

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

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?

Which statement most accurately describes the pathologic changes of sickle cell anemia?

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