Question 1

A child with sickle cell disease is in a vasoocclusive crisis.What nonpharmacologic pain intervention should the nurse plan?
A) Exercise as a distraction
B) Heat to the affected area
C) Elevation of the extremity
D) Cold compresses to the affected area

Accepted Answer

Frequently,heat to the affected area is soothing.Cold compresses are not applied to the area because doing so enhances vasoconstriction and occlusion.Bed rest is usually well tolerated during a crisis,although the actual rest obtained depends a great deal on pain alleviation and the use of organized schedules of nursing care.Although the objective of bed rest is to minimize oxygen consumption,some activity,particularly passive range of motion exercises,is beneficial to promote circulation.Usually the best course is to let children determine their activity tolerance.Elevating the extremity will not help in sickle cell disease.

Question 2

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia?
A) Prolonged use of oxygen can decrease erythropoiesis.
B) Prolonged use of oxygen can interfere with iron production.
C) Prolonged use of oxygen interferes with a child's appetite.
D) Prolonged use of oxygen can affect the synthesis of hemoglobin.

Accepted Answer

Oxygen administration is of limited value,because each gram of hemoglobin is able to carry a limited amount of the gas.In addition,prolonged use of supplemental oxygen can decrease erythropoiesis.Prolonged use of oxygen does not interfere with iron production,a child's appetite,or affect the synthesis of hemoglobin.

Question 3

The nurse is caring for a school-age child with severe anemia and activity intolerance.What diversional activity should the nurse plan for this child?
A) Playing a musical instrument
B) Playing board or card games
C) Participating in a game of table tennis
D) Participating in decorating the hospital room

Accepted Answer

Plan diversional activities that promote rest but prevent boredom and withdrawal.Because short attention span,irritability,and restlessness are common in anemia and increase stress demands on the body,plan appropriate activities such as playing board or card games.Playing a musical instrument,participating in a game of table tennis,or decorating the hospital room would cause undue exertion.

Question 4

The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection.What should the nurse include in the teaching session?
A) Avoid obtaining the pneumococcal vaccination for the child.
B) Avoid obtaining the meningococcal vaccination for the child.
C) The child should receive prophylactic penicillin for certain procedures.
D) Have the child immunized with the Haemophilus influenzae type b vaccination.
E) Notify the health care provider if your child develops a fever of 38.5° C (101.3° F).

Accepted Answer

Because of the risk of life-threatening bacterial infection after splenectomy,these children are immunized with the pneumococcal,meningococcal,and H.influenzae type b vaccines before surgery and receive prophylactic penicillin for several years after splenectomy.The parents should be instructed in the importance of seeking immediate medical attention if their child develops a fever of 38.5° C (101.3° F)or higher as a common sign of infection or postsplenectomy sepsis.

Question 5

The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC).What clinical manifestations should the nurse expect to observe?
A) Petechiae
B) Chronic diarrhea
C) Hepatosplenomegaly
D) Bleeding from openings in the skin
E) Hypotension
F) Purpura

Accepted Answer

Some clinical manifestations of DIC are petechiae,bleeding from openings in the skin,hypotension,and purpura.Hepatosplenomegaly and chronic diarrhea are clinical manifestations of human immunodeficiency virus (HIV)infection in children.

Question 6

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption.What should the nurse recognize as causes for iron deficiency due to impaired iron absorption?
A) Gastric acidity
B) Chronic diarrhea
C) Lactose intolerance
D) Absence of phosphates
E) Inflammatory bowel disease

Accepted Answer

Causes for iron deficiency due to impaired iron absorption include chronic diarrhea,lactose intolerance,and inflammatory bowel disease.Gastric alkalinity,not acidity,and the presence,not absence,of phosphates can be causes of impaired iron absorption.

Question 7

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child.What is an appropriate action that applies to administering blood?
A) Take the vital signs every 15 minutes while blood is infusing.
B) Use blood within 1 hour of its arrival from the blood bank.
C) Administer the blood with 5% glucose in a piggyback setup.
D) Administer the first 50 ml of blood slowly and stay with the child.

Accepted Answer

The nurse should administer the first 50 ml of blood or initial 20% of volume (whichever is smaller)slowly and stay with the child.Vitals signs should be taken 15 minutes after initiation and then every hour,not every 15 minutes.Blood should be used within 30 minutes,not 1 hour.Normal saline,not 5% glucose,should be the IV solution.

Question 8

The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease).What clinical features of severe congenital neutropenia should the nurse recognize?
A) Anemia is present.
B) Neutropenia is present.
C) The illness is severe.
D) It has a dominant inheritance pattern.
E) There are decreased eosinophils in the bone marrow.

Accepted Answer

The clinical features of severe congenital neutropenia include anemia and neutropenia,and the illness is severe.It has an autosomal recessive inheritance pattern,and there are increased,not decreased,eosinophils in the bone marrow.

Question 9

The clinic nurse is evaluating lab results for a child.What recorded hemoglobin (Hgb)result is considered within the normal range?
A) 9 g/dl
B) 10 g/dl
C) 11 g/dl
D) 12 g/dl

Accepted Answer

Normal hemoglobin (Hgb)determination is 11.5 to 15.5 g/dl.

Question 10

What activity should the school nurse recommend for a child with hemophilia A?
A) Golf
B) Soccer
C) Rugby
D) Jogging
E) Swimming

Accepted Answer

Children and adolescents with severe hemophilia can participate in noncontact sports such as swimming,golf,walking,jogging,fishing,and bowling.Contact sports such as football,boxing,hockey,soccer,and rugby are strongly discouraged because the risk of injury outweighs the physical and psychosocial benefits of participating in these sports.

Question 11

What are signs and symptoms of anemia?
A) Pallor
B) Fatigue
C) Dilute urine
D) Bradycardia
E) Muscle weakness

Accepted Answer

Signs and symptoms of anemia include,pallor,fatigue,and muscle weakness.Tachycardia,not bradycardia,and dark urine,not dilute,are signs and symptoms of anemia.

Question 12

What immunoglobulin pattern does the nurse expect in a child recently diagnosed with Wiskott-Aldrich syndrome?
A) Diminished levels of IgG
B) Diminished levels of IgA
C) Diminished levels of IgM
D) Diminished levels of IgE

Accepted Answer

The level of IgM is diminished early in the course of the disease,but levels of IgG,IgA,and IgE may be elevated initially.

Question 13

The health care provider has prescribed a unit of packed red blood cells to be administered over 3 hours to a child with sickle cell disease.The unit from the blood bank totals 240 ml.What milliliters per hour should the nurse set the infusion pump to deliver the packed red blood cells? Fill in the blank and record your answer in a whole number.
____________

Accepted Answer

The answer of The health care provider has prescribed a...

Question 14

The nurse is caring for a 12-year-old child with b-thalassemia.What clinical manifestations should the nurse expect to observe?
A) Anorexia
B) Unexplained fever
C) Enlarged spleen or liver
D) Bronzed, freckled complexion
E) Precocious sexual development

Accepted Answer

The clinical manifestations of b-thalassemia include anorexia; unexplained fever; an enlarged spleen or liver; and a bronzed,freckled complexion.There is delayed sexual maturation,not precocious.

Question 15

The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia.What clinical features of chronic benign neutropenia should the nurse recognize?
A) Gingivitis is present.
B) Anemia is not present.
C) Monocytosis is present.
D) It has an autosomal recessive pattern.
E) Treatment is by bone marrow transplantation.

Accepted Answer

The clinical features of chronic benign neutropenia include gingivitis,no anemia,and monocytosis.It is not inherited,and because it is benign,it does not require treatment except antibiotics as indicated.

Question 16

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron.What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply?
A) Prematurity
B) Slow growth rate
C) Excessive milk intake
D) Severe iron deficiency in the mother
E) Exclusive breastfeeding of infant from birth to 3 months

Accepted Answer

Causes for iron deficiency caused by an inadequate supply of iron include prematurity,excessive milk intake,and severe iron deficiency in the mother.Rapid growth rate,not slow,and exclusive breastfeeding of infant after 6 months,not from birth to 3 months,can be causes of inadequate supply of iron.

Question 17

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food.What amount should the nurse teach to the parent?
A) 500 ml
B) 750 ml
C) 1000 ml
D) 1250 ml

Accepted Answer

The nurse should teach the parent to limit the amount of formula to no more than 1 1/day to encourage intake of iron-rich solid foods.

Question 18

The clinic nurse is evaluating lab results for a child.What recorded hematocrit (Hct)result is considered within the normal range?
A) 30%
B) 40%
C) 50%
D) 60%

Accepted Answer

Normal hematocrit (Hct)is 35% to 45%.

Question 19

A health care provider prescribes morphine sulfate,0.2 mg/kg IV every 2 to 4 hours as needed for pain for a child with sickle cell disease.The child weighs 20 kg.The medication label states: "Morphine sulfate 5 mg/ml." The nurse prepares to administer one dose.How many milliliters will the nurse prepare to administer one dose? Fill in the blank.Record your answer using one decimal place.
________________

Accepted Answer

The answer of A health care provider prescribes morphine sulfate,0.2...

Question 20

The nurse is administering a unit of blood to a child.What are signs and symptoms of a transfusion reaction?
A) Chills
B) Shaking
C) Flank pain
D) Hypothermia
E) Sudden severe headache

Accepted Answer

Signs and symptoms of a transfusion reaction include chills,shaking,flank pain,and sudden severe headache.Hyperthermia,not hypothermia,occurs.

Quiz 30: The Child With Hematologic or Immunologic Dysfunction

A child with sickle cell disease is in a vasoocclusive crisis.What nonpharmacologic pain intervention should the nurse plan?

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia?

The nurse is caring for a school-age child with severe anemia and activity intolerance.What diversional activity should the nurse plan for this child?

The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection.What should the nurse include in the teaching session?

The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC) .What clinical manifestations should the nurse expect to observe?

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption.What should the nurse recognize as causes for iron deficiency due to impaired iron absorption?

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child.What is an appropriate action that applies to administering blood?

The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease) .What clinical features of severe congenital neutropenia should the nurse recognize?

The clinic nurse is evaluating lab results for a child.What recorded hemoglobin (Hgb) result is considered within the normal range?

What activity should the school nurse recommend for a child with hemophilia A?

What are signs and symptoms of anemia?

What immunoglobulin pattern does the nurse expect in a child recently diagnosed with Wiskott-Aldrich syndrome?

The nurse is caring for a 12-year-old child with b-thalassemia.What clinical manifestations should the nurse expect to observe?

The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia.What clinical features of chronic benign neutropenia should the nurse recognize?

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron.What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply?

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food.What amount should the nurse teach to the parent?

The clinic nurse is evaluating lab results for a child.What recorded hematocrit (Hct) result is considered within the normal range?

The nurse is administering a unit of blood to a child.What are signs and symptoms of a transfusion reaction?