Question 1

Which parental statement indicates correct understanding of information presented regarding the treatment for infant anemia?

Accepted Answer

The correct treatment for infant anemia is to begin iron-fortified infant cereal at 4 to 6 months of age. Adding green leafy vegetables to low-iron formula may not be enough to provide adequate iron intake. Discontinuing the use of vitamin C supplements by 6 months of age is not necessary as vitamin C can enhance the absorption of iron. Introducing cow's milk by 6 months of age is also not recommended as it can lead to anemia and other health issues.

Question 2

Which teaching topic should the nurse include in the discharge instructions for the family of child diagnoses with sickle-cell disease to prevent crisis?

Accepted Answer

Respiratory infection and dehydration are common triggers for sickle-cell crisis. The nurse should instruct the family to maintain good hydration, encourage hand washing and good hygiene, avoid exposure to sick individuals, and seek medical attention promptly if signs of infection or dehydration occur. The other options are not specifically related to preventing sickle-cell crisis.

Question 3

During a natural disaster, a child diagnosed with hemophilia is injured and bleeding internally. Which blood product should the nurse plan to administer if the appropriate factor is not available?

Accepted Answer

Fresh or fresh frozen plasma contains clotting factors, including factor VIII which is deficient in hemophilia. It can be given in emergency situations if the appropriate factor concentrate is not available. Platelets, packed cells, and whole blood do not contain the clotting factors needed to treat hemophilia.

Question 4

Which parental statements regarding precipitating factors for sickle-cell disease indicate correct understanding of the discharge information presented by the nurse? Select all that apply.

Accepted Answer

Regular exercise is actually recommended for individuals with sickle-cell disease to prevent complications, so choice A is incorrect. Acetaminophen or ibuprofen can help manage pain and fever, making choices B correct. Drinking plenty of fluids is also important to prevent dehydration, so choice C is correct. High altitudes can cause complications, so choice D is correct. Fluid restriction is not necessary and may actually contribute to dehydration, so choice E is incorrect.

Question 5

Which nursing action is appropriate when treating a school-age child, diagnosed with hemophilia, for a superficial wound above the knee?

Accepted Answer

Applying pressure to the area is appropriate for treating a superficial wound in a child with hemophilia as it will stop bleeding by promoting clotting. A warm, moist pack or passive range-of-motion could aggravate bleeding and keeping the affected extremity in a dependent position could cause additional bleeding.

Question 6

Which symptoms should the nurse include in the teaching plan for the family of a recently child diagnosed with aplastic anemia?

Accepted Answer

Fatigue and fever are common symptoms of aplastic anemia, as the bone marrow is unable to produce enough red blood cells and white blood cells, leading to anemia and increased susceptibility to infections. Runny nose and cough, nausea and vomiting, and cyanosis and bradycardia are not typical symptoms of aplastic anemia.

Question 7

Which is the priority teaching point for the nurse to include in the discharge instructions for the parents of a child who was admitted in a sickle-cell crisis?

Accepted Answer

Adequate hydration is the priority teaching point for the nurse to include in the discharge instructions for a child who was admitted with a sickle-cell crisis. Maintaining good hydration is crucial in preventing sickling of the red blood cells, which can trigger a sickle-cell crisis. Adequate hydration also helps to prevent complications such as kidney damage or stroke. The other options (rapid weaning of pain medications, a diet high in protein, and restriction of activities) may be important aspects of the child's care, but they are not the priority teaching point for the parents at the time of discharge.

Question 8

Which rationale should the nurse include in the teaching session, related to infant iron deficiency anemia, when a parent asks why it is inappropriate to switch from formula to cow's milk prior to 1 year of age? Select all that apply.

Accepted Answer

Cow's milk is a poor source of iron and can lead to bleeding from the gastrointestinal tract in young children. This increases the risk of iron deficiency anemia. Antibiotics are not routinely given to cows and are not a significant concern in terms of switching to cow's milk. While cow's milk does have a high fat content, this is not directly related to iron deficiency anemia. Cow's milk also does not contain vitamin C, but this is not the primary concern in terms of iron absorption.

Question 9

Which is the priority nursing intervention when providing care to a pediatric client who is experiencing disseminated intravascular coagulation (DIC)?

Accepted Answer

DIC can lead to bleeding and blood clotting, which can cause hemodynamic instability. Therefore, monitoring the child's oxygen saturation and vital signs is a priority nursing intervention to assess for signs of shock or respiratory distress. Preparing the child for radiographic procedures or implementing prescribed fluid restrictions may also be necessary interventions, but they are not the priority in this case. Encouraging frequent ambulation can actually increase the risk of bleeding in a child with DIC.

Question 10

A school-age child diagnosed with classic hemophilia is admitted to the hospital for hemorrhage into the knee joint. Which nursing diagnosis should the nurse use to plan care for this child?

Accepted Answer

Hemophilia can lead to joint damage and bleeding into the joints, resulting in stiffness and contractures, which can impair physical mobility. Therefore, the nursing diagnosis of Risk for Impaired Physical Mobility related to joint stiffness and contractures would be most appropriate for this situation. The other options are not as relevant in this case.

Question 11

The parents of an infant diagnosed with sickle-cell disease ask, "How did our child get this disease? Neither one of us has it." Which should the nurse consider when responding to the parents?

Accepted Answer

Sickle-cell disease is an autosomal recessive disorder, which means that the child must inherit two copies of the gene, one from each parent, to have the disease. Both parents are carriers of the sickle-cell trait, which is why their child has sickle-cell disease.

Question 12

Which is the priority nursing diagnosis for the child diagnosed with idiopathic thrombocytopenic purpura (ITP)?

Accepted Answer

The child with ITP is at risk for injury due to the decreased platelet count, which increases the risk for bleeding or hemorrhage. The other options may be present in the child with ITP, but the priority is the risk for injury related to the condition.

Question 13

The nurse is administering packed red blood cells to a child with sickle-cell disease (SCD). When should the nurse monitor the child closely due to the risk of reaction?

Accepted Answer

The first 20 mL of blood administered is a critical period for monitoring any transfusion recipient for potential adverse reactions. This is when signs of a reaction are most likely to occur if the blood is incompatible or if the patient has an allergy to the blood components.

Question 14

Which risks should the nurse closely assess a pediatric client for during the posttransplant phase of hematopoietic stem cell transplantation (HSCT)?

Accepted Answer

The answer of Which risks should the nurse closely assess...

Question 15

A child who has beta-thalassemia is receiving numerous blood transfusions and deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which response by the nurse is accurate?

Accepted Answer

Deferoxamine (Desferal) therapy is used in individuals who receive multiple blood transfusions to prevent iron overload. Iron overload can occur due to the constant influx of iron from the transfused blood, and deferoxamine helps remove this excess iron from the body.

Question 16

A child diagnosed with hemophilia presents to the emergency department (ED) with multiple injuries following a motor vehicle crash. Which injury is the priority when conducting the nursing assessment?

Accepted Answer

The occipital hematoma is the priority injury to assess because it can result in increased intracranial pressure and potential brain damage in a child with hemophilia. Bleeding within the skull can also put pressure on the brain and cause neurologic deficits. The other injuries should also be assessed and treated, but the occipital hematoma takes priority.

Question 17

Which concepts should the nurse include in the discharge instructions for a child who has undergone a hematopoietic stem cell transplantation (HSCT)? Select all that apply.

Accepted Answer

The answer of Which concepts should the nurse include in...

Question 18

The nurse prepares to administer a vitamin K injection during the admission assessment for a newborn. The father asks, "Why does my baby need a shot?" Which rationale for administering this injection should the nurse include in the response?

Accepted Answer

Vitamin K injection is necessary for newborns because they have a low level of vitamin K at birth, and vitamin K is essential for the activation of clotting factors in the blood. This is important to prevent bleeding, including potentially life-threatening bleeding in the brain, which can occur in newborns who do not receive vitamin K supplementation.

Question 19

The nurse is providing care to a child diagnosed with hemophilia who states, "I am going to join a bike club at school." Which recommendation should the nurse give to the child?

Accepted Answer

The nurse should recommend that the child wear knee pads, elbow pads, and a helmet to prevent injury while bicycling. It is important for the child with hemophilia to avoid activities that may increase their risk of bleeding, but with proper precautions, the child can still enjoy physical activities such as biking. Swimming may also be a good option, but it is not necessary to discourage the child from joining the bike club altogether. Rather, the nurse should emphasize the importance of safety measures to prevent injury. Social activities of the club may also be enjoyed, but it is important for the child to be able to participate in physical activities as well.

Question 20

A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse what aplastic anemia is. Which response by the nurse is accurate?

Accepted Answer

Aplastic anemia is a disorder in which the bone marrow does not produce enough new cells to replenish the blood cells. It affects all three blood cell types – red blood cells, white blood cells, and platelets, due to ineffective hematopoiesis. Option A is incorrect, as proliferation of white blood cells is a characteristic of leukemia, not aplastic anemia. Option B is incorrect as abnormally shaped red blood cells are seen in sickle cell anemia, not aplastic anemia. Option D is incorrect because although viral illnesses can cause aplastic anemia, it is not the only cause, and the etiology of aplastic anemia is multifactorial.

Quiz 49: The Child With Alterations in Hematologic Function