Deck 27: The Child with a Condition of the Blood, Blood-Forming Organs, or

Question 1

A child with thalassemia major receives blood transfusions frequently.The nurse is aware that a complication of repeated blood transfusions is:

A) hemarthrosis.
B) hematuria.
C) hemoptysis.
D) hemosiderosis.

Answer 1

hemosiderosis.

Question 2

The nurse,caring for a child receiving chemotherapy,notes that the child's abdomen is firm and slightly distended.Also,there is no record of a bowel movement for the last 2 days.These assessment findings suggest the possibility of:

A) peripheral neuropathy.
B) stomatitis.
C) myelosuppression.
D) hemorrhage.

Answer 2

peripheral neuropathy.

Question 3

An adolescent is diagnosed with Hodgkin's disease.Lymph nodes on both sides of her diaphragm have been found to be involved,including cervical and inguinal nodes.The disease is in stage:

A) I.
B) II.
C) III.
D) IV.

Answer 3

III.

Question 4

The nurse would include in a teaching plan about mouth care of a child receiving chemotherapy to:

A) use commercial mouthwash.
B) clean teeth with a soft toothbrush.
C) avoid use of a Water-Pik.
D) inspect the mouth weekly for ulcerations.

Question 5

When dealing with a preschool-age child with a life-threatening illness,the nurse should remember that at this age the child's concept of death includes:

A) that it is final.
B) only a fear of separation from her parents.
C) that a person becomes alive again soon after death.
D) an understanding based on simple logic.

Question 6

On admission,a child with leukemia has widespread purpura and a platelet count of 19,000/mm³.The priority nursing intervention is:

A) assessing neurological status.
B) inserting an intravenous line.
C) monitoring vital signs during platelet transfusions.
D) providing family education about how to prevent bleeding.

Question 7

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain.The nurse recognizes that the type of crisis the child is most likely experiencing is:

A) aplastic.
B) hyperhemolytic.
C) vaso-occlusive.
D) splenic sequestration.

Question 8

When teaching the parents of a young child about iron deficiency anemia,the nurse would tell them that a rich source of iron is:

A) an egg white.
B) cream of Wheat.
C) a banana.
D) a carrot.

Question 9

The nurse would teach the parents of a child with a low platelet count to avoid:

A) ibuprofen.
B) aspirin.
C) caffeine.
D) prednisone.

Question 10

A child who is receiving a transfusion should be closely assessed for:

A) fever.
B) lethargy.
C) jaundice.
D) bradycardia.

Question 11

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait.How can the nurse best explain the children's risk of inheriting this disease?

A) Every fourth child will have the disease; two others will be carriers.
B) All of their children will be carriers, just as they are.
C) Each child has a one in four chance of having the disease and a two in four chance of being a carrier.
D) The risk levels of their children cannot be determined by this information.

Question 12

The statement made by a parent indicating understanding of health maintenance of a child with sickle cell disease is:

A) "I should give my child a daily iron supplement. "
B) "It is important for my child to drink plenty of fluids. "
C) "He needs to wear protective equipment if he plays contact sports. "
D) "He shouldn't receive any immunizations until he is older. "

Question 13

A 2-year-old child has been diagnosed with hemophilia A.The information the nurse would include in a teaching plan about home care would be:

A) if bleeding occurs, apply pressure, ice, elevate, and rest the extremity.
B) children's aspirin in lowered doses may be given for joint discomfort.
C) a firm, dry toothbrush should be used to clean teeth at least twice a day.
D) do not permit interactive play with other children.

Question 14

A 6-year-old with leukemia asks,"Who will take care of me in heaven?" The best response for the nurse to make is:

A) "Who do you think will take care of you?"
B) "Your grandparents and God will take care of you. "
C) "Your mom will know more about that than I do. "
D) "Why are you asking me that?"

Question 15

The nurse would instruct the parent to give ferrous sulfate drops to the child:

A) with milk.
B) with orange juice.
C) with water.
D) on a full stomach.

Question 16

A child has just been diagnosed with acute lymphoblastic leukemia.The nurse is aware that the result of an overproduction of immature white blood cells in the bone marrow is:

A) decreased T-cell production.
B) decreased hemoglobin.
C) increased blood clotting.
D) increased susceptibility to infection.

Question 17

The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities.The lab value that would be consistent with these symptoms is:

A) platelet count of 25,000/mm³.
B) hemoglobin level of 8 g/dL.
C) hematocrit level of 36%.
D) leukocyte count of 14,000/mm³.

Question 18

The nurse clarifies that the deficiency of factor IX results in:

A) thalassemia.
B) idiopathic thrombocytopenic purpura.
C) hemophilia A.
D) Christmas disease.

Question 19

The statement by a mother that may indicate a cause for her 9-month-old having iron deficiency anemia is:

A) "Formula is so expensive. We switched to regular milk right away. "
B) "She almost never drinks water. "
C) "She doesn't really like peaches or pears, so we stick to bananas for fruit. "
D) "I give her a piece of bread now and then. She likes to chew on it. "

Question 20

When the child receiving a transfusion complains of back pain and itching,the nurse's initial action would be to:

A) notify the charge nurse.
B) disconnect intravenous lines immediately.
C) give diphenhydramine (Benadryl).
D) clamp off blood and keep line open with normal saline.

Question 21

Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? Select all that apply.

A) She will feel less neglected by the parents.
B) She can make amends for past hostilities to her brother.
C) She will feel less helpless.
D) She can express her feelings through care.
E) She can experience being supportive of her parents and brother.
F) None of the above

Question 22

The nurse takes into consideration that hemophilia A is a congenital disorder that is:

A) seen in males and females equally.
B) transmitted by symptom-free females.
C) a sex-linked dominant trait.
D) a defective gene located on the Y chromosome.

Question 23

The most recent blood count for a child who received chemotherapy last week shows neutropenia.The priority nursing diagnosis for this child is:

A) risk for infection.
B) risk for hemorrhage.
C) altered skin integrity.
D) disturbance in body image.

Question 24

The nurse confirms that sickle cell trait can be distinguished from sickle cell disease by a lab test called ________________.

Question 25

The nurse explains that the COPP medical regimen for the treatment of Hodgkin's disease uses a combination of which drugs? Select all that apply.

A) Vincristine
B) Cyclophosphamide
C) Methotrexate
D) Prednisone
E) Procarbazine hydrochloride

Question 26

What are the classic symptoms of thalassemia major (Cooley's anemia)? Select all that apply.

A) Hepatomegaly
B) Jaundice
C) Protruding teeth
D) Pathological fractures
E) Cardiac failure
F) None of the above

Question 27

The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s)of the child's care? Select all that apply.

A) Using a support group
B) Stimulating appetite
C) Maintaining adequate hydration
D) Continuing with scheduled immunizations
E) Reporting exposure to infectious diseases

Question 28

What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease? Select all that apply.

A) Application of sunblock
B) Appetite stimulation
C) Conservation of energy
D) Provision for expressions of anger
E) Preparation for premature sexual development

Question 29

To prevent ________________ ________________ the nurse warms the blood that is to be given as a transfusion through a central line.

Question 30

The nurse finds an adolescent with Hodgkin's disease crying.The adolescent says,"I am so scared." The most appropriate nursing response to this comment is:

A) "I understand how you must feel. "
B) "You shouldn't feel that way. "
C) "Is this the strongest feeling you've had today?"
D) "Tell me what's got you scared. "

Question 31

The nurse shows slides of red blood cells from a child with sickle cell disease,noting that in addition to their sickle shape,the cells contain the abnormal element of ______________ _____.

Question 32

How has synthetic recombinant antihemophilic factor improved the management of hemophilia? Select all that apply.

A) Eliminates the need for frequent transfusions
B) Can be administered by family at home
C) Prevents hemorrhage
D) Reduces cost of care of the hemophiliac
E) Reduces risk of HIV and hepatitis A and B transmission

Question 33

The nurse takes into consideration an important focus of nursing care for the dying child and the family,which is that:

A) nursing care should be organized to minimize contact with the child.
B) adequate oral intake is crucial to the dying child.
C) families should be made aware that hearing is the last sense to stop functioning before death.
D) it is best for the family if the nursing staff provides all of the child's care.