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Peds Chapter 47: The Child with a Hematologic Alteration
Terms in this set (25)
What is the best response to a parent who asks the nurse whether her 5-month-old infant
can have cow's milk?
a. "You need to wait until she is 8 months old and eating solids well."
b. "Yes, if you think that she will eat enough meat to get the iron she needs."
c. "Infants younger than 12 months need iron-rich formula to get the iron they need."
d. "Try it and see how she tolerates it."
A A 5-month-old infant cannot get adequate iron without drinking an iron-fortified
formula or taking an iron supplement.
B The American Academy of Pediatrics recommends beginning solid foods at 4 to
6 months of age. Meats are typically introduced in later infancy. Iron-fortified
formula is still recommended.
C Infants younger than 12 months need iron-fortified formula or breast milk.
Infants who drink cow's milk do not get adequate iron and are at risk for iron
D Counseling a parent to give a 5-month-old infant cow's milk is inappropriate.
An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to
reveal an infant who is
a. Lethargic, pale, and irritable
b. Thin, energetic, and sleeps little
c. Anorexic, vomiting, and has watery stools
d. Flushed, fussy, and tired
A Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron
deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia.
B A child with a hemoglobin level of 6.5 mg/dL has anemia. Infants with iron
deficiency anemia are not typically thin and energetic but do tend to sleep a lot.
C A child with a hemoglobin level of 6.5 mg/dL has anemia. Gastrointestinal
symptoms are not clinical manifestations associated with iron deficiency anemia.
D A child with a hemoglobin level of 6.5 mg/dL has anemia. Although the infant
with iron deficiency anemia may be tired and fussy, pallor, rather than a flushed
appearance, is characteristic of a low hemoglobin level.
What action is not appropriate for a 14-month-old child with iron deficiency anemia?
a. Decreasing the infant's daily milk intake to 24 oz or less
b. Giving oral iron supplements between meals with orange juice
c. Including apricots, dark-green leafy vegetables, and egg yolk in the infant's diet
d. Allowing the infant to drink the iron supplement from a small medicine cup
A A daily milk intake in toddlers of less than 24 oz will encourage the consumption
of iron-rich solid foods.
B Because food interferes with the absorption of iron, iron supplements are taken
between meals. Administering this medication with foods rich in vitamin C
facilitates absorption of iron.
C Apricots, dark-green leafy vegetables, and egg yolks are rich sources of iron.
Other iron-rich foods include liver, dried beans, Cream of Wheat, iron-fortified
cereal, and prunes.
D Iron supplements should be administered through a straw or by a medicine
dropper placed at the back of the mouth because iron temporarily stains the teeth.
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
A Increased blood viscosity is usually a function of too many cells or of
dehydration, not of anemia.
B A depressed hematopoietic system or abnormal hemoglobin can contribute to
anemia, but the definition is dependent on the deceased oxygen-carrying capacity
of the blood.
C A depressed hematopoietic system or abnormal hemoglobin can contribute to
anemia, but the definition is dependent on the decreased oxygen-carrying
capacity of the blood.
D 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.
What is true about the genetic transmission of sickle cell disease?
a. Both parents must carry the sickle cell trait.
b. Both parents must have sickle cell disease.
c. One parent must have the sickle cell trait.
d. Sickle cell disease has no known pattern of inheritance.
A In this scenario, there is a 50% risk of having a child with sickle cell disease.
B The sickle cell trait, not the disease itself, must be present in the parents for the
child to have the disease.
C An autosomal recessive pattern of inheritance means that both parents must be
carriers of the sickle cell trait.
D Sickle cell disease is known to have an autosomal recessive pattern of
A condition in which the normal adult hemoglobin is partly or completely replaced by
abnormal hemoglobin is known as
a. Aplastic anemia
b. Sickle cell anemia
c. Thalassemia major
d. Iron-deficiency anemia
A Aplastic anemia is a lack of cellular elements being produced.
B Sickle cell anemia is one of a group of diseases collectively called
hemoglobinopathies, in which normal adult hemoglobin is replaced by an
C Hemophilia refers to a group of bleeding disorders in which there is deficiency
of one of the factors necessary for coagulation.
D Iron-deficiency anemia affects size and depth of color and does not involve an
What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis?
a. Administration of antibiotics and nebulizer treatments
b. Hydration and pain management
c. Blood transfusions and an increased calorie diet
d. School work and diversion
A Antibiotics may be given prophylactically. Oxygen therapy rather than nebulizer
treatments is used to prevent further sickling.
B Hydration and pain management decrease the cells' oxygen demands and prevent
C Although blood transfusions and increased calories may be indicated, they are
not primary considerations for vaso-occlusive crisis.
D School work and diversion are not major considerations when the child is in a
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
A Sickled red cells have decreased oxygen-carrying capacity and transform into the
sickle shape in conditions of low oxygen tension.
B When the sickle cells change shape, they increase the viscosity in the area where
they are involved in the microcirculation.
C 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
D Increased red blood cell destruction occurs.
Which clinical manifestation should the nurse expect when a child with sickle cell anemia
experiences an acute vaso-occlusive crisis?
a. Circulatory collapse
b. Cardiomegaly, systolic murmurs
c. Hepatomegaly, intrahepatic cholestasis
d. Painful swelling of hands and feet; painful joints
A Circulatory collapse results from sequestration crises.
B Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis
result from chronic vaso-occlusive phenomena.
C Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis
result from chronic vaso-occlusive phenomena.
D 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.
What should the discharge plan for a school-age child with sickle cell disease include?
a. Restricting the child's participation in outside activities
b. Administering aspirin for pain or fever
c. Limiting the child's interaction with peers
d. Administering penicillin daily as ordered
A Sickle cell disease does not prohibit the child from outdoor play. Active and
passive exercises help promote circulation.
B Aspirin use should be avoided. Acetaminophen or ibuprofen should be
administered for fever or pain.
C The child needs to interact with peers to meet his developmental needs.
D Children with sickle cell disease are at a high risk for pneumococcal infections
and should receive long-term penicillin therapy and preventive immunizations.
How should the nurse respond when asked by the mother of a child with beta-thalassemia
why the child is receiving deferoxamine?
a. "To improve the anemia."
b. "To decrease liver and spleen swelling."
c. "To eliminate excessive iron being stored in the organs."
d. "To prepare your child for a bone marrow transplant."
A Chronic transfusion therapy is the treatment for anemia. Deferoxamine is
administered to prevent complications from repeated transfusions.
B Deferoxamine is used to prevent organ damage, not as a treatment for existing
conditions such as hepatosplenomegaly.
C Multiple transfusions result in hemosiderosis. Deferoxamine is given to chelate
iron and prevent organ damage.
D Preparation for a bone marrow transplant does not include administration of
Which statement best describes beta-thalassemia major (Cooley 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.
A An overproduction of red cells occurs. Although numerous, the red cells are
B An overproduction of red cells occurs. Although numerous, the red cells are
C Individuals who live near the Mediterranean Sea and their descendants have the
highest incidence of thalassemia.
D Sickle cell disease is common in blacks of West African descent.
What is the priority nursing intervention for a child hospitalized with hemarthrosis
resulting from hemophilia?
a. Immobilization and elevation of the affected joint
b. Administration of acetaminophen for pain relief
c. Assessment of the child's response to hospitalization
d. Assessment of the impact of hospitalization on the family system
A Immobilization and elevation of the joint will prevent further injury until
bleeding is resolved.
B Although acetaminophen may help with pain associated with the treatment of
hemarthrosis, it is not the priority nursing intervention.
C Assessment of a child's response to hospitalization is relevant to all hospitalized
children; however, in this situation, psychosocial concerns are secondary to
physiologic concerns. A priority nursing concern for this child is the
management of hemarthrosis.
D Assessing the impact of hospitalization on the family system is relevant to all
hospitalized children, but it is not the priority in this situation.
What is descriptive of most cases of hemophilia?
a. Autosomal dominant disorder causing deficiency is a factor involved in the
b. X-linked recessive inherited disorder causing deficiency of platelets and
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
A The inheritance pattern is X-linked recessive.
B The disorder involves coagulation factors, not platelets.
C 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.
D The disorder does not involve red cells or the Y chromosome.
The mother of a child with hemophilia asks the nurse how long her child will need to be
treated for hemophilia. What is the best response to this question?
a. "Hemophilia is a lifelong blood disorder."
b. "There is a 25% chance that your child will have spontaneous remission and
treatment will no longer be necessary."
c. "Treatment is indicated until after your child has progressed through the toddler
d. "It is unlikely that your child will need to be treated for his hemophilia because
your first child does not have the disease."
A Hemophilia is a lifelong hereditary blood disorder with no cure. Prevention by
avoiding activities that induce bleeding and by treatment is lifelong. The
management of hemophilia is highly individual and depends on the severity of
B This is an untrue statement. Hemophilia is a lifelong hereditary blood disorder
with no cure. Treatment is lifelong.
C This is an untrue statement. Hemophilia is a lifelong hereditary blood disorder
with no cure. Treatment is lifelong.
D Because hemophilia has an X chromosome-linked recessive inheritance, there is
a risk with each pregnancy that a child will either have the disease or be a carrier.
Hemophilia is a life-long hereditary blood disorder with no cure. Treatment is
In teaching family members about their child's von Willebrand disease, what is the priority
outcome for the child that the nurse should discuss?
a. Prevention of injury
b. Maintaining adequate hydration
c. Compliance with chronic transfusion therapy
d. Prevention of respiratory infections
A Hemorrhage as a result of injury is the child's greatest threat to life.
B Fluid volume status becomes a concern when hemorrhage has occurred.
C The treatment of von Willebrand disease is desmopressin acetate (DDAVP),
which is administered intranasally or intravenously.
D Respiratory infections do not constitute a major threat to the child with von
A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and
excessive bruising that covers the body. The nurse is aware that these signs are clinical
b. von Willebrand disease
d. Immune thrombocytopenic purpura (ITP)
A The clinical manifestations of erythroblastopenia are pallor, lethargy, headache,
fainting, and a history of upper respiratory infection.
B The clinical manifestations of von Willebrand disease are bleeding from the
gums or nose, prolonged bleeding from cuts, and excessive bleeding after
surgery or trauma.
C Bleeding is the clinical manifestation of hemophilia and results from a deficiency
of normal factor activity necessary to produce blood clotting.
D Excessive bruising and petechiae, especially involving the mucous membranes
and gums in a child who is otherwise healthy, are the clinical manifestations of
ITP, resulting from decreased platelets. The etiology of ITP is unknown, but it is
considered to be an autoimmune process.
What is the priority in the discharge plan for a child with immune thrombocytopenic
a. Teaching the parents to report excessive fatigue to the physician
b. Monitoring the child's hemoglobin level every 2 weeks
c. Providing a diet that contains iron-rich foods
d. Establishing a safe, age-appropriate home environment
A Excessive fatigue is not a significant problem for the child with ITP.
B ITP is associated with low platelet levels.
C Increasing the child's intake of iron in the diet will not correct ITP.
D Prevention of injury is a priority concern for a child with ITP.
What is a priority intervention in planning care for the child with disseminated
intravascular coagulation (DIC)?
a. Hospitalization at the first sign of bleeding
b. Teaching the child relaxation techniques for pain control
c. Management in the intensive care unit
d. Provision of adequate hydration to prevent complications
A DIC typically develops in a child who is already hospitalized.
B Relaxation techniques and pain control are not high priorities for the child with
C The child with DIC is seriously ill and needs to be monitored in an intensive care
D Hydration is not the major concern for the child with DIC.
What is the nurse's best response to a parent with questions about how her child's blood
disorder will be treated?
a. "Your child may be able to receive home care."
b. "What did the physician tell you?"
c. "Blood diseases are transient, so there is no need to worry."
d. "Your child will be tired for awhile and then be back to her old self."
A Treatment depends on the child's condition and the type of blood disorder.
Although it is possible that the child could be treated in the home, the child may
need to be treated as an outpatient or in the hospital. It is best to first assess what
the parent has been told by the physician.
B Providing the parent an opportunity to express what she was told by the
physician allows the nurse to assess the parent's understanding and provide
C Minimizing the parent's concern is inappropriate.
D The nurse needs to assess the parent's knowledge before teaching about the
The nurse is caring for a child with aplastic anemia. What nursing diagnoses are
appropriate? Select all that apply.
a. Acute Pain related to vaso-occlusion
b. Risk for Infection related to inadequate secondary defenses or immunosuppression
c. Ineffective Protection related to thrombocytopenia
d. Ineffective Tissue Perfusion related to anemia
e. Ineffective Protection related to abnormal clotting
ANS: B, C, D
Correct These are appropriate nursing diagnosis for the nurse planning care for a
child with aplastic anemia. Aplastic anemia is a condition in which the
bone marrow ceases production of the cells it normally manufactures,
resulting in pancytopenia. The child will have varying degrees of the
disease depending on how low the values are for absolute neutrophil count
(affecting the body's response to infection), platelet count (putting the
child at risk for bleeding), and absolute reticulocyte count (causing the
child to have anemia).
Incorrect Acute pain related to vaso-occlusion is an appropriate nursing diagnosis
for sickle cell anemia for the child in vaso-occlusive crisis, but it is not
applicable to a child with aplastic anemia. Ineffective protection related to
abnormal clotting is an appropriate diagnosis for von Willebrand disease.
The nurse is caring for a child with iron-deficiency anemia. What should the nurse expect
to find when reviewing the results of the complete blood count (CBC)? Select all that
a. Low hemoglobin levels
b. Elevated red blood cell (RBC) levels
c. Elevated mean cell volume (MCV) levels
d. Low reticulocyte count
e. Decreased MCV levels
ANS: A, D, E
Correct The results of the complete blood count in a child with iron-deficiency
anemia will show low hemoglobin levels (6 to 11 g/dL) and microcytic,
hypochromic RBCs; this manifests as decreased MCV and decreased mean
cell hemoglobin. The reticulocyte count is usually slightly elevated or
Incorrect The reticulocyte count is usually slightly elevated or normal, and mean cell
volume levels are decreased, not increased.
A nurse is teaching home care instructions to parents of a child with sickle cell disease.
Which instructions should the nurse include? Select all that apply.
a. Limit fluid intake.
b. Administer aspirin for fever.
c. Administer penicillin as ordered.
d. Avoid cold and extreme heat.
e. Provide for adequate rest periods.
ANS: C, D, E
Correct Parents should be taught to avoid cold, which can increase sickling, and
extreme heat, which can cause dehydration. Adequate rest periods should
be provided. Penicillin should be administered daily as ordered.
Incorrect The use of aspirin should be avoided; acetaminophen or ibuprofen should
be used as an alternative. Fluids should be encouraged and an increase in
fluid intake is encouraged in hot weather or when there are other risks for
A syndrome that leads to the deposition of platelets and fibrinogen plugs in the vasculature
and the simultaneous depletion of platelets and clotting factor proteins is commonly
known as DIC or _____________________.
disseminated intravascular coagulation
The pathophysiology of DIC is complicated and not easily understood because both
extreme bleeding and clotting occur at the same time.
The nurse is evaluating lab results to determine if her patient is experiencing a diagnosis of
DIC. The nurse should anticipate the following results: increased red blood cell count, low
platelet counts, and an increased fibrinogen level. Is this statement true or false?
The results indicate a decreased red blood cell count, low platelets, red blood cell
fragments, prolonged prothrombin time, and a decreased fibrinogen level with an increased
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