Chapter 21: Alterations of Hematologic Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 21: Alterations of Hematologic Function in Children

Test Bank

MULTIPLE CHOICE

1. A 1-year-old female is diagnosed with anemia secondary to insufficient erythropoiesis. When the parents asked what caused this, how should the nurse respond? The most likely cause(s) is (are):

a.

Genetic factors

b.

An iron deficiency

c.

A hemoglobin abnormality

d.

An erythrocyte structural abnormality

ANS: B

The most common cause of insufficient erythropoiesis is iron deficiency.

The most common cause of insufficient erythropoiesis is iron deficiency, not genetic factors.

The most common cause of insufficient erythropoiesis is iron deficiency, not a hemoglobin abnormality.

The most common cause of insufficient erythropoiesis is iron deficiency, not an erythrocyte structural abnormality.

REF: p. 535

2. A 12-month-old toddler weighing 18 pounds is brought to the clinic because of weakness, slow physical growth, and developmental delays. His mother reports that the only food he will consume is cows milk. Considering this information, the nurse decides that the child probably has _____ anemia.

a.

Pernicious

b.

Iron deficiency

c.

Aplastic

d.

Hemolytic

ANS: B

As many as one-third of infants with severe iron deficiency anemia have chronic intestinal blood loss induced by exposure to a heat-labile protein in cows milk. Such exposure causes an inflammatory gastrointestinal reaction that damages the mucosa and results in diffuse hemorrhage.

The intake of cows milk leads to iron deficiency anemia; it does not lead to pernicious anemia.

The intake of cows milk leads to iron deficiency anemia; it does not lead to aplastic anemia.

The intake of cows milk leads to iron deficiency anemia; it does not lead to hemolytic anemia.

REF: p. 536

3. A 16-month-old female presents with tachycardia, pallor, anorexia, and systolic murmur. The nurse is checking the lab results, and the hemoglobin determination indicates a level below _____ g/dL.

a.

5

b.

7

c.

10

d.

14

ANS: A

When hemoglobin levels fall below 5 g/dL, pallor, anorexia, tachycardia, and systolic murmurs may occur.

When hemoglobin levels fall below 5 g/dL, not 7, pallor, anorexia, tachycardia, and systolic murmurs may occur.

When hemoglobin levels fall below 5 g/dL, not 10, pallor, anorexia, tachycardia, and systolic murmurs may occur.

When hemoglobin levels fall below 5 g/dL, not 14, pallor, anorexia, tachycardia, and systolic murmurs may occur.

REF: p. 536

4. Which mother is at most risk for a maternal-fetal blood incompatibility?

a.

Mother is Rh-positive, and fetus is Rh-negative.

b.

Mother is Rh-negative, and fetus is Rh-positive.

c.

Mother has type A blood, and fetus has type O blood.

d.

Mother has type AB, blood and fetus has type B blood.

ANS: B

Maternal-fetal incompatibility exists if mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative.

Maternal-fetal incompatibility exists if mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative.

Symptoms do not occur in a type O fetus.

Symptoms do not occur in type AB mothers.

REF: p. 536

5. A 22-year-old female gives birth at 20 weeks gestation to a stillborn fetus. Physical exam of the fetus by the nurse reveals gross edema of the entire body and anemia. This condition is referred to as:

a.

Hyperbilirubinemia.

b.

Hydrops fetalis.

c.

Erythroblastosis fetalis.

d.

Ascites.

ANS: B

Fetuses that do not survive anemia in utero usually are stillborn, with gross edema in the entire body, a condition called hydrops fetalis.

Fetuses that do not survive anemia in utero usually are stillborn, with gross edema in the entire body, a condition called hydrops fetalis, not hyperbilirubinemia.

Fetuses that do not survive anemia in utero usually are stillborn, with gross edema in the entire body, a condition called hydrops fetalis, not erythroblastosis fetalis.

Fetuses that do not survive anemia in utero usually are stillborn, with gross edema in the entire body, a condition called hydrops fetalis, not ascites.

REF: p. 539

6. Sickle cell disease is characterized by the presence of Hb S. A nurse is trying to differentiate between Hb S and normal Hb. Which of the following amino acids is present in Hb S and not present in normal Hb?

a.

Valine

b.

Glutamic acid

c.

Proline

d.

Histidine

ANS: A

Hb S is formed by a genetic mutation in which one amino acid (valine) replaces another (glutamic acid).

Valine has replaced glutamic acid.

Hb S is formed by a genetic mutation in the amino acid (valine), not proline.

Hb S is formed by a genetic mutation in the amino acid (valine), not histidine.

REF: p. 539

7. A 10-year-old male is diagnosed with sickle cell anemia. When the parents ask who is responsible for this disease, what is the nurses best response? He most likely inherited it from:

a.

His mother

b.

His father

c.

Noth his mother and father

d.

None of the above; sickle cell disease is not clearly an inherited disease.

ANS: C

Sickle cell is a recessive disorder inherited from both parents.

Sickle cell is a recessive disorder inherited from both parents.

Sickle cell is a recessive disorder inherited from both parents.

Sickle cell is a recessive disorder inherited from both parents.

REF: p. 540

8. In the United States, which group of people should be assessed first for sickle cell disease?

a.

Asians

b.

African-Americans

c.

Hispanics

d.

Caucasians

ANS: B

In the United States, sickle cell disease is most common in African-Americans.

In the United States, sickle cell disease is most common in African-Americans, not Asians.

In the United States, sickle cell disease is most common in African-Americans, not Hispanics.

In the United States, sickle cell disease is most common in African-Americans, not Caucasians.

REF: p. 540

9. A 25-year-old female has a child that is diagnosed with sickle cell anemia. She does not have the disease. Which of the following characterizes the genetic makeup of the parents with regard to this trait?

a.

Hb S and Hb S

b.

Hb S and Hb A

c.

Hb S and Hb C

d.

Hb A and Hb C

ANS: B

In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A), not Hb S, for both.

In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A).

In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A), not Hb C, and Hb S.

In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A).

REF: p. 540

10. When should the nurse start closely monitoring the patient with sickle cell anemia? If:

a.

Oxygen tension is low

b.

pH is increased

c.

Plasma osmolality is decreased

d.

Fever develops

ANS: A

Sickling occurs when oxygen tension is low.

Sickling occurs when oxygen tension is low, not due to pH.

Sickling occurs when oxygen tension is low, not due to a decrease in plasma osmolality.

Sickling occurs when oxygen tension is low, now due to the development of fever.

REF: p. 540

11. A 12-year-old male is diagnosed with sickle cell anemia. A blood smear reveals severely sickled cells. A nurse recalls the sickled cells will be removed from circulation mostly by the:

a.

Liver

b.

Pancreas

c.

Kidney

d.

Spleen

ANS: D

Sickled cells undergo hemolysis in the spleen or become sequestered there, causing blood pooling and infarction of splenic vessels.

Sickled cells undergo hemolysis in the spleen, not the liver.

Sickled cells undergo hemolysis in the spleen, not the pancreas.

Sickled cells undergo hemolysis in the spleen, not the kidney.

REF: p. 540

12. Which major symptom in a patient with sickle cell anemia indicates to the nurse, the patient is experiencing a vaso-occlusive crisis?

a.

Peripheral edema

b.

Pain

c.

Petechiae

d.

An enlarged spleen

ANS: B

Vaso-occlusive crisis is extremely painful and may last for days or even weeks, with an average duration of 4 to 6 days.

Vaso-occlusive crisis is extremely painful; it does not promote peripheral edema.

Vaso-occlusive crisis is extremely painful; it does not promote petechiae.

Vaso-occlusive crisis is extremely painful; it does not lead to an enlarged spleen.

REF: p. 541

13. For which type of sickle cell crisis should the nurse assess for in young children?

a.

Hyperhemolytic crisis

b.

Vaso-occlusive crisis

c.

Aplastic crisis

d.

Sequestration crisis

ANS: D

Sequestration occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

Sequestration, not hyperhemolysis, occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

Sequestration, not vaso-occlusive crisis, occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

Sequestration, not aplastic crisis, occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

REF: p. 541

14. A 6-year-old male presents with fatigue, jaundice, and irritability. A blood smear shows the presence of sickled cells. Erythropoiesis is compromised in this child; which crisis should the nurse monitor the patient for?

a.

Vaso-occlusive crisis

b.

Sequestration crisis

c.

Aplastic crisis

d.

Hyperhemolytic crisis

ANS: C

Aplastic anemia is caused by diminished erythropoiesis despite an increased need for new erythrocytes.

Vaso-occlusive crisis is manifested by pain.

Sequestered crisis is manifested by enlarged spleen.

Hyperhemolytic crisis is due to infection.

REF: p. 541

15. A 5-year-old female dies from sickle cell disease. The pediatrician will document the most likely cause of death is:

a.

Decreased hemoglobin

b.

Infection

c.

An obstructive crisis

d.

A hyperhemolytic crisis

ANS: B

Infection is the most common cause of death related to sickle cell disease.

Infection, not decreased hemoglobin, is the most common cause of death related to sickle cell disease.

Infection, not an obstructive crisis, is the most common cause of death related to sickle cell

disease.

Infection, not a hyperhemolytic crisis, is the most common cause of death related to sickle cell disease.

REF: p. 541

16. A geneticist is discussing thalassemias. Which information should be included? The alpha and beta thalassemias are inherited in an _____ fashion.

a.

Autosomal recessive

b.

Autosomal dominant

c.

X-linked recessive

d.

X-linked dominant

ANS: A

The alpha and beta thalassemias are inherited autosomal recessive disorders.

The alpha and beta thalassemias are inherited autosomal recessive disorders, not dominant.

The alpha and beta thalassemias are inherited autosomal recessive disorders, not X-linked recessive.

The alpha and beta thalassemias are inherited autosomal recessive disorders, not X-linked dominant.

REF: p. 542

17. A 2-year-old male presented with growth and maturation retardation and splenomegaly. He died shortly after arriving at the ER. Autopsy revealed thalassemia secondary to defective:

a.

Erythrocyte membranes

b.

Iron metabolism

c.

Stem cell formation

d.

Hemoglobin synthesis

ANS: D

Thalassemia would be secondary to defective hemoglobin synthesis.

Thalassemia would be secondary to defective hemoglobin synthesis; it is not due to erythrocyte membrane abnormalities.

Thalassemia would be secondary to defective hemoglobin synthesis. It is not due to defective iron metabolism.

Thalassemia would be secondary to defective hemoglobin synthesis. It is not due to defective stem cell formation.

REF: p. 535

18. A 38-year-old female gives birth to a stillborn fetus. Autopsy reveals cardiomegaly, hepatomegaly, edema, and ascites. Which of the following does the nurse suspect caused the death?

a.

Alpha thalassemia minor

b.

Alpha thalassemia major

c.

Hemoglobin H disease

d.

Alpha trait

ANS: B

Alpha thalassemia major causes hydrops fetalis and fulminant intrauterine congestive heart failure. In addition to edema and massive ascites, the fetus has a grossly enlarged heart and liver.

The fetus has alpha thalassemia major, not minor. Major is manifested by heart failure and ascites.

The stillborn fetus has symptoms of alpha thalassemia major, not hemoglobin H disease.

The stillborn fetus has symptoms of alpha thalassemia major, not alpha trait, which is the mildest form of the disease.

REF: p. 542

19. If an infant has hydrops fetalis, which type of thalassemia does the nurse suspect?

a.

Beta minor

b.

Beta major

c.

Alpha minor

d.

Alpha major

ANS: D

Hydrops fetalis is due to alpha thalassemia major.

Hydrops fetalis is due to alpha thalassemia major, not beta minor.

Hydrops fetalis is due to alpha thalassemia major, not beta major .

Hydrops fetalis is due to alpha thalassemia major, not alpha minor which results in anemia.

REF: p. 543

20. The mother of a 3-year-old child speaks to the pediatrician because the child took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia A resulting from a deficiency in factor:

a.

IX

b.

XII

c.

XIII

d.

VIII

ANS: D

Hemophilia A is a deficiency in factor VIII.

Hemophilia A is a deficiency in factor VIII, not IX.

Hemophilia A is a deficiency in factor VIII, not factor XII.

Hemophilia A is a deficiency of factor VIII, not factor XIII.

REF: p. 544

21. A nurse wants to chart the other name for hemophilia B. Which term should the nurse write?

a.

Classic hemophilia

b.

Christmas disease

c.

Thalassemia

d.

von Willebrand disease

ANS: B

Hemophilia B is also known as Christmas disease.

Hemophilia B is also known as Christmas disease, not classic hemophilia.

Hemophilia B is also known as Christmas disease; thalassemia is not a clotting disorder.

Hemophilia B is also known as Christmas disease; von Willebrand disease is a factor VIII disorder.

REF: p. 544

22. A 3-year-old child presents with bruising on the legs and trunk and a petechial rash. The mother also reports frequent nosebleeds. Lab tests reveal a decreased platelet count. Which is the most likely diagnosis the nurse will see documented on the chart?

a.

Idiopathic thrombocytopenic purpura (ITP)

b.

Leukemia

c.

Thalassemia

d.

Hemophilia

ANS: A

A decreased platelet count is the cause of ITP.

A decreased platelet count is the cause of ITP. Leukemia is not related to platelets.

A decreased platelet count is the cause of ITP. Thalassemia is not related to platelets.

A decreased platelet count is the cause of ITP. Hemophilia is not related to platelets.

REF: p. 545

23. A 5-year-old male is diagnosed with idiopathic thrombocytic purpura (ITP). Which information should the nurse give the staff regarding the cause of this condition?

a.

Normal postnatal platelet lysis

b.

Virally induced antibody destruction of platelets

c.

An allergic reaction to vaccinations

d.

Maternal antibodies that target platelets in the neonate

ANS: B

In approximately 70% of cases of ITP, there is an antecedent viral disease.

A viral disease leads to antibody destruction of platelets, not lysis.

A viral disease leads to antibody destruction of platelets; it may be related to vaccination but is not an allergic response.

A prior viral disease can lead to ITP; it is not due to maternal antibodies.

REF: p. 545

24. Which of the following clusters of symptoms would lead the nurse to suspect a child has idiopathic thrombocytopenic purpura (ITP)?

a.

Multiple infections; bruising; abnormal bone marrow aspiration

b.

Lower extremity that is warm to touch, edematous, and painful

c.

Spontaneous nosebleeds, bruising, petechiae

d.

Increased platelet count; recent-onset venous thrombosis

ANS: C

Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP.

Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP, not infections.

Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP, not warmth in extremities that are edematous and painful.

Bleeding would not be related to an increased platelet count.

REF: p. 545

25. A 1-year-old is diagnosed with idiopathic thrombocytopenic purpura (ITP). The nurse assesses for the most serious concern, which is development of:

a.

Respiratory infection

b.

Asymmetric bruising

c.

Intracranial bleeding

d.

Immunosuppression

ANS: C

Although the incidence is less than 1%, intracranial hemorrhage is the most serious complication of ITP.

Intracranial hemorrhage is the most serious concern, not respiratory infection.

Intracranial hemorrhage is the most serious concern, not asymmetric bleeding.

Intracranial hemorrhage is the most serious concern, not immunosuppression.

REF: p. 545

26. A nurse monitors for the most common childhood cancer, which is:

a.

Acute lymphoblastic leukemia (ALL)

b.

Chronic myelocytic leukemia (CML)

c.

Non-Hodgkin lymphoma

d.

Hodgkin lymphoma

ANS: A

Approximately 80% to 85% of leukemias in children are ALL.

Approximately 80% to 85% of leukemias in children are ALL, not CML.

Approximately 80% to 85% of leukemias in children are ALL, not non-Hodgkin.

Approximately 80% to 85% of leukemias in children are ALL, not Hodgkin lymphoma.

REF: p. 546

27. A 10-year-old male with Down syndrome undergoes chemotherapy for cancer. Following treatment, monitoring for which condition is priority?

a.

Acute lymphoblastic leukemia (ALL)

b.

Acute myelogenous leukemia (AML)

c.

Non-Hodgkin lymphoma (NHL)

d.

Hodgkin lymphoma

ANS: B

AML is attributable to prior chemotherapy.

AML is attributable to prior chemotherapy, not ALL.

AML is attributable to prior chemotherapy, not NHL.

AML is attributable to prior chemotherapy, not Hodgkin lymphoma.

REF: p. 546

28. A 10-year-old female is diagnosed with a malignancy in the brain and lung. DNA analysis reveals translocation at chromosome 7 and 14. The most likely medical diagnosis the primary care provider will make is:

a.

Lymphoblastic non-Hodgkin lymphoma (NHL)

b.

Nodular NHL

c.

Hodgkin lymphoma

d.

Small noncleaved cell NHL

ANS: A

Lymphoblastic NHL shows chromosomal translocations, particularly chromosomes 7 and 14.

Lymphoblastic NHL, not nodular, shows chromosomal translocations, particularly chromosomes 7 and 14.

Lymphoblastic NHL, not Hodgkin, shows chromosomal translocations, particularly chromosomes 7 and 14.

Lymphoblastic NHL, not small cell non-Hodgkin, shows chromosomal translocations, particularly chromosomes 7 and 14.

REF: p. 547

29. Which condition makes the patient most prone for developing non-Hodgkin lymphoma (NHL)?

a.

Sickle cell disease

b.

Sickle cell trait

c.

Renal failure

d.

AIDS

ANS: D

Children with AIDS have an increased risk of developing NHL.

Children with AIDS, not sickle cell disease, have an increased risk of developing NHL.

Children with AIDS, not sickle cell trait, have an increased risk of developing NHL.

Children with AIDS, not renal failure, have an increased risk of developing NHL.

REF: p. 548

30. What is a priority assessment for Hodgkin lymphoma in children?

a.

Painless adenopathy in cervical nodes

b.

Significant bruising

c.

Weight gain

d.

Petechiae

ANS: A

Painless adenopathy in the lower cervical chain, with or without fever, is the most common symptom in children with Hodgkin lymphoma.

Painless adenopathy is the most common symptom, not bruising.

Painless adenopathy is the most common symptom, not weight gain.

Painless adenopathy is the most common symptom, not petechiae.

REF: p. 548

31. Which laboratory test will assist the nurse in identifying infants who are prone to develop hemolytic disease of the newborn (HDN)?

a.

Total bilirubin

b.

Coombs

c.

Rh antibodies

d.

Platelets

ANS: B

Routine evaluation of fetuses at risk for HDN includes the Coombs test.

Routine evaluation of fetuses at risk for HDN includes the Coombs test, not bilirubin.

Routine evaluation of fetuses at risk for HDN includes the Coombs test, not Rh antibodies.

Routine evaluation of fetuses at risk for HDN includes the Coombs test, not platelets.

REF: p. 539

MULTIPLE RESPONSE

1. A nurse is planning care for a child with iron deficiency anemia. Characteristics of iron deficiency anemia include which of the following? (Select all that apply.)

a.

It is most common between the ages of 6 months and 2 years.

b.

It is related to gender and race.

c.

It may be related to socioeconomic factors.

d.

It is rare among teenagers.

e.

It is difficult to diagnose in early stages.

ANS: A, C, E

Iron deficiency anemia is the most common blood disorder of infancy and childhood, with the highest incidence occurring between 6 months and 2 years of age. Incidence is not related to gender or race, but socioeconomic factors are important because they affect nutrition. The symptoms of mild anemialistlessness and fatigueusually are not present or are undetectable in infants and young children who are unable to describe these symptoms. Therefore, parents generally do not note any change in the childs behavior or appearance until moderate anemia has developed.

REF: p. 536

2. A 5-year-old male is diagnosed with leukemia. Which of the following symptoms would the nurse expect? (Select all that apply.)

a.

Fatigue

b.

Jaundice

c.

Pallor

d.

Petechiae

e.

Fever

ANS: A, C, D

Pallor, fatigue, petechiae, purpura, bleeding, and fever generally are present. Jaundice is not.

REF: p. 546

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

Leave a Reply