CHAPTER 26: HEMATOLOGICAL ALTERATIONS My Nursing Test Banks

CHAPTER 26: HEMATOLOGICAL ALTERATIONS

MULTIPLE CHOICE

1.Where are blood cells produced during fetal development?

a.

bone marrow

c.

liver and spleen

b.

stem cells

d.

heart and lungs

ANS: C

Feedback

A

Incorrect. After birth, blood cells are produced in the bone marrow, but not during fetal development.

B

Incorrect. After birth, blood cells are produced from stem cells in the bone marrow, but not during fetal development.

C

Correct. During fetal development blood cells are produced in the liver and the spleen.

D

Incorrect. Blood cells are never produced in the heart and lungs.

PTS: 1 REF: p. 912 Hematological Alterations OBJ: Cognitive Level: Knowledge

2.What features of red blood cells (RBCs) allow them to reach all the tissues of the body?

a.

shape, size, and structure

c.

propulsive DNA energy

b.

gelatinous quality

d.

compacting of various cells

ANS: A

Feedback

A

Correct. The red blood cells (RBCs) primary function is to supply the tissues of the body with oxygen, made possible by the shape, size, and structure of these cells.

B

Incorrect. A gelatinous quality is not a feature of red blood cells (RBCs) that allows them to reach all the tissues of the body.

C

Incorrect. Propulsive DNA energy is not a feature of red blood cells (RBCs) that allows them to reach all the tissues of the body.

D

Incorrect. Compacting of various cells is not a feature of red blood cells (RBCs) that allows them to reach all the tissues of the body.

PTS: 1 REF: p. 912 Hematological Alterations OBJ: Cognitive Level: Knowledge

3.The primary function of white blood cells (WBCs) is to guard against microorganisms and to do which of the following?

a.

produce erythrocytes

c.

disperse platelets

b.

remove debris

d.

boost antibiotics

ANS: B

Feedback

A

Incorrect. The primary function of white blood cells (WBCs) is not to produce erythrocytes.

B

Correct. The primary function of white blood cells (WBCs) is to defend against invading microorganisms and remove debris.

C

Incorrect. The primary function of white blood cells (WBCs) is not to disperse platelets.

D

Incorrect. The primary function of white blood cells (WBCs) is not to boost antibiotics.

PTS: 1 REF: p. 912 Hematological Alterations OBJ: Cognitive Level: Knowledge

4.What is the main function of platelets?

a.

to wall off foreign proteins, preventing infection

b.

to carry nutrients to tissues throughout the body

c.

to be involved in the recovery process in infection

d.

to facilitate blood coagulation to control bleeding

ANS: D

Feedback

A

Incorrect. The main function of platelets is not to wall off foreign proteins, preventing infection.

B

Incorrect. The main function of platelets is not to carry nutrients to tissues throughout the body.

C

Incorrect. The main function of platelets is not to be involved in the recovery process in infection.

D

Correct. The platelets are disk-shaped cytoplasmic fragments and are not considered cells, and their primary function is to facilitate blood coagulation in order to control bleeding.

PTS: 1 REF: p. 913 Anatomy and Physiology OBJ: Cognitive Level: Knowledge

5.The pediatric nurse doing assessments on infants and young children is aware that the most common blood disorder in children is:

a.

leukemia

c.

thalassemia minor

b.

anemia

d.

von Willebrands disease

ANS: B

Feedback

A

Incorrect. The most common blood disorder in children is not leukemia.

B

Correct. Anemia is not a disease, but rather a term used to describe a decrease in oxygen-carrying capacity of the blood caused by underlying disease or injury. Anemia is the most common blood disorder in children.

C

Incorrect. The most common blood disorder in children is not thalassemia minor.

D

Incorrect. The most common blood disorder in children is not von Willebrands disease.

PTS: 1 REF: p. 913 Anatomy and Physiology OBJ: Cognitive Level: Knowledge

6.Which of the following types of anemia would the nurse most expect to find in infants and toddlers?

a.

iron deficiency

c.

sickle cell

b.

aplastic

d.

decreased production

ANS: A

Feedback

A

Correct. Iron deficiency anemia is the most common hematologic disorder of infancy and children.

B

Incorrect. Aplastic anemia is not the most common hematologic disorder of infancy and children.

C

Incorrect. Sickle cell anemia is not the most common hematologic disorder of infancy and children.

D

Incorrect. Decreased production anemia is not the most common hematologic disorder of infancy and children.

PTS:1REF:p. 914 Anemia

OBJ: Cognitive Level: Comprehension

7.Parents ask the nurse why their adolescent daughter and several of her friends tend to be anemic. Which of the following is the nurses best response?

a.

There is decreased production of red blood cells (RBCs) during adolescence as the body focuses on growth in other areas.

b.

Some adolescent girls are anemic because of pregnancy and others because the body is preparing for pregnancy.

c.

This is a time when girls have a very heavy menstrual flow, which reduces the amount of hemoglobin.

d.

While there are several causes of anemia, teenage girls tend to make poor dietary choices at a time when they are growing.

ANS: D

Feedback

A

Incorrect. Answering a parents question about why their adolescent daughter tends to be anemic, the nurses best response is not that there is a decreased production of red blood cells.

B

Incorrect. Answering a parents question about why their adolescent daughter tends to be anemic, the nurses best response is not that it has anything to do with pregnancy.

C

Incorrect. Answering a parents question about why their adolescent daughter tends to be anemic, the nurses best response is not that it is in relation to menstruation.

D

Correct. Prevalence of iron deficiency anemia in adolescence is a period of rapid growth and is often associated with poor food choices.

PTS:1REF:p. 914 Anemia

OBJ: Cognitive Level: Application

8.When a child progresses to moderate iron-deficiency anemia, the caregivers or the nurse will notice which of the following signs?

a.

yellow color of skin, fatigue, and increased aggressiveness

b.

mottling of skin, joint pain, and muscular weakness

c.

general irritability, weakness, and lack of interest in play

d.

respiratory distress, cardiac irregularities, seizures

ANS: C

Feedback

A

Incorrect. Once the child becomes moderately anemic, he or she does not present with yellow color of skin, fatigue, and increased aggressiveness.

B

Incorrect. Once the child becomes moderately anemic, he or she does not present with mottling of skin, joint pain, and muscular weakness.

C

Correct. Once the child becomes moderately anemic, he or she presents with general irritability, weakness, and lack of interest in play.

D

Incorrect. Once the child becomes moderately anemic, he or she does not present with respiratory distress, cardiac irregularities, and seizures.

PTS:1REF:p. 915 Anemia

OBJ: Cognitive Level: Comprehension

9.As iron-deficiency anemia progresses beyond the moderate stage, the nurse assessing the child will most likely find which of the following signs?

a.

decreased reticulocytes and increased serum ferritin

b.

systolic murmurs, hair falling out, brittle nails, and enlarged spleen

c.

elevated blood pressure and pulse

d.

seizures and loss of consciousness

ANS: B

Feedback

A

Incorrect. Assessing the child beyond the moderate stage of anemia, the nurse will not expect decreased reticulocytes and increased serum ferritin.

B

Correct. Assessing the child beyond the moderate stage of anemia, the nurse will expect pallor, anorexia, and systolic murmurs.

C

Incorrect. Assessing the child beyond the moderate stage of anemia, the nurse will not expect elevated blood pressure and pulse.

D

Incorrect. Assessing the child beyond the moderate stage of anemia, the nurse will not expect seizures and loss of consciousness.

PTS:1REF:p. 916 Anemia

OBJ: Cognitive Level: Application

10.The nurse is assessing a child who has anemia. The child has a yellowish skin color. This skin color is most likely indicative of which of the following conditions associated with severe anemia?

a.

increased destruction of red blood cells (RBCs)

b.

compensatory polycythemia

c.

increased melatonin

d.

liver disease

ANS: A

Feedback

A

Correct. The child with a yellowish skin color (jaundice) indicates severe anemia from increased red blood cell destruction. When RBCs are destroyed, they release iron (heme) portion and bilirubin (waste product from the destruction of hemoglobin).

B

Incorrect. Yellowish skin color does not indicate compensatory polycythemia.

C

Incorrect. Yellowish skin color does not indicate increased melatonin.

D

Incorrect. Yellowish skin color can indicate liver disease, but is not the cause in this child. This child has severe anemia with increased destruction of RBCs.

PTS:1REF:p. 916 Anemia

OBJ: Cognitive Level: Application

11.Why are premature infants more at risk for iron-deficiency anemia than full-term infants?

a.

They do not nurse or take formula as well as full-term infants, so their intake of iron is considerably less.

b.

Their liver and spleen are smaller and functionally less well-developed than full-term infants.

c.

Premature infants use up their stores of hemosiderin within 6 to 8 weeks compared to approximately 20 weeks for full-term infants.

d.

The bone marrow production of iron is depressed and does not come up to the production level of full-term infants for several months.

ANS: C

Feedback

A

Incorrect. Premature infants are not more at risk for iron-deficiency anemia than full-term infants because they do not eat as well.

B

Incorrect. Premature infants are not more at risk for iron-deficiency anemia than full-term infants because of the size of their liver and spleen.

C

Correct. Premature infants use up their stores of hemosiderin within 6 to 8 weeks compared to approximately 20 weeks for full-term infants. These stores function to protect the infant from anemia as they can be used in lieu of dietary iron intake.

D

Incorrect. Premature infants are not more at risk for iron-deficiency anemia than full-term infants because the production of iron is depressed.

PTS:1REF:p. 928 Anemia

OBJ: Cognitive Level: Application

12.The nurse is working with a mother who is breastfeeding her 2-month-old infant with blood-loss anemia. The blood loss has been stopped, and efforts are made to increase the infants supply of iron. The nurse will advise the mother to:

a.

switch to a formula high in iron

b.

feed half formula with iron and half breast milk

c.

feed formula with iron and iron-fortified cereal

d.

give only mothers breast milk

ANS: D

Feedback

A

Incorrect. After stopping blood loss in a 2-month-old infant, to boost the infants iron level, the nurse will not advise the caregiver to switch to a formula high in iron.

B

Incorrect. After stopping blood loss in a 2-month-old infant, to boost the infants iron level, the nurse will not advise the caregiver to feed half formula with iron and half breast milk.

C

Incorrect. After stopping blood loss in a 2-month-old infant, to boost the infants iron level, the nurse will not advise the caregiver to feed formula with iron and iron-fortified cereal.

D

Correct. For infants, breast milk should be encouraged as the exclusive source of nutrition because the bioavailability of iron in human milk is greater than the iron found in formula.

PTS:1REF:p. 916 Anemia

OBJ: Cognitive Level: Application

13.The school nurse is working with a pregnant adolescent. The nurse will advise the young woman to eat foods high in iron and also high in which of the following vitamins to increase the absorption of iron?

a.

the B vitamins

c.

vitamin C

b.

vitamin E

d.

vitamin D

ANS: C

Feedback

A

Incorrect. Working with a pregnant adolescent, the school nurse will not advise the young woman to eat foods high in iron and the B vitamins.

B

Incorrect. Working with a pregnant adolescent, the school nurse will not advise the young woman to eat foods high in iron and vitamin E.

C

Correct. Both school-age children and adolescents should be encouraged to increase their intake of foods high in iron and vitamin C which increases the bodys absorption of iron.

D

Incorrect. Working with a pregnant adolescent, the school nurse will not advise the young woman to eat foods high in iron and vitamin D.

PTS:1REF:p. 916 Anemia

OBJ: Cognitive Level: Application

14.A parent calls the nurse and frantically reports that a child has gotten into the mothers ferrous sulfate pills and ingested a number of these pills. The child is vomiting, has bloody diarrhea, and is complaining of abdominal pain. The nurse will tell the mother to:

a.

call the poison control center

b.

administer syrup of ipecac

c.

call emergency medical services (EMS) and get the child to the emergency room

d.

relax because these symptoms will pass and the child will be fine

ANS: C

Feedback

A

Incorrect. Being told by a frantic parent that a child has ingested some ferrous sulfate pills and presently is vomiting, having bloody diarrhea, and is complaining of abdominal pain, the nurse will not tell the mother to call the poison control center.

B

Incorrect. Being told by a frantic parent that a child has ingested some ferrous sulfate pills and presently is vomiting, having bloody diarrhea, and is complaining of abdominal pain, the nurse will not tell the mother to administer syrup of ipecac.

C

Correct. Although oral iron supplementation is generally perceived as a safe treatment alternative, an overdose can be lethal for children. Initial signs and symptoms of overdose include vomiting, abdominal pain, and bloody diarrhea. These manifestations are typically followed by shock, lethargy, and dyspnea. Urgent treatment is essential.

D

Incorrect. Being told by a frantic parent that a child has ingested some ferrous sulfate pills and presently is vomiting, having bloody diarrhea, and is complaining of abdominal pain, the nurse will not tell the mother to relax because these symptoms will pass and the child will be fine.

PTS:1REF:p. 918 Anemia

OBJ: Cognitive Level: Application

15.What is the primary focus of nursing intervention when the child has iron-deficiency anemia?

a.

caregiver education

c.

control of acute pain

b.

reduction of episodes of constipation

d.

reduction of febrile episodes

ANS: A

Feedback

A

Correct. The primary focus of nursing intervention when a child has iron-deficiency anemia is caregiver education. This education should include a discussion of iron deficiency anemia, age-appropriate dietary guidelines, and information regarding the administration of oral iron supplements.

B

Incorrect. The primary focus of nursing intervention when a child has iron-deficiency anemia is not reduction of episodes of constipation.

C

Incorrect. The primary focus of nursing intervention when a child has iron-deficiency anemia is not control of acute pain.

D

Incorrect. The primary focus of nursing intervention when a child has iron-deficiency anemia is not reduction of febrile episodes.

PTS:1REF:p. 918 Anemia

OBJ: Cognitive Level: Comprehension

16.The nurse is doing discharge teaching with caregivers who will be giving their toddler a liquid iron supplement. The nurse will teach the parents to administer the liquid iron supplement in which of the following ways?

a.

mixed half and half with water

b.

through a straw, a medicine dropper, or a syringe in the back part of the mouth

c.

with food such as eggs, milk, cheese, or a slice of toasted whole grain bread with butter

d.

mixed with antacids

ANS: B

Feedback

A

Incorrect. Teaching caregivers who will be giving their toddler a liquid iron supplement, the nurse will not teach the parents to administer the liquid iron supplement mixed half and half with water.

B

Correct. Liquid iron supplements may stain teeth. If the child is old enough, give the iron solution with a straw. Otherwise, give with a dropper or syringe in the back part of the mouth.

C

Incorrect. Teaching caregivers who will be giving their toddler a liquid iron supplement, the nurse will not teach the parents to administer the liquid iron supplement with food such as eggs, milk, cheese, or a slice of toasted whole grain bread with butter. These foods should be avoided within 1 hour before or 2 hours after giving the iron because they interfere with iron absorption.

D

Incorrect. Teaching caregivers who will be giving their toddler a liquid iron supplement, the nurse will not teach the parents to administer the liquid iron supplement mixed with antacids for the same reason stated in option C.

PTS:1REF:p. 920 Anemia

OBJ: Cognitive Level: Application

17.The nurse is talking to the working parents of a child with sickle cell anemia. The nurse explores the feelings of the parents and finds that both parents are admitting to feeling guilty a lot of the time. Which of the following causes will the nurse most likely find as the greatest contributor or cause of this guilt?

a.

Both parents are carrying at least one recessive gene for sickle cell anemia.

b.

Both parents are working and cannot spend as much time with the child as they would like.

c.

The parents are not able to help their child more, and they fear that the child is suffering a great amount of the time.

d.

The child wants more and more things that cost more and more money, and the parents cant comply because of hospital bills.

ANS: A

Feedback

A

Correct. Sickle cell anemia is an autosomal recessive disorder that can transmit from parent to child, but both parents must carry at least one of the recessive genes.

B

Incorrect. Finding that both parents are feeling guilty about their child having sickle cell anemia, the nurse would not likely find as the greatest cause of the guilt that both parents work outside the home.

C

Incorrect. Finding that both parents are feeling guilty about their child having sickle cell anemia, the nurse would not likely find as the greatest cause of the guilt that the parents are not able to help more and they fear the child is suffering a great amount of the time.

D

Incorrect. Finding that both parents are feeling guilty about their child having sickle cell anemia, the nurse would not likely find as the greatest cause of the guilt that they have to balance buying things for their child with paying the hospital bills.

PTS:1REF:p. 920 Anemia

OBJ: Cognitive Level: Application

18.In talking with parents about the life expectancy of children who have the sickle cell trait, the nurse will share with the parents whose children with the sickle cell trait:

a.

often live only into their 20s or early 30s

b.

usually die at about age 45

c.

most often do not live past age 55

d.

do not have a decreased life expectancy

ANS: D

Feedback

A

Incorrect. The life expectancy of children who have the sickle cell trait is not drastically affected, and the nurse will not say that they often live only into their 20s or early 30s.

B

Incorrect. The life expectancy of children who have the sickle cell trait is not drastically affected, and the nurse will not say that they usually die at about age 45.

C

Incorrect. The life expectancy of children who have the sickle cell trait is not drastically affected, and the nurse will not say that they most often do not live past age 55.

D

Correct. Sickle cell trait is not associated with decreased life expectancy.

PTS:1REF:p. 920 Anemia

OBJ: Cognitive Level: Comprehension

19.When sickle cells are not able to pass through the microcirculation, which of the following signs or symptoms will the nurse find on assessment of a child with sickle cell anemia?

a.

edema

c.

fever

b.

pain

d.

dizziness

ANS: B

Feedback

A

Incorrect. Among signs or symptoms of sickle cell anemia, edema is not listed.

B

Correct. When compared to normal RBCs, sickled cells are stiffer and less able to change shape. As a result, they are often unable to pass through the microcirculation, causing vaso-occlusion, pain, and organ infarction.

C

Incorrect. Among signs or symptoms of sickle cell anemia, fever is not listed.

D

Incorrect. Among signs or symptoms of sickle cell anemia, dizziness is not listed.

PTS:1REF:p. 921 Anemia

OBJ: Cognitive Level: Application

20.The nurse is working with a child who has vaso-occlusive crisis. The nurse is aware that if this vaso-occlusive crisis is not resolved, the most likely result will be:

a.

priapism

c.

bruising

b.

bleeding into the surrounding tissues

d.

infarction of the distal tissues

ANS: D

Feedback

A

Incorrect. Working with a child who has vaso-occlusive crisis, the nurse is aware that if this vaso-occlusive crisis is not resolved, the most likely result will not be priapism.

B

Incorrect. Working with a child who has vaso-occlusive crisis, the nurse is aware that if this vaso-occlusive crisis is not resolved, the most likely result will not be bleeding into the surrounding tissues.

C

Incorrect. Working with a child who has vaso-occlusive crisis, the nurse is aware that if this vaso-occlusive crisis is not resolved, the most likely result will not be bruising.

D

Correct. Working with a child who has vaso-occlusive crisis, the nurse is aware that if this vaso-occlusive crisis is not resolved, the most likely result will be infarction of the distal tissues.

PTS:1REF:p. 922 Anemia

OBJ: Cognitive Level: Comprehension

21.The school nurse will educate teachers of children with a diagnosis of sickle cell anemia that when these children have a deterioration in school performance or a severe headache, this can be followed by which of the following problems?

a.

cerebral vascular accident (CVA)

c.

loss of consciousness

b.

petit mal seizure

d.

migraine or cluster headaches

ANS: A

Feedback

A

Correct. Another commonly occurring manifestation in children is a cerebral vascular accident (CVA). These CVAs typically occur without warning, but may be preceded by severe headaches or deterioration in school performance.

B

Incorrect. Educating teachers about sickle cell anemia, the school nurse will not teach them to observe for petit mal seizure.

C

Incorrect. Educating teachers about sickle cell anemia, the school nurse will not teach them to observe for loss of consciousness.

D

Incorrect. Educating teachers about sickle cell anemia, the school nurse will not teach them to observe for migraine or cluster headaches.

PTS:1REF:p. 922 Anemia

OBJ: Cognitive Level: Comprehension

22.Parents of children with sickle cell anemia need to know the risks of various activities. The nurse will teach the parents of a child with sickle cell anemia that on rare occasions children who have the sickle cell trait can have vaso-occlusive episodes and severe crisis caused by which of the following activities?

a.

being in very hot water (e.g., in a bathtub or a hot tub) that is 40.5 degrees C (105 degrees F) or higher

b.

failure to take rest periods morning and afternoon and to get 9 hours sleep daily

c.

flying at high altitudes in depressurized aircraft, exercising at high altitudes, or using anesthesia

d.

doubling up on medication either on purpose or by accident, then forgetting that the medicine was already been taken

ANS: C

Feedback

A

Incorrect. The nurse will not teach the parents of a child with sickle cell anemia that being in very hot water can cause vaso-occlusive episodes.

B

Incorrect. The nurse will not teach the parents of a child with sickle cell anemia that failure to take rest periods morning and afternoon and to get 9 hours sleep daily can cause vaso-occlusive episodes.

C

Correct. Children with sickle cell anemia, and on rare occasions children who have the sickle cell trait, can have vaso-occlusive episodes and severe hypoxia caused by shock, vigorous exercising at high altitudes, flying at high altitudes in unpressurized aircraft, or undergoing anesthesia.

D

Incorrect. The nurse will not teach the parents of a child with sickle cell anemia to double up on medication.

PTS:1REF:p. 924 Anemia

OBJ: Cognitive Level: Application

23.When the nurse realizes that a child is in sequestration crisis, the nurse will assess for and most likely need to initiate interventions for:

a.

shock

c.

breathing difficulty

b.

bleeding

d.

cardiac arrest

ANS: A

Feedback

A

Correct. The term sequestration crisis refers to the excessive pooling of blood in the liver and spleen. As more and ore of the childs blood leaves circulation, the decreased blood volume results in shock.

B

Incorrect. Realizing that a child is in sequestration crisis, the nurse will not assess for and most likely need to initiate interventions for bleeding.

C

Incorrect. Realizing that a child is in sequestration crisis, the nurse will not assess for and most likely need to initiate interventions for breathing difficulty.

D

Incorrect. Realizing that a child is in sequestration crisis, the nurse will not assess for and most likely need to initiate interventions for cardiac arrest.

PTS:1REF:p. 925 Anemia

OBJ: Cognitive Level: Application

24.Which of the following precipitates 80% of the cases of aplastic crisis?

a.

pneumococcal infection

c.

staphylococcus

b.

human parvovirus B-19

d.

streptococcus

ANS: B

Feedback

A

Incorrect. Pneumococcal infection does not precipitate 80% of the cases of aplastic crisis.

B

Correct. Aplastic crisis occurs when there is a decrease in erythropoiesis, despite the shortened life span of sickled RBCs and the bodys need for increased RBC production. In 80% of cases, this type of crisis is precipitated by an infection with human parvovirus B-19. The infection is self-limited, but highly contagious and warrants isolation from persons vulnerable to infection. Aplastic crisis results in severe anemia.

C

Incorrect. Staphylococcus does not precipitate 80% of the cases of aplastic crisis.

D

Incorrect. Streptococcus does not precipitate 80% of the cases of aplastic crisis.

PTS:1REF:p. 922 Anemia

OBJ: Cognitive Level: Comprehension

25.Parents of a child with anemia of unknown cause learn that their child will be tested for sickle cell anemia. The parents ask the nurse to explain why after having a sickle solubility test the child is now going to have a hemoglobin electrophoresis. Which of the following explanations by the nurse would be most accurate?

a.

The physician has to verify the results of the first test and doesnt like to base a diagnosis on just one test.

b.

The solubility has to do with the sickle cell and the electrophoresis with the severity of the anemia.

c.

The solubility test has to do with what solutions will dissolve a sickle cell and the electrophoresis with determining the electrical charge.

d.

The solubility test is to detect the presence of hemoglobin S(Hb S), while the hemoglobin electrophoresis is to determine the amount of Hb S in the blood.

ANS: D

Feedback

A

Incorrect. Explaining why the solubility test is followed by a hemoglobin electrophoresis test, the most accurate statement is not that the physician needs two tests to verify the results.

B

Incorrect. Explaining why the solubility test is followed by a hemoglobin electrophoresis test, the most accurate statement is not that hemoglobin electrophoresis reveals the severity of the anemia.

C

Incorrect. Explaining why the solubility test is followed by a hemoglobin electrophoresis test, the most accurate statement is not that the solubility test has to do with what solutions will dissolve a sickle cell and the electrophoresis with determining the electrical charge.

D

Correct. Testing would begin with a sickle solubility test in order to confirm the presence of Hb S in the blood. If this test is positive, hemoglobin electrophoresis would then be conducted to determine the amount of Hb S in the blood. The results of this test can then be used to differentiate SCA from other types of sickle disease.

PTS:1REF:p. 924 Anemia

OBJ: Cognitive Level: Application

26.Parents with sickle cell anemia in their families ask the nurse to tell them which test for sickle cell anemia can be done the earliest in the prenatal period. The nurse will respond that prenatal diagnosis for sickle cell anemia can be conducted as early as 8 to 10 weeks with which of the following tests?

a.

chorionic villi sampling

c.

sickle cell solubility tests

b.

amnionic fluid analysis

d.

hemoglobin electrophoresis

ANS: A

Feedback

A

Correct. Prenatal diagnosis for sickle cell anemia can be made through chorionic villi sampling as early as 8 to 10 weeks gestation or with amniotic fluid analysis at 15 weeks gestation.

B

Incorrect. Prenatal diagnosis for sickle cell anemia can be made with amniotic fluid analysis at 15 weeks gestation, not as early as 8 to 10 weeks.

C

Incorrect. The sickle cell solubility test is not used for prenatal diagnosis.

D

Incorrect. The hemoglobin electrophoresis test is not used for prenatal diagnosis.

PTS:1REF:p. 924 Anemia

OBJ: Cognitive Level: Comprehension

27.The nurse is giving parents discharge instructions for the care of their child with sickle cell anemia. The nurse explains that the child will be maintained on prophylactic oral penicillin until age 5 and tells the parents that the rationale for this antibiotic is:

a.

because of the increased risk for infection

b.

to prevent the destruction of red blood cells (RBCs)

c.

to prevent vegetation on the mitral valve

d.

antibiotics alter the shape of the sickle cell

ANS: A

Feedback

A

Correct. Giving parents discharge instructions for the care of their child with sickle cell anemia, the nurse explains that the child will be maintained on prophylactic oral penicillin until age 5 and tells the parents that the rationale for this antibiotic is the increased risk for infection.

B

Incorrect. The nurse explains that the child will be maintained on prophylactic oral penicillin until age 5, but does not tell the parents that the rationale for this antibiotic is to prevent the destruction of red blood cells (RBCs).

C

Incorrect. The nurse explains that the child will be maintained on prophylactic oral penicillin until age 5, but does not tell the parents that the rationale for this antibiotic is to prevent vegetation on the mitral valve.

D

Incorrect. The nurse explains that the child will be maintained on prophylactic oral penicillin until age 5, but does not tell the parents that the rationale for this antibiotic is that antibiotics alter the shape of the sickle cell.

PTS:1REF:p. 925 Anemia

OBJ: Cognitive Level: Application

28.The school nurse will need to know and share with teachers and caregivers that a child with a diagnosis of sickle cell anemia must avoid:

a.

diets high in sugar, cola drinks, and classroom treats that are high in sugar content

b.

homework assignments that require loss of sleep to be completed on time

c.

fever, infection, dehydration, constricting clothing, and exposure to cold

d.

playing with other children, small group projects, and paired projects

ANS: C

Feedback

A

Incorrect. The school nurse will not teach the teachers and caregivers that the child with sickle cell anemia must avoid diets high in sugar, cola drinks, and classroom treats that are high in sugar content.

B

Incorrect. The school nurse will not teach the teachers and caregivers that the child with sickle cell anemia must avoid homework assignments that require loss of sleep to be completed on time.

C

Correct. The primary treatment for children with sickle cell disease is prevention of RBC sickling in order to prevent anemia and sickle cell crises. This entails avoiding stimuli such as fever, infection, acidosis, dehydration, constricting clothing, and exposure to cold.

D

Incorrect. The school nurse will not teach the teachers and caregivers that the child with sickle cell anemia must avoid playing with other children, small group projects, and paired projects.

PTS:1REF:p. 925 Anemia

OBJ: Cognitive Level: Application

29.Which of the following approaches to pain treatment would be best for a child with a diagnosis of sickle cell anemia who is having pain related to a vaso-occlusive crisis?

a.

pain medication every 3 to 4 hours as necessary

b.

pain medication every 3 to 4 hours around the clock

c.

each pain medication dose ordered specifically by the physician in response to the nurse calling the doctor

d.

as little pain medication as possible by using some alternative comforting methods

ANS: B

Feedback

A

Incorrect. Analgesics should be given around the clock on a scheduled basis rather than on an as-needed basis.

B

Correct. Pain management is most commonly needed when a child experiences a vaso-occlusive crisis. In this instance, analgesics should be given around the clock on a scheduled basis rather than on an as-needed basis.

C

Incorrect. Analgesics should be given around the clock on a scheduled basis rather than as ordered by the physician.

D

Incorrect. Pain management requires that analgesics should be given around the clock on a scheduled basis rather than on a limited basis.

PTS:1REF:p. 925 Anemia

OBJ: Cognitive Level: Application

30.The nurse reporting on duty is assigned to care for a child with a diagnosis of sickle cell anemia. In the report the nurse hears that this child is clock watching in regard to pain medication and sometimes asks for pain medication before it is time. The nurse suspects which of the following as the most likely cause of the childs behavior in regard to pain medication?

a.

The child is drug addicted.

b.

The child is on the way to being drug addicted.

c.

The childs pain is undermedicated.

d.

The child is over-medicated and needs to be weaned downward.

ANS: C

Feedback

A

Incorrect. Hearing the child with sickle cell anemia is clock watching, the nurse will not suspect that the child is drug addicted.

B

Incorrect. Hearing the child with sickle cell anemia is clock watching, the nurse will not suspect that the child is on the way to being drug addicted.

C

Correct. Children experiencing sickle cell crisis are often undermedicated, resulting in clock watching and requests for additional doses occurring sooner than prescribed.

D

Incorrect. Hearing the child with sickle cell anemia is clock watching, the nurse will not suspect that the child is over-medicated and needs to be weaned downward.

PTS:1REF:p. 925 Anemia

OBJ: Cognitive Level: Application

31.Which of the following statements about thalassemia is true?

a.

It involves the inheritance of dominant genes from both parents.

b.

It is characterized by an impaired rate of hemoglobin chain synthesis.

c.

It always involves early death.

d.

It involve years of transfusions, which cause few side effects if any.

ANS: B

Feedback

A

Incorrect. Thalassemia does not involve dominant genes.

B

Correct. The thalassemias are a group of inherited autosomal recessive disorders, characterized by an impaired rate of hemoglobin chain synthesis.

C

Incorrect. If children with this disorder are not treated, they will die by the age of 5 to 6 years; but, their life can be extended with treatments by 1 to 2 decades.

D

Incorrect. Treatment of thalassemia involves years of transfusions with often severe side effects.

PTS: 1 REF: p. 926 Anemia OBJ: Cognitive Level: Knowledge

32.If a child with thalassemia major is not treated, death will most likely occur by which of the following ages?

a.

3 to 4 years

c.

8 to 9 years

b.

5 to 6 years

d.

11 to 12 years

ANS: B

Feedback

A

Incorrect. If a child with thalassemia major is not treated, death will most likely occur by 5 to 6 years of age, not 3 to 4 years.

B

Correct. If a child with thalassemia major is not treated, death will most likely occur by 5 to 6 years of age.

C

Incorrect. If a child with thalassemia major is not treated, death will most likely occur by 5 to 6 years of age, not 8 to 9 years.

D

Incorrect. If a child with thalassemia major is not treated, death will most likely occur by 5 to 6 years of age, not 11 to 12 years.

PTS: 1 REF: p. 926 Anemia OBJ: Cognitive Level: Knowledge

33.The parents ask the nurse if there is anything that can be done to reduce or eliminate the need for transfusions every 2 to 3 weeks for their child who has thalassemia. Which one of the following treatments will the nurse report as one that will decrease the childs need for frequent transfusions?

a.

beta cell transplantation

b.

liver and pancreatic transplantation

c.

splenectomy or bone marrow transplantation

d.

allergy testing and serum treatment of allergies

ANS: C

Feedback

A

Incorrect. Answering parents question about any means to reduce or eliminate the need for transfusions every 2 to 3 weeks, the nurses would not recommend beta cell transplantation.

B

Incorrect. Answering parents question about any means to reduce or eliminate the need for transfusions every 2 to 3 weeks, the nurses would not recommend liver and pancreatic transplantation.

C

Correct. A splenectomy is often performed because eliminating the site of hemolysis can decrease the childs need for frequent transfusions. A bone marrow transplant or cord blood transplant will also decrease the childs need for frequent transfusions. The goals of both of these interventions is to introduce healthy stem cells into the marrow so normal RBCs and hemoglobin production will occur.

D

Incorrect. Answering parents question about any means to reduce or eliminate the need for transfusions every 2 to 3 weeks, the nurses would not recommend allergy testing and serum treatment of allergies.

PTS:1REF:p. 928 Anemia

OBJ: Cognitive Level: Application

34.The nurse is assigned to a child with hemosiderosis. The nurse will most expect to give which of the following ordered medications to reduce hemosiderosis?

a.

naloxone hydrochloride (Narcan)

c.

ferrous sulfate

b.

deferoxamine (Desferal)

d.

a daily vitamin with minerals

ANS: B

Feedback

A

Incorrect. Assigned to a child with hemosiderosis, the nurse will not most expect to give naloxone hydrochloride (Narcan) to reduce hemosiderosis.

B

Correct. Repeated transfusions eventually result in a buildup of excess iron in the body, causing iron overload or hemosiderosis. Iron is toxic to the tissues and organs and eventually causes organ failure and death. A chelating agent is required to reduce the amount of stored iron. Desferal (Deferoxamine) is the preferred medication.

C

Incorrect. Assigned to a child with hemosiderosis, the nurse will not most expect to give ferrous sulfate (more iron) to reduce hemosiderosis.

D

Incorrect. Assigned to a child with hemosiderosis, the nurse will not most expect to give a daily vitamin (more iron) with minerals to reduce hemosiderosis.

PTS:1REF:p. 928 Anemia

OBJ: Cognitive Level: Application

35.When the nurse learns that the assigned clients include a child with aplastic anemia, the nurse knows that this is a condition involving:

a.

production of an inadequate number of erythrocytes

b.

lack of, or deficiency in, factor V

c.

circulation of highly moldable platelets

d.

production of inadequate amounts of hemoglobin

ANS: A

Feedback

A

Correct. Aplastic anemia is a condition therein injury to or abnormal expression of the stem cells in the bone marrow results in the production of inadequate numbers of erythrocytes, leukocytes, and platelets.

B

Incorrect. Aplastic anemia is not a condition involving the lack of, or deficiency in, factor V.

C

Incorrect. Aplastic anemia is not a condition involving the circulation of highly moldable platelets.

D

Incorrect. Aplastic anemia is not a condition involving the production of inadequate amounts of hemoglobin.

PTS:1REF:p. 929 Anemia

OBJ: Cognitive Level: Comprehension

COMPLETION

1.The father of a newborn has sickle cell anemia and the mother of a newborn is a carrier for sickle cell disease. There is a ____________________% chance that the child conceived will have the disease.

ANS:

50

fifty

When one parent has a disease and the other parent is a carrier for the disease, there is a 50% chance that each child conceived will have the disease.

PTS:1REF:p. 932 Disorders of Coagulation

OBJ: Cognitive Level: Application

MULTIPLE RESPONSE

1.Which of the following drugs might a nurse find in the doctors orders for clients with mild hemophilia A? Select all that apply.

a.

desmopressin

c.

meperidine (Demerol)

b.

third-generation cephalosporin drug

d.

factor VIII concentrates

ANS: A, D

Feedback

Correct

Desmopressin has been identified as an effective treatment for spontaneous bleeding in the client with hemophilia A.

Factor VIII concentrates replace the missing coagulation factor in hemophilia A.

Incorrect

Third-generation cephalosporin medications would not be indicated in the treatment of hemophilia A.

Meperidine would not be indicated in the treatment of hemophilia A.

PTS:1REF:p. 933 Disorders of Coagulation

OBJ: Cognitive Level: Application

2.When a child has hemophilia, which of the following conditions are present? Select all that apply.

a.

The child has either a missing or a deficient clotting factor.

b.

There is a deficiency in the production of platelets.

c.

The prothrombin time will be within normal limits.

d.

The child has an allergic reaction to his or her own body proteins.

ANS: A, C

Feedback

Correct

In hemophilia, there is a missing or a deficient clotting factor that prevents the body from making adequate fibrin for clot formation.

The prothrombin time will be within normal limits.

Incorrect

The platelet count will not suggest a deficiency, but rather will indicate that it is within normal limits.

Hemophilia is not associated with an allergic reaction to ones own body proteins.

PTS:1REF:p. 934 Disorders of Coagulation

OBJ: Cognitive Level: Application

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