Chapter 26: The Child With a Condition of the Blood, Blood-Forming Organs, or Lymphatic System My Nursing Test Banks

Chapter 26: The Child With a Condition of the Blood, Blood-Forming Organs, or Lymphatic System

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. When teaching the mother of a young child about iron deficiency anemia, the nurse would tell her that a rich source of iron is:

a.

Egg whites

b.

Cream of wheat

c.

Bananas

d.

Carrots

ANS: B

Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, cream of wheat, dried fruits, beans, nuts, and whole-grain breads.

DIF: Cognitive Level: Application REF: Text Reference: 612

OBJ: Objective: 7 TOP: Topic: Iron Deficiency Anemia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. 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 doesnt 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.

ANS: A

Because cows milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

DIF: Cognitive Level: Analysis REF: Text Reference: 612

OBJ: Objective: 6 TOP: Topic: Iron Deficiency Anemia

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. 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

ANS: B

Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

DIF: Cognitive Level: Application REF: Text Reference: 613

OBJ: Objective: 6 TOP: Topic: Iron Deficiency Anemia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. The nurse would ask the patient with hemophilia A to reconsider a vacation he has planned to:

a.

The Caribbean for a cruise

b.

Denver for skiing

c.

Canada for a rail tour

d.

New England for a bus tour

ANS: B

Hemophiliacs are discouraged from exercising in high altitudes and exposure to cold as this depletes their already low oxygen concentration.

DIF: Cognitive Level: Analysis REF: Text Reference: 616

OBJ: Objective: 14 TOP: Topic: Hemophilia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

5. 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.

Childrens 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.

ANS: A

When bleeding occurs, the traditional approach is to follow RICErest, ice, compression, and elevation.

DIF: Cognitive Level: Application REF: Text Reference: 618

OBJ: Objective: 15 TOP: Topic: Hemophilia

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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

a.

Ibuprofen

b.

Aspirin

c.

Caffeine

d.

Prednisone

ANS: B

Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

DIF: Cognitive Level: Application REF: Text Reference: 619

OBJ: Objective: 17 TOP: Topic: Leukemia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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

a.

Fever

b.

Lethargy

c.

Jaundice

d.

Bradycardia

ANS: A

The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

DIF: Cognitive Level: Analysis REF: Text Reference: 622

OBJ: Objective: 13 TOP: Topic: Blood Transfusion

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

8. 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

ANS: A

When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

DIF: Cognitive Level: Analysis REF: Text Reference: 619

OBJ: Objective: 17 TOP: Topic: Leukemia

KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

a.

Stage I

b.

Stage II

c.

Stage III

d.

Stage IV

ANS: C

Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkins disease.

DIF: Cognitive Level: Analysis REF: Text Reference: 623, Table 26-2

OBJ: Objective: N/A TOP: Topic: Hodgkins Disease

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis for 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

ANS: C

Vaso-occlusive crises or painful crises are caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

DIF: Cognitive Level: Analysis REF: Text Reference: 615, Table 26-1

OBJ: Objective: 12 TOP: Topic: Sickle Cell Anemia

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. The statement made by a parent indicating understanding of health maintenance of a child with sickle cell anemia 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 shouldnt receive any immunizations until he is older.

ANS: B

Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

DIF: Cognitive Level: Analysis REF: Text Reference: 616

OBJ: Objective: 10 TOP: Topic: Sickle Cell Anemia

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

12. A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain their childrens 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.

ANS: C

The sickle cell gene is inherited from both parents; therefore each offspring has a one-in-four chance of inheriting the disease.

DIF: Cognitive Level: Analysis REF: Text Reference: 614, Figure 26-4

OBJ: Objective: 11 TOP: Topic: Sickle Cell Anemia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

13. 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

ANS: D

As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

DIF: Cognitive Level: Analysis REF: Text Reference: 617

OBJ: Objective: 13 TOP: Topic: Thalassemia

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. 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

ANS: D

An overproduction of immature white blood cells increases the childs susceptibility to infection.

DIF: Cognitive Level: Comprehension REF: Text Reference: 620

OBJ: Objective: 17 TOP: Topic: Leukemia

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. When the child receiving a transfusion complains of back pain and itching, the nurses initial action would be to:

a.

Notify the charge nurse

b.

Disconnect IV lines immediately

c.

Give Benadryl

d.

Clamp off blood and keep line open with NS

ANS: D

If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

DIF: Cognitive Level: Application REF: Text Reference: 622

OBJ: Objective: 18 TOP: Topic: Blood Transfusion

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

16. 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 Waterpik

d.

Inspect the mouth weekly for ulcerations

ANS: B

A soft toothbrush reduces capillary damage and mucous membrane breakdown, and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Waterpiks are useful for toughening gums.

DIF: Cognitive Level: Application REF: Text Reference: 622

OBJ: Objective: 17 TOP: Topic: Leukemia

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. 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?

ANS: A

This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas the closed response in option 2 shuts off communication. The asking of a why question is not therapeutic as it calls for justification.

DIF: Cognitive Level: Application REF: Text Reference: 627

OBJ: Objective: 17 TOP: Topic: Leukemia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

18. When dealing with a preschool-age child with a life-threatening illness, the nurse should remember that at this age the childs 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

ANS: C

The preschooler views death as reversible and temporary.

DIF: Cognitive Level: Comprehension REF: Text Reference: 627, Table 26-3

OBJ: Objective: 19 TOP: Topic: Nursing Care of the Dying Child

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

19. The nurse notes that a 4-year-old childs 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

ANS: A

The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

DIF: Cognitive Level: Analysis REF: Text Reference: 619

OBJ: Objective: 3 TOP: Topic: Idiopathic Thrombocytopenic Purpura

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. The nurse, caring for a child receiving chemotherapy, notes that the childs 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

ANS: A

Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

DIF: Cognitive Level: Analysis REF: Text Reference: 621

OBJ: Objective: 17 TOP: Topic: Leukemia

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

21. The nurse finds an adolescent with Hodgkins 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 shouldnt feel that way.

c.

Is this the strongest feeling youve had today?

d.

Tell me whats got you scared.

ANS: D

The nurse should encourage the adolescent to express her feelings and concerns.

DIF: Cognitive Level: Analysis REF: Text Reference: 628

OBJ: Objective: 20

TOP: Topic: Adolescent With Cancer-Fear of Death

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

22. 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

ANS: A

The child with neutropenia is at risk for infection.

DIF: Cognitive Level: Analysis REF: Text Reference: 620

OBJ: Objective: 17 TOP: Topic: Chemotherapy

KEY: Nursing Process Step: Nursing Diagnosis

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

23. The nurse takes into consideration an important focus of nursing care for the dying child and his/her family, which is:

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 childs care.

ANS: C

Hearing is intact even when there is a loss of consciousness.

DIF: Cognitive Level: Analysis REF: Text Reference: 631

OBJ: Objective: 22 TOP: Topic: Dying Child

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

1. The nursing care of a 12-year-old child receiving radiation therapy for Hodgkins disease, should include:

Select all that apply.

a.

Application of sunblock to the skin to prevent burning

b.

Appetite stimulation

c.

Conservation of energy

d.

Provision for expressions of anger

e.

Preparation for delay in sexual development

ANS: A, B, C, D, E

Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.

DIF: Cognitive Level: Analysis REF: Text Reference: 623

OBJ: Objective: 16 TOP: Topic: Effects of Radiation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse reviews the classic symptoms of thalassemia major (Cooleys anemia), such as:

Select all that apply.

a.

Hepatomegaly

b.

Jaundice

c.

Protruding teeth

d.

Pathological fractures

e.

Cardiac failure

ANS: A, B, C, D, E

All of the options are classic signs of thalassemia major.

DIF: Cognitive Level: Comprehension REF: Text Reference: 618

OBJ: Objective: 8 TOP: Topic: Signs of Thalassemia Major

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Heath Promotion and Maintenance: Prevention and Early Detection of Disease

3. The nurse reviews for a family how the development of synthetic recombinant antihemophilic factor has improved the management of hemophilia, because this drug:

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

ANS: A, B, D, E

The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.

DIF: Cognitive Level: Analysis REF: Text Reference: 618

OBJ: Objective: 15 TOP: Topic: Hemophilia A

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. The family of a child receiving chemotherapy for leukemia should be taught to focus on the childs care in regard to the need to:

Select all that apply.

a.

Use a support group

b.

Stimulate appetite

c.

Maintain adequate hydration

d.

Delay immunizations

e.

Report exposure to infectious diseases

ANS: A, B, C, D, E

The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization. Support groups are helpful for emotional support and realistic tips on care.

DIF: Cognitive Level: Analysis REF: Text Reference: 620

OBJ: Objective: 17 TOP: Topic: Chemotherapy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

COMPLETION

1. The nurse shows slides of red blood cells from a child with sickle cell anemia, noting that in addition to their sickle shape, the cells contain the abnormal element of ________ ______.

ANS: hemoglobin S

DIF: Cognitive Level: Application REF: Text Reference: 614

OBJ: Objective: 11 TOP: Topic: Sickle Cell Anemia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

NOT: Rationale: Hemoglobin S is the abnormal hemoglobin that makes red blood cells fragile and causes the walls of the cells to collapse, giving them the characteristic sickle shape.

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