Question 1

The parents of a child diagnosed with aplastic anemia tell the nurse that a bone marrow transplant (BMT)may be necessary.What should the nurse recognize as important when discussing this with the family?
A) BMT should be done at time of diagnosis.
B) Parents and siblings of child have a 25% chance of being a suitable donor.
C) Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
D) If BMT fails, chemotherapy or radiotherapy must be continued.

Accepted Answer

The most successful BMTs come from suitable HLA-matched donors.The timing of a BMT depends on the disease process involved.It usually follows intensive high-dose chemotherapy and/or radiation therapy.Usually parents only share approximately 50% of the genetic material with their children.A one-in-four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci.Discussing the continuation of chemotherapy or radiotherapy is not appropriate when planning the BMT.That decision will be made later.

Question 2

MATCHING
The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest.

-Fourth priority
A)Take the vital signs
B)Stop the transfusion
C)Notify the practitioner
D)Maintain a patent intravenous (IV) line with normal saline

Accepted Answer

The answer of MATCHING
The nurse has initiated a blood transfusion...

Question 3

MATCHING
The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest.

-First priority
A)Take the vital signs
B)Stop the transfusion
C)Notify the practitioner
D)Maintain a patent intravenous (IV) line with normal saline

Accepted Answer

Stopping the transfusion is the highest priority intervention because it will prevent further exposure to the incompatible blood.

Question 4

A school-age child is admitted in vaso-occlusive sickle cell crisis.The child's care should include which intervention? (Select all that apply.)
A) Correction of acidosis
B) Adequate hydration
C) Pain management
D) Administration of heparin
E) Replacement of factor VIII

Accepted Answer

The management of crises includes adequate hydration,minimizing energy expenditures,pain management,electrolyte replacement,and blood component therapy if indicated.The acidosis will be corrected as the crisis is treated.Heparin and factor VIII are not indicated in the treatment of vaso-occlusive sickle cell crisis.

Question 5

MATCHING
The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest.

-Third priority
A)Take the vital signs
B)Stop the transfusion
C)Notify the practitioner
D)Maintain a patent intravenous (IV) line with normal saline

Accepted Answer

The answer of MATCHING
The nurse has initiated a blood transfusion...

Question 6

Parents of a school-age child with hemophilia ask the nurse,"Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.)
A) Soccer
B) Swimming
C) Basketball
D) Golf
E) Bowling

Accepted Answer

Because almost all persons with hemophilia are boys,the physical limitations in regard to active sports may be a difficult adjustment,and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs.Use of protective equipment,such as padding and helmets,is particularly important,and noncontact sports,especially swimming,walking,jogging,tennis,golf,fishing,and bowling,are encouraged.Contact sports such as soccer and basketball are not recommended.

Question 7

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

Accepted Answer

Immobilization and elevation of the joint will prevent further injury until bleeding is resolved.Although acetaminophen may help with pain associated with the treatment of hemarthrosis,it is not the priority nursing intervention.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.Assessing the impact of hospitalization on the family system is relevant to all hospitalized children; however,it is not the priority in this situation.

Question 8

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.)
A) Limit fluids at bedtime.
B) Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs.
C) Give penicillin as prescribed.
D) Use ice packs to decrease the discomfort of vaso-occlusive pain in the legs.
E) Notify the health care provider if your child begins to develop symptoms of cold.

Accepted Answer

The most important issues to teach the family of a child with sickle cell anemia are to (1)seek early intervention for problems,such as a fever of 38.5° C (101.3° F)or greater; (2)give penicillin as ordered; (3)recognize signs and symptoms of splenic sequestration,as well as respiratory problems that can lead to hypoxia; and (4)treat the child normally.The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle.It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required.Many foods are also a source of fluid,particularly soups,flavored ice pops,ice cream,sherbet,gelatin,and puddings.Increased fluids combined with impaired kidney function result in the problem of enuresis.Parents who are unaware of this fact frequently use the usual measures to discourage bed-wetting,such as limiting fluids at night.Enuresis is treated as a complication of the disease,such as joint pain or some other symptom,to alleviate parental pressure on the child.Ice should not be used during a vaso-occlusive pain crisis because it vasoconstricts and impairs circulation even more.

Question 9

The nurse is caring for a child with aplastic anemia.Which 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

Accepted Answer

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).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 a child with hemophilia.

Question 10

The nurse is planning activity for a 4-year-old child with anemia.Which activity should the nurse plan for this child?
A) Game of "hide and seek" in the children's outdoor play area
B) Participation in dance activities in the playroom
C) Puppet play in the child's room
D) A walk down to the hospital lobby

Accepted Answer

Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity,an important nursing responsibility is to assess the child's energy level and minimize excess demands.The child's level of tolerance for activities of daily living and play is assessed,and adjustments are made to allow as much self-care as possible without undue exertion.Puppet play in the child's room would not be overly tiring.Hide and seek,dancing,and walking to the lobby would not conserve the anemic child's energy.

Question 11

The nurse is planning care for a school-age child admitted to the hospital with hemophilia.Which interventions should the nurse plan to implement for this child? (Select all that apply.)
A) Fingersticks for blood work instead of venipunctures
B) Avoidance of intramuscular (IM) injections
C) Acetaminophen for mild pain control
D) Soft toothbrush for dental hygiene
E) Administration of packed red blood cells

Accepted Answer

Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding,such as IM injections.The subcutaneous route is substituted for IM injections whenever possible.Venipunctures for blood samples are usually preferred for these children.There is usually less bleeding after the venipuncture than after finger or heel punctures.Neither aspirin nor any aspirin-containing compound should be used.Acetaminophen is a suitable aspirin substitute,especially for controlling mild pain.A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums.Packed red blood cells are not administered.The primary therapy for hemophilia is replacement of the missing clotting factor.The products available are factor VIII concentrates.

Question 12

What is the most common mode of transmission of human immunodeficiency virus (HIV)in the pediatric population?
A) Perinatal transmission
B) Sexual abuse
C) Blood transfusions
D) Poor hand washing

Accepted Answer

Infected women can transmit the virus to their infants across the placenta during pregnancy,at delivery,and through breastfeeding.Cases of HIV infection from sexual abuse have been reported; however,perinatal transmission accounts for most pediatric HIV infections.In the past some children became infected with HIV through blood transfusions; however,improved laboratory screening has significantly reduced the probability of contracting HIV from blood products.Poor hand washing is not an etiology of HIV infection.

Question 13

MATCHING
The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest.

-Second priority
A)Take the vital signs
B)Stop the transfusion
C)Notify the practitioner
D)Maintain a patent intravenous (IV) line with normal saline

Accepted Answer

The answer of MATCHING
The nurse has initiated a blood transfusion...

Quiz 43: The Child With Hematologic or Immunologic Dysfunction

The parents of a child diagnosed with aplastic anemia tell the nurse that a bone marrow transplant (BMT) may be necessary.What should the nurse recognize as important when discussing this with the family?

MATCHING The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest. -Fourth priority

MATCHING The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest. -First priority

A school-age child is admitted in vaso-occlusive sickle cell crisis.The child's care should include which intervention? (Select all that apply.)

MATCHING The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest. -Third priority

Parents of a school-age child with hemophilia ask the nurse,"Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.)

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.)

The nurse is caring for a child with aplastic anemia.Which nursing diagnoses are appropriate? (Select all that apply.)

The nurse is planning activity for a 4-year-old child with anemia.Which activity should the nurse plan for this child?

The nurse is planning care for a school-age child admitted to the hospital with hemophilia.Which interventions should the nurse plan to implement for this child? (Select all that apply.)

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population?

MATCHING The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest. -Second priority