Chapter 47
An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is
Lethargic, pale, and irritable
Thin, energetic, and sleeps little
Anorexic, vomiting, and has watery stools
Flushed, fussy, and tired
What action is not appropriate for a 14-month-old child with iron deficiency anemia?
Decreasing the infant’s daily milk intake to 24 oz or less
Giving oral iron supplements between meals with orange juice
Including apricots, dark-green leafy vegetables, and egg yolk in the infant’s diet
Allowing the infant to drink the iron supplement from a small medicine cup
An accurate description of anemia is
Increased blood viscosity
Depressed hematopoietic system
Presence of abnormal hemoglobin
Decreased oxygen-carrying capacity of blood
What is true about the genetic transmission of sickle cell disease?
Both parents must carry the sickle cell trait.
Both parents must have sickle cell disease.
One parent must have the sickle cell trait.
Sickle cell disease has no known pattern of inheritance.
A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is known as
Aplastic anemia
Sickle cell anemia
Thalassemia major
Iron-deficiency anemia
What are the nursing priorities for a child with sickle cell disease in vaso-occlusive crisis?
Administration of antibiotics and nebulizer treatments
Hydration and pain management
Blood transfusions and an increased calorie diet
School work and diversion
What describes the pathologic changes of sickle cell anemia?
Sickle-shaped cells carry excess oxygen.
Sickle-shaped cells decrease blood viscosity.
Increased red blood cell destruction occurs.
Decreased red blood cell destruction occurs.
Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?
Circulatory collapse
Cardiomegaly, systolic murmurs
Hepatomegaly, intrahepatic cholestasis
Painful swelling of hands and feet; painful joints
What should the discharge plan for a school-age child with sickle cell disease include?
Restricting the child’s participation in outside activities
Administering aspirin for pain or fever
Limiting the child’s interaction with peers
Administering penicillin daily as ordered
How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine?
�To improve the anemia.”
�To decrease liver and spleen swelling.”
�To eliminate excessive iron being stored in the organs.”
�To prepare your child for a bone marrow transplant.”
Which statement best describes beta-thalassemia major (Cooley anemia)?
All formed elements of the blood are depressed.
Inadequate numbers of red blood cells are present.
Increased incidence occurs in families of Mediterranean extraction.
Increased incidence occurs in persons of West African descent.
What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?
Immobilization and elevation of the affected joint
Administration of acetaminophen for pain relief
Assessment of the child’s response to hospitalization
Assessment of the impact of hospitalization on the family system
What is descriptive of most cases of hemophilia?
Autosomal dominant disorder causing deficiency is a factor involved in the blood-clotting reaction
X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding
X-linked recessive inherited disorder in which a blood-clotting factor is deficient
Y-linked recessive inherited disorder in which the red blood cells become moon shaped
The mother of a child with hemophilia asks the nurse how long her child will need to be treated for hemophilia. What is the best response to this question?
�Hemophilia is a lifelong blood disorder.”
�There is a 25% chance that your child will have spontaneous remission and treatment will no longer be necessary.”
�Treatment is indicated until after your child has progressed through the toddler years.”
�It is unlikely that your child will need to be treated for his hemophilia because your first child does not have the disease.”
In teaching family members about their child’s von Willebrand disease, what is the priority outcome for the child that the nurse should discuss?
Prevention of injury
Maintaining adequate hydration
Compliance with chronic transfusion therapy
Prevention of respiratory infections
A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of
Erythroblastopenia
Von Willebrand disease
Hemophilia
Immune thrombocytopenic purpura (ITP)
What is the priority in the discharge plan for a child with immune thrombocytopenic purpura (ITP)?
Teaching the parents to report excessive fatigue to the physician
Monitoring the child’s hemoglobin level every 2 weeks
Providing a diet that contains iron-rich foods
Establishing a safe, age-appropriate home environment
What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)?
Hospitalization at the first sign of bleeding
Teaching the child relaxation techniques for pain control
Management in the intensive care unit
Provision of adequate hydration to prevent complications
What is the nurse’s best response to a parent with questions about how her child’s blood disorder will be treated?
�Your child may be able to receive home care.”
�What did the physician tell you?”
�Blood diseases are transient, so there is no need to worry.”
�Your child will be tired for awhile and then be back to her old self.”
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