Pedi Ch 24

Caring for the Child With a Hematological Condition

A child has mild anemia, and the parent asks why this makes the child have difficulty concentrating. What response by the nurse is best?

A. "All sick children have trouble concentrating." B. "Her anemia makes her too tired to think."

C. "She may have another problem with her brain."

D. "The brain isn't getting enough oxygen."

ANS: D

Anemia leads to decreased oxygenation of body tissues, including the brain. A lowered cerebral oxygen concentration can lead to dizziness and difficulty concentrating.

Page: 820 Heading: Anemia

A 2-year-old child's hemoglobin is 8.2 g/dL. What action by the nurse is best?

A. Ask the parents about activity level.

B. Document findings in the chart.

C. Notify the provider immediately.

D. Schedule a redraw of blood in 6 months.

ANS: A

The normal hemoglobin for a child this age is 10.55-12.7 g/dL, so this child is somewhat anemic. The nurse should assess for other manifestations of anemia, including normal activity level.

Page: 823 Heading: Labs

A nurse working in pediatrics learns that the normal hemoglobin value for an infant is high at birth, then decreases by 2 months of age before increasing again as the child grows. The nurse knows the reason for this shift is which of the following?

A. Hemodilution from starting oral nutrition

B. Lower available oxygen while in utero

C. Rapid hemoglobin destruction at birth

D. Slower hemoglobin production after birth

ANS: B

The fetus needs a higher hemoglobin level to compensate for the relatively low-oxygen environment of the uterus.

Page: 824 Heading: Labs

The nurse has educated parents on administration of iron to their child. What statement by the parents indicates a need for further instruction?

A. "I will call the doctor right away if my child has black, tarry stools."

B. "It is best if the iron is taken on an empty stomach or with orange juice."

C. "Rinsing the mouth after taking liquid iron will prevent staining the teeth."

D. "We should increase fiber and water intake to prevent constipation."

ANS: A

Black, tarry stools are a common side effect of iron. The parents do not need to call the provider for this symptom

Page: 826-827 Heading: Education/Discharge Instructions

The parents of an 8-year-old child with sickle cell anemia call the clinic to report that the child developed chest pain after playing soccer. What advice from the nurse is most appropriate?

A. "Go to the nearest emergency department."

B. "Have him rest and take Tylenol (acetaminophen)."

C. "If he doesn't improve, bring him in to the clinic."

D. "Try a warm pack on his chest for 10 minutes."

ANS: A

In sickle cell disease, the abnormally shaped RBCs are sticky and adhere to the blood vessel walls, creating obstructions to circulation. This creates the potential for tissue ischemia and death. The child could be having a heart attack and needs immediate evaluation.

Page: 827 Heading: Sickle Cell Disease

A child presents to the emergency department with sickle cell crisis. Which intervention does the nurse perform first?

A. Administer oxygen.

B. Assess and treat pain.

C. Provide warm blankets.

D. Start IV fluids.

ANS: A

Airway and breathing interventions are always the priority, so the nurse will administer oxygen first

Page: 828-829 Heading: Nursing Care

A teenager is hospitalized with sickle cell disease and vaso-occlusive crisis. What pain medication regimen does the nurse assist the patient with?

A. Acetaminophen (children's Tylenol)

B. Ketorolac (Toradol) orally

C. Meperidine (Demerol), given intravenously

D. PCA pump with morphine (Duramorph)

ANS: D

A teenager is able to manage their own pain control, so a PCA pump is ideal. Morphine is often considered the drug of choice in sickle cell crises.

Page: 829 Heading: Medical Care

A child has been hospitalized with a sickle cell crisis and given morphine sulfate (Duramorph) for severe pain. On assessment 45 minutes later, the child appears to be sleeping quietly with a respiratory rate of 6 breaths/minute. What action by the nurse is most appropriate?

A. Document findings and let the child sleep.

B. Plan to hold the next dose of morphine.

C. Prepare to administer naloxone (Narcan).

D. Wake the child up to take deep breaths.

ANS: C

This child's respiratory rate is dangerously low, brought on by the narcotic analgesic. The nurse should prepare to administer Narcan per protocol.

Page: 829 Heading: Medical Care

A child with sickle cell disease is receiving hypertransfusion therapy, and the current serum ferritin level is 1,035 mcg/L. What medication does the nurse prepare to administer?

A. Deferoxamine (Desferal)

B. Elemental iron

C. Furosemide (Lasix)

D. Morphine sulfate (Duramorph)

ANS: A

Page: 822 Heading: Table 24-2 Medications

A complication of hypertransfusion is iron overload, diagnosed with a serum ferritin level of greater than 1,000 mcg/L. The treatment is chelation therapy with an agent such as deferoxamine.

Which health promotion measure does the nurse teach as being most important for the child with sickle cell disease?

A. Adequate nutrition

B. Ensured rest periods

C. Plenty of fluids

D. Routine vaccinations

ANS: D

Vaccinations are vital for children with sickle cell disease to prevent sepsis and death from preventable diseases.

Page: 828 Heading: Diagnostic Tools

A couple who recently married and want to have children ask the nurse what the chances are that their children will inherit thalassemia from them, as they both are carriers. What information from the nurse is most accurate?

A. All of your children will inherit it.

B. Each child has a 25% chance of inheriting it.

C. None of your children will inherit it.

D. Only the boys will inherit it.

ANS: B

Thalassemia is an autosomal recessive disorder. Each of their children has a 25% chance of having only normal genes, a 25% chance of inheriting both defective genes from the parents and expressing the disease, and a 50% chance of being a carrier.

Page: 830-831 Heading: Thalassemia

An acutely ill, anemic child's peripheral blood smear shows small, dense, spherical RBCs. What action by the nurse takes priority?

A. Assess and treat the child's pain adequately.

B. Discuss the option of a bone marrow transplant.

C. Obtain informed consent for blood transfusions.

D. Prepare the family for chelation therapy.

ANS: C

The peripheral blood smear indicates spherocytosis, which, when acute, is treated with transfusions. The nurse ensures informed consent is obtained and present on the chart.

Page: 825 Heading: Anemia

A toddler had a minor fall and now has a swollen, bruised, painful knee. What diagnostic test is most important for the nurse to educate the parents about?

A. Complete blood count

B. Plasma factor assay

C. Plasma ferritin level

D. Platelet count

ANS: B

The child has manifestations consistent with hemophilia. The most important diagnostic testing for this disease is a direct assay of plasma factor activity level for hemophilia A and B.

Page: 831 Heading: Diagnosis

An adolescent has been taught to administer replacement factors for bleeding episodes related to hemophilia. What action by the teen indicates that further instruction is needed?

A. Disposes of sharps in an approved container

B. Reconstitutes the medication with sterile water

C. Selects the appropriate needle for an IM injection

D. Washes hands prior to working with the drug

ANS: C

Replacement factors are given intravenously. They are not an intramuscular injection.

Page: 832 Heading: Education/Discharge Instructions

A child is taking desmopressin acetate (DDAVP) for von Willebrand's disease. What teaching about this medication does the nurse provide?

A. Avoid products with aspirin (salicylate) in them. B. Get a new needle for each injection.

C. Monitor your child's weight and report a gain. D. Use ice packs and pressure for epistaxi

ANS: C

DDAVP can cause hypervolemia and hyponatremia. The child may show a rapid

weight gain, which should be reported.

Page: 822 Heading: Table 24-2 Medications

An 8-year-old child had a hematopoietic stem cell transplant 10 months ago. The father brings her to the clinic, where the child reports "I just don't feel well." Dad relates that the child has been lethargic and sleeping a lot. The child's vital signs are within normal range for age. What action by the nurse is best?

A. Explain that growth spurts can cause fatigue. B. Prepare the family for a "fever" work-up.

C. Provide reassurance to the father and child.

D. Review side effects of immunosuppressants.

ANS: B

After a stem cell transplant, patients are on lifelong immunosuppressant therapy. These patients may contract illnesses, especially infections, without showing the classic signs and symptoms. The nurse should assume the child has an infection and prepare the child and father for a full work-up to determine the origins of the infection.

Page: 843 Heading: Nursing Care

A group of student nurses are reviewing common causes of iron-deficiency anemia (IDA). Which findings support a clinical diagnosis of IDA? Select all that apply.

A! "Preterm birth at 32 weeks."

B! "High cereal content in diet."

C! "Vitamin D deficiency."

D! "Platelet count of 150,000."

E! "History of menorrhagia."

ANS: A B E

Page: 823 Heading: Box 24-1 Common Causes of Iron Deficiency Anemia

The pediatric nurse is reviewing lab results for a 6-year-old oncology patient. Which findings require immediate action by the nurse? Select all that apply.

A! "ANC of 5,000."

B! "Platelet count of 25,000."

C! "Brisk capillary refill."

D! "Epistaxis."

E! "Acute onset of nausea."

ANS: B D E

Page: 837 Heading: Box 24-2 Causative Factors of Acquired Aplastic Anemia

The nurse is reviewing laboratory results for a pediatric patient: WBCs 1.2 cells/ul, 70.1% neutrophils, and 3% bands. Based on this information, the absolute neutrophil count would be _____________. Record your answer as a whole number.

ANS: 877

Page: 838 Heading: Neutropenia