Anemia Flashcards
The nurse has been asked to participate in a community health teaching session. Which
interventions should the nurse include to help achieve the 2020 National Health Goals to reduce the incidence of anemias?
(Select all that apply.)
A) Explain the importance of healthy eating for adolescent participants.
B) Instruct pregnant women to take iron supplementation as prescribed.
C) Emphasize ways to reduce unintentional injuries at home, work, and play.
D) Review foods that are rich in iron that should be a part of school-age children’s
diets.
E) Examine strategies for elderly community members to improve the quality of life.
Ans:
A - Explain the importance of healthy eating for adolescent participants.
B - Instruct pregnant women to take iron supplementation as prescribed.
D - Review foods that are rich in iron that should be a part of school-age children’s diets.
Nurses can help the nation achieve the 2020 National Health Goals to improve children’s health and reduce hospitalization from anemia by educating parents about the importance of women taking an iron supplement during pregnancy, encouraging iron-rich food sources for young children, and educating adolescents about healthy diets.
Prevention of unintentional injuries and improving the quality of life for the elderly are
not interventions to achieve this National Health Goal.
The nurse is concerned that a school-age child has iron-deficiency anemia. What did the nurse assess in this patient?
A) Shyness
B) Thumb-sucking
C) Asks many questions
D) Craving for ice cubes
Ans: D - Craving for ice cubes
In school-age children, there is an association between iron-deficiency anemia and pica
or the craving for ice cubes. Iron-deficiency anemia is not associated with shyness,
thumb-sucking, or inquisitive behavior.
The nurse is evaluating the effectiveness of teaching provided to the parents of a school-
age child prescribed liquid ferrous sulfate (Feosol) for iron-deficiency anemia. Which observations indicate that teaching has been effective?
(Select all that apply.)
A) Mother places medication in orange juice.
B) Mother provides medication with a glass of milk.
C) Child observed consuming fresh raw fruit and drinking water.
D) Mother provides liquid-prepared medication to the child with a straw.
E) Child goes to the bathroom to brush teeth immediately after taking the
medication.
Ans: A, C, D, E
A - Mother places medication in orange juice.
C - Child observed consuming fresh raw fruit and drinking water.
D - Mother provides liquid-prepared medication to the child with a straw.
E - Child goes to the bathroom to brush teeth immediately after taking the
medication.
The liquid preparation of ferrous sulfate (Feosol) should be mixed with juice and
swallowed by using a straw to avoid teeth staining. The child should thoroughly brush
teeth to also prevent staining. High-fiber foods and water help reduce the risk of
constipation from this medication. This medication should not be taken with milk
because it will interfere with absorption.
A school-age child is scheduled for a bone marrow aspiration to confirm the diagnosis
of aplastic anemia. What should the nurse instruct the child about this procedure?
A) Leg pain will occur after the procedure.
B) It will be done under general anesthesia.
C) A narrow needle is used so there is no pain.
D) The patient will have to lie on the stomach for the procedure.
Ans: D - The patient will have to lie on the stomach for the procedure.
The child is to lie on prone on a hard surface for the procedure. Leg pain is not expected
after the procedure. Conscious sedation and not general anesthesia is used for the
procedure. This is a painful procedure, and topical anesthesia is applied in addition to
conscious sedation to help reduce the pain.
It is determined that a preschool-age child developed anemia after exposure to an
insecticide. What should the nurse teach the parents before the child is discharged from
the hospital?
A) Schedule weekly chelating treatments.
B) Provide the child with a high-protein diet.
C) Schedule hospital visits to desensitize the child to the insecticide.
D) Ensure that the child has no further exposure exposed to the insecticide.
Ans: D - Ensure that the child has no further exposure exposed to the insecticide.
The first step in therapy is to immediately ensure that the child is never exposed to the
substance again. Chelation therapy is to remove excess iron from the blood and body. A high protein diet is not indicated for this health problem. The child does not need weekly hospital visits for desensitization.
The nurse is assessing a school-age child with sickle-cell anemia. Which assessment
finding is consistent with this patient’s diagnosis?
A) Slightly yellow sclera
B) Enlarged mandibular growth
C) Increased growth of long bones
D) Depigmented areas on the abdomen
Ans: A - Slightly yellow sclera
In sickle-cell anemia, eye scleras become icteric or yellowed from the release of
bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and
depigmentation are not manifestations of this health problem.
An 18-month-old child is diagnosed with insufficient platelets. What should the nurse
instruct the parents to reduce the risk of the child bleeding when at home?
(Select all that apply.)
A) Check that all toys have soft corners.
B) Engage in limited amounts of rough play each day.
C) Ensure mouth care is performed with a soft toothbrush.
D) Do not apply Band-Aids or adhesive tape onto the skin.
E) Pad the side and crib rails on the bed at home to prevent bruising.
Ans: A, C, D, E
A - Check that all toys have soft corners.
C- Ensure mouth care is performed with a soft toothbrush.
D - Do not apply Band-Aids or adhesive tape onto the skin.
E - Pad the side and crib rails on the bed at home to prevent bruising.
To prevent bleeding in the child with insufficient platelets, the nurse should instruct the
parents to check that all toys have soft corners so no skin scratches occur. Mouth care
should only be done with a soft toothbrush so that gum excoriation does not occur. No
adhesives should be applied to the skin because the skin can tear during the removal of
these items. The bed and crib rails should be padded to ensure the child does not become
bruised while sleeping. All rough play is to be avoided because this can lead to an
accidental injury and subsequent bleeding.
The nurse is instructing the parents of a child with sickle-cell anemia on safety precautions. What should the nurse emphasize during this teaching?
A) Suggest the child participate in sports activities without restriction.
B) Treat upper respiratory infections with over-the-counter medication.
C) Ensure a consistent and daily intake of adequate fluids to prevent dehydration.
D) Remind to avoid immunizations to prevent the introduction of bacteria into the
body.
Ans: C - Ensure a consistent and daily intake of adequate fluids to prevent dehydration.
Safety interventions for the child with sickle-cell anemia include ensuring an adequate
daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which
can be avoided. The child should avoid contact sports and long-distance running. Upper
respiratory infections should be reported to the health care provider so appropriate
treatment can be provided. Routine health care such as immunizations should be
provided in order to prevent common childhood illnesses.
While receiving a transfusion of packed red blood cells, a school-age child begins to experience itchy skin, hives, and wheezes. What should the nurse do first for this child?
A) Stop the transfusion.
B) Obtain a blood culture.
C) Slow the transfusion rate.
D) Provide a diuretic as prescribed.
Ans: A - Stop the transfusion.
Itchy skin, hives, and wheezes while receiving a blood transfusion indicate an allergic
reaction to the blood proteins. The nurse should stop the infusion. This will be
temporary because after the child receives oxygen and an antihistamine, the transfusion
will be resumed. Blood cultures are indicated if the child experiences an increase in
body temperature. Slowing the transfusion rate will not reduce the patient’s symptoms.
A diuretic would be indicated if the child demonstrates shortness of breath and an
increased pulse rate.
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?
A) Risk for infection related to abnormal immune system
B) Risk for bleeding related to insufficient platelet formation
C) Risk for altered urinary elimination related to kidney impairment
D) Ineffective breathing pattern related to decreased white blood count
Ans: B - Risk for bleeding related to insufficient platelet formation
Idiopathic thrombocytopenic purpura (ITP) is the result of a decrease in the number of
circulating platelets in the presence of adequate megakaryocytes, which are precursors
to platelets. Because bleeding can occur with this disease process, the diagnosis most
appropriate for the patient at this time is risk for bleeding related to insufficient platelet
formation. Reduced numbers of platelets would not increase the patient’s risk for
infection. Reduced numbers of platelets does not increase the patient’s risk for renal
impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.
The nurse is planning care for a school-age child recovering from being hit by a motor vehicle while riding a bicycle home from school. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?
A) Blurred vision
B) Nausea and vomiting
C) Sudden onset of knee pain
D) Bleeding from intravenous sites
Ans: D - Bleeding from intravenous sites
Disseminated intravascular coagulation is an acquired disorder of blood clotting that
result from excessive trauma. The child begins to develop petechiae or have
uncontrolled bleeding from puncture sites from injections or intravenous therapy.
Blurred vision, nausea, vomiting, and a sudden onset of knee pain are not manifestations
associated with disseminated intravascular coagulation.
A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with which of the following drinks?
- Skim milk
- Ginger ale
- Orange juice
- Chamomile tea
Ans: 3 The nurse would recommend that the iron be taken with orange juice because ascorbic acid, which is in orange juice, promotes the absorption of iron into the body.
- Milk inhibits the absorption of iron. Milk and iron should not be consumed at the same time.
- There is no recommendation that iron be taken with ginger ale.
- The nurse would recommend that the iron be taken with orange juice because ascorbic acid, which is in orange juice, promotes the absorption of iron into the body.
- There is no recommendation that iron be taken with chamomile tea.
Test-Taking Tip: Since ascorbic acid promotes the absorption of iron into the body, it is appropriate for the nurse to recommend that the client take her iron supplement with a food source high in ascorbic acid, like orange juice.
Ans:
- This meal choice high in iron and ascorbic acid. It would be an excellent lunch choice for this client who had a below normal hematocrit and hemoglobin.
- Although high in calcium, this lunch choice will not help to change the client’s lab value.
- Although nutrition, this lunch choice will not help to change the client’s lab values.
- Cream cheese has little to no nutritional value. This meal choice would provide a large number of calories and is not the most nutritious choice.
Test-Taking Tip: The client in the scenario is anemic. Although a hematocrit of 32% in pregnancy is acceptable, it is recommended that the value not drop below that level. The nurse, having evaluated the lab statement, should choose foods that are high in iron. Liver and dried fruits are good iron sources. Tomatoes are high in vitamin C, which promotes the absorption or iron.
A woman who is a carrier for sickle cell anemia is advised that if her baby has two recessive genes, the penetrance of the disease is 100%, but the expressivity is variable. Which of the following explanations will clarify this communication for the mother? All babies with 2 recessive sickle cell genes will:
1.Develop painful vaso-occlusive crises during their first year of life.
2. Exhibit at least some signs of the disease while in the neonatal nursery.
3.Show some symptoms of the disease but the severity of the symptoms will be individual.
4.Be diagnosed with sickle cell trait but will be healthy and disease-free throughout their lives.
Ans: 3 Exhibit at least some signs of the disease while in the neonatal nursery.
1.This response is incorrect. No one can make such a prediction.
2.Neonates virtually never exhibit signs of sickle cell because fetal hemoglobin does not sickle.
3. This response is correct. Babies with two recessive sickle cell genes will show some symptoms of the disease but the severity of the symptoms will be individual.
4. This response is incorrect. Virtually all children with sickle cell anemia will exhibit some symptoms during their lives.
TEST-TAKING TIP: The test taker must be familiar with common terms used to describe genetic diseases, like penetrance and expressivity. Penetrance: When a disease is 100% penetrant, 100% of the individuals who have the gene(s) for the disease will exhibit the disease. Similarly, if a disease is 80% penetrant, only 80% of the individuals who have the gene(s) for the disease will exhibit the disease. Expressivity: This term refers to the range of severity—or phenotypes—of a particular genetic disease.
- Which finding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client?
- Anemia.
- Thrombocytopenia.
- Polycythemia.
- Hyperbilirubinemia.
Ans: Anemia
- Anemia is an expected finding.
2.The client should not be thrombocytopenic. Although some women do develop idiopathic thrombocytopenia of pregnancy, this is a complication of pregnancy .
3.The nurse would not expect to see polycythemia.
4.The nurse would not expect to see hyperbilirubinemia
TEST-TAKING TIP: By the end of the second trimester, the blood supply of the woman increases by approximately 50%. This increase is necessary for the client to be able to perfuse the placenta. There is a concurrent increase in red blood cell production, but the vast majority of women are unable to produce the red blood cells in sufficient numbers to keep pace with the increase in blood volume. As a result, clients develop what is commonly called “physiological anemia of pregnancy.” A hematocrit of 32% is considered normal for a pregnant woman.
