Chapter 23: Aplastic Anemia Flashcards
What is the primary pathophysiology of aplastic anemia?
A. Overproduction of immature blood cells
B. Failure of bone marrow to produce sufficient blood cells
C. Increased destruction of red blood cells
D. Excessive bleeding leading to anemia
B. Failure of bone marrow to produce sufficient blood cells
Rationale: Aplastic anemia results from the bone marrow’s inability to produce adequate amounts of blood cells, leading to pancytopenia.
Which of the following is a common cause of acquired aplastic anemia in children?
A. Sickle cell trait
B. Nutritional deficiencies in vitamin B12 and folic acid
C. Overuse of corticosteroids
D. Prolonged exposure to ultraviolet radiation
B. Nutritional deficiencies in vitamin B12 and folic acid
Rationale: Acquired aplastic anemia may result from deficiencies in vitamin B12 or folic acid, exposure to chemicals, infections, or certain drugs.
Which drug is most associated with acquired aplastic anemia in children?
A. Ibuprofen
B. Aspirin
C. Chloramphenicol
D. Penicillin
C. Chloramphenicol
Rationale: Chloramphenicol is one of the drugs most frequently linked to acquired aplastic anemia.
Which of the following symptoms is associated with neutropenia in aplastic anemia?
A. Petechiae
B. Purpura
C. Fever
D. Exercise intolerance
C. Fever
Rationale: Fever and bacterial infections are symptoms related to neutropenia, a component of pancytopenia in aplastic anemia.
What is the primary diagnostic test to confirm aplastic anemia?
A. Bone marrow aspiration
B. Peripheral blood smear
C. Hemoglobin electrophoresis
D. Coagulation studies
A. Bone marrow aspiration
Rationale: Bone marrow aspiration revealing yellow, fatty marrow instead of red marrow confirms aplastic anemia.
What is the definitive treatment for severe aplastic anemia in children?
A. Transfusion of platelets and packed red blood cells
B. Immunosuppressive drug therapy
C. Administration of vitamin B12
D. Hematopoietic stem cell transplantation (HSCT)
D. Hematopoietic stem cell transplantation (HSCT)
Rationale: HSCT from an HLA-matched sibling donor is the treatment of choice for severe aplastic anemia.
Which complication is the most common cause of death in aplastic anemia?
A. Hemorrhage and sepsis
B. Cardiopulmonary arrest
C. Acute kidney failure
D. Malnutrition
A. Hemorrhage and sepsis
Rationale: Hemorrhage and sepsis are the primary causes of death in patients with aplastic anemia due to pancytopenia.
Which immunosuppressive agent is commonly used in the treatment of aplastic anemia?
A. Methotrexate
B. Prednisone
C. Mycophenolate mofetil
D. Cyclosporine
D. Cyclosporine
Rationale: Cyclosporine and antithymocyte globulin (ATG) are commonly used immunosuppressive agents for aplastic anemia.
What clinical sign is indicative of thrombocytopenia in a child with aplastic anemia?
A. Fatigue
B. Fever
C. Jaundice
D. Petechiae
D. Petechiae
Rationale: Petechiae and purpura are characteristic of thrombocytopenia due to reduced platelet levels.
Which of the following infections is associated with acquired aplastic anemia?
A. Epstein-Barr virus
B. Clostridioides difficile
C. Helicobacter pylori
D. Varicella-zoster virus
A. Epstein-Barr virus
Rationale: Epstein-Barr virus (causing mononucleosis), cytomegalovirus, and viral hepatitis can lead to acquired aplastic anemia.
Which laboratory finding is expected in aplastic anemia?
A. Increased reticulocyte count
B. Elevated hemoglobin levels
C. Pancytopenia
D. Hypersegmented neutrophils
C. Pancytopenia
Rationale: Pancytopenia, including leukopenia, thrombocytopenia, and decreased red blood cells, is a hallmark of aplastic anemia.
Which intervention is prioritized in the nursing care plan for a child with aplastic anemia?
A. Providing dietary supplements for vitamin B12
B. Monitoring for signs of infection or bleeding
C. Encouraging participation in vigorous physical activities
D. Administering routine vaccinations
B. Monitoring for signs of infection or bleeding
Rationale: Preventing and monitoring for complications such as infection and bleeding is critical in managing aplastic anemia.
What is the primary purpose of antithymocyte globulin (ATG) in treating aplastic anemia?
A. To stimulate erythropoiesis in the bone marrow
B. To suppress the immune response attacking the bone marrow
C. To provide temporary relief from anemia
D. To replace deficient vitamins
B. To suppress the immune response attacking the bone marrow
Rationale: ATG is used to suppress the immune system, which is thought to attack bone marrow in aplastic anemia.
Which chemical exposure is linked to acquired aplastic anemia?
A. Benzene
B. Sulfates
C. Nitrates
D. Ammonia
A. Benzene
Rationale: Benzene, found in pesticides and insecticides, is a known chemical associated with acquired aplastic anemia.
What nursing teaching is critical for a child undergoing HSCT for aplastic anemia?
A. “You will need lifelong transfusions after the transplant.”
B. “You will need frequent corticosteroid injections post-transplant.”
C. “The transplant will eliminate the risk of future infections.”
D. “Your immune system will be weakened for several months.”
D. “Your immune system will be weakened for several months.”
Rationale: After HSCT, the child’s immune system is suppressed, requiring protective measures to reduce the risk of infection.
What is the primary nursing intervention for a child with aplastic anemia?
A. Encouraging a high-protein diet to improve hemoglobin levels
B. Preventing bleeding by minimizing invasive procedures
C. Initiating early ambulation to prevent muscle atrophy
D. Administering antibiotics prophylactically to prevent infection
B. Preventing bleeding by minimizing invasive procedures
Rationale: Preventing bleeding is a priority in managing aplastic anemia due to the risk of thrombocytopenia, which increases susceptibility to hemorrhage.
Which outcome would indicate that a nursing goal for a child with aplastic anemia has been achieved?
A. The child’s hemoglobin level remains stable at 7 g/dL.
B. The child reports no episodes of fever or signs of infection.
C. The parents express an understanding of iron-rich food options.
D. The child tolerates frequent ambulation without fatigue.
B. The child reports no episodes of fever or signs of infection.
Rationale: An absence of fever and infection indicates that neutropenia-related complications are being effectively managed.
When educating parents of a child with aplastic anemia, which topic is most important to include?
A. Strategies to manage episodes of hypoglycemia
B. How to administer subcutaneous injections of deferoxamine
C. Recognizing early signs of bleeding or infection
D. Dietary recommendations to increase red blood cell production
C. Recognizing early signs of bleeding or infection
Rationale: Early identification of bleeding or infection is critical in preventing life-threatening complications in children with aplastic anemia.
What is the nurse’s primary role when preparing a child with aplastic anemia for a blood transfusion?
A. Monitoring the child’s heart rate before, during, and after the transfusion
B. Educating the child about iron chelation therapy
C. Verifying blood compatibility and observing for signs of transfusion reactions
D. Encouraging fluid intake before starting the transfusion
C. Verifying blood compatibility and observing for signs of transfusion reactions
Rationale: The nurse must ensure safe transfusion practices, including verifying compatibility and monitoring for reactions, as these are critical aspects of care.
Which nursing intervention helps improve mobility for a child with aplastic anemia while minimizing risk?
A. Encouraging bedrest until blood counts normalize
B. Implementing passive range-of-motion exercises as tolerated
C. Allowing unrestricted ambulation to build muscle strength
D. Limiting all physical activity to prevent fatigue
B. Implementing passive range-of-motion exercises as tolerated
Rationale: Passive range-of-motion exercises promote mobility while reducing the risk of injury or fatigue associated with thrombocytopenia and anemia.
Which clinical manifestation is most indicative of thrombocytopenia in a child with aplastic anemia?
A. Fatigue and pallor
B. Petechiae and epistaxis
C. Fever and bacterial infections
D. Menorrhagia and growth retardation
B. Petechiae and epistaxis
Rationale: Petechiae and epistaxis are hallmark signs of bleeding associated with thrombocytopenia, which is common in aplastic anemia.
What is the primary nursing intervention for a child with aplastic anemia experiencing pallor and fatigue?
A. Administering blood transfusions as ordered
B. Encouraging physical activity to increase circulation
C. Providing iron-rich foods to enhance hemoglobin synthesis
D. Monitoring vital signs for signs of hypovolemic shock
A. Administering blood transfusions as ordered
Rationale: Blood transfusions help restore red blood cells, improving oxygen delivery and alleviating symptoms of anemia such as pallor and fatigue.
What is the priority nursing goal for a child with neutropenia secondary to aplastic anemia?
A. Promoting adequate tissue perfusion
B. Maintaining hydration status
C. Preventing bacterial infections
D. Ensuring adequate nutrition
C. Preventing bacterial infections
Rationale: Neutropenia increases the risk of bacterial infections, making infection prevention the primary goal.
Which nursing intervention promotes growth and development in a child with aplastic anemia?
A. Encouraging age-appropriate activities while monitoring for fatigue
B. Restricting physical activities to prevent injury
C. Allowing unrestricted screen time to compensate for physical limitations
D. Delaying education about the disease until adolescence
A. Encouraging age-appropriate activities while monitoring for fatigue
Rationale: Age-appropriate activities support physical, emotional, and cognitive development while considering the child’s energy level.
Which statement by the parents indicates a need for further education about managing a child with aplastic anemia?
A. “We will avoid crowded places to reduce the risk of infection.”
B. “Our child can participate in light physical activities.”
C. “We should increase fluid intake to maintain hydration.”
D. “We’ll give aspirin to manage pain and fever.”
D. “We’ll give aspirin to manage pain and fever.”
Rationale: Aspirin increases the risk of bleeding and should be avoided in children with thrombocytopenia or bleeding disorders.
What laboratory finding would the nurse expect in a child with aplastic anemia?
A. Increased reticulocyte count
B. Pancytopenia
C. Elevated hemoglobin levels
D. Normal platelet levels
B. Pancytopenia
Rationale: Pancytopenia, or a reduction in red blood cells, white blood cells, and platelets, is a diagnostic feature of aplastic anemia.
What is a priority teaching point for parents of a child with aplastic anemia related to nutrition?
A. Provide a high-protein diet to promote healing.
B. Encourage a high-calcium diet for bone health.
C. Offer a low-sodium diet to prevent fluid retention.
D. Focus on a diet rich in vitamin B12 and folic acid.
D. Focus on a diet rich in vitamin B12 and folic acid.
Rationale: Vitamin B12 and folic acid support red blood cell production, which is essential for managing anemia.
Which condition poses the greatest risk of death for a child with aplastic anemia?
A. Chronic fatigue
B. Sepsis
C. Growth retardation
D. Epistaxis
B. Sepsis
Rationale: Neutropenia in aplastic anemia increases the risk of sepsis, which can lead to life-threatening complications.
What is the purpose of monitoring hydration status in a child with aplastic anemia?
A. To prevent dehydration-related thrombosis
B. To improve kidney function during treatment
C. To maintain adequate tissue perfusion
D. To promote medication absorption
C. To maintain adequate tissue perfusion
Rationale: Hydration is essential to ensure adequate tissue perfusion and oxygen delivery, especially in children with anemia.
Which clinical sign should the nurse monitor for to identify the onset of a bacterial infection in a child with neutropenia?
A. Pallor
B. Fatigue
C. Fever
D. Petechiae
C. Fever
Rationale: Fever is a hallmark sign of infection, particularly in immunocompromised patients such as those with neutropenia.
What is the rationale for promoting tissue perfusion in a child with aplastic anemia?
A. To enhance oxygen delivery to tissues
B. To prevent blood clots in major vessels
C. To minimize the risk of fluid overload
D. To reduce fatigue associated with anemia
A. To enhance oxygen delivery to tissues
Rationale: Adequate tissue perfusion ensures that oxygen is delivered to vital organs and tissues, preventing complications of hypoxia.
Which symptom requires immediate intervention in a child with aplastic anemia?
A. Fatigue
B. Petechiae
C. Fever of 101°F (38.3°C)
D. Mild pallor
C. Fever of 101°F (38.3°C)
Rationale: Fever indicates a possible bacterial infection, which can rapidly progress to sepsis in a child with neutropenia.
What nursing intervention can help prevent bleeding in a child with aplastic anemia?
A. Encouraging the child to use an electric toothbrush
B. Administering NSAIDs for pain management
C. Allowing frequent intramuscular injections
D. Promoting the use of anticoagulant medications
A. Encouraging the child to use an electric toothbrush
Rationale: Using an electric toothbrush reduces the risk of gum injury and subsequent bleeding, which is essential for thrombocytopenic patients.
What is the most appropriate referral for a family coping with a child diagnosed with aplastic anemia?
A. Physical therapy for mobility limitations
B. Genetic counseling to evaluate hereditary risks
C. Occupational therapy for developmental delays
D. Local support groups for emotional support
D. Local support groups for emotional support
Rationale: Support groups provide families with emotional support and coping strategies for managing a chronic, life-threatening disease.
A child recently diagnosed with aplastic anemia is being prepared for discharge. When planning support for the family, which service should the nurse plan to include in the discharge plan?
- Referrals to support groups and social services
- Short-term support
- Genetic counseling
- Nutrition counseling
- Referrals to support groups and social services
Rationale: Families require support in dealing with a child who has a life-threatening disease. They should be referred to support groups for counseling, if indicated, and to social services. The support will be long term in nature. Aplastic anemia is not a genetically transmitted disease. Nutrition counseling is not a priority and may or may not be needed with aplastic anemia.
