Chapter 23: Aplastic Anemia

Question 1

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

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

Which drug is most associated with acquired aplastic anemia in children?

A. Ibuprofen
B. Aspirin
C. Chloramphenicol
D. Penicillin

Answer 3

C. Chloramphenicol

Rationale: Chloramphenicol is one of the drugs most frequently linked to acquired aplastic anemia.

Question 4

Which of the following symptoms is associated with neutropenia in aplastic anemia?

A. Petechiae
B. Purpura
C. Fever
D. Exercise intolerance

Answer 4

C. Fever

Rationale: Fever and bacterial infections are symptoms related to neutropenia, a component of pancytopenia in aplastic anemia.

Question 5

What is the primary diagnostic test to confirm aplastic anemia?

A. Bone marrow aspiration
B. Peripheral blood smear
C. Hemoglobin electrophoresis
D. Coagulation studies

Answer 5

A. Bone marrow aspiration

Rationale: Bone marrow aspiration revealing yellow, fatty marrow instead of red marrow confirms aplastic anemia.

Question 6

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)

Answer 6

D. Hematopoietic stem cell transplantation (HSCT)

Rationale: HSCT from an HLA-matched sibling donor is the treatment of choice for severe aplastic anemia.

Question 7

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

Answer 7

A. Hemorrhage and sepsis

Rationale: Hemorrhage and sepsis are the primary causes of death in patients with aplastic anemia due to pancytopenia.

Question 8

Which immunosuppressive agent is commonly used in the treatment of aplastic anemia?

A. Methotrexate
B. Prednisone
C. Mycophenolate mofetil
D. Cyclosporine

Answer 8

D. Cyclosporine

Rationale: Cyclosporine and antithymocyte globulin (ATG) are commonly used immunosuppressive agents for aplastic anemia.

Question 9

What clinical sign is indicative of thrombocytopenia in a child with aplastic anemia?

A. Fatigue
B. Fever
C. Jaundice
D. Petechiae

Answer 9

D. Petechiae

Rationale: Petechiae and purpura are characteristic of thrombocytopenia due to reduced platelet levels.

Question 10

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

Answer 10

A. Epstein-Barr virus

Rationale: Epstein-Barr virus (causing mononucleosis), cytomegalovirus, and viral hepatitis can lead to acquired aplastic anemia.

Question 11

Which laboratory finding is expected in aplastic anemia?

A. Increased reticulocyte count
B. Elevated hemoglobin levels
C. Pancytopenia
D. Hypersegmented neutrophils

Answer 11

C. Pancytopenia

Rationale: Pancytopenia, including leukopenia, thrombocytopenia, and decreased red blood cells, is a hallmark of aplastic anemia.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

Which chemical exposure is linked to acquired aplastic anemia?

A. Benzene
B. Sulfates
C. Nitrates
D. Ammonia

Answer 14

A. Benzene

Rationale: Benzene, found in pesticides and insecticides, is a known chemical associated with acquired aplastic anemia.

Question 15

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.”

Answer 15

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.

Question 16

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

Answer 16

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.

Question 17

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.

Answer 17

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.

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

B. Petechiae and epistaxis

Rationale: Petechiae and epistaxis are hallmark signs of bleeding associated with thrombocytopenia, which is common in aplastic anemia.

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

C. Preventing bacterial infections

Rationale: Neutropenia increases the risk of bacterial infections, making infection prevention the primary goal.

Question 24

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

Answer 24

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.

Question 25

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.”

Answer 25

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.

Question 26

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

Answer 26

B. Pancytopenia

Rationale: Pancytopenia, or a reduction in red blood cells, white blood cells, and platelets, is a diagnostic feature of aplastic anemia.

Question 27

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.

Answer 27

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.

Question 28

Which condition poses the greatest risk of death for a child with aplastic anemia?

A. Chronic fatigue
B. Sepsis
C. Growth retardation
D. Epistaxis

Answer 28

B. Sepsis

Rationale: Neutropenia in aplastic anemia increases the risk of sepsis, which can lead to life-threatening complications.

Question 29

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

Answer 29

C. To maintain adequate tissue perfusion

Rationale: Hydration is essential to ensure adequate tissue perfusion and oxygen delivery, especially in children with anemia.

Question 30

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

Answer 30

C. Fever

Rationale: Fever is a hallmark sign of infection, particularly in immunocompromised patients such as those with neutropenia.

Question 31

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

Answer 31

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.

Question 32

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

Answer 32

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.

Question 33

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

Answer 33

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.

Question 34

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

Answer 34

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.

Question 35

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?

1. Referrals to support groups and social services
2. Short-term support
3. Genetic counseling
4. Nutrition counseling

Answer 35

1. 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.