Hematologic function

Question 1

The nurse prepares to administer a vitamin K injection during the admission assessment for
a newborn. The father asks, “Why does my baby need a shot?” Which rationale for
administering this injection should the nurse include in the response?
1. Activates clotting factors
2. Dissolves blood clots
3. Promotes gas exchange
4. Promotes the production of hemoglobin

Answer 1

1. Activates clotting factors
   Explanation:
2. Levels of clotting factors are lower in infants, so vitamin K is given prophylactically to
   activate essential clotting factors.
3. Vitamin K promotes clotting; it is not administered to dissolve blood clots.
4. Vitamin K does not promote gas exchange.
5. Vitamin K has no effect on the production of hemoglobin.

Question 2

Which parental statement indicates correct understanding of information presented
regarding the treatment for infant anemia?
1. “We will add green leafy vegetables to our child’s low-iron formula.”
2. “We will discontinue the use of vitamin C supplements by 6 months of age.”
3. “We will begin an iron-fortified infant cereal at 4 to 6 months of age.”
4. “We will introduce cow’s milk by 6 months of age.”

Answer 2

3. “We will begin an iron-fortified infant cereal at 4 to 6 months of age.”
   Explanation:
4. The infant’s maternal iron stores are depleted by 6 months. Infants who are not
   breastfed should get iron-fortified formula. Green leafy vegetables, while iron fortified,
   are not appropriate for the infant.
5. Vitamin C should be started at 6 to 9 months of age and continued because foods rich in
   vitamin C improve iron absorption.
6. Starting iron-fortified infant cereal at 4 to 6 months of age is recommended for
   prevention of iron deficiency in children.
7. Cow’s milk should not be introduced until 12 months of age.

Question 3

The parents of an infant diagnosed with sickle-cell disease ask, “How did our child get this
disease? Neither one of us has it.” Which should the nurse consider when responding to the
parents?
1. The father is not the biologic father of the infant.
2. The mother of the child has the trait, but the father does not.
3. The father of the child has the trait, but the mother does not.
4. The mother and the father of the child have the sickle-cell trait.

Answer 3

4. The mother and the father of the child have the sickle-cell trait
   Explanation:
5. There is no indication that the father is not the actual parent. Both parents could be
   carriers of the disorder but unaware of their status.
6. Both parents must have the trait for the child to have a 25% chance of having this
   disease.
7. Both parents must have the trait for the child to have a 25% chance of having this
   disease.
8. Sickle-cell disease is an autosomal recessive disorder; both parents must have the trait in
   order for a child to have a 25% chance of having this disease.

Question 4

Which parental statements regarding precipitating factors for sickle-cell disease indicate
correct understanding of the discharge information presented by the nurse? Select all that
apply.
1. “My child should avoid regular exercise.”
2. “We should provide acetaminophen or ibuprofen to treat fever.”
3. “Our child needs to drink lots of fluid to avoid dehydration when playing sports.”
4. “High altitudes can cause exacerbation and should be avoided.”
5. “Fluid restriction is necessary to avoid exacerbations from occurring.”

Answer 4

2. “We should provide acetaminophen or ibuprofen to treat fever.”
3. “Our child needs to drink lots of fluid to avoid dehydration when playing sports.”
4. “High altitudes can cause exacerbation and should be avoided.

Question 5

The nurse is administering packed red blood cells to a child with sickle-cell disease (SCD).
When should the nurse monitor the child closely due to the risk of reaction?
1. Six hours after the transfusion is given.
2. At the end of the administration of the transfusion.
3. The first 20 mL of blood administered.
4. Never; children with SCD do not have reactions.

Answer 5

3. The first 20 mL of blood administered.

Question 6

A child who has beta-thalassemia is receiving numerous blood transfusions and
deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their
child. Which response by the nurse is accurate?
1. “It stimulates red blood cell production.”
2. “It prevents iron overload.”
3. “It provides vitamin supplementation.”
4. “It decreases the risk of transfusion reactions.”

Answer 6

2. “It prevents iron overload.”
   Explanation:
3. Desferal does not stimulate red blood cell production.
4. Iron overload can be a side effect of a hypertransfusion therapy. Desferal is an iron-
   chelating drug that binds excess iron so it can be excreted by the kidneys. It does not
   prevent blood transfusion reactions, stimulate red blood cell production, or provide
   vitamin supplementation.
5. Desferal does not provide vitamin supplementation.
6. Desferal does not prevent blood transfusion reactions.

Question 7

A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse
what aplastic anemia is. Which response by the nurse is accurate?
1. “Aplastic anemia causes a proliferation of white blood cells.”
2. “Aplastic anemia is characterized by abnormally shaped red blood cells.”
3. “Aplastic anemia is caused the bone marrow producing inadequate cells.”
4. “Aplastic anemia is a disorder that occurs after a viral illness.”

Answer 7

3. “Aplastic anemia is caused the bone marrow producing inadequate cells.”
   Explanation:
4. All blood cells, not just white blood cells, are affected by aplastic anemia.
5. Aplastic anemia does not cause abnormally shaped red blood cells; this is a description
   of sickle-cell disease.
6. In aplastic anemia, the bone marrow does not produce sufficient numbers of circulating
   blood cells.
7. There is no known association between aplastic anemia and viral illness.

Question 8

Which symptoms should the nurse include in the teaching plan for the family of a recently
child diagnosed with aplastic anemia?
1. Fatigue and fever
2. Runny nose and cough
3. Nausea and vomiting
4. Cyanosis and bradycardia

Answer 8

1. fatigue and fever
   Explanation:
2. Fatigue secondary to anemia and fever related to infection secondary to neutropenia are
   common symptoms.
3. Aplastic anemia is not associated with upper respiratory infections.
4. Nausea and vomiting are not symptoms of aplastic anemia.
5. The child would exhibit tachycardia rather than bradycardia, and there is no reason for
   cyanosis.

Question 9

A child diagnosed with hemophilia presents to the emergency department (ED) with
multiple injuries following a motor vehicle crash. Which injury is the priority when
conducting the nursing assessment?
1. Occipital hematoma
2. Radial fracture
3. Dislocated shoulder
4. Abdominal abrasions

Answer 9

1. Occipital hematoma
   Explanation:
2. A potential intracranial bleed would receive highest priority because of the danger of
   increased intracranial pressure and potential neurologic damage.
3. Although at risk for bleeding, this would not take priority over a head injury.
4. A dislocation is not at high risk for bleeding or tissue ischemia.
5. Although at risk for bleeding, this would not take priority over a head injury.

Question 10

Which nursing action is appropriate when treating a school-age child, diagnosed with
hemophilia, for a superficial wound above the knee?
1. Applying pressure to the area
2. Applying a warm, moist pack to the area
3. Performing some passive range-of-motion to the affected leg
4. Keeping the affected extremity in a dependent position

Answer 10

1. Applying pressure to the area.
   Explanation:
2. If a child with hemophilia experiences a bleeding episode, superficial bleeding should
   be controlled by applying pressure to the wound.
3. Heat would increase the bleeding by dilating the superficial blood vessels. A cool
   compress should be applied.
4. The extremity should be immobilized to prevent further bleeding; passive range-of-
   motion could cause further bleeding at the site.
5. The extremity should be elevated, if possible, to prevent swelling at the site.

Question 11

The nurse is providing care to a child diagnosed with hemophilia who states, “I am going to
join a bike club at school.” Which recommendation should the nurse give to the child?
1. Wear knee pads, elbow pads, and a helmet while bicycling.
2. Consider a swim club instead of the bicycling club.
3. Do not join the club.
4. Participate only in the social activities of the club.

Answer 11

1. Wear knee pads, elbow pads, and a helmet while bicycling.
   Explanation:
2. Children with hemophilia should be encouraged to participate in noncontact sports
   activities. Bicycling is an excellent option, and is recommended, along with swimming.
   However, the child should always use knee pads, elbow pads, and a helmet when
   participating in any physical sport.
3. Biking is an acceptable sport as long as protective equipment is worn, and the child
   should be encouraged to make choices when possible.
4. Discouraging a child from joining a club would not foster growth and development.
5. Participating only in the social aspects of the club would not encourage physical
   activity.

Question 12

Which is the priority nursing intervention when providing care to a pediatric client who is
experiencing disseminated intravascular coagulation (DIC)?
1. Preparing the child for radiographic procedures
2. Implementing the prescribed fluid restriction for the child
3. Encouraging the child to frequently ambulate
4. Monitoring the child’s oxygen saturation and vital signs

Answer 12

4. Monitoring the child’s oxygen saturation and vital signs
   Explanation:
5. DIC is not diagnosed with a radiographic examination but by serum laboratory studies.
6. Fluids need to be monitored but will not be restricted.
7. Ambulation places stress on joints and can promote bleeding. The child with DIC
   should be placed on bed rest.
8. In a child who has a bleeding and clotting disorder, the priority nursing intervention
   would be monitoring for life-threatening complications.

Question 13

Which is the priority nursing diagnosis for the child diagnosed with idiopathic
thrombocytopenic purpura (ITP)?
1. Ineffective Breathing Pattern
2. Nausea
3. Fluid Volume Deficit
4. Risk for Injury

Answer 13

4. Risk for injury
   Explanation:
5. Although in an advanced state thrombocytopenic purpura can impact breathing, it does
   not usually cause ineffective breathing patterns.
6. Nausea is not a symptom of ITP.
7. Fluid-volume deficits are not likely to occur with ITP.
8. ITP is the most common bleeding disorder in children, so risk for injury and subsequent
   bleeding is the priority nursing diagnosis.

Question 14

Which is the priority teaching point for the nurse to include in the discharge instructions for
the parents of a child who was admitted in a sickle-cell crisis?
1. Rapid weaning of pain medications
2. A diet high in protein
3. Adequate hydration
4. Restriction of activities

Answer 14

3. Adequate hydration
   Explanation:
4. Rapid weaning is not necessary; reduction of pain medication should proceed at a rate
   dictated by the child’s pain.
5. A high-protein diet is not necessary; a well-balanced diet should be promoted.
6. Adequate hydration will help prevent further sequestration and crisis.
7. Normal activities are not restricted.

Question 15

Which teaching topic should the nurse include in the discharge instructions for the family of
child diagnoses with sickle-cell disease to prevent crisis?
1. Respiratory infection and dehydration
2. Mid-range altitudes
3. Weight loss without dehydration
4. Overhydration

Answer 15

1. Respiratory infection and dehydration
   Explanation:
2. The child with sickle-cell disease is at risk for infection, and dehydration can precipitate
   crisis.
3. High altitudes with lower oxygen concentrations pose a risk; mid-altitude is not a risk
   factor.
4. Weight loss is acceptable as long as hydration is maintained.
5. Hydration should be encouraged; risk of overhydration is minimal.

Question 16

Which risks should the nurse closely assess a pediatric client for during the posttransplant
phase of hematopoietic stem cell transplantation (HSCT)?
1. Hemorrhage
2. Thrombosis
3. Pancytopenia
4. Infection
5. Fluid volume overload

Answer 16

1. Hemorrhage
2. Pancytopenia
3. Infection
   Explanation:
4. Suppression of platelets increases the risk for bleeding.
5. There is no increased risk for thrombosis.
6. It takes 2 to 4 weeks for the bone marrow to begin producing cells; the client will show
   evidence of suppression until that time.
7. Suppression of white blood cells increases the client’s risk for infection.
8. There is no increased risk of excess fluid; the client is at greater risk for dehydration.

Question 17

Which concepts should the nurse include in the discharge instructions for a child who has
undergone a hematopoietic stem cell transplantation (HSCT)? Select all that apply.
1. Keeping the child on a high-calcium diet
2. Practicing good hand washing
3. Avoiding live plants and fresh vegetables
4. Avoiding influenza vaccinations
5. Returning the child to school within 6 weeks

Answer 17

1. Keeping the child on a high-calcium diet
2. Practicing good hand washing
3. Avoiding live plants and fresh vegetables
   Explanation:
4. The child should be placed on calcium supplements to reduce the risk of osteopenia.
   Hand washing is essential to prevent the spread of infection. Live plants and fresh
   vegetables can carry bacteria; they should be avoided to decrease the risk of infection.
5. The child should be placed on calcium supplements to reduce the risk of osteopenia.
   Hand washing is essential to prevent the spread of infection. Live plants and fresh
   vegetables can carry bacteria; they should be avoided to decrease the risk of infection.
6. The child should be placed on calcium supplements to reduce the risk of osteopenia.
   Hand washing is essential to prevent the spread of infection. Live plants and fresh
   vegetables can carry bacteria; they should be avoided to decrease the risk of infection.
7. The child cannot return to school for 6 to 12 months after an HSCT. In-hospital or in-
   home schooling is required. The child and the family should be encouraged to get a
   yearly influenza vaccination.

Question 18

During a natural disaster, a child diagnosed with hemophilia is injured and bleeding
internally. Which blood product should the nurse plan to administer if the appropriate factor
is not available?
1. Platelets
2. Whole blood
3. Packed cells
4. Fresh or fresh frozen plasma

Answer 18

4. Fresh or fresh frozen plasma
   Explanation:
5. The child has adequate platelets, and administration of platelets will not promote
   clotting.
6. Whole blood will increase the blood volume without promoting clotting.
7. A unit of packed cells will provide red blood cells (RBCs) but not the factor needed to
   clot.
8. Factors are located in the plasma. Fresh or fresh frozen plasma will provide the best
   source of factor available.

Question 19

A school-age child diagnosed with classic hemophilia is admitted to the hospital for
hemorrhage into the knee joint. Which nursing diagnosis should the nurse use to plan care
for this child?
1. Risk for Impaired Physical Mobility related to joint stiffness and contractures
2. Risk for Impaired Tissue Perfusion (cerebral) related to blood loss.
3. Activity Intolerance related to bleeding
4. Disturbed Body Image related to swollen knee

Answer 19

1. Risk for impaired physical mobility related to joint stiffness and contractures
   Explanation:
2. A bleed into the joint can lead to permanent contracture of the joint. Bone changes can
   result from the immobility associated with the bleed.
3. Bleeding into the knee joint tends to be limited and decreased blood flow to the brain is
   unlikely.
4. Activity intolerance is not the best diagnosis for this child.
5. Although the knee will be swollen, body image is not the priority diagnosis at this time.

Question 20

Which rationale should the nurse include in the teaching session, related to infant iron
deficiency anemia, when a parent asks why it is inappropriate to switch from formula to
cow’s milk prior to 1 year of age? Select all that apply.
1. Cow’s milk is a poor source of iron.
2. The child may be exposed to an antibiotic in processed milk.
3. Cow’s milk has a high fat content.
4. In young children, cow’s milk can lead to bleeding from the gastrointestinal tract.
5. Cow’s milk contains no vitamin C, which is necessary for iron absorption.

Answer 20

1. Cow’s milk is a poor source of iron.
2. In young children, cow’s milk can lead to bleeding from the GI tract.

Question 21

The nurse is preparing to administer a blood transfusion to a child with a severe anemia.
Which type of transfusion reaction can be avoided by the nurse’s assessment?
1. Allergic
2. Hemolytic
3. Febrile
4. Septic

Answer 21

2. Hemolytic
   Explanation:
3. Allergic reactions are due to a protein in the donated blood to which the child reacts.
   The nurse cannot prevent this type of reaction.
4. A hemolytic reaction results from mismatched blood, a preventable error. This error is
   most likely to occur at the bedside if the nurse does not carefully identify the unit of
   blood and the patient.
5. A febrile reaction is related to contamination of blood. The nurse has no control over
   this type of reaction.
6. Septic is another name for a febrile reaction and is not preventable by the nurse.

Question 22

The heatlthcare provider prescribes a unit of packed red blood cells for a pediatric client.
Which intravenous fluid should the nurse hang during the blood transfusion?
1. D 5 W
2. D 5 LR
3. D 5 1/4NS
4. NS

Answer 22

4. NS

Question 23

A school-age child is admitted to the hospital in a sickle-cell crisis. Which actions should
the nurse include in the plan of care to address the child’s pain?
1. Administering opioid analgesics, per order
2. Administering nonsteroidal anti-inflammatory drugs (NSAIDs), per order
3. Applying cold packs to affected joints, prn
4. Encouraging oral fluid intake
5. Maintaining bed rest

Answer 23

1. Administering opioid analgesics, per order
2. Administering NSAIDs , per order.
3. Encouraging oral fluid intake
4. Maintaining bed rest.
   Explanation:
5. Narcotics, such as morphine, are used to control the pain and reduce sickling.
6. NSAIDs may be used in combination with narcotics to control the pain.
7. Cold application is inappropriate in this situation as it would increase the sickling.
8. Oral fluids will help “thin” the blood and reduce sickling.
9. Bed rest will reduce the oxygen requirements of the body and prevent further sickling.

Question 24

The healthcare provider orders laboratory tests following the initiation of treatment for a
child diagnosed with iron deficiency anemia. Which laboratory result should the nurse share
with the child’s family as an indication of improvement?
1. Low hemoglobin
2. Normal platelet count
3. High reticulocyte count
4. Low hematocrit

Answer 24

3. High reticulocyte count
   Explanation:
4. Low hemoglobin is a typical finding in iron deficiency anemia.
5. Platelet count is unrelated to iron deficiency anemia.
6. Reticulocytes are immature red blood cells and indicate new cells are being produced.
7. This would be a typical finding in iron deficiency anemia.

Question 25

Which topic should the nurse include in the discharge instructions for the family of a child
who has undergone hematopoietic stem cell transplantation (HSCT)?
1. Avoiding influenza vaccination
2. Returning to school within 6 weeks
3. Maintaining a low-calcium diet
4. Practicing diligent hand hygiene

Answer 25

4. Practicing diligent hand hygiene.
   Explanation:
5. The child and the family should be encouraged to get yearly influenza vaccinations.
6. The child cannot return to school for 6 to 12 months after an HSCT. In-hospital or in-
   home schooling is required.
7. The child should be placed on calcium supplements to reduce the risk of osteopenia.
8. Handwashing is essential to prevent the spread of infection.

Question 26

26) Which functions of red blood cells (RBCs) should the nurse include in a teaching session for
the family of a pediatric client who is diagnosed with anemia? Select all that apply.
1. Carry oxygen from the lungs to the tissues
2. Return carbon dioxide from the tissues to the lungs
3. Assist the body to fight infection
4. Assist the body to fight allergens
5. Form hemostatic plugs to stop bleeding

Answer 26

1. Carry oxygen from the lungs to the tissues
2. Return carbon dioxide from the tissues to the lungs
   Explanation:
3. A function of RBCs is to carry oxygen from the lungs to the tissues.
4. A function of RBCs is to return carbon dioxide from the tissues to the lungs.
5. A function of the white blood cells, not the RBCs, is to fight infection.
6. A function of the white blood cells, not the RBCs, is to fight allergens.
7. A function of platelets, not RBCs, is to form hemostatic plugs to stop bleeding.

Question 27

Which functions of white blood cells (WBCs) should the nurse include in a teaching session
for the family of a pediatric client who is diagnosed with human immunodeficiency virus (HIV)?
Select all that apply.
1. Carry oxygen from the lungs to the tissues
2. Return carbon dioxide from the tissues to the lungs
3. Assist the body to fight infection
4. Assist the body to fight allergens
5. Form hemostatic plugs to stop bleeding

Answer 27

3. Assist the body to fight infection
4. Assist the body to fight allergens

Question 28

28) A child is diagnosed with lymphocytopenia. Which parental statements indicate
understanding of this diagnosis? Select all that apply.
1. “My child may be prone to allergic reactions.”
2. “My child may have trouble initiating an inflammatory response.”
3. “My child may require iron supplements to treat this disorder.”
4. “My child may require further testing for leukemia.”
5. “My child may have been exposed to tuberculosis.”

Answer 28

4. “My child may require further testing for leukemia.”
5. “My child may have been exposed to TB”

Question 29

The nurse is providing care to a pediatric client who is diagnosed with leukopenia. Which
disorders should the nurse suspect based on this information? Select all that apply.
1. Cardiovascular
2. Immune
3. Bone marrow
4. Respiratory
5. Neurologic

Answer 29

2. Immune
3. Bone marrow