Level 1
Which blood cell is primarily responsible for clotting?
A. Leukocyte
B. Erythrocyte
C. Platelet
D. Neutrophil
Correct answer: C
Rationale:Platelets, also called thrombocytes, are responsible for clotting.
Which test is most commonly used to identify different types of hemoglobin, including hemoglobin S?
A. Hemoglobin electrophoresis
B. CBC
C. Ferritin
D. INR
Correct answer: A
Rationale:Hemoglobin electrophoresis identifies and quantifies different hemoglobin types and is commonly used for sickle cell disease.
Which finding is most characteristic of iron deficiency anemia?
A. Smooth glossy tongue and pica
B. Splenomegaly and jaundice
C. Petechiae and purpura
D. Severe joint swelling
Correct answer: A
Rationale: Iron deficiency anemia commonly causes pica, fatigue, pallor, and a smooth glossy tongue.
A 2-year-old child is seen in clinic for fatigue, pallor, and easy bruising. The parent also reports frequent infections over the last month. Which nurse interpretation is most appropriate?
A. This pattern is reassuring for iron deficiency only
B. These findings are concerning for altered blood cell production, including possible malignancy
C. This is expected with normal toddler growth
D. The bruising is likely from increased activity alone
Correct answer: B
Rationale:Your notes list fatigue, pallor, frequent/severe infection, and easy bruising as warning signs that may reflect abnormal blood cell production, including malignancy.
A school-age child with sickle cell disease arrives with severe pain, swollen hands, pallor, and a recent history of poor fluid intake during a febrile illness. Which type of crisis is the nurse most likely seeing?
A. Aplastic crisis
B. Hyperhemolytic crisis
C. Vaso-occlusive crisis
D. Sequestration crisis
Correct answer: C
Rationale:The most common sickle cell crisis is vaso-occlusive crisis, caused by vessel blockage and severe pain. Dehydration and infection are major triggers.
Which blood cell primarily transports oxygen and nutrients to tissues?
A. Red blood cell
B. White blood cell
C. Platelet
D. Lymphocyte
Correct answer: A
Rationale:Red blood cells carry oxygen and nutrients to tissues and remove waste.
By what age does hemoglobin A become the predominant hemoglobin type, causing sickle cell symptoms to begin appearing?
A. Birth
B. 2 weeks
C. 3 months
D. 6 months
Correct answer: D
Rationale:By about 6 months, hemoglobin A becomes predominant, which is why sickle cell symptoms often begin after this age.
Which finding is most associated with aplastic anemia?
A. Elevated bilirubin
B. Pancytopenia
C. Dactylitis
D. High ferritin only
Correct answer: B
Rationale:Aplastic anemia is bone marrow failure and causes pancytopenia, meaning low RBCs, WBCs, and platelets.
A child receiving warfarin has a significantly elevated PT/INR. Which nursing interpretation is best?
A. The child is clotting too quickly
B. The child has an increased risk for bleeding
C. This finding confirms sickle cell disease
D. This means the platelet count is elevated
Correct answer: B
Rationale:A high PT/INR means blood is taking longer to clot, which increases bleeding risk.
A child with sickle cell disease has severe pain and signs of dehydration. Which intervention should the nurse expect to prioritize first?
A. Fluid restriction and quiet rest only
B. Pain control and IV hydration
C. Immediate iron therapy
D. Intramuscular vaccine administration
Correct answer: B
Rationale:Your notes emphasize treating sickle cell crises with pain control, often opioids, and IV fluids/hydration, along with oxygen and treatment for infection when present.
What is the most common childhood cancer?
A. Osteosarcoma
B. Lymphoma
C. Leukemia
D. Neuroblastoma
Correct answer: C
Rationale:Your notes specifically state that the most common childhood cancer is leukemia.
Which blood type is the universal donor?
A. AB positive
B. O negative
C. A positive
D. B negative
Correct answer: B
Rationale:Your notes identify O negative as the universal donor.
Which sign is most associated with megaloblastic anemia from vitamin B12 deficiency?
A. Honey-colored crusts
B. Beefy red tongue
C. Cola-colored urine
D. Bounding pulses
Correct answer: B
Rationale:Megaloblastic anemia can present with a beefy red tongue, and B12 deficiency can also cause neurologic symptoms.
A 10-month-old infant is diagnosed with severe iron deficiency anemia. The parent says, “I know the iron is working because my baby’s stool turned black, so I stopped it because I got scared.” Which nursing response is best?
A. “Black stools are an expected side effect of iron; continue the supplement as prescribed.”
B. “Black stools mean internal bleeding, so iron should never be given again.”
C. “Iron should only be given with milk to stop black stools.”
D. “Constipation means the child is allergic to iron.”
Correct answer: A
Rationale:Iron supplements commonly cause black stools and constipation. That is expected and does not mean the medication should be stopped.
A toddler is being evaluated for lead poisoning. The parent reports behavioral changes and learning difficulties. Which nurse statement is most accurate?
A. Lead only affects the skin and lungs
B. Lead poisoning mainly causes hyperkalemia
C. Lead can affect heme production, the nervous system, and the kidneys
D. Lead exposure never causes anemia
Correct answer: C
Rationale:Lead is toxic to blood/heme production, the brain, and the kidneys, and can cause anemia, behavioral changes, and severe neurologic complications.
Which finding is a warning sign for cancer in children related to changes in blood cell production?
A. Frequent or severe infections
B. Productive cough only
C. Rash after antibiotics
D. Ear pulling
Correct answer: A
Rationale:Cancer warning signs can include fatigue, pallor, frequent or severe infection, and easy bruising.
Which lab is used to monitor warfarin therapy?
A. PTT
B. aPTT
C. INR
D. Reticulocyte count
Correct answer: C
Rationale: INR standardizes PT results and is used to monitor warfarin therapy.
Which finding is most consistent with hemolytic anemia?
A. Low reticulocyte count only
B. Jaundice and dark urine
C. Hypotension after exercise only
D. Strawberry tongue
Correct answer: B
Rationale:Hemolytic anemia involves rapid RBC destruction and commonly causes jaundice, dark urine, splenomegaly, fever, and increased bilirubin.
A child with hemolytic anemia is admitted with jaundice, fever, dark urine, and splenomegaly. Which additional lab finding would the nurse expect?
A. Decreased bilirubin
B. Decreased reticulocytes
C. Increased reticulocytes
D. Decreased Coombs test only
Correct answer: C
Rationale:In hemolytic anemia, RBCs are being destroyed, so the bone marrow responds by increasing production, causing increased reticulocytes.
A child with thalassemia is receiving repeated RBC transfusions. Which additional therapy should the nurse expect to help manage a major long-term complication?
A. Chelation therapy for iron overload
B. Desmopressin for clotting support
C. Ketoconazole for fungal prevention
D. Phototherapy for jaundice only
Correct answer: A
Rationale:Children with thalassemia often need repeated RBC transfusions, which can lead to iron overload, so chelation therapy is used to remove excess iron.
Which lab test measures the number of immature red blood cells?
A. Ferritin
B. Reticulocyte count
C. PT
D. Blood culture
Correct answer: B
Rationale:A reticulocyte count measures immature RBCs and helps show how the bone marrow is responding to anemia.
Which lab is the most sensitive test for total iron stores?
A. Iron
B. TIBC
C. Ferritin
D. Hgb
Correct answer: C
Rationale: Serum ferritin is the most sensitive test for total iron stores and for iron-deficiency anemia.
Which condition is most associated with petechiae and purpura after a viral illness?
A. Thalassemia
B. Iron deficiency anemia
C. Immune thrombocytopenic purpura
D. Megaloblastic anemia
Correct answer: C
Rationale:ITP is often an immune response after a viral illness and causes low platelets, leading to petechiae and purpura.
A child with ITP is admitted after a recent viral infection. The nurse notes petechiae and purpura. Which provider order would the nurse question most?
A. Administer IVIG
B. Monitor for bleeding
C. Prepare corticosteroid therapy if platelets are very low
D. Give an intramuscular injection for routine medication
Correct answer: D
Rationale:In a child with thrombocytopenia and bleeding risk, IM injections should be questioned because they can worsen bleeding and tissue hemorrhage. IVIG and corticosteroids fit the disorder described in your notes.
A child with sickle cell disease is being discharged after hospitalization for vaso-occlusive crisis. Which parent statement shows a need for further teaching?
A. “We need to encourage fluids every day.”
B. “We should avoid extreme temperatures and high altitude.”
C. “We can lower the chance of crisis by preventing infection.”
D. “As long as my child feels fine, strenuous activity will always be safe.”
Correct answer: D
Rationale:Discharge teaching for sickle cell disease includes staying hydrated, avoiding extreme temperatures, avoiding high altitude, preventing infection, and getting adequate rest. Strenuous activity can trigger crisis and is not always safe.