Anemia
A child is brought to the clinic with jaundice, dark-colored urine, and splenomegaly. The nurse recognizes these symptoms are most consistent with anemia caused by which underlying process?
A.Inadequate production of red blood cells
B.Impaired absorption of dietary iron
C.Increased destruction of red blood cells
D.Excessive loss of red blood cells
C.Increased destruction of red blood cells
A nurse is teaching the parent of a toddler prescribed liquid iron. Which statement by the parent indicates a need for further education regarding administration?
A.I will give the iron with a small glass of milk to improve the taste.
B.I should give this medication between my child's meals.
C.I can mix the supplement in a small amount of orange juice.
D.It is best to get the prescription filled for only one month at a time.
A.I will give the iron with a small glass of milk to improve the taste.
A school-age child with sickle cell disease is admitted for a severe vaso-occlusive crisis. Which order in the client's care plan is most appropriate for managing their pain?
A.Administer meperidine (Demerol) every 4 hours.
B.Encourage the child to limit fluid intake to prevent enuresis.
C.Administer opioid analgesics on a fixed schedule.
D.Apply cold compresses to painful joints.
C.Administer opioid analgesics on a fixed schedule.
The parents of a newly diagnosed infant with sickle cell disease ask why their child must take penicillin twice a day. What is the nurse's best response?
A.This medication will reduce the frequency of painful episodes.
B.It helps correct the anemia by stimulating red blood cell production.
C.The penicillin helps the body produce more fetal hemoglobin.
D.It prevents serious infections because the spleen's function is impaired.
D.It prevents serious infections because the spleen's function is impaired.
A nurse is providing dietary education to the family of a child with beta thalassemia major who receives blood transfusions every three weeks. Which statement by the parent indicates a need for further teaching?
A.“We need to be careful with vitamins, as some contain extra iron.”
B.“I should encourage iron-fortified cereals and red meat to help with the anemia.”
C.“Our primary goal is to limit the amount of iron our child consumes.”
D.“We will avoid giving our child cast-iron cooked foods.”
B.“I should encourage iron-fortified cereals and red meat to help with the anemia.”
During an assessment of a child with chronic anemia due to inadequate RBC production, the nurse observes frontal bossing. What is the physiological reason for this clinical sign?
A.Bilirubin byproducts are being deposited in the cranial bones.
B.Iron toxicity is causing neurological and skeletal changes.
C.Severe tachycardia leads to fluid accumulation in the facial tissues.
D.The bone marrow is congested from attempting to produce more RBCs.
D.The bone marrow is congested from attempting to produce more RBCs.
When reviewing laboratory results for a child being evaluated for iron deficiency anemia, which test provides the most direct assessment of the body's iron stores?
A.Complete Blood Count (CBC)
B.Serum Iron (Fe)
C.Ferritin
D.Hemoglobin (Hgb)
C.Ferritin
A 7-year-old child with sickle cell disease is scheduled for an annual transcranial Doppler (TCD) ultrasound. The parent asks about the purpose of this test. The nurse should explain that the TCD is used to screen for:
A.The risk of a cerebrovascular accident (stroke)
B.Restrictive lung disease
C.Cardiomyopathy and heart murmurs
D.Glomerular and tubular fibrosis in the kidneys
A.The risk of a cerebrovascular accident (stroke)
A nurse is educating the parents of a 1-year-old with sickle cell disease about vaso-occlusive crises. Which of the following early signs should the nurse instruct the parents to watch for in a child this age?
A.Delayed puberty and being underweight
B.Jaundice and dark urine
C.Painful swelling of the hands and feet
D.Severe chest pain and cough
C.Painful swelling of the hands and feet
A nurse is creating a plan of care for a child with beta thalassemia major. Which of the following complications, resulting from the underlying pathophysiology and treatment, should the nurse monitor for?
A.Spontaneous bleeding into joints and muscles
B.Normal red blood cells but depressed white blood cells and platelets
C.Petechiae and decreased platelet count
D.Splenomegaly, heart murmurs, and delayed growth
D.Splenomegaly, heart murmurs, and delayed growth
A public health nurse is counseling the parents of a 15-month-old child on nutrition. To help prevent 'Milk Anemia,' what is the recommended maximum daily intake of cow's milk for a young child?
A.32 ounces per day
B.24 ounces per day
C.16 ounces per day
D.26 ounces per day
B.24 ounces per day
A mother expresses concern at a 4-month well-child visit that her exclusively breastfed baby might not be getting enough iron. What is the nurse's most accurate explanation?
A.As long as you are eating an iron-rich diet, your breast milk will provide all the iron he needs.
B.Iron deficiency is only a risk if we introduce cow's milk before one year of age.
C.Breast milk contains very little iron, so deficiency is a risk from birth.
D.Babies are born with iron stores from their mother, which start to deplete around this age.
D.Babies are born with iron stores from their mother, which start to deplete around this age.
The child presents with a rapidly enlarging abdomen, profound pallor, and a heart rate of 150 bpm. Which complication should the nurse prioritize as the most likely cause?
A.Vaso-occlusive Crisis (VOC)
B.Aplastic Crisis
C.Splenic Sequestration Crisis
.D.Hyperhemolytic Crisis
C.Splenic Sequestration Crisis
A nurse is reviewing the lab results for a child with sickle cell disease. The reticulocyte count is significantly elevated at 22%. How should the nurse interpret this finding?
A.The bone marrow is actively compensating for chronic red blood cell destruction.
B.The child is likely developing megaloblastic anemia.
C.This is a normal finding for a child with sickle cell disease.
D.It is a sign of impending bone marrow failure.
A.The bone marrow is actively compensating for chronic red blood cell destruction.
A 10-year-old boy with severe hemophilia falls while playing and develops swelling and pain in his right knee. What is the nurse's priority action?
A.Obtain a blood sample to check platelet levels.
B.Perform passive range-of-motion exercises to prevent stiffness.
C.Administer the prescribed dose of clotting factor concentrate.
D.Apply a warm compress to the knee to ease the pain.
C.Administer the prescribed dose of clotting factor concentrate.
A 5-year-old known to have mild anemia presents to the clinic. Which of the following assessment findings would most strongly suggest the child's condition has progressed to a severe state?
A.Irritability and pale nail beds
B.Tachypnea and swollen hands and feet
C.Koilonychia (spooning of nails) and stomatitis
D.Tiring easily and mild weakness
B.Tachypnea and swollen hands and feet
A parent of a child newly diagnosed with iron deficiency anemia asks how to administer the prescribed liquid iron supplement. What is the nurse's best response?
A.Give the iron with a large glass of milk to prevent stomach upset.
B.Provide the iron supplement right before bedtime to minimize side effects.
C.Mix the supplement into their morning cereal for easier administration.
D.Administer it in two divided doses between meals, preferably with orange juice.
D.Administer it in two divided doses between meals, preferably with orange juice.
A teenager with sickle cell disease who receives chronic blood transfusions has a serum ferritin level of 1,500 mg/mL. The nurse should anticipate preparing the client for which intervention?
A.A diet high in iron-rich foods
B.Initiation of iron chelation therapy
C.Administration of hydroxyurea
D.Increased frequency of blood transfusions
B.Initiation of iron chelation therapy
What is the primary mechanism by which hydroxyurea helps manage sickle cell disease?
A.It directly prevents red blood cells from changing into a sickle shape.
B.It removes excess iron from the body to prevent organ damage.
C.It increases the production of fetal hemoglobin (HbF).
D.It acts as a powerful anti-inflammatory agent to reduce pain.
C.It increases the production of fetal hemoglobin (HbF).
A patient is diagnosed with aplastic anemia. When reviewing the patient's lab results, what finding would the nurse expect?
A.Depression of all formed blood elements, a condition known as pancytopenia.
B.A lack of factor VIII or factor IX in the blood coagulation profile.
C.Defective hemoglobin formation due to an imbalance in globin chain synthesis.
D.Profound depression of red blood cells with normal white blood cells and platelets.
A.Depression of all formed blood elements, a condition known as pancytopenia.
During a well-child visit for a 10-month-old infant, the nurse provides anticipatory guidance. According to standard screening recommendations, when is the most appropriate time to screen for iron deficiency anemia?
A.At 6 months of age, when solid foods are introduced.
B.At the 2-month visit, before maternal stores are depleted.
C.Between 9 and 12 months of age.
D.Only if the infant is showing signs such as pallor or fatigue.
C.Between 9 and 12 months of age.
When providing dietary teaching for a family of a child with iron deficiency, which of the following food combinations would the nurse recommend as being 'better' sources of iron?
A.A bowl of oatmeal with a glass of milk
B.Spinach salad with raisins and apricots
C.Scrambled eggs with a side of kale
D.Turkey chili with beans and a side of peanut butter toast
D.Turkey chili with beans and a side of peanut butter toast
The nurse is providing discharge instructions to the parents of a toddler newly diagnosed with sickle cell disease. Which statement by a parent indicates a need for further education?
A.If he develops a fever of 101.3°F, we need to call our practitioner immediately.
B.It is important to keep him well-hydrated, especially during warm weather.
C.We will apply cold packs to his swollen hands and feet for pain.
D.We must ensure he gets his daily dose of penicillin to prevent infection.
C.We will apply cold packs to his swollen hands and feet for pain.
A nurse is reviewing the lab work of a child with sickle cell anemia who is clinically stable. Which finding would be an expected result of the body's chronic compensatory response to the disease?
A.A low erythropoietin stimulating factor level.
B.Predominance of Hemoglobin A (HgbA) on electrophoresis.
C.An elevated reticulocyte count of 25%.
D.A normal reticulocyte count of 1%.
C.An elevated reticulocyte count of 25%.
A nurse is preparing a patient with severe aplastic anemia for a bone marrow transplant. Which nursing diagnosis has the highest priority during the pre-transplant phase?
A.Knowledge Deficit related to genetic inheritance patterns.
B.Risk for Infection related to immunosuppression and neutropenia.
C.Disturbed Body Image related to skin darkening.
D.Chronic Pain related to joint bleeding.
B.Risk for Infection related to immunosuppression and neutropenia.