Chapter 28 : Select all

Question 1

1. The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
   a. Petechiae
   b. Chronic diarrhea
   c. Hepatosplenomegaly
   d. Bleeding from openings in the skin
   e. Hypotension
   f. Purpura

Answer 1

ANS: A, D, E, F

Some clinical manifestations of DIC are petechiae, bleeding from openings in the skin, hypotension, and purpura. Hepatosplenomegaly and chronic diarrhea are clinical manifestations of human immunodeficiency virus (HIV) infection in children.

Question 2

2. What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.)
   a. Golf
   b. Soccer
   c. Rugby
   d. Jogging
   e. Swimming

Answer 2

ANS: A, D, E

Children and adolescents with severe hemophilia can participate in noncontact sports such as swimming, golf, walking, jogging, fishing, and bowling. Contact sports such as football, boxing, hockey, soccer, and rugby are strongly discouraged because the risk of injury outweighs the physical and psychosocial benefits of participating in these sports.

Question 3

3. What are signs and symptoms of anemia? (Select all that apply.)
   a. Pallor
   b. Fatigue
   c. Dilute urine
   d. Bradycardia
   e. Muscle weakness

Answer 3

ANS: A, B, E

Signs and symptoms of anemia include, pallor, fatigue, and muscle weakness. Tachycardia, not bradycardia, and dark urine, not dilute, are signs and symptoms of anemia.

Question 4

4. The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.)
   a. Chills
   b. Shaking
   c. Flank pain
   d. Hypothermia
   e. Sudden severe headache

Answer 4

ANS: A, B, C, E

Signs and symptoms of a transfusion reaction include chills, shaking, flank pain, and sudden severe headache. Hyperthermia, not hypothermia, occurs.

Question 5

5. The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection. What should the nurse include in the teaching session? (Select all that apply.)
   a. Avoid obtaining the pneumococcal vaccination for the child.
   b. Avoid obtaining the meningococcal vaccination for the child.
   c. The child should receive prophylactic penicillin for certain procedures.
   d. Have the child immunized with the Haemophilus influenzae type b vaccination.
   e. Notify the health care provider if your child develops a fever of 38.5 C (101.3 F).

Answer 5

ANS: C, D, E

Because of the risk of life-threatening bacterial infection after splenectomy, these children are immunized with the pneumococcal, meningococcal, and H. influenzae type b vaccines before surgery and receive prophylactic penicillin for several years after splenectomy. The parents should be instructed in the importance of seeking immediate medical attention if their child develops a fever of 38.5 C (101.3 F) or higher as a common sign of infection or postsplenectomy sepsis.

Question 6

6. The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.)
   a. Prematurity
   b. Slow growth rate
   c. Excessive milk intake
   d. Severe iron deficiency in the mother
   e. Exclusive breastfeeding of infant from birth to 3 months

Answer 6

ANS: A, C, D

Causes for iron deficiency caused by an inadequate supply of iron include prematurity, excessive milk intake, and severe iron deficiency in the mother. Rapid growth rate, not slow, and exclusive breastfeeding of infant after 6 months, not from birth to 3 months, can be causes of inadequate supply of iron.

Question 7

7. The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.)
   a. Gastric acidity
   b. Chronic diarrhea
   c. Lactose intolerance
   d. Absence of phosphates
   e. Inflammatory bowel disease

Answer 7

ANS: B, C, E

Causes for iron deficiency due to impaired iron absorption include chronic diarrhea, lactose intolerance, and inflammatory bowel disease. Gastric alkalinity, not acidity, and the presence, not absence, of phosphates can be causes of impaired iron absorption.

Question 8

8. The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease). What clinical features of severe congenital neutropenia should the nurse recognize? (Select all that apply.)
   a. Anemia is present.
   b. Neutropenia is present.
   c. The illness is severe.
   d. It has a dominant inheritance pattern.
   e. There are decreased eosinophils in the bone marrow.

Answer 8

ANS: B, C

The clinical features of severe congenital neutropenia include anemia and neutropenia, and the illness is severe. It has an autosomal recessive inheritance pattern, and there are increased, not decreased, eosinophils in the bone marrow.

Question 9

9. The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia. What clinical features of chronic benign neutropenia should the nurse recognize? (Select all that apply.)
   a. Gingivitis is present.
   b. Anemia is not present.
   c. Monocytosis is present.
   d. It has an autosomal recessive pattern.
   e. Treatment is by bone marrow transplantation.

Answer 9

ANS: A, B, C

The clinical features of chronic benign neutropenia include gingivitis, no anemia, and monocytosis. It is not inherited, and because it is benign, it does not require treatment except antibiotics as indicated.

Question 10

10. The nurse is caring for a 12-year-old child with b-thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a.

Anorexia

b.

Unexplained fever

c.

Enlarged spleen or liver

d.

Bronzed, freckled complexion

e.

Precocious sexual development

Answer 10

ANS: A, B, C, D

The clinical manifestations of b-thalassemia include anorexia; unexplained fever; an enlarged spleen or liver; and a bronzed, freckled complexion. There is delayed sexual maturation, not precocious.