Hematology/Oncology Quiz

The primary care pediatric nurse practitioner is examining a 5-year-old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to a specialist for what diagnostic testing?

• bone marrow biopsy

• corticosteroids and intravenous immunoglobulin (IVIG)

• hemoglobin electrophoresis d. immunoglobulin testing

• abdominal CT scan

A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects what disorder?

• hereditary spherocytosis

• iron-deficiency anemia

• lead intoxication

• sickle-cell anemia

The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy-red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition?

• Hemoglobin electrophoresis

• RBC folate, iron, and B12 levels

• Reticulocyte levels

• Serum lead levels

A child who has had a single non-febrile seizure has a normal neurologic exam. Which diagnostic test is indicated?

• Computerized tomography (CT)

• Electroencephalogram (EEG)

• Magnetic resonance imaging (MRI)

• Polysomnography

When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by implementing what action?

• flexing the infant’s neck to touch chin to chest.

• turning the infant’s head from side to side.

• extending the leg at the knee with the infant supine.

• bending the infant at the waist to touch fingers to toes.

A child who has sustained a head injury after falling on the playground is brought to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric APRN notes slight slurring of the child’s speech and the child has vomited twice in the exam room. Which course of action is warranted?

• Admit the child to the hospital for a neurology consult.

• Observe the child in the clinic for several hours.

• Order a head CT and observe the child at home.

• Send the child home with instructions for follow-up.

The pediatric brain is more susceptible to mTBI due to:

• Heightened susceptibility to chemical and metabolic changes.

• Axons are not as myelinated or insulated.​

• Less developed cervical and shoulder musculature

• A and C only.

• All the above

Which indications should prompt admission to a hospital for a patient with mTBI?

• Any signs of intracranial injury that require monitoring and repeat neurological exams.​

• Fluctuating or deteriorating neurological or cognitive symptoms.​

• Patient complains of trouble concentrating and feeling fatigued.​

• All the above.​