EXAM 4 LADIESSSS!!!!

A nurse is caring for a child with sickle cell disease. Which of the following findings should the nurse recognize as a trigger for a vaso-occlusive crisis?

• Dehydration

• Hyperglycemia

• High-protein diet

• Allergic reaction

Answer explanation

Correct Answer: a. Dehydration

Rationale:
Sickle cell disease is caused by an inherited defect in hemoglobin formation. Sickling (clumping of red blood cells) occurs when blood oxygen levels decrease. Triggers include dehydration, infection, physical or emotional stress, and exposure to cold. These conditions make red blood cells crescent-shaped, leading to vessel obstruction, infarcts, and severe pain. Hyperglycemia, high-protein diets, and allergic reactions are not identified as triggers of a sickle cell crisis in this condition.

A nurse is teaching the parents of an infant prescribed oral iron supplements. Which of the following statements by the parent indicates A NEED FOR FURTHER TEACHING?

• “I should avoid giving the iron with milk because it interferes with absorption.”

• “I will give the iron between meals to help it absorb better.”

• “I’ll expect my baby’s stools to turn greenish-black while on iron.”

• “If my baby’s stools remain normal in color, it means the iron is being absorbed well.”

Answer explanation

Correct Answer: d. “If my baby’s stools remain normal in color, it means the iron is being absorbed well.”

Rationale:
When infants take oral iron supplements, stools typically become tarry green/black. An absence of this finding may suggest poor compliance, not effective absorption. Parents should give iron between meals for best absorption, avoid giving it with milk, and continue both dietary changes and supplements to manage and prevent anemia. Regular follow-ups to monitor blood status are important.

A child is admitted with a diagnosis of Wilms tumor. Which nursing action is the priority?

• Encourage frequent abdominal massages to relieve discomfort.

• Place a sign above the bed that reads “Do not palpate abdomen.”

• Monitor for hematuria and report findings to the provider.

• Encourage fluid intake to promote urinary output.

Answer explanation

Correct Answer: b. Place a sign above the bed that reads “Do not palpate abdomen.”

Rationale:
With Wilms tumor, abdominal palpation is avoided because rupture of the tumor capsule can cause the cancer to spread. A sign is placed to alert all staff and visitors. While monitoring for hematuria and encouraging hydration are important, preventing tumor rupture takes priority. After surgery, treatment typically includes chemotherapy and radiation at a specialized cancer center, and children should avoid contact sports to protect the remaining kidney.

A nurse is assessing a child suspected of having a blood dyscrasia. Which skin findings should alert the nurse to this condition?

• Ecchymosis and jaundice

• Petechiae and purpura

• Pallor and cyanosis

• Urticaria and erythema

Answer explanation

Correct Answer: b. Petechiae and purpura

Rationale:
Skin findings can provide important clues to blood disorders. Petechiae (tiny pinpoint hemorrhages) and purpura (larger areas of bleeding under the skin) are common manifestations of blood dyscrasias. These should prompt further evaluation, including examination of the liver and spleen for enlargement. Ecchymosis, pallor, cyanosis, urticaria, or erythema may occur with other conditions but are not the hallmark signs described for blood dyscrasias.

A nurse is teaching parents about strategies for therapeutic communication with their child. Which statement by the parents indicates correct understanding?

• “We should focus on giving strict instructions to maintain control.”

• “We will use the HELP strategy by offering hope, showing empathy and loyalty, and participating in a consistent plan of care.”

• “We should avoid discussing the plan of care in front of our child.”

• “It’s best not to show emotions so our child does not become upset.”

Answer explanation

Correct Answer: b. “We will use the HELP strategy by offering hope, showing empathy and loyalty, and participating in a consistent plan of care.”

Rationale:
Therapeutic communication with children includes the HELP strategy: offering Hope, showing Empathy and Loyalty, and Participating in a consistent plan of care with the family. This approach builds trust, reduces anxiety, and supports the child and family. The other responses reflect non-therapeutic approaches that may increase stress or reduce trust.

A child with neutropenia is at greatest risk for which complication?

• Infection

• Hemorrhage

• Electrolyte imbalance

• Hypertension

Answer explanation

Correct Answer: a. Infection

Rationale:
Neutropenia is a low neutrophil count, which significantly weakens the body’s ability to fight off invading organisms. Children with neutropenia are especially prone to infection. Hemorrhage, electrolyte imbalance, and hypertension are not the primary risks associated with neutropenia.

A nurse is reviewing causes of iron-deficiency anemia with the parents of a young child. Which of the following are potential causes? Select all that apply.

• Severe hemorrhage

• Inability to absorb iron

• Excessive growth requirements

• Inadequate diet

• Feeding whole cow’s milk to infants

Answer explanation

Correct Answers: a, b, c, d, e

Rationale:
Iron-deficiency anemia may result from severe hemorrhage, inability to absorb dietary iron, excessive growth needs, or inadequate iron intake. Additionally, feeding whole cow’s milk to infants can precipitate gastrointestinal bleeding, which can also lead to anemia. All listed options are correct.

A nurse is assessing a child with thalassemia major. Which manifestations should the nurse expect? Select all that apply.

• Pale appearance and hypoxia

• Enlarged liver and spleen

• Protruding teeth and changes in facial contour

• Abdominal distention with pressure on chest organs

• Thin, fragile bones prone to fracture

Answer explanation

Correct Answers: a, b, c, d, e

Rationale:
Children with thalassemia major present with pallor, hypoxia, poor appetite, fever, and jaundice progressing to a muddy bronze color due to hemosiderosis. Hepatomegaly and splenomegaly occur as defective RBCs are destroyed. The child develops abdominal distention, which presses on the chest organs, and is at constant risk for cardiac failure from severe anemia. Bone marrow expands to produce more RBCs, leading to changes in facial contour, protruding teeth, and thin bones that fracture easily. Decreased bone marrow activity is incorrect, since marrow activity is actually increased in thalassemia major.

A nurse is providing dietary teaching to the parents of a child with iron-deficiency anemia. Which of the following foods are good sources of iron? Select all that apply.

• Boiled egg yolk

• Leafy green vegetables

• Whole-grain bread

• Liver

• Cream of Wheat

Answer explanation

Correct Answers: a, b, c, d, e

Rationale:
Good food sources of iron include boiled egg yolk, liver, leafy green vegetables, Cream of Wheat, dried fruits (apricots, peaches, prunes, raisins), dry beans, crushed nuts, whole-grain bread, and iron-fortified cereals. Applesauce is not a significant source of iron,

A nurse is reviewing hemophilia with the parents of a child recently diagnosed. Which statement correctly describes the most common type and cause of hemophilia?

• Hemophilia B is the most common type and is caused by a deficiency of factor VIII.

• Hemophilia A is the most common type and is caused by a deficiency of factor VIII.

• Hemophilia A is caused by a deficiency of factor IX and accounts for 85% of cases.

• Hemophilia B is the most common type and is caused by a deficiency of factor IX.

Answer explanation

Correct Answer: b. Hemophilia A is the most common type and is caused by a deficiency of factor VIII.

Rationale:
The two most common types of hemophilia are Hemophilia A (factor VIII deficiency, also called classic hemophilia) and Hemophilia B (factor IX deficiency, or Christmas disease). Hemophilia A accounts for approximately 85% of cases. Severity depends on factor VIII plasma levels, and therapy aims to maintain factor VIII at levels sufficient for clotting. Minor injuries can be life-threatening in severe cases. Factor VIII levels can be measured by partial thromboplastin time (PTT), and prenatal diagnosis is possible via amniocentesis.