29.
3. Characteristic sickle cells tend to cause“log jams” in capillaries. This results in poor cir- culation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of the red blood cells.
The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum biliru- bin concentrations are associated with jaundice, not sickle cell disease.
CN: Physiological adaptation; CL: Apply
30.
4. Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborn’s hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term.The fetus produces all its own hemoglobin from the earliest production in the fi rst trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.
CN: Physiological adaptation;
CL: Apply
31.
3. For the child in sickle cell crisis, Pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, lead- ing to occlusion and subsequent tissue ischemia.Although Ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vasoocclusive crisis.
Typically, a sickle cell crisis can be precipitated by a fl uid volume defi cit or dehydration.
CN: Physiological adaptation;
CL: Analyze
The Client with Iron Defi ciency
to severe bleeding episodes in children with hemophilia.
CN: Safety and infection control;
CL: Synthesize
38.
2. The child is displaying symptoms of bleed- ing in the joint and factor replacement is indicated.The RICE method is used additionally as a support- ive measure to help control the bleeding. Aspirin containing compounds contribute to bleeding and should never be used to control pain. Physical ther- apy is instituted after the acute bleeding to prevent further damage. Orthopedic traction is considered in some rare cases during the rehabilitation phase, but not the acute phase.
CN: Physiological adaptation;
CL: Synthesize
39.
1. Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concen- trate is not associated with constipation, abdominal distention, or puffi ness around the eyes.CN: Pharmacological and parenteral therapies; CL: Synthesize
40.
2. Swimming is an ideal activity for a child with hemophilia because it is a noncontact sport.Many noncontact sports and physical activities that do not place excessive strain on joints are also appropriate. Such activities strengthen the muscles surrounding joints and help control bleeding in these areas. Noncontact sports also enhance general mental and physical well-being. Falls and sub- sequent injury to the child may occur with snow skiing. Basketball is a contact sport and therefore increases the child’s risk for injury. Gymnastics is a very strenuous sport. Gymnasts frequently have muscle and joint injuries that result in bleeding episodes.
CN: Health promotion and maintenance;
CL: Apply
The Client with Leukemia
41.
2. Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leu- kemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority which is normal and does not need to be reported.However, light-colored stools indicate the iron is not being absorbed and should be reported.
CN: Psychosocial adaptation;
CL: Evaluate
33.
2. Children with iron defi ciency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with micro- cytosis.CN: Physiological adaptation; CL: Apply
34.
1, 2. Toddlers should have between two and three cups of milk per day and 8 oz of juice per day.If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients. Food prefer- ences vary among children. It is acceptable for the child to refuse foods as long as the diet is balanced and contains adequate calories. The child is obtain- ing a normal amount of sleep.
CN: Basic care and comfort;
CL: Evaluate
35.
2. Potatoes, peas, chicken, green vegetables, and rice cereal contain signifi cant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice by itself also is not a good source of iron. Macaroni, cheese, and ham are not high in iron. While pud- ding (made with fortifi ed milk) and green vegetables contain some iron, the better diet has protein and iron from the chicken and potato.CN: Physiological adaptation;
CL: Apply
The Client with Hemophilia
36.
4. Coordinating labs to minimize sticks reduces trauma and the risk of bleeding. Finger sticks in general are more painful and associated with more bleeding than venipunctures. In hemo- philia, platelets are typically normal. Heat would increase vasodilatation and increase bleeding.CN: Reduction of risk potential;
CL: Apply
37.
2. As the hemophilic infant begins to acquire motor skills, the risk of bleeding increases because of falls and bumps. Such injuries can be minimized by padding vulnerable joints. Aspirin is contraindi- cated because of its antiplatelet properties, which increase the infant’s risk for bleeding. Because genitourinary bleeding is not a typical problem in children with hemophilia, urine testing is not indicated. Although some bleeding may occur with tooth eruption, it does not normally cause moderateBillings_Part 2_Chap 2_Test 3.indd 224
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and many children do not like tea. Water does not relieve nausea.
CN: Reduction of risk potential;
CL: Apply
47.
3. Ibuprofen prolongs bleeding time and is contraindicated in clients with leukemia. Non-nar- cotic drugs other than ibuprofen or aspirin, such as acetaminophen (Tylenol), may be prescribed to con- trol pain. Narcotic analgesics, such as acetamino- phen with codeine or propoxyphene hydrochloride, may be required when pain is severe.CN: Pharmacological and parenteral therapies; CL: Synthesize
48.
4. Although bone marrow specimens may be obtained from various sites, the most commonly used site in children is the posterior iliac crest, the back of the hipbone. This area is close to the body’s surface but removed from vital organs. The area is large, so specimens can easily be obtained. For infants, the proximal tibia and the posterior iliac crest are used. The middle of the chest or sternum is the usual site for bone marrow aspiration in an adult. The wrist, chest, and thigh are not sites from which to obtain bone marrow specimens.CN: Reduction of risk potential;
CL: Evaluate
49.
1. Dactinomycin and vincristine both cause nausea and vomiting. Oral fl uids are encouraged, and antiemetics are given to prevent dehydration.Avoiding sun exposure is not necessary because photosensitivity is not associated with these drugs.
Heart rate changes and drowsiness also are not asso- ciated with either of these two drugs.
CN: Pharmacological and parenteral therapies; CL: Synthesize
50.
2. It has been found that parents are more grieved when optimism is followed by defeat. The nurse should recognize this when planning various ways to help the parents of a dying child. It is not necessarily true that knowing about a poor prog- nosis for years helps prepare parents for a child’s death. Death is still a shock when it occurs. Trust in health care personnel is not necessarily destroyed when a death is untimely if the family views the personnel as having done all that was possible. It is not more diffi cult for parents to accept the death of an older child than that of a younger child.CN: Psychosocial adaptation;
CL: Synthesize
51.
1. Vincristine may cause constipation, so the client should be encouraged to eat a high-residue (fi ber) diet. The other diets do not help with consti- pation that can occur while receiving vincristine.CN: Physiological adaptation; CL: Apply intervention. Swollen glands and lethargy may be
uncomfortable but they do not require immedi- ate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.
CN: Reduction of risk potential;
CL: Analyze
42.
3. Cystitis is a potential adverse effect of cyclophosphamide. The client should be monitored for pain on urination. Photosensitivity, ataxia, and cardiac arrhythmias are not adverse effects associ- ated with cyclophosphamide.CN: Pharmacological and parenteral therapies; CL: Analyze
43.
2. Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is character- ized by a proliferation of immature white blood cells. Leukemia is not an infection, infl ammation, or allergic disorder.CN: Physiological adaptation;
CL: Evaluate
44.
2. The anemia seen in children with leuke- mia is caused by the bone marrow’s overproduction of immature white blood cells at the expense of producing red blood cells and platelets. In this cli- ent, anemia is not caused by an inadequate intake of iron but, rather, by insuffi cient red blood cells. The anemia is not caused by destruction of red blood cells by lymphocytes or by the replacement of bone marrow with scar tissue.CN: Reduction of risk potential;
CL: Analyze
45.
4. In leukemia, the number of normal white blood cells that are capable of fi ghting an infection is decreased. Although there is an increased number of immature white blood cells, they are unable to combat infection. Therefore, a child with leukemia is subject to infection. The major morbidity and mortality factor associated with leukemia is infec- tion resulting from the presence of granulocytope- nia. While increased activity may cause fatigue, it does not put the child at risk for infection. Vitamin C intake should not decrease if the child has ade- quate dietary intake. Decreased red blood cells are not directly caused by infection.CN: Reduction of risk potential;
CL: Apply
46.
4. Carbonated beverages ordinarily are the best tolerated when a child feels nauseated. Many children fi nd cola drinks especially easy to toler- ate, but noncola beverages are also recommended.Orange juice usually is not tolerated well because of its high acid content. Tea may also be too acidic
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and recording the intake and output. LPNs may also take vital signs to gather data, but the nurse must interpret the data. Administering I.V. morphine requires assessment of the client’s respiratory status before, during, and after the procedure. While insti- tutions may allow for LPNs to monitor vital signs during a transfusion, a nurse would be in the best position to assess for a transfusion reaction. Cir- culation checks are assessments the nurses should complete. Discharge teaching requires an evaluation of learning and thus should be done by the nurse.
CN: Management of care; CL: Synthesize
56.
3. During conscious sedation the client may lose protective refl exes and adequate respiratory and cardiac function may be impaired. At every procedure there must be one health care profes- sional whose sole responsibility is to monitor the client. Topical agents must be given in advance of the procedure to be effective. During the procedure, the nurse would not leave the child to speak with parents. While the procedure would be documented according to the facility’s protocols, proper monitor- ing of the client is the intervention most associated with reducing risks.CN: Reduction of risk potential;
CL: Apply
57.
1, 2, 3, 4, 5. The report made when nurses are “handing off” a client from one nursing unit to another must include information about the condi- tion of the client, potential for changes in the cli- ent’s condition, current medications, and care and services received.CN: Safety and infection control;
CL: Synthesize
58.
4. Safety standards require the use of two identifi ers prior to medication administration. A parent can be used as the second identifi er. Many young children will only answer to a nick name that does not coincide with the medical identifi cation band or may answer to any name. It is common for children on a pediatric fl oor to go into each other’s rooms. A small child may not know their birth date.CN: Safety and infection control;
CL: Synthesize
52.
2. Children who are immunosuppressed should not receive any live attenuated vaccines.Clients who are immunosuppressed and are given live attenuated vaccines such as measles, mumps, rubella and oral polio vaccine can develop severe forms of the diseases for which they are being immunized, which can result in death. Inactivated vaccines may be given if necessary, but the client is not able to adequately produce needed antibod- ies and it is recommended that immunizations be delayed for 3 months after the immunosuppressive drugs have be discontinued. Vitamin and mineral supplements are not normally given in conjunction with immunosuppressive drugs. When the client is immunosuppressed, the client should avoid only persons who have an infection.
CN: Health promotion and maintenance;
CL: Synthesize
53.
4. Any child with a chronic illness should be treated as normally as possible. Unless the child has severe bone marrow depression, he should be allowed to go to school with others and can go to the mall. If the child is in remission, athletic activi- ties are allowed.CN: Health promotion and maintenance;
CL: Synthesize
Managing Care Quality and Safety
54.
2. The best evidence indicates that a catheter as small as 27 gauge may safely be used for transfu- sion in children, but blood must be infused with normal saline, not dextrose. A 1-year-old should be able to maintain their blood glucose for the 2 hour duration of the infusion without the need for a sec- ond I.V.CN: Management of care; CL: Synthesize
55.
1, 3, 4, 6. The RN’s scope of practice includes assessment, planning, implementing, and evalua- tion. Only aspects of care implementation may be delegated to the LPN and the exact skills which may be delegated vary by state and institution. In gen- eral, LPNs have been trained to perform the tasks of administering oral medications, performing hygiene,Billings_Part 2_Chap 2_Test 3.indd 226
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