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101 Cards in this Set

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What is the most common and valuable test to assess hematologic function?
a. CBC
b. MRI
c. CT scan
d. blood transfusion
a. CBC
What is a common term used to describe an abnormal CBC?
a. shift to the right
b. slide to the left
c. slide to the right
d. shift to the left
d. shift to the left, which refers to the presence of immature neutrophils in the peripheral blood from hyperfunction of the bone marrow, as seen during a bacterial infection.
The term _________ describes a condition in which the number of red blood cells or hemoglobin concentration is reduced below normal values for age.
a. hemophilia
b. anemia
c. leukemia
d. alopecia
b. anemia, b/c of the decrease, the oxygen-carrying capacity of the blood is diminished, causing a reduction in the oxygen available to the tissues.
What is the most common hematologic disorder of infancy and childhood?
a. anemia
b. hemophilia
c. hodgkin disease
d. HIV
a. anemia, which is not a disease itself but an indication or manifestation of an underlying pathologic process.
What is the basic physiologic defect caused by anemia?
a. a deficiency of factor VIII, which is produced by the liver and is necessary for the formation of thromboplastin in phase I of blood coagulation.
b. is an unrestricted proliferation of immature WBCs in the vlood-forming tissues of the body.
c. is a decrease in the oxygen-carrying capacity of blood and consequently a reduction in the same amount of oxygen available to the cells.
d. primarily infects a specific subset of T lymphocytes, the CD4+ T Cells.
c. b/c of the decrease of RBC and or hemoglobin
The increased circulation and turbulence within the heart, due to anemias, may produce what?
a. bradycardia
b. a murmur
c. clear urine
d. high blood pressure
b. with anemia there is decreased peripherally resistance which increases the cardiac circulation and turbulence, so with anemia what happens is there is a sort of sloshing of the blood as it goes through the heart which causes a murmur...not bad. But, b/c the cardiac workload is greatly increased, especially during exercise, infection, or emotional stress it can also lead to cardiac failure.
Cyanosis (the result of the quantity of deoxygenated Hgb in arterial blood) is typically evident.

True or False
False, it's not typically evident, b/c children seem to have a remarkable ablity to function quite well despite low levels of Hgb
Variation in RBC sizes:___________

Nomal cell size is called ____________

Smaller than normal cell size is called __________

Larger than normal cell size is called ___________
anisocytosis

normocytes

microcytes

macrocytes
Variation in RBC shapes ____________

Globular cells is called ______________

Sickle-shaped cells is called __________
poikilocytes

spherocytes

drepanocytes
COLOR (STAINING CHARACTERISTICS) OF RBC's

Sufficient or normal amount of hemoglobin per RBC is called ____________

reduced amount of hemoglobin per RBC is called ____________________

increased amount of hemoglobin per RBC is called ______________________
normochromic

hypochromic

hyperchromic
The objective of medical management is to reverse the anemia by treating the underlying cause and to make up for any deficiency of blood, blood component, or substance the blood needs for normal functioning.

True or False
True, iron deficiency anemia should get iron supplements. Iron loss from hemorhage should get a transfusion
In patients with severe anemia, supportive medical care may include all of the following except
a. oxygen therapy
b. bed rest
c. NG feedings
d. replacement of intravascular volume with IV fluids
c.
What age does iron deficiecy anemia occur more frequently?
a. toddler
b. pre-schooler
c. adolescence
d. a and c
d.
What are some nursing considerations when preparing the child and family for the multiple invasive tests that are done with finger, heel, or venipunctures?
a. explain the significance of each test, particularly why the tests are not done at one time
b. encouraging parents or another supportive person to be with the child during the procedure
c. allowing the child to play with the equipment on a doll or participate in the actual procedure
d. use the topical application of EMLA or Elamax before needle punctures to eliminate pain
e. all of the above
e.
Because the basic pathology in anemia is a decrease in oxygen-carrying capacity, an important nursing responsiility is to assess the child's energy level and minimize excess demands.

True or False
True
What is the most prevalent nutritional disorder in the United States and the most common mineral disturbance?
a. sickle-cell anemia
b. iron-deficiency anemia
c. aplastic anemia
d. idiopathic anemia
c.
Why are children 12-36 at risk for iron-deficiency anemia?
a. b/c of their reduced fetal iron supply
b. b/c of their increase in mobility
c. b/c of their rapid growth rate combined with poor eating habits
d. b/c of cow's milk being a major staple of the child's diet
d.
Why are premature infants at risk for iron-deficiency anemia?

a. b/c of their reduced fetal iron supply
b. b/c of their increase in mobility
c. b/c of their rapid growth rate combined with poor eating habits
d. b/c of cow's milk being a major staple of the child's diet
a.
Why are adolescents at risk for iron deficiency anemia?

a. b/c of their reduced fetal iron supply
b. b/c of their increase in mobility
c. b/c of their rapid growth rate combined with poor eating habits
d. b/c of cow's milk being a major staple of the child's diet
c.
What factors can cause iron-deficiency anemia?

a. a decrease in the supply of iron
b. Impaired iron absorption
c. the body's increased need for iron
d. alterations in the synthesis of Hgb
e. all of the above
e.
What trimester of pregnancy is iron transferrred from mother to fetus?
a. third
b. second
c. first
d. never
a. Most of the iron is stored in the circulating erythrocytes of the fetus, with the remainder stored in the fetal iver, spleen, and bone marrow.
How long will the fetal iron supply last in a full term baby?
a. 2-3 months
b. 5-6 months
c. throughout the first year
d. 7-8 months
b.
How long will the fetal iron supply last in a premature infant or from multiple births?
a. 2-3 months
b. 5-6 months
c. throughout the first year
d. 7-8 months
a. Since anemia is higher in pre-term infants, you always want to ask the birth hx of a patient and find out if they were full term or pre term to determine the risk of anemia.
If dietary iron is not supplied to meet the infant's growth demands after the fetal iron stores are depleted, iron-deficiency anemia results.

True or False
True
Infants older than 9 months of age can be given fresh cow's milk.

True or False
False, Infants younger than 12 months of age should not be given fresh cow's milk b/c it may increase the risk of GI blood loss occuring from allergy to the milk protein or from GI mucosal damage resulting from a lack of cytochrome iron.
What appears to facilitate in absorption of iron?
a. Vitamin K
b. Folic acid
c. Vitamin C
d. Vitamin B12
c. Encourage client to administer oral iron supplements with orange juice or something high in vitamin C.
Oral iron should be given as prescribed in two divided doses in between meals, when the presence of free hydrochloric acid is ........?
a. abscent
b. greatest
c. least
d. available
b.
Joey doesn't like the taste of his iron supplement, so he asks his nurse for a glass of milk to help with the taste. The correct response from the nurse would be.........
a. to give him the milk, if he Joey thinks that will help
b. ask if he wants chocolate in it
c. explain that milk shouldn't be given with iron supplements and offer orange juice instead
d. give Joey only 8 oz of milk b/c the more milk he drinks the more constipated he will become
c.
Which one of the objective signs indicates that an adequate dosage of iron was given?
a. foul smelling fatty stool
b. bleached white stool
c. tarry green stool
d. loose clear stool
c.
What should the nurse do if the parents report that after administering the iron supplements their child vomits and has diarrhea?
a. notify the doctor
b. do nothing
c. provide options to relieve these side effects
d. ask what color the vomit and diarrhea are
c. Let the parents know that the iron can be given at meals and the dosage can be reduced and then gradually increased until well tolerated
What are some ways to lessen the discoloration of the teeth from the liquid preparations of iron?
a. brush teeth after administration
b. use a straw
c. use a medicine dropper
d. give through a syringe
e. all of the above
e.
If parenteral iron prepartaions are prescribed, iron dextran must be injected deeply into a large muscle mass using the Z-track method. The injection site should be massaged afterwards to reduce the irritation.

True or False
False, the injection site is not massaged after injection to minimize skin staining and irritation.
How much iron can be injected into one site?
a. 5mL
b. 2mL
c. 1L
d. 1mL
d. b/c of that IV should be considered to avoid multiple injections.
What would be a good way to get a teenage girl to understand the implications of not getting enough iron in her diet?
a. emphasize the effect anemia will have on her heart
b. emphasize the effect anemia will have on appearance
c. empasize the effect anemia will have on energy level
d. b and c
d. pallor and difficulty maintaining poplular activities will have the most implact
When both parents have the sickle-cell trait, what is the percentage of chance they will have a child with SCA?
a. 50%
b. 25%
c. 15%
d. 2.5%
b. 25% they will not be affected at all. 50% they will be carriers of the trait and 25% they will have sickle cell anemia
What is a key question to ask during the assessment when suspecting anemia?
a. What is the childs energy level?
b. What does the child participate in?
c. What has their growth pattern been?
d. all of the above
d. Some of the anemias can affect the growth, especially sickle-cell anemia
If the anemia has been gradual over months to a year, the child will adapt and get used to having that decrease in oxygen level.
True or False
True
What is a common finding in chronic severe anemia and is frequently accompanied by delayed sexual maturation in the older child?
a. high IQ
b. growth retartdation
c. bulging eyeballs
d. bad breath
b. Growth retardation, results form decreased cellular metabolism and coexisiting anorexia.
What do they look for in CBC that is indicative of anemia?
*HINT* a decrease in three things
Decrease in RBCs, Hgb and hematocrit (Hct). Although anemia is sometimes defined as an Hgb level below 10 or 11 g/dL
Signs of exertion include:
bradycardia or tachycardia
bradypnea or tachypnea
hyperpnea or hypopnea
tachycardia, tachypnea, hyperpnea and
palpitations, dyspnea, shortness of breath, dizziness, diaphoresis, and change in skin color. The child looks fatigued (sagging, limp posture; slow, strained movements; inability to tolerate additional activity; difficulty sucking in infants.
Why would you want to get a stool sample after the CBC came back and someone was newly diagnosed with anemia?
B/c you want to check for occult blood which can identify chronic intestianal bleeding that results from a primary or secondary lactase deficiency. When a child drinks way to much cow's milk.
What should the nurse advise the mother who exclusivly breastfeeds her 4 to 6 month old?
a. Advise the mom to continue to exclusivly breastfeed until at least a year.
b. Advise the mom to breastfeed on one side only to get the other to dry up.
c. Advise the mom to start giving iron supplements or iron fortified cereal to prevent anemia.
d. Advise the mom to take extra iron supplements so that the baby will get the iron from her.
c.
Most toddlers and infants are underweight with iron-deficiency anemia.
True or False
False, most toddlers are, but infants are often overweight b/c of ecessive milk ingestion (milk babies). These children become anemic for two reasons; milk, a poor source of iron, is given almost to the exlusion of solid foods, and 50% of iron-deficient infants fed cow's milk have an increased fecal loss of blood.
What are some symptoms of iron-deficiency anemia?
a. pale
b. shortness of breath
c. intolerance to any activity
d. irritable
e. all of the above
e, Most of these sympoms go along with all anemias, not just iron-deficiency
What is the basic physiologic defect caused by sickle-cell anemia?
a. a deficiency of factor VIII, which is produced by the liver and is necessary for the formation of thromboplastin in phase I of blood coagulation.
b. is an unrestricted proliferation of immature WBCs in the vlood-forming tissues of the body.
c. is when normal adult hemoglobin is partl or completely replaced by sickle hemoglobin.
d. primarily infects a specific subset of T lymphocytes, the CD4+ T Cells.
c.
Which ethnic group is sickle-cell anemia most prevalent?
a. asians
b. african americans
c. hispanics
d. caucasions
b. although, it is prevalent in hispanics, it is highest in the african community.
The inheritance pattern of sickle cell anemia is essentially that of an autosomal dominant disorder.
True or False
False, it is an autosomal recessive disorder
What can cause the sickling of cells?
a. fever
b. emotional stress
c. physical stress
d. hypoxia
e. dehydration
f. all of the above
f. Anything that increases the bodies need for oxygen or alters the transport of oxygen. Including: hypothermia (cold weather), high altitudes (planes and such), and hyperventilation. Think about if it thickens the blood or constricts the vessels then it will cause problems.
The clinical features of sickle cell anemia are primarily the result of what two occurances?
1) obstruction caused by the sickled RBCs
2) increased RBC destruction
**The entanglement and enmeshing of rigid sickle-shaped cells with one another intermittently block the microcirculation, causing vaso-occlusion.
Large tissue infarctions (cellular death) can occur. Cells can get obstructed in the liver or spleen.
True or False
True, If obstruction happens in the spleen it can be fatal w/in a few hours
When would a child get a splenectomy?
a. if they have reoccuring splenic obstructions
b. when the spleen is palpable and tender
c. if there is a hx of splenic cancer
d. after a bad reaction to flu vaccine
a. Should wait to be done until they are 5 years old, b/c then they will have more of their own immunities and have had more vaccinations
What diagnostic tests are done to determine if there is a sickle cell gene?
a. newborn screening
b. sickle-trubidity test (Sickledex)
c. genetic testing
d. all of the above
d. newborn screening before discharge from hospital. Sickle trubidity test over age of 6 months. Genetic testing to id carriers and children with the disease.
It is easier to detect sickle cell anemia in children under the age of 6 months.
True or False
False, under 6 months they still have some of the fetal hemoglobin floating around which makes it difficult to detect.
What would be the first nursing intervention of someone experiencing a sickle cell crisis?
a. rehydration
b. find the source of the fever
c. provide relief from pain
d. administer antibiotics for any existing infection
c. The patient will be in extreme pain, that needs to be addressed first.
All of these are complications of a sickle cell crisis except
a. CVA (leading to paralysis or death)
b. retinopathy (cause blindness)
c. loss of a limb
d. pneumonia in the lungs
e. hepatameglay and splenomegaly
f. joint and bone pain
g. ostiomyelitis
h. chronic ulcers
i. poor wound healing
c.
Define vaso-occlusive crisis.
a. a pooling of blood in the liver and spleen with decreased blood volume and shock
b. an accelerated rate of RBC destruction characterized by anemia, jaundice, and reiculocytosis.
c. diinished RBC production resulting in profound anemia
d. preferably called a "painful episode," characterized by distal ischemia and pain
d.
Define hyperhemolytic crisis.
a. a pooling of blood in the liver and spleen with decreased blood volume and shock
b. an accelerated rate of RBC destruction characterized by anemia, jaundice, and reiculocytosis.
c. diinished RBC production resulting in profound anemia
d. preferably called a "painful episode," characterized by distal ischemia and pain
d.
Define aplastic crisis.
a. a pooling of blood in the liver and spleen with decreased blood volume and shock
b. an accelerated rate of RBC destruction characterized by anemia, jaundice, and reiculocytosis.
c. diinished RBC production resulting in profound anemia
d. preferably called a "painful episode," characterized by distal ischemia and pain
c.
Define sequestration crisis.
a. a pooling of blood in the liver and spleen with decreased blood volume and shock
b. an accelerated rate of RBC destruction characterized by anemia, jaundice, and reiculocytosis.
c. diinished RBC production resulting in profound anemia
d. preferably called a "painful episode," characterized by distal ischemia and pain
a.
One serious complication of SCA is acute chest syndrome, which is clinically similar to pneumonia. It is associated with all of the following symptoms except
a. bradypnea
b. chest pain
c. fever
d. cough
e. tachypnea
f. wheezing
g. hypoxia
a.
A patient comes in with the following symptoms: pain, fever, tissue enlargement, painful swelling of hands and feet, and very painful joints. What would you suspect?
a. sequestration crisis
b. vaso-occlusive crisis
c. CVA
d. acute chest syndrome
b.
All of these are some outcomes of pooling in the spleen except
a. profound anemia
b. hypovolimia
c. shock
d. distended abdomin
e. pale, tachycardia, short of breath, hypotensive
f. none, all of these are correct
f.
Medical management of a crisis is usually directed at supportive and symptomatic treatment and includes all of the following except
a. rest
b. rehydration
c. electrolyte replacement
d. stool softners
e. analgesics
f. blood replacement
g. administer antibiotics for any existing infection
d.
What is done to prevent a sickle cell crisis.
a. prophylactic antibiotics
b. regular transfusions
c. monthly screening
d. sickle cell vaccine
a. This is done from the ages of 2 months to 5 years, b/c this is highest incidence for infections...strep and ear infections
What vaccine is recommended for children at risk for a sickle cell crisis?
a. pnemococcal
b. yearly influenza vaccine
c. MMR
d. meningococcal
e. a, b, and c
e. b/c of their susceptibility to infection as a result of a functional asplenia.
What are children at risk for after a splenectomy?
a. cardiac arrest
b. seizures
c. cancer
d. infections
d.
Long term oxygent therapy is often used when a child is having a crisis.
True or False
False, oxygen will slow down sickling short term, but long term it will cause problems
All of these medications may be given during a sickling crises except
a. Tylenol with or without codeine
b. morphine
c. demerol
d. Dilaudid
e. oxycodone
f. meyhadone
g. high dose of methylprednisolone
c. it is a central nervous system stimulant and will cause anxiety, tremors and seizures
There is no cure for sickle cell anemia.
True or False
False, possible with a bone marrow transplant
What is the leading cause of death in children with sickle cell anemia?
a. delayed sexual maturation
b. dehydration
c. bacterial infections
d. high levels of HgF
c. Bacterial infections may occur a lot b/c or renal compromise. Strokes may occur in up to 15% of children, resulting in developmental delay and mental retardation.
Nursing management for a child with sickle cell includes all of the following except
a. monitor for an itchy rash
b. watch their growth and for failure to thrive
c. assessing pain
d. look for signs of inflamation or infection
e. monitor for signs of shock
a.
Nursing management for sickle cell include educating the family when to seek medical advice. They need to look out for all of the following except
a. fever over 101.5
b. respiratory problems
c. overactive bladder
d. a and b
d.
Education to parents of sickle cell child include all of the following except
a. make sure they treat child normal
b. keep child hydrated
c. teach them to give penicilin as ordered
d. none, all are correct
d.
What can you expect from a child in the hospital with sickle cell anemia.
a. bursts of energy
b. increased appetite
c. clock watching
d. all of the above
c. They are usually under medicated for their pain and they are very aware when their next dose is due.
Johnny complains about knee and joint pain, what would be the appropriate nursing intervention?
a. provide a cold pack to sooth the inflammed area
b. massage the area gently
c. provide a hot pack to sooth the inflammed area
d. nothing, just make sure he get his next scheduled dose of analgesics.
c. hot is soothing, cold causes vasoconstriction and increases sickling.
What would the nurse observe during an assessment of a child with sickle cell anemia that would indicate a positive responce to therapy?
a. an enlarged spleen
b. awake, alert, and oriented
c. non tenderness of legs
d. decreased spleen size
d.
Define B- thalassemia (cooley anemia).
a. refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed
b. refers to a group of genetic bleeding disorders.
c. inherited disorder of the hemoglobin
d. none of the above
c.
B-thalassemia affects descendants of or those living near the Mediterranean sea including all except
a. italians
b. greeks
c. aussies
d. syrians
c
Both of the parents have to be carriers of B-thalassemia in order for their children to have this disease.
True or False
True
Defective synthesis of the hemoglobin causes the blood cells to be impaired and they have a shorter life than the 128 days in B-thalassemia.
True or False
True
What would you see in the reticulite count that would be indictive of B-thalassemia.
a. decreased RBC count
b. increased RBC count
c. a & b
d. none of the above
b. RBC are distroyed b/c of the defective synthesis of heme, but the bone marrow will be producing a lot of RBC to make up for this
Clinical manifestations of B-thalassemia include all but which one?
a. hypoxia
b. irritability
c. headache
d. bone pain
e. exercise intolerance
f. diaphoresis
f.
If the hemoglobin in less than 6 what medical intervention would be done?
a. transfusion
b. iron supplements
c. oxygen therapy
d. nothing, 6 is a normal variation
a.
Before diagnosis of B-thalassemia would manifestations may be seen in infants an toddlers?
a. pallor
b. unexplained fever
c. poor feeding
d. enlarged liver/spleen
e. all of the above
e.
B-thalassemia is the most common of the thalassemias, and occurs in four forms: two heterozygous forms: thalassemia _______, an asymptomatic silent carrier, and thalassemia _________, which produces a mild microcytic anemia; thalassemia _________, which is manifested as spleenomegaly and moderate to severe anemia, and a homozygous form, thalassemia _________(also known as Cooley anemia), whih results in a severe anemia that would lead to cardiac failure and death in early childhood without transfusion support.
Minor
Trait
Intermedia
Major
If you saw a picture of cells of B-thalassemia what would you expect?
a. cells that are microcytosis
b. hypochromic cells
c. poikilocytosis in cells
d. all of the above
d. Red blood cell changes are seen around 6 weeks of age, the symptoms become more pronounced as the fetal hemoglobin decreases
How can B-thalassemia be detected?
a. ultrasound
b. MRI
c. electrophoresis
d. bladder scan
c.
During blood transfusions they want to keep the hemoglobin above...
a. 2.5
b. 6.5
c. 9.5
d. 12.5
c. If they have Cooley's they are going to need infusions every 3-5 weeks.
Because of all the transfusions, children suffering from B-thalassemia will have an excess of iron.
True or False
True, they will need meds to bind to the iron to help excrete it
Why would someone with B-thalassemia get a splendectomy?
a. to increase the lifespan of RBC
b. to help with circulation
c. to decrease the pressure in the abdominal cavity
d. a & c
d.
A fever over 101.5 with a child that has had a spendectomy is a red flag.
True or False
True, could be indicative of sepsis and sepsis w/out a speen can be fatal
Most common cause of death in children with B-thalassemia is bacterial infections.
True or False
False, the increase in iron from all the transfusions is the leading cause of death. It can lead to multiple organ failure.
What would be indicative of a complication from a blood transfusion?
a. decreased temp
b. decreased blood pressure
c. all of the above
d. none of the above
b. they could have anaphalactic shock, as well
All the elements of the blood are depressed in aplastic anemia.
True or False
True, due to bone marrow failure
Hypoplastic anemia is characterized by a profound (increase or decrease) of RBCs, but (normal or abnormal) or slightly (increased or decreased) white blood cells and platelets.
Decrease
Normal
Decrease
Aplastic anemia can be hereditary (primary) or acquired (secondary). Common causes of acquired aplastic anema include all but
a. chemotherapy
b. household chemicals
c. certain antibiotics
d. multigestation
e. idiopathic
d.
How is aplastic anemia diagnosed?
a. through bone marrow aspiration
b. blood smear
c. urine test
d. none of the above
a.
Bone marrow transplants is better done after several blood transfusions.
True or False
False, it should be done before or else is is very hard to find a match
Children with B-thalassemia should take what supplement?
a. vit B12
b. vit K
c. folic acid
d. vit C
c. will help with RBC production
Which of these diseases has a defieciency of the clotting factor?
a. idiopathic thromocytopenic pupura
b. hemophilia
c. disseminated intravascular coagulation
d. leukemia
b.
Hemophilia can affect men and women.
True or False
True, hemophilia A (deficiency of factor VIII) affects men only, type B (Christmas disease associated with deficiency of factor IX) affects men only, but then there is von Willebrand disease (vWD) which affects men and women and is a prolonged bleeding time.