03-‐03-‐15:
Saunders
Online
Questions
Bank;
PEDS;
gastrointestinal,
Hematological,
Immune,
Infections
and
communicable
diseases,
Metabolic/endocrine,
Renal
and
Urinary.
1. The
nurse
analyzes
the
laboratory
results
of
a
child
with
hemophilia.
The
nurse
understands
that
which
result
will
most
likely
be
abnormal
in
this
child?
=
1.
Platelet
count
3.
Hemoglobin
level
2.
Hematocrit
level
4.
Partial
thromboplastin
time
RATIONALE:
Hemophilia
refers
to
a
group
of
bleeding
disorders
resulting
from
a
deficiency
of
specific
coagulation
proteins.
Results
of
tests
that
measure
platelet
function
are
normal;
results
of
tests
that
measure
clotting
factor
function
may
be
abnormal.
Abnormal
laboratory
results
in
hemophilia
indicate
a
prolonged
partial
thromboplastin
time.
The
platelet
count,
hemoglobin
level,
and
hematocrit
level
are
normal
in
hemophilia.
2.
The
nurse
is
providing
home
care
instructions
to
the
parents
of
a
10-‐year-‐old
child
with
hemophilia.
Which
sport
activity
should
the
nurse
suggest
for
this
child?
1.
Soccer
3.
Swimming
2.
Basketball
4.
Field
hockey
Rationale:
Hemophilia
refers
to
a
group
of
bleeding
disorders
resulting
from
a
deficiency
of
specific
coagulation
proteins.
Children
with
hemophilia
need
to
avoid
contact
sports
and
to
take
precautions
such
as
wearing
elbow
and
knee
pads
and
helmets
with
other
sports.
The
safe
activity
for
them
is
swimming
3. The
nursing
student
is
presenting
a
clinical
conference
and
discusses
the
cause
of
b-‐thalassemia.
The
nursing
student
informs
the
group
that
a
child
at
greatest
risk
of
developing
this
disorder
is
which
one?
=
1.
A
child
of
Mexican
descent
3.
A
child
whose
intake
of
iron
is
extremely
poor
2.
A
child
of
Mediterranean
descent
4.
A
breast-‐fed
child
of
a
mother
with
chronic
anemia
Rationale:
b-‐Thalassemia
is
an
autosomal
recessive
disorder
characterized
by
the
reduced
production
of
one
of
the
globin
chains
in
the
synthesis
of
hemoglobin
(both
parents
must
be
carriers
to
produce
a
child
with
b-‐thalassemia
major).
This
disorder
is
found
primarily
in
individuals
of
Mediterranean
descent.
Options
1,
3,
and
4
are
incorrect.
4.
A
child
with
b-‐thalassemia
is
receiving
long-‐term
blood
transfusion
therapy
for
the
treatment
of
the
disorder.
Chelation
therapy
is
prescribed
as
a
result
of
too
much
iron
from
the
transfusions.
Which
medication
should
the
nurse
anticipate
to
be
prescribed?
=
1.
Fragmin
3.
Metoprolol
(Toprol-‐XL)
2.
Meropenem
(Merrem)
4.
Deferoxamine
(Desferal)
Rationale:
b-‐Thalassemia
is
an
autosomal
recessive
disorder
characterized
by
the
reduced
production
of
one
of
the
globin
chains
in
the
synthesis
of
hemoglobin
(both
parents
must
be
carriers
to
produce
a
child
with
b-‐thalassemia
major).
The
major
complication
of
long-‐term
transfusion
therapy
is
hemosiderosis.
To
prevent
organ
damage
from
too
much
iron,
chelation
therapy
with
either
Exjade
or
deferoxamine
(Desferal)
may
be
prescribed.
Deferoxamine
is
classified
as
an
antidote
for
acute
iron
toxicity.
Fragmin
is
an
anticoagulant
used
as
prophylaxis
for
postoperative
deep
vein
thrombosis.
Meropenem
is
an
antibiotic.
Metoprolol
is
a
b-‐blocker
used
to
treat
hypertension.
,03-‐03-‐15:
Saunders
Online
Questions
Bank;
PEDS;
gastrointestinal,
Hematological,
Immune,
Infections
and
communicable
diseases,
Metabolic/endocrine,
Renal
and
Urinary.
5.
The
clinic
nurse
instructs
parents
of
a
child
with
sickle
cell
anemia
about
the
precipitating
factors
related
to
sickle
cell
crisis.
Which,
if
identified
by
the
parents
as
a
precipitating
factor,
indicates
the
need
for
further
instructions?
=
1.
Stress
3.
Infection
2.
Trauma
4.
Fluid
overload
Rationale:
Sickle
cell
crises
are
acute
exacerbations
of
the
disease,
which
vary
considerably
in
severity
and
frequency;
these
include
vaso-‐occlusive
crisis,
splenic
sequestration,
hyperhemolytic
crisis,
and
aplastic
crisis.
Sickle
cell
crisis
may
be
precipitated
by
infection,
dehydration,
hypoxia,
trauma,
or
physical
or
emotional
stress.
The
mother
of
a
child
with
sickle
cell
disease
should
encourage
fluid
intake
of
1½
to
2
times
the
daily
requirement
to
prevent
dehydration
6.
A
10-‐year-‐old
child
with
hemophilia
A
has
slipped
on
the
ice
and
bumped
his
knee.
The
nurse
should
prepare
to
administer
which
prescription?
=
1.
Injection
of
factor
X
2.
Intravenous
infusion
of
iron
3.
Intravenous
infusion
of
factor
VIII
4.
Intramuscular
injection
of
iron
using
the
Z-‐track
method
Rationale:
Hemophilia
refers
to
a
group
of
bleeding
disorders
resulting
from
a
deficiency
of
specific
coagulation
proteins.
The
primary
treatment
is
replacement
of
the
missing
clotting
factor;
additional
medications,
such
as
agents
to
relieve
pain,
may
be
prescribed
depending
on
the
source
of
bleeding
from
the
disorder.
A
child
with
hemophilia
A
is
at
risk
for
joint
bleeding
after
a
fall.
Factor
VIII
would
be
prescribed
intravenously
to
replace
the
missing
clotting
factor
and
minimize
the
bleeding.
Factor
X
and
iron
are
not
used
to
treat
children
with
hemophilia
A.
7.
The
nurse
is
instructing
the
parents
of
a
child
with
iron
deficiency
anemia
regarding
the
administration
of
a
liquid
oral
iron
supplement.
Which
instruction
should
the
nurse
tell
the
parents?
=
1.
Administer
the
iron
at
mealtimes.
3.
Mix
the
iron
with
cereal
to
administer.
2.
Administer
the
iron
through
a
straw.
4.
Add
the
iron
to
formula
for
easy
administration.
Rationale:
In
iron
deficiency
anemia,
iron
stores
are
depleted,
resulting
in
a
decreased
supply
of
iron
for
the
manufacture
of
hemoglobin
in
red
blood
cells.
An
oral
iron
supplement
should
be
administered
through
a
straw
or
medicine
dropper
placed
at
the
back
of
the
mouth
because
the
iron
stains
the
teeth.
The
parents
should
be
instructed
to
brush
or
wipe
the
child's
teeth
or
have
the
child
brush
the
teeth
after
administration.
Iron
is
administered
between
meals
because
absorption
is
decreased
if
there
is
food
in
the
stomach.
Iron
requires
an
acid
environment
to
facilitate
its
absorption
in
the
duodenum.
Iron
is
not
added
to
formula
or
mixed
with
cereal
or
other
food
items.
8.
Laboratory
studies
are
performed
for
a
child
suspected
to
have
iron
deficiency
anemia.
The
nurse
reviews
the
laboratory
results,
knowing
that
which
result
indicates
this
type
of
anemia?
=
1.
Elevated
hemoglobin
level
3.
Elevated
red
blood
cell
count
2.
Decreased
reticulocyte
count
4.
Red
blood
cells
that
are
microcytic
and
hypochromic
,03-‐03-‐15:
Saunders
Online
Questions
Bank;
PEDS;
gastrointestinal,
Hematological,
Immune,
Infections
and
communicable
diseases,
Metabolic/endocrine,
Renal
and
Urinary.
Rationale:
In
iron
deficiency
anemia,
iron
stores
are
depleted,
resulting
in
a
decreased
supply
of
iron
for
the
manufacture
of
hemoglobin
in
red
blood
cells.
The
results
of
a
complete
blood
cell
count
in
children
with
iron
deficiency
anemia
show
decreased
hemoglobin
levels
and
microcytic
and
hypochromic
red
blood
cells.
The
red
blood
cell
count
is
decreased.
The
reticulocyte
count
is
usually
normal
or
slightly
elevated.
9.
The
nurse
is
conducting
staff
in-‐service
training
on
von
Willebrand's
disease.
Which
should
the
nurse
include
as
characteristics
of
von
Willebrand's
disease?
Select
all
that
apply.
1.
Easy
bruising
occurs.
2.
Gum
bleeding
occurs.
3.
It
is
a
hereditary
bleeding
disorder.
4.
Treatment
and
care
are
similar
to
that
for
hemophilia.
5.
It
is
characterized
by
extremely
high
creatinine
levels.
6.
The
disorder
causes
platelets
to
adhere
to
damaged
endothelium
Rationale:
von
Willebrand's
disease
is
a
hereditary
bleeding
disorder
characterized
by
a
deficiency
of
or
a
defect
in
a
protein
termed
von
Willebrand
factor.
The
disorder
causes
platelets
to
adhere
to
damaged
endothelium.
It
is
characterized
by
an
increased
tendency
to
bleed
from
mucous
membranes.
Assessment
findings
include
epistaxis,
gum
bleeding,
easy
bruising,
and
excessive
menstrual
bleeding.
An
elevated
creatinine
level
is
not
associated
with
this
disorder.
10.
A
school-‐age
child
with
type
1
diabetes
mellitus
has
soccer
practice
three
afternoons
a
week.
The
school
nurse
provides
instructions
regarding
how
to
prevent
hypoglycemia
during
practice.
Which
should
the
school
nurse
tell
the
child
to
do?
1.
Eat
twice
the
amount
normally
eaten
at
lunchtime.
2.
Take
half
the
amount
of
prescribed
insulin
on
practice
days.
3.
Take
the
prescribed
insulin
at
noontime
rather
than
in
the
morning.
4.
Eat
a
small
box
of
raisins
or
drink
a
cup
of
orange
juice
before
soccer
practice.
Rationale:
Hypoglycemia
is
a
blood
glucose
level
less
than
70
mg/dL
and
results
from
too
much
insulin,
not
enough
food,
or
excessive
activity.
An
extra
snack
of
15
to
30
g
of
carbohydrates
eaten
before
activities
such
as
soccer
practice
would
prevent
hypoglycemia.
A
small
box
of
raisins
or
a
cup
of
orange
juice
provides
15
to
30
g
of
carbohydrates.
The
child
or
parents
should
not
be
instructed
to
adjust
the
amount
or
time
of
insulin
administration.
Meal
amounts
should
not
be
doubled.
11.
The
mother
of
a
6-‐year-‐old
child
who
has
type
1
diabetes
mellitus
calls
a
clinic
nurse
and
tells
the
nurse
that
the
child
has
been
sick.
The
mother
reports
that
she
checked
the
child's
urine
and
it
was
positive
for
ketones.
The
nurse
should
instruct
the
mother
to
take
which
action?
1.
Hold
the
next
dose
of
insulin.
2.
Come
to
the
clinic
immediately.
3.
Encourage
the
child
to
drink
liquids.
4.
Administer
an
additional
dose
of
regular
insulin.
, 03-‐03-‐15:
Saunders
Online
Questions
Bank;
PEDS;
gastrointestinal,
Hematological,
Immune,
Infections
and
communicable
diseases,
Metabolic/endocrine,
Renal
and
Urinary.
Rationale:
When
the
child
is
sick,
the
mother
should
test
for
urinary
ketones
with
each
voiding.
If
ketones
are
present,
liquids
are
essential
to
aid
in
clearing
the
ketones.
The
child
should
be
encouraged
to
drink
liquids.
Bringing
the
child
to
the
clinic
immediately
is
unnecessary.
Insulin
doses
should
not
be
adjusted
or
changed.
12.
A
health
care
provider
prescribes
an
intravenous
(IV)
solution
of
5%
dextrose
and
half-‐normal
saline
(0.45%)
with
40
mEq
of
potassium
chloride
for
a
child
with
hypotonic
dehydration.
The
nurse
performs
which
priority
assessment
before
administering
this
IV
prescription?
1.
Obtains
a
weight
2.
Takes
the
temperature
3.
Takes
the
blood
pressure
4.
Checks
the
amount
of
urine
output
Rationale:
In
hypotonic
dehydration,
electrolyte
loss
exceeds
water
loss.
The
priority
assessment
before
administering
potassium
chloride
intravenously
would
be
to
assess
the
status
of
the
urine
output.
Potassium
chloride
should
never
be
administered
in
the
presence
of
oliguria
or
anuria.
If
the
urine
output
is
less
than
1
to
2
mL/kg/hour,
potassium
chloride
should
not
be
administered.
Although
options
1,
2,
and
3
are
appropriate
assessments
for
a
child
with
dehydration,
these
assessments
are
not
related
specifically
to
the
IV
administration
of
potassium
chloride.
13.
An
adolescent
client
with
type
1
diabetes
mellitus
is
admitted
to
the
emergency
department
for
treatment
of
diabetic
ketoacidosis.
Which
assessment
findings
should
the
nurse
expect
to
note?
1. Sweating
and
tremors
2.
Hunger
and
hypertension
3.
Cold,
clammy
skin
and
irritability
4.
Fruity
breath
odor
and
decreasing
level
of
consciousness
Rationale:
Diabetic
ketoacidosis
is
a
complication
of
diabetes
mellitus
that
develops
when
a
severe
insulin
deficiency
occurs.
Hyperglycemia
occurs
with
diabetic
ketoacidosis.
Signs
of
hyperglycemia
include
fruity
breath
odor
and
a
decreasing
level
of
consciousness.
Hunger
can
be
a
sign
of
hypoglycemia
or
hyperglycemia,
but
hypertension
is
not
a
sign
of
diabetic
ketoacidosis.
Hypotension
occurs
because
of
a
decrease
in
blood
volume
related
to
the
dehydrated
state
that
occurs
during
diabetic
ketoacidosis.
Cold
clammy
skin,
irritability,
sweating,
and
tremors
all
are
signs
of
hypoglycemia.
14.
A
mother
brings
her
3-‐week-‐old
infant
to
a
clinic
for
a
phenylketonuria
rescreening
blood
test.
The
test
indicates
a
serum
phenylalanine
level
of
1
mg/dL.
The
nurse
reviews
this
result
and
makes
which
interpretation?
1.
It
is
positive.
2.
It
is
negative.
3.
It
is
inconclusive.
4.
It
requires
rescreening
at
age
6
weeks
Rationale:
Phenylketonuria
is
a
genetic
(autosomal
recessive)
disorder
that
results
in
central
nervous
system
damage
from
toxic
levels
of
phenylalanine
(an
essential
amino
acid)
in
the
blood.
It
is
characterized
by
blood
phenylalanine
levels
greater
than
20
mg/dL
(normal
level
is
1.2
to
3.4
mg/dL
in
newborns
and
0.8
to
1.8
mg/dL
thereafter).
A
result
of
1
mg/dL
is
a
negative
test
result.
