Instructor s Manual Chapter 26 Hematological Alterations. 1. A man and woman both test positive for the sickle cell trait. The couple asks the

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1 1 Instructor s Manual Chapter 26 Hematological Alterations Answers to Study Questions 1. A man and woman both test positive for the sickle cell trait. The couple asks the nurse how many of their children with have sickle cell disease. The nurse understands that when both parents carry the sickle cell trait gene: a. out of four children, only one will have the sickle cell disease. b. only male children will be affected. c. all of their children will carry the sickle cell trait. d. each pregnancy will have a 25% chance of having the disease. Answer: d. Sickle cell anemia is an autosomal recessive disorder, which means that when both parents carry the recessive gene, each pregnancy has a 25% chance of not having the disease or carrying the disease. There is a 50% chance that each pregnancy will carry the gene and a 25% chance that each pregnancy will have the disease. It is important to remember that each pregnancy is an individual event; that is, the outcome of a previous pregnancy in no way affects the outcome of the current pregnancy. 2. A 6-year-old child has been admitted to the emergency department with the diagnosis of vaso-occlusive crisis. What should the nurse anticipate as a priority medical intervention? a. IV pain medications and IV fluids

2 2 b. CBC and IV fluids c. IV antibiotics and oxygen d. transfuse platelets Answer: a. Vaso-occlusive crisis is a painful event occurring when a group of sickled red blood cells obstruct a vessel. Often this crisis can be managed at home but if the child is seeking care at an emergency room then the nurse can assume this particular crisis is very painful. IV fluids are necessary to rehydrate the child and reverse the sickling. 3. The nurse identifies which group as being most at risk for developing iron-deficiency anemia? a. school-aged children enrolled in an after-school program b. breast-fed infants under the age of 6 months c. children ages 6 months to 2 years of age d. 3- to 5-year-old children in daycare five days a week Answer: c. School-aged children regardless of their afterschool activities are at least risk of developing iron-deficiency anemia. Infants under the age of 6 month have adequate stores of iron from birth and preschool children in daycare receive supplemental dietary iron. Children ages 6 months to 2 years are most at risk due to depleting maternal stores and picky eating. 4. An important nursing intervention for the prevention of infection in a child with sickle disease includes which of the following?

3 3 a. encouraging compliance of regular exchange transfusions b. administering hepatitis b and pneumococcal vaccines c. explaining the importance of frequent urination d. preparing the child for IV replacement therapy Answer: b. Adherence to recommended immunizations including hepatitis b and pneumococcal vaccines is the only choice that prevents disease. 5. A mother of a 3-month-old infant newly diagnosed with sickle cell anemia asks the nurse why her baby does not have any symptoms. The nurse understands that most newborns are asymptomatic because: a. newborns have sufficient maternal stores of iron. b. newborns have a higher percentage of HbF. c. newborns blood is relatively high in water content. d. newborns have immature liver function. Answer: b. Newborns have a higher percentage of fetal hemoglobin (HbF) which does not sickle. Gradually HbF will be replaced with hemoglobin that does sickle (HbS). 6. The nurse is caring for a 5-year-old hemophiliac complaining of knee pain. The nurse understands that hemarthrosis predisposes the child to long-term joint dysfunction. What is an important nursing intervention? a. starting active range of motion exercises b. administering aspirin for pain relief

4 4 c. appling heat to the affected joint d. immobilizing and elevating the extremity Answer: d. Active range of motion exercises should not be started until 48 hours after ice or cold is applied to the area. Aspirin is not used for pain therapy due to the anticoagulation properties of the drug. Immobilization and elevation prevents further damage. 7. A child is admitted with immune thrombocytopenic purpura (ITP). What will the nurse anticipate the history to include? a. petechial rash following a viral infection b. frequent urinary tract infections c. recent transfusion of platelets d. recent aspirin use Answer: a. Immune thrombocytopenic purpura (ITP) is often preceded by viral infection. 8. The nurse is caring for a child with septicemia in the intensive care unit and notices blood oozing from around the arterial line. The nurse would suspect which of the following? a. hand-foot syndrome b. aplastic anemia c. hemosiderosis d. disseminated intravascular coagulation

5 5 Answer: d. DIC is a coagulation disorder in which the stimulus for coagulation overwhelms the control mechanisms that normally confine coagulation to the area of bleeding. This sequence of events can lead to hemorrhage, which in this case is seen as blood oozing from the arterial line. 9. The nurse is performing a well-baby checkup on a 12-month-old infant. What finding would be of most concern? a. cannot walk yet b. has increased bruising c. eating less variety of foods d. straining during bowel movements Answer: b. Increased bruising may be a sign of anemia, which is abnormal for a 12 month old. 10. Which of the following foods are a good dietary sources of iron? Check all that apply. a. meat b. red potatoes c. whole grains d. green beans e. canned peaches f. raisins g. seafood Answer: a, c, f & g. Red potatoes, canned peaches, and green beans are not good sources of dietary iron.