Chapter 28: The Child With
Hematologic Or Immunologic
Dysfunction| 2026 Update| Get It Right
The regulation of red blood cell (RBC) production is thought to be controlled
by which physiologic factor?
A. Hemoglobin
B. Tissue hypoxia
C. Reticulocyte count
D. Number of RBCs - Ans--B. Tissue hypoxia
Hemoglobin does not directly control RBC production. If there is insufficient
hemoglobin to adequately oxygenate the tissue, then erythropoietin may be
released. When tissue hypoxia occurs, the kidneys release erythropoietin
into the bloodstream. This stimulates the marrow to produce new RBCs.
Reticulocytes are immature RBCs. The retic count can be used to monitor
hematopoiesis. The number of RBCs does not directly control production.
In congenital cardiac disorders with mixed blood flow or decreased
pulmonary blood flow, RBC production continues secondary to tissue
hypoxia.
What physiologic defect is responsible for causing anemia?
a. Increased blood viscosity
b. Depressed hematopoietic system
c. Presence of abnormal hemoglobin
d. Decreased oxygen-carrying capacity of blood - Ans--d. Decreased
oxygen-carrying capacity of blood
A mother states that she brought her child to the clinic because the 3-year-
old girl was not keeping up with her siblings. During physical assessment,
the nurse notes that the child has pale skin and conjunctiva and has muscle
,weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the
practitioner of the results, what nursing priority intervention should occur
next?
a. Reduce environmental stimulation to prevent seizures.
b. Have the laboratory repeat the analysis with a new specimen.
c. Minimize energy expenditure to decrease cardiac workload.
d. Administer intravenous fluids to correct the dehydration. - Ans--c.
Minimize energy expenditure to decrease cardiac workload
A child with severe anemia requires a unit of red blood cells (RBCs). The
nurse explains to the child that the transfusion is necessary for which
reason?
a. Allow her parents to come visit her.
b. Fight the infection that she now has.
c. Increase her energy so she will not be so tired.
d. Help her body stop bleeding by forming a clot (scab). - Ans--c. Increase
her energy so she will not be so tired.
What explanation provides the rationale for why iron-deficiency anemia is
common during infancy?
a. Cows milk is a poor source of iron.
b. Iron cannot be stored during fetal development.
c. Fetal iron stores are depleted by 1 month of age.
d. Dietary iron cannot be started until 12 months of age. - Ans--a. Cows milk
is a poor source of iron
Children between the ages of 12 and 36 months are at risk for anemia
because cows milk is a major component of their diet, and it is a poor source
of iron. Iron is stored during fetal development, but the amount stored
depends on maternal iron stores. Fetal iron stores are usually depleted by
ages 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-
fortified formula, and cereals during the first 12 months of life.
What statement best describes iron deficiency anemia in infants?
,a. It is caused by depression of the hematopoietic system.
b. Diagnosis is easily made because of the infants emaciated appearance.
c. It results from a decreased intake of milk and the premature addition of
solid foods.
d. Clinical manifestations are related to a reduction in the amount of oxygen
available to tissues. - Ans--d. Clinical manifestations are related to a
reduction in the amount of oxygen available to tissues.
What information should the nurse include when teaching the mother of a 9-
month-old infant about administering liquid iron preparations?
a. Give with meals.
b. Stop immediately if nausea and vomiting occur.
c. Adequate dosage will turn the stools a tarry green color.
d. Allow preparation to mix with saliva and bathe the teeth before
swallowing. - Ans--c. Adequate dosage will turn the stools a tarry green
color.
Therapeutic management of a 6-year-old child with hereditary
spherocytosis (HS) should include which therapeutic intervention?
a. Perform a splenectomy.
b. Supplement the diet with calcium.
c. Institute a maintenance transfusion program.
d. Increase intake of iron-rich foods such as meat. - Ans--a. Perform a
splenectomy
What condition occurs when the normal adult hemoglobin is partly or
completely replaced by abnormal hemoglobin?
a. Aplastic anemia
b. Sickle cell anemia
c. Thalassemia major
d. Iron deficiency anemia - Ans--b. Sickle cell anemia
The parents of a child with sickle cell anemia (SCA) are concerned about
subsequent children having the disease. What statement most accurately
reflects inheritance of SCA?
, a. SCA is not inherited.
b. All siblings will have SCA.
c. Each sibling has a 25% chance of having SCA.
d. There is a 50% chance of siblings having SCA. - Ans--c. Each sibling has
a 25% chance of having SCA.
The clinical manifestations of sickle cell anemia (SCA) are primarily the
result of which physiologic alteration?
a. Decreased blood viscosity
b. Deficiency in coagulation
c. Increased red blood cell (RBC) destruction
d. Greater affinity for oxygen - Ans--c. Increase red blood cell (RBC)
destruction.
A child with sickle cell anemia (SCA) develops severe chest and back pain,
fever, a cough, and dyspnea. What should be the first action by the nurse?
a. Administer 100% oxygen to relieve hypoxia.
b. Notify the practitioner because chest syndrome is suspected.
c. Infuse intravenous antibiotics as soon as cultures are obtained.
d. Give ordered pain medication to relieve symptoms of pain episode. -
Ans--b. Notify the practitioner because chest syndrome is suspected.
In a child with sickle cell anemia (SCA), adequate hydration is essential to
minimize sickling and delay the vasoocclusion and hypoxiaischemia cycle.
What information should the nurse share with parents in a teaching plan?
a. Encourage drinking.
b. Keep accurate records of output.
c. Check for moist mucous membranes.
d. Monitor the concentration of the childs urine. - Ans--c. Check for moist
mucous membranes.
What statement best describes b-thalassemia major (Cooley anemia)?
a. It is an acquired hemolytic anemia.
Hematologic Or Immunologic
Dysfunction| 2026 Update| Get It Right
The regulation of red blood cell (RBC) production is thought to be controlled
by which physiologic factor?
A. Hemoglobin
B. Tissue hypoxia
C. Reticulocyte count
D. Number of RBCs - Ans--B. Tissue hypoxia
Hemoglobin does not directly control RBC production. If there is insufficient
hemoglobin to adequately oxygenate the tissue, then erythropoietin may be
released. When tissue hypoxia occurs, the kidneys release erythropoietin
into the bloodstream. This stimulates the marrow to produce new RBCs.
Reticulocytes are immature RBCs. The retic count can be used to monitor
hematopoiesis. The number of RBCs does not directly control production.
In congenital cardiac disorders with mixed blood flow or decreased
pulmonary blood flow, RBC production continues secondary to tissue
hypoxia.
What physiologic defect is responsible for causing anemia?
a. Increased blood viscosity
b. Depressed hematopoietic system
c. Presence of abnormal hemoglobin
d. Decreased oxygen-carrying capacity of blood - Ans--d. Decreased
oxygen-carrying capacity of blood
A mother states that she brought her child to the clinic because the 3-year-
old girl was not keeping up with her siblings. During physical assessment,
the nurse notes that the child has pale skin and conjunctiva and has muscle
,weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the
practitioner of the results, what nursing priority intervention should occur
next?
a. Reduce environmental stimulation to prevent seizures.
b. Have the laboratory repeat the analysis with a new specimen.
c. Minimize energy expenditure to decrease cardiac workload.
d. Administer intravenous fluids to correct the dehydration. - Ans--c.
Minimize energy expenditure to decrease cardiac workload
A child with severe anemia requires a unit of red blood cells (RBCs). The
nurse explains to the child that the transfusion is necessary for which
reason?
a. Allow her parents to come visit her.
b. Fight the infection that she now has.
c. Increase her energy so she will not be so tired.
d. Help her body stop bleeding by forming a clot (scab). - Ans--c. Increase
her energy so she will not be so tired.
What explanation provides the rationale for why iron-deficiency anemia is
common during infancy?
a. Cows milk is a poor source of iron.
b. Iron cannot be stored during fetal development.
c. Fetal iron stores are depleted by 1 month of age.
d. Dietary iron cannot be started until 12 months of age. - Ans--a. Cows milk
is a poor source of iron
Children between the ages of 12 and 36 months are at risk for anemia
because cows milk is a major component of their diet, and it is a poor source
of iron. Iron is stored during fetal development, but the amount stored
depends on maternal iron stores. Fetal iron stores are usually depleted by
ages 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-
fortified formula, and cereals during the first 12 months of life.
What statement best describes iron deficiency anemia in infants?
,a. It is caused by depression of the hematopoietic system.
b. Diagnosis is easily made because of the infants emaciated appearance.
c. It results from a decreased intake of milk and the premature addition of
solid foods.
d. Clinical manifestations are related to a reduction in the amount of oxygen
available to tissues. - Ans--d. Clinical manifestations are related to a
reduction in the amount of oxygen available to tissues.
What information should the nurse include when teaching the mother of a 9-
month-old infant about administering liquid iron preparations?
a. Give with meals.
b. Stop immediately if nausea and vomiting occur.
c. Adequate dosage will turn the stools a tarry green color.
d. Allow preparation to mix with saliva and bathe the teeth before
swallowing. - Ans--c. Adequate dosage will turn the stools a tarry green
color.
Therapeutic management of a 6-year-old child with hereditary
spherocytosis (HS) should include which therapeutic intervention?
a. Perform a splenectomy.
b. Supplement the diet with calcium.
c. Institute a maintenance transfusion program.
d. Increase intake of iron-rich foods such as meat. - Ans--a. Perform a
splenectomy
What condition occurs when the normal adult hemoglobin is partly or
completely replaced by abnormal hemoglobin?
a. Aplastic anemia
b. Sickle cell anemia
c. Thalassemia major
d. Iron deficiency anemia - Ans--b. Sickle cell anemia
The parents of a child with sickle cell anemia (SCA) are concerned about
subsequent children having the disease. What statement most accurately
reflects inheritance of SCA?
, a. SCA is not inherited.
b. All siblings will have SCA.
c. Each sibling has a 25% chance of having SCA.
d. There is a 50% chance of siblings having SCA. - Ans--c. Each sibling has
a 25% chance of having SCA.
The clinical manifestations of sickle cell anemia (SCA) are primarily the
result of which physiologic alteration?
a. Decreased blood viscosity
b. Deficiency in coagulation
c. Increased red blood cell (RBC) destruction
d. Greater affinity for oxygen - Ans--c. Increase red blood cell (RBC)
destruction.
A child with sickle cell anemia (SCA) develops severe chest and back pain,
fever, a cough, and dyspnea. What should be the first action by the nurse?
a. Administer 100% oxygen to relieve hypoxia.
b. Notify the practitioner because chest syndrome is suspected.
c. Infuse intravenous antibiotics as soon as cultures are obtained.
d. Give ordered pain medication to relieve symptoms of pain episode. -
Ans--b. Notify the practitioner because chest syndrome is suspected.
In a child with sickle cell anemia (SCA), adequate hydration is essential to
minimize sickling and delay the vasoocclusion and hypoxiaischemia cycle.
What information should the nurse share with parents in a teaching plan?
a. Encourage drinking.
b. Keep accurate records of output.
c. Check for moist mucous membranes.
d. Monitor the concentration of the childs urine. - Ans--c. Check for moist
mucous membranes.
What statement best describes b-thalassemia major (Cooley anemia)?
a. It is an acquired hemolytic anemia.
