Peds TEST-BANK25 Chapter 25: Alterations in Hematologic Function

1. A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first? A. Discontinue the transfusion. B. Obtain a blood culture. C. Give an iron-chelating agent. D. Ask the health care provide for a prescription for a diuretic. ANS: A Rationale: The child is experiencing a transfusion reaction; the first step with any transfusion reaction is to discontinue the transfusion. Oxygen should be given, and the nurse should anticipate the need for an antihistamine to reduce the child's symptoms. An iron-chelating agent would be given for hemosiderosis after repeated transfusions. A blood culture would be obtained if the child developed a fever. PTS: 1 REF: p. 483 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 25: Hematologic Disorders BLM: Cognitive Level: Apply 2. A child develops treatment-related thrombocytopenia. When preparing the plan of care for the child, which would the nurse include? Select all that apply. A. Allowing frequent blood-drawing procedures for laboratory testing B. Applying pressure to a puncture site for a full 5 minutes C. Limiting the use of adhesive tape on the child's skin D. Administering medications orally or intravenously E. Obtaining extra amounts of blood just in case when drawing blood ANS: B, C, D Rationale: With thrombocytopenia, the risk for bleeding is increased. Therefore, the nurse should institute measures to reduce this risk. Measures include limiting the number of blood-drawing procedures, applying pressure to a puncture site for a full 5 minutes, limiting the use of adhesive tape on the child' skin, administering medications orally or intravenously instead of by injection, and not drawing extra amounts of blood just in case. PTS: 1 REF: p. 509 OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 25: Hematologic Disorders BLM: Cognitive Level: Apply 3. A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 g/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: A. removal or covering of flaking paint on the walls of the home B. putting child safety locks on kitchen cabinets C. putting medicine away where children cannot reach it D. placing house plants out of reach of children ANS: A TEST BANK FOR PEDIATRIC NURSING 1ST BY TAGHER WWW.NURSING-TESTBANK.COM N U R S I N G - T E S T B A N K . C O M Rationale: The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries. A child with a blood lead level over 5 g/dL needs to be rescreened to confirm the level and then active interventions begun to prevent further lead exposure, such as removal of the child from the environment containing the lead source or removal of the source of lead from the child's environment. Removal of the lead source is not an easy task in homes because simple repainting or wallpapering does not necessarily remo