Hematologic and Immune Disorders of
the Child NCLEX Test Questions And
Actual Verified Detailed Answers.
Which of the following would the nurse most expect to find in the child with idiopathic
(immune) thrombocytopenia purpura (ITP)?
a) Platelet 10,000, Hgb 8, Hct 27%
b) Petechiae of the lip and reports of hematuria
c) Recent MMR immunization and excessive bruising on body
d) Swollen joints and complaints of pain upon walking - Answer Answer: C. See page 937. ITP
is associated with recent viral infection, and sometimes can occur following an MMR
immunization. Common signs and symptoms include excessive bruising, petechiae, and
purpura. Excessive hemorrhage is not typically noted in this patient.
The nurse is providing teaching to the parents of the child diagnosed with ITP. Which of the
following statements, if made by the parents indicates the need for further teaching?
A) We should avoid the use of aspirin and antihistamines in our child
B) Every day we should give Billy his corticosteroids at the same time each day
C) It's still important that our child remain active. Swimming would be a good thing to do with
him.
D) We should call the doctor if we see any extra bruises on his arms - Answer Answer: D.
Bruising is a common symptom of ITP. It would be more important to teach the parents of any
signs of organ damage such as changes in LOC or SOB. Aspirin, NSAID's, and antihistamines
should be avoided in patients with ITP. Contact sports should also be avoided. Corticosteroids
are prescribed to patients with severely low platelet counts for 2-3 weeks.
The nurse is assessing a child and thinks that the child may have petechiae and purpura. How
would the nurse best confirm this finding?
A) Request labs to be drawn for platelet levels
B) Palpate the lesions
C) Press on a clear area of skin to see if more spots form
D) Prepare the child for an X-ray - Answer Answer: B. Petechiae and purpura are non-
blanchable raised lesions that indicate small hemorrhages under the skin. They are often
present in children with Idiopathic Thrombocytopenia (ITP) or DIC.
, C) Increased clotting factors
D) Platelets 50,000
E) Positive fibrin split products - Answer Answer: A, D, and E. See page 938. A positive D-dimer
and positive fibrin split products would indicate the presence of excessive clotting, a key finding
in DIC. Platelets are used up quickly as these small clots are formed, causing the platelet count
to drop (which places the patient at a high risk for bleeding). PTT would be expected to be
prolonged and clotting factors would be expected to decrease.
A child with Hemophilia A comes to the ED with his parents. His parents say that he hit his head
while jumping on the trampoline outside. The child complains of a HA. Which of the following is
the nurse's priority action?
A) Assess the child's neurological status
B) Administer Factor IX to the child immediately
C) Prepare the child for an MRI
D) Teach the family that jumping on the trampoline is an inappropriate activity - Answer
Answer: A. Assessing the child's neurological status would be the first thing the nurse should do.
Administering factor would also be a priority action, but Hemophilia A is a disorder of factor VIII
therefore administering factor IX would be inappropriate. An MRI would lengthen the time until
treatment, worsening injury. Teaching would be performed last.
A nurse is providing education to a mother whose infant has just begun taking iron
supplements. Which of the following instructions should the nurse not include?
1) Dosing is based on milligrams of elemental iron.
2) The supplement should be given with orange juice or milk for better absorption.
3) The mother does not need to report black urine or stools.
4) The mother should increase the amount of fluids and fiber in the diet. - Answer Answer: 2)
The supplement should NOT be given with milk or milk products. Black urine and stools are
expected. Iron supplements can cause constipation, so increasing fiber and fluids are
appropriate. Could also use stool softeners.
A mother who inquired early last week about lead poisoning calls the clinic again crying, saying
"my son is acting so strange. I just know it's that lead poisoning!" Which of the following
symptoms, if reported by the mother, would lead the nurse to believe lead poisoning is present?
Select all that apply:
1) The child has become hyperactive lately
the Child NCLEX Test Questions And
Actual Verified Detailed Answers.
Which of the following would the nurse most expect to find in the child with idiopathic
(immune) thrombocytopenia purpura (ITP)?
a) Platelet 10,000, Hgb 8, Hct 27%
b) Petechiae of the lip and reports of hematuria
c) Recent MMR immunization and excessive bruising on body
d) Swollen joints and complaints of pain upon walking - Answer Answer: C. See page 937. ITP
is associated with recent viral infection, and sometimes can occur following an MMR
immunization. Common signs and symptoms include excessive bruising, petechiae, and
purpura. Excessive hemorrhage is not typically noted in this patient.
The nurse is providing teaching to the parents of the child diagnosed with ITP. Which of the
following statements, if made by the parents indicates the need for further teaching?
A) We should avoid the use of aspirin and antihistamines in our child
B) Every day we should give Billy his corticosteroids at the same time each day
C) It's still important that our child remain active. Swimming would be a good thing to do with
him.
D) We should call the doctor if we see any extra bruises on his arms - Answer Answer: D.
Bruising is a common symptom of ITP. It would be more important to teach the parents of any
signs of organ damage such as changes in LOC or SOB. Aspirin, NSAID's, and antihistamines
should be avoided in patients with ITP. Contact sports should also be avoided. Corticosteroids
are prescribed to patients with severely low platelet counts for 2-3 weeks.
The nurse is assessing a child and thinks that the child may have petechiae and purpura. How
would the nurse best confirm this finding?
A) Request labs to be drawn for platelet levels
B) Palpate the lesions
C) Press on a clear area of skin to see if more spots form
D) Prepare the child for an X-ray - Answer Answer: B. Petechiae and purpura are non-
blanchable raised lesions that indicate small hemorrhages under the skin. They are often
present in children with Idiopathic Thrombocytopenia (ITP) or DIC.
, C) Increased clotting factors
D) Platelets 50,000
E) Positive fibrin split products - Answer Answer: A, D, and E. See page 938. A positive D-dimer
and positive fibrin split products would indicate the presence of excessive clotting, a key finding
in DIC. Platelets are used up quickly as these small clots are formed, causing the platelet count
to drop (which places the patient at a high risk for bleeding). PTT would be expected to be
prolonged and clotting factors would be expected to decrease.
A child with Hemophilia A comes to the ED with his parents. His parents say that he hit his head
while jumping on the trampoline outside. The child complains of a HA. Which of the following is
the nurse's priority action?
A) Assess the child's neurological status
B) Administer Factor IX to the child immediately
C) Prepare the child for an MRI
D) Teach the family that jumping on the trampoline is an inappropriate activity - Answer
Answer: A. Assessing the child's neurological status would be the first thing the nurse should do.
Administering factor would also be a priority action, but Hemophilia A is a disorder of factor VIII
therefore administering factor IX would be inappropriate. An MRI would lengthen the time until
treatment, worsening injury. Teaching would be performed last.
A nurse is providing education to a mother whose infant has just begun taking iron
supplements. Which of the following instructions should the nurse not include?
1) Dosing is based on milligrams of elemental iron.
2) The supplement should be given with orange juice or milk for better absorption.
3) The mother does not need to report black urine or stools.
4) The mother should increase the amount of fluids and fiber in the diet. - Answer Answer: 2)
The supplement should NOT be given with milk or milk products. Black urine and stools are
expected. Iron supplements can cause constipation, so increasing fiber and fluids are
appropriate. Could also use stool softeners.
A mother who inquired early last week about lead poisoning calls the clinic again crying, saying
"my son is acting so strange. I just know it's that lead poisoning!" Which of the following
symptoms, if reported by the mother, would lead the nurse to believe lead poisoning is present?
Select all that apply:
1) The child has become hyperactive lately
