NUR 254 Exam 4 Review: Questions & Answers
UNIT 9
Iron Deficiency Anemia
An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is:
a. Anorexic, vomiting, and has watery stools.
b. Thin, energetic, and sleeps little.
c. Flushed, fussy, and tired
d. Lethargic, pale, and irritable.
ANS: D
Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron-deficiency anemia. A child with a
hemoglobin level of 6.5 mg/dL has anemia. Typically these children will not be thin, energetic, anorexic, have GI
complaints, or flushed. They may be tired, fussy, and sleep a lot.
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should
recommend that the infant be given:
a. Skim milk.
b. c. Commercial iron-fortified formula.
c. Whole cows milk.
d. d. Commercial formula without iron.
ANS: C
For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If
breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cows milk should not be
used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron - fortified
formula will help prevent the development of iron deficiency anemia.
Which statement best explains why iron deficiency anemia is common during toddlerhood?
a. Milk is a poor source of iron.
b. Iron cannot be stored during fetal development.
c. Fetal iron stores are depleted by age 1 month.
d. Dietary iron cannot be started until age 12 months.
ANS: A
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 age 5 to 6 months. Dietary iron can be introduced by
breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.
,When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should
include that:
a. They should be given with meals.
b. They should be stopped immediately if nausea and vomiting occur.
c. Adequate dosage will turn the stools a tarry green color.
d. Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.
ANS: C
The nurse should prepare the mother for the anticipated change in the childs stools. If the iron dose is adequate the
stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be
given in two divided doses between meals, when the presence of free hydrochloric acid is greatest. Iron is absorbed
best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron
should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid
preparations of iron stain the teeth. They should be administered through a straw, and the mouth rinsed after
administration.
Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include:
a. Administering with meals.
b. Administering between meals.
c. Injecting deeply into a large muscle.
d. Massaging injection site for 5 minutes after administration of drug.
ANS: C
Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle
using the Z-track method. Iron dextran is for intramuscular or intravenous administration; it is not taken orally. The
site should not be massaged to prevent leakage, potential irritation, and staining of the skin.
The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should
she or he suggest?
a. Iron (ferrous sulfate) drops after age 1 month.
b. Iron-fortified commercial formula can be used by ages 4 to 6 months.
c. Iron-fortified infant cereal can be introduced at age 2 months.
d. Iron-fortified infant cereal can be introduced at approximately 6 months of age. ANS: D
Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is
necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated.
Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue
breastfeeding.
Sickle Cell Anemia
A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:
a. Aplastic anemia. c. Thalassemia major.
,b. Sickle cell anemia. d. Iron deficiency anemia.
ANS: B
Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult
hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced.
Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for
coagulation. Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal
hemoglobin.
Which statement most accurately describes the pathologic changes of sickle cell anemia?
a. Sickle-shaped cells carry excess oxygen.
b. Sickle-shaped cells decrease blood viscosity.
c. Increased red blood cell destruction occurs.
d. Decreased red blood cell destruction occurs.
ANS: C
The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused
by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle
shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they
are involved in the microcirculation.
Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-
occlusive crisis?
a. Circulatory collapse
b. Cardiomegaly, systolic murmurs
c. Hepatomegaly, intrahepatic cholestasis
d. Painful swelling of hands and feet, painful joints
ANS: D
A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful
swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if
in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly,
systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso- occlusive phenomena.
A school-age child is admitted in vaso-occlusive sickle cell crisis. The childs care should include:
a. Correction of acidosis.
b. Adequate hydration and pain management.
c. Pain management and administration of heparin.
d. Adequate oxygenation and replacement of factor VIII.
ANS: B
The management of crises includes adequate hydration, minimizing energy expenditures, pain management,
electrolyte replacement, and blood component therapy if indicated. The acidosis will be corrected as the crisis is
treated. Heparin and factor VIII are not indicated in the treatment of vaso-occlusive sickle cell crisis. Oxygen may
prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.
The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic
, analgesics causing addiction. The nurse should explain that narcotic analgesics: a. Are often ordered but not usually
needed.
b. Rarely cause addiction because they are medically indicated.
c. Are given as a last resort because of the threat of addiction.
d. Are used only if other measures such as ice packs are ineffective.
ANS: B
The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to-moderate pain can be controlled
by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock.
Patient-controlled analgesia reinforces the patients role and responsibility in managing the pain and provides
flexibility in dealing with pain. Few if any patients who receive opioids for severe pain become behaviorally addicted
to the drug. Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis. Ice is
contraindicated because of its vasoconstrictive effects.
Hemophilia
As related to inherited disorders, which statement is descriptive of most cases of hemophilia?
a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction
b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding
c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient
d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped
ANS: C
The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of
the disorder are factor VIII deficiency (hemophilia A or classic hemophilia), and factor IX deficiency (hemophilia B or
Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or
the Y chromosome.
What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?
a. Immobilization and elevation of the affected joint
b. Administration of acetaminophen for pain relief
c. Assessment of the childs response to hospitalization
d. Assessment of the impact of hospitalization on the family system
ANS: A
Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. Although
acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing
intervention. Assessment of a childs response to hospitalization is relevant to all hospitalized children; however, in this
situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the
management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all
hospitalized children; however, it is not the priority in this situation.
The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should
the nurse plan to implement for this child (Select all that apply)?
UNIT 9
Iron Deficiency Anemia
An assessment of a 7-month-old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is:
a. Anorexic, vomiting, and has watery stools.
b. Thin, energetic, and sleeps little.
c. Flushed, fussy, and tired
d. Lethargic, pale, and irritable.
ANS: D
Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron-deficiency anemia. A child with a
hemoglobin level of 6.5 mg/dL has anemia. Typically these children will not be thin, energetic, anorexic, have GI
complaints, or flushed. They may be tired, fussy, and sleep a lot.
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should
recommend that the infant be given:
a. Skim milk.
b. c. Commercial iron-fortified formula.
c. Whole cows milk.
d. d. Commercial formula without iron.
ANS: C
For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If
breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cows milk should not be
used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron - fortified
formula will help prevent the development of iron deficiency anemia.
Which statement best explains why iron deficiency anemia is common during toddlerhood?
a. Milk is a poor source of iron.
b. Iron cannot be stored during fetal development.
c. Fetal iron stores are depleted by age 1 month.
d. Dietary iron cannot be started until age 12 months.
ANS: A
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 age 5 to 6 months. Dietary iron can be introduced by
breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.
,When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should
include that:
a. They should be given with meals.
b. They should be stopped immediately if nausea and vomiting occur.
c. Adequate dosage will turn the stools a tarry green color.
d. Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.
ANS: C
The nurse should prepare the mother for the anticipated change in the childs stools. If the iron dose is adequate the
stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be
given in two divided doses between meals, when the presence of free hydrochloric acid is greatest. Iron is absorbed
best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron
should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid
preparations of iron stain the teeth. They should be administered through a straw, and the mouth rinsed after
administration.
Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include:
a. Administering with meals.
b. Administering between meals.
c. Injecting deeply into a large muscle.
d. Massaging injection site for 5 minutes after administration of drug.
ANS: C
Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle
using the Z-track method. Iron dextran is for intramuscular or intravenous administration; it is not taken orally. The
site should not be massaged to prevent leakage, potential irritation, and staining of the skin.
The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should
she or he suggest?
a. Iron (ferrous sulfate) drops after age 1 month.
b. Iron-fortified commercial formula can be used by ages 4 to 6 months.
c. Iron-fortified infant cereal can be introduced at age 2 months.
d. Iron-fortified infant cereal can be introduced at approximately 6 months of age. ANS: D
Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is
necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated.
Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue
breastfeeding.
Sickle Cell Anemia
A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:
a. Aplastic anemia. c. Thalassemia major.
,b. Sickle cell anemia. d. Iron deficiency anemia.
ANS: B
Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult
hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced.
Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for
coagulation. Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal
hemoglobin.
Which statement most accurately describes the pathologic changes of sickle cell anemia?
a. Sickle-shaped cells carry excess oxygen.
b. Sickle-shaped cells decrease blood viscosity.
c. Increased red blood cell destruction occurs.
d. Decreased red blood cell destruction occurs.
ANS: C
The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused
by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle
shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they
are involved in the microcirculation.
Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-
occlusive crisis?
a. Circulatory collapse
b. Cardiomegaly, systolic murmurs
c. Hepatomegaly, intrahepatic cholestasis
d. Painful swelling of hands and feet, painful joints
ANS: D
A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful
swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if
in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly,
systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso- occlusive phenomena.
A school-age child is admitted in vaso-occlusive sickle cell crisis. The childs care should include:
a. Correction of acidosis.
b. Adequate hydration and pain management.
c. Pain management and administration of heparin.
d. Adequate oxygenation and replacement of factor VIII.
ANS: B
The management of crises includes adequate hydration, minimizing energy expenditures, pain management,
electrolyte replacement, and blood component therapy if indicated. The acidosis will be corrected as the crisis is
treated. Heparin and factor VIII are not indicated in the treatment of vaso-occlusive sickle cell crisis. Oxygen may
prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.
The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic
, analgesics causing addiction. The nurse should explain that narcotic analgesics: a. Are often ordered but not usually
needed.
b. Rarely cause addiction because they are medically indicated.
c. Are given as a last resort because of the threat of addiction.
d. Are used only if other measures such as ice packs are ineffective.
ANS: B
The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to-moderate pain can be controlled
by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock.
Patient-controlled analgesia reinforces the patients role and responsibility in managing the pain and provides
flexibility in dealing with pain. Few if any patients who receive opioids for severe pain become behaviorally addicted
to the drug. Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis. Ice is
contraindicated because of its vasoconstrictive effects.
Hemophilia
As related to inherited disorders, which statement is descriptive of most cases of hemophilia?
a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction
b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding
c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient
d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped
ANS: C
The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of
the disorder are factor VIII deficiency (hemophilia A or classic hemophilia), and factor IX deficiency (hemophilia B or
Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or
the Y chromosome.
What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?
a. Immobilization and elevation of the affected joint
b. Administration of acetaminophen for pain relief
c. Assessment of the childs response to hospitalization
d. Assessment of the impact of hospitalization on the family system
ANS: A
Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. Although
acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing
intervention. Assessment of a childs response to hospitalization is relevant to all hospitalized children; however, in this
situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the
management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all
hospitalized children; however, it is not the priority in this situation.
The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should
the nurse plan to implement for this child (Select all that apply)?
