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Chapter 28 the Child with Hematologic or
Immunologic Dysfunction
MULTIPLE CHOICE
1. 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
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.
DIF: Cognitive Level: Understanding REF: MCS: 1324
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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2. 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
Anemia is a condition in which the number of red blood cells or hemoglobin concentration is
reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of
blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of
anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia,
but the definition depends on the decreased oxygen-carrying capacity of the blood.
DIF: Cognitive Level: Understanding REF: MCS: 1328
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
3. 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
The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl. When
the oxygen-carrying capacity of the blood decreases slowly, the child is able to compensate by
increasing cardiac output. With the increasing workload of the heart, additional stress can lead to
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cardiac failure. Reduction of environmental stimulation can help minimize energy expenditure,
but seizures are not a risk. A repeat hemoglobin analysis is not necessary. The child does not
have evidence of dehydration. If intravenous fluids are given, they can further dilute the
circulating blood volume and increase the strain on the heart.
DIF: Cognitive Level: Applying REF: MCS: 1329
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
4. 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
The indication for RBC transfusion is risk of cardiac decompensation. When the number of
circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the
child will have more energy. Parental visiting is not dependent on transfusion. The decrease in
tissue hypoxia will minimize the risk of infection. There is no evidence that the child is currently
infected. Forming a clot is the function of platelets.
DIF: Cognitive Level: Applying REF: MCS: 1329
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
5. An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has
developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough.
These manifestations are most suggestive of what complication?
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a. Air embolism
b. Allergic reaction
c. Hemolytic reaction
d. Circulatory overload
ANS: D
The signs of circulatory overload include distended neck veins, hypertension, crackles, a dry
cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing,
sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing, asthmatic wheezing, and
laryngeal edema are signs and symptoms of allergic reactions. Hemolytic reactions are
characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest,
flank pain, red or black urine, and progressive signs of shock and renal failure.
DIF: Cognitive Level: Applying REF: MCS: 1332
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
6. 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
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.
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Chapter 28 the Child with Hematologic or
Immunologic Dysfunction
MULTIPLE CHOICE
1. 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
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.
DIF: Cognitive Level: Understanding REF: MCS: 1324
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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2. 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
Anemia is a condition in which the number of red blood cells or hemoglobin concentration is
reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of
blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of
anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia,
but the definition depends on the decreased oxygen-carrying capacity of the blood.
DIF: Cognitive Level: Understanding REF: MCS: 1328
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
3. 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
The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl. When
the oxygen-carrying capacity of the blood decreases slowly, the child is able to compensate by
increasing cardiac output. With the increasing workload of the heart, additional stress can lead to
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cardiac failure. Reduction of environmental stimulation can help minimize energy expenditure,
but seizures are not a risk. A repeat hemoglobin analysis is not necessary. The child does not
have evidence of dehydration. If intravenous fluids are given, they can further dilute the
circulating blood volume and increase the strain on the heart.
DIF: Cognitive Level: Applying REF: MCS: 1329
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
4. 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
The indication for RBC transfusion is risk of cardiac decompensation. When the number of
circulating RBCs is increased, tissue hypoxia decreases, cardiac function is improved, and the
child will have more energy. Parental visiting is not dependent on transfusion. The decrease in
tissue hypoxia will minimize the risk of infection. There is no evidence that the child is currently
infected. Forming a clot is the function of platelets.
DIF: Cognitive Level: Applying REF: MCS: 1329
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
5. An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has
developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough.
These manifestations are most suggestive of what complication?
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a. Air embolism
b. Allergic reaction
c. Hemolytic reaction
d. Circulatory overload
ANS: D
The signs of circulatory overload include distended neck veins, hypertension, crackles, a dry
cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing,
sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing, asthmatic wheezing, and
laryngeal edema are signs and symptoms of allergic reactions. Hemolytic reactions are
characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest,
flank pain, red or black urine, and progressive signs of shock and renal failure.
DIF: Cognitive Level: Applying REF: MCS: 1332
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
6. 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
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.
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