NURS 355 Chapter 30 Questions With Complete Solutions
A 5-year-old child is admitted to the hospital in a sickle cell
crisis. The child has been alert and oriented but in severe pain.
The nurse notes that the child is complaining of a headache and
is having unilateral hemiplegia. What action should the nurse
implement? Correct Answer Notify the health care provider
Any number of neurologic symptoms can indicate a minor
cerebral insult, such as headache, aphasia, weakness,
convulsions, visual disturbances, or unilateral hemiplegia. Loss
of vision is usually the result of progressive retinopathy and
retinal detachment. The nurse should notify the health care
provider.
A child with hemophilia A is scheduled for surgery. What
precautions should the nurse institute with this child? Correct
Answer Handle the child gently when transferring to a cart
The goal of prevention of bleeding episodes is directed toward
decreasing the risk of injury. The child should be handled
carefully when transferring to a cart. Brushing teeth, use of tape,
and giving analgesics will not risk a bleeding episode.
A child with hemophilia A will have which abnormal laboratory
result? Correct Answer PTT (partial thromboplastin time)
The basic defect of hemophilia A is a deficiency of factor VIII.
The partial thromboplastin time measures abnormalities in the
intrinsic pathway (abnormalities in factors I, II, V, VIII, IX, X,
XII, HMK, and KAL). The prothrombin time measures
,abnormalities of the extrinsic pathway (abnormalities in factors
I, II, V, VII, and X). Fibrinogen level is not dependent on the
intrinsic pathway. Platelets are not affected with hemophilia A.
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? Correct Answer Increase her
energy so she will not be so tired
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.
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? Correct Answer Notify the practitioner
because chest syndrome is suspected
These are the symptoms of chest syndrome, which is a medical
emergency. Notifying the practitioner is the priority action.
Oxygen may be indicated; however, it does not reverse the
sickling that has occurred. Antibiotics are not indicated initially.
Pain medications may be required, but evaluation by the
practitioner is the priority.
, A child with sickle cell disease is in a vasoocclusive crisis. What
nonpharmacologic pain intervention should the nurse plan?
Correct Answer Heat to the affected area
Frequently, heat to the affected area is soothing. Cold
compresses are not applied to the area because doing so
enhances vasoconstriction and occlusion. Bed rest is usually
well tolerated during a crisis, although the actual rest obtained
depends a great deal on pain alleviation and the use of organized
schedules of nursing care. Although the objective of bed rest is
to minimize oxygen consumption, some activity, particularly
passive range of motion exercises, is beneficial to promote
circulation. Usually the best course is to let children determine
their activity tolerance. Elevating the extremity will not help in
sickle cell disease.
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?
Correct Answer Minimize energy expenditure to decrease
cardiac workload.
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 cardiac failure. Reduction of
environmental stimulation can help minimize energy
A 5-year-old child is admitted to the hospital in a sickle cell
crisis. The child has been alert and oriented but in severe pain.
The nurse notes that the child is complaining of a headache and
is having unilateral hemiplegia. What action should the nurse
implement? Correct Answer Notify the health care provider
Any number of neurologic symptoms can indicate a minor
cerebral insult, such as headache, aphasia, weakness,
convulsions, visual disturbances, or unilateral hemiplegia. Loss
of vision is usually the result of progressive retinopathy and
retinal detachment. The nurse should notify the health care
provider.
A child with hemophilia A is scheduled for surgery. What
precautions should the nurse institute with this child? Correct
Answer Handle the child gently when transferring to a cart
The goal of prevention of bleeding episodes is directed toward
decreasing the risk of injury. The child should be handled
carefully when transferring to a cart. Brushing teeth, use of tape,
and giving analgesics will not risk a bleeding episode.
A child with hemophilia A will have which abnormal laboratory
result? Correct Answer PTT (partial thromboplastin time)
The basic defect of hemophilia A is a deficiency of factor VIII.
The partial thromboplastin time measures abnormalities in the
intrinsic pathway (abnormalities in factors I, II, V, VIII, IX, X,
XII, HMK, and KAL). The prothrombin time measures
,abnormalities of the extrinsic pathway (abnormalities in factors
I, II, V, VII, and X). Fibrinogen level is not dependent on the
intrinsic pathway. Platelets are not affected with hemophilia A.
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? Correct Answer Increase her
energy so she will not be so tired
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.
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? Correct Answer Notify the practitioner
because chest syndrome is suspected
These are the symptoms of chest syndrome, which is a medical
emergency. Notifying the practitioner is the priority action.
Oxygen may be indicated; however, it does not reverse the
sickling that has occurred. Antibiotics are not indicated initially.
Pain medications may be required, but evaluation by the
practitioner is the priority.
, A child with sickle cell disease is in a vasoocclusive crisis. What
nonpharmacologic pain intervention should the nurse plan?
Correct Answer Heat to the affected area
Frequently, heat to the affected area is soothing. Cold
compresses are not applied to the area because doing so
enhances vasoconstriction and occlusion. Bed rest is usually
well tolerated during a crisis, although the actual rest obtained
depends a great deal on pain alleviation and the use of organized
schedules of nursing care. Although the objective of bed rest is
to minimize oxygen consumption, some activity, particularly
passive range of motion exercises, is beneficial to promote
circulation. Usually the best course is to let children determine
their activity tolerance. Elevating the extremity will not help in
sickle cell disease.
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?
Correct Answer Minimize energy expenditure to decrease
cardiac workload.
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 cardiac failure. Reduction of
environmental stimulation can help minimize energy
