Chapter 35: The Child with Hematologic or Immunologic Dysfunction

Chapter 35: The Child with Hematologic or Immunologic Dysfunction

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The regulation of red blood cell (RBC) production is thought to be controlled by:

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: Comprehension     REF:   p. 1416

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

2. Which of the following is an accurate description of the physiologic defect caused by 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: Comprehension     REF:   p. 1416

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

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, the nurse’s priority intervention is to:

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 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: Comprehension     REF:   p. 1417

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

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 to:

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: Application           REF:   p. 1417

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies