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NUR 230 Exam 4 Childbearing and Pediatric
Nursing 2026/2027 Study Questions with Verified
Answers and Detailed Rationales Grade A - Galen
1. What are the clinical manifestations of sickle cell anemia (vaso-
occlusive crisis)?
Correct Answer: Pain in area(s) of involvement; manifestations related
to ischemia of involved areas. Extremities: painful swelling of hands and
feet (sickle cell dactylitis, or hand-foot syndrome), painful joints;
Abdomen: severe pain resembling acute surgical condition; Cerebrum:
stroke, visual disturbances; Chest: symptoms resembling pneumonia,
protracted episodes of pulmonary disease; Liver: obstructive jaundice,
hepatic coma; Kidney: hematuria; Genitalia: priapism (persistent painful
penile erection).
Rationale:
1. Vaso-occlusive crisis causes ischemia and pain in affected areas.
2. Dactylitis (hand-foot syndrome) is often the first manifestation.
3. Priapism is a urologic emergency.
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2. What is a sequestration crisis in sickle cell anemia?
Correct Answer: Pooling of large amounts of blood; hepatomegaly;
splenomegaly; circulatory collapse.
Rationale:
1. Sequestration crisis is a medical emergency.
2. Blood pools in the spleen (or liver), causing hypovolemic shock.
3. Splenomegaly is massive and rapid.
3. What are the effects of chronic vaso-occlusive phenomena in sickle
cell anemia?
Correct Answer: Heart: cardiomegaly, systolic murmurs; Lungs: altered
pulmonary function, susceptibility to infections, pulmonary
insufficiency; Kidneys: inability to concentrate urine, enuresis,
progressive renal failure; Liver: hepatomegaly, cirrhosis, intrahepatic
cholestasis; Spleen: splenomegaly, susceptibility to infection, functional
reduction in splenic activity progressing to autosplenectomy; Eyes:
intraocular abnormalities with visual disturbances, sometimes
progressive retinal detachment and blindness; Extremities: avascular
necrosis of hip or shoulder, skeletal deformities (especially lordosis and
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kyphosis), chronic leg ulcers, susceptibility to osteomyelitis; Central
nervous system (CNS): hemiparesis, seizures.
Rationale:
1. Chronic organ damage occurs over time.
2. Autosplenectomy leads to functional asplenia by age 6.
3. Avascular necrosis causes joint destruction.
4. What is the therapeutic management of sickle cell disease?
Correct Answer: The main objectives are to: (1) rest to minimize energy
expenditure and to improve oxygen use; (2) hydration through oral and
IV therapy; (3) electrolyte replacement because hypoxia results in
metabolic acidosis, which also promotes sickling; (4) analgesia for the
severe pain from vaso-occlusion; (5) blood replacement to treat
progressing severe anemia; (6) antibiotic therapy to treat any existing
infection.
Rationale:
1. Hydration reduces blood viscosity and sickling.
2. Pain management with opioids is essential.
3. Penicillin prophylaxis prevents pneumococcal sepsis.
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5. What vaccines are recommended for children with sickle cell disease?
Correct Answer: Pneumococcal, yearly Haemophilus influenzae, and
meningococcal vaccines are recommended for these children because of
their susceptibility to infection as a result of functional asplenia.
Rationale:
1. Functional asplenia increases risk of encapsulated bacterial infections.
2. Pneumococcal and meningococcal vaccines are essential.
3. Yearly influenza vaccine is also recommended.
6. What is hemophilia?
Correct Answer: A group of bleeding disorders resulting from a
deficiency of specific coagulation proteins.
Rationale:
1. Hemophilia A (factor VIII) is most common.
2. Hemophilia B (factor IX) is less common.
3. X-linked recessive inheritance (males affected).
7. What are the assessment findings in hemophilia?
Correct Answer: Abnormal bleeding in response to trauma or surgery
(sometimes detected after circumcision); epistaxis (nosebleeds); joint
NUR 230 Exam 4 Childbearing and Pediatric
Nursing 2026/2027 Study Questions with Verified
Answers and Detailed Rationales Grade A - Galen
1. What are the clinical manifestations of sickle cell anemia (vaso-
occlusive crisis)?
Correct Answer: Pain in area(s) of involvement; manifestations related
to ischemia of involved areas. Extremities: painful swelling of hands and
feet (sickle cell dactylitis, or hand-foot syndrome), painful joints;
Abdomen: severe pain resembling acute surgical condition; Cerebrum:
stroke, visual disturbances; Chest: symptoms resembling pneumonia,
protracted episodes of pulmonary disease; Liver: obstructive jaundice,
hepatic coma; Kidney: hematuria; Genitalia: priapism (persistent painful
penile erection).
Rationale:
1. Vaso-occlusive crisis causes ischemia and pain in affected areas.
2. Dactylitis (hand-foot syndrome) is often the first manifestation.
3. Priapism is a urologic emergency.
,2|Page
2. What is a sequestration crisis in sickle cell anemia?
Correct Answer: Pooling of large amounts of blood; hepatomegaly;
splenomegaly; circulatory collapse.
Rationale:
1. Sequestration crisis is a medical emergency.
2. Blood pools in the spleen (or liver), causing hypovolemic shock.
3. Splenomegaly is massive and rapid.
3. What are the effects of chronic vaso-occlusive phenomena in sickle
cell anemia?
Correct Answer: Heart: cardiomegaly, systolic murmurs; Lungs: altered
pulmonary function, susceptibility to infections, pulmonary
insufficiency; Kidneys: inability to concentrate urine, enuresis,
progressive renal failure; Liver: hepatomegaly, cirrhosis, intrahepatic
cholestasis; Spleen: splenomegaly, susceptibility to infection, functional
reduction in splenic activity progressing to autosplenectomy; Eyes:
intraocular abnormalities with visual disturbances, sometimes
progressive retinal detachment and blindness; Extremities: avascular
necrosis of hip or shoulder, skeletal deformities (especially lordosis and
,3|Page
kyphosis), chronic leg ulcers, susceptibility to osteomyelitis; Central
nervous system (CNS): hemiparesis, seizures.
Rationale:
1. Chronic organ damage occurs over time.
2. Autosplenectomy leads to functional asplenia by age 6.
3. Avascular necrosis causes joint destruction.
4. What is the therapeutic management of sickle cell disease?
Correct Answer: The main objectives are to: (1) rest to minimize energy
expenditure and to improve oxygen use; (2) hydration through oral and
IV therapy; (3) electrolyte replacement because hypoxia results in
metabolic acidosis, which also promotes sickling; (4) analgesia for the
severe pain from vaso-occlusion; (5) blood replacement to treat
progressing severe anemia; (6) antibiotic therapy to treat any existing
infection.
Rationale:
1. Hydration reduces blood viscosity and sickling.
2. Pain management with opioids is essential.
3. Penicillin prophylaxis prevents pneumococcal sepsis.
, 4|Page
5. What vaccines are recommended for children with sickle cell disease?
Correct Answer: Pneumococcal, yearly Haemophilus influenzae, and
meningococcal vaccines are recommended for these children because of
their susceptibility to infection as a result of functional asplenia.
Rationale:
1. Functional asplenia increases risk of encapsulated bacterial infections.
2. Pneumococcal and meningococcal vaccines are essential.
3. Yearly influenza vaccine is also recommended.
6. What is hemophilia?
Correct Answer: A group of bleeding disorders resulting from a
deficiency of specific coagulation proteins.
Rationale:
1. Hemophilia A (factor VIII) is most common.
2. Hemophilia B (factor IX) is less common.
3. X-linked recessive inheritance (males affected).
7. What are the assessment findings in hemophilia?
Correct Answer: Abnormal bleeding in response to trauma or surgery
(sometimes detected after circumcision); epistaxis (nosebleeds); joint
