Chp43
The nurse suspects that a child with enlarged lymph nodes and fever has leukemia. Which test does the nurse evaluate to confirm the condition?
Bone marrow biopsy
Leukemia is confirmed when the bone marrow biopsy indicates that the bone marrow is hypercellular, with primarily blast cells. Peripheral blood smear is not a
definite diagnosis of leukemia because it reveals immature forms of leukocytes, frequently combined with low blood counts. Lumbar puncture is performed
after a bone marrow biopsy to determine whether there is any involvement of the central nervous system. A tourniquet test helps identify an abnormal platelet
count.
After determining a 7-month-old African American infant girl has sickle cell anemia and is having a crisis, the health care team begins therapy. What activities
would the nurse determine as priorities for this infant?
administering pain medication, initiating intravenous (IV) fluids and electrolytes, and administering oxygen
Because this infant is experiencing a vasoocclusive crisis, IV fluids and electrolytes, oxygen, and pain medication must be administered immediately to
decrease the sickling and to decrease the pain. Knowing the triggers for sickling leads to interventions to reduce the sickling. There is no need to immobilize
the infant's upper extremities. There may be a need for elbow restraints depending on where the IV site is, but not immobilization. Antibiotics might be
administered if infection is expected, but this needs to be determined first. Blood products might be administered to provide blood that is not sickling. A
transcranial Doppler test is not indicated at this time because the infant is too young and a cerebrovascular accident (CVA) is not suspected. Penicillin might be
the antibiotic used after determining that an infection is present. Demerol is contraindicated because of the side effects it can cause in children with sickle cell
anemia. The urine output will be monitored by weighing the diaper without the risk of infection because of an indwelling catheter. Rest is indicated for healing
and to conserve energy in this very ill child.
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include:
using good handwashing.
Good handwashing is the most effective means of preventing disease transmission. There is no indication that fluids should be reduced. Strict isolation is not
necessary. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine.
Nursing considerations related to the administration of chemotherapeutic drugs include:
many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates.
Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving
these drugs and be prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be
thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some
chemotherapeutic and immunologic agents.
The parents of a child taking oral iron supplements report that the child's stools are a tarry green color. What is the best response the nurse provides to the
parents?
"Tarry green color is expected with oral iron supplements."
Tarry green stools indicate that the child is taking an adequate doses of oral iron. The symptoms of iron toxicity are stomach pain, nausea, and vomiting. Asking
the parents to change the timing of the dose is not appropriate; it must be administered as prescribed. The medication should be stopped immediately if there
are any allergic symptoms or toxicity. Tarry green stools is not a side effect of taking oral iron supplements.
The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they:
help the body stop bleeding by forming a clot (scab) over the hurt area.
Platelets help the body stop bleeding by forming a clot over the hurt area. Keeping germs from causing infection is the function of white blood cells. The liquid
portion of blood is plasma. Carrying oxygen from the lungs to all parts of the body is the function of red blood cells.
The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a/an:
normally expected change caused by the iron preparation.
An adequate dosage of iron turns the stools a tarry green color. If the stools do not become a tarry green color, it may indicate administration issues.
The parent of a child with immune thrombocytopenia (ITP) asks the nurse what kind of sport activity will be beneficial for the child. What does the nurse
respond?
"Encourage swimming or walking."
A child with ITP is at risk for bleeding and easy bruising. Hence, the nurse advises the parents to encourage noncontact sports such as swimming and walking.
Gymnastics increase the risk for injury and are avoided. The nurse does not advise to stop all kinds of sport activity because it is not beneficial for the child's
physical development. Quiet indoor activities are beneficial for the child; however, any kind of vigorous physical activity indoors may also increase the risk for
injury.
Which condition in a child indicates a deficiency of one of the factors (proteins) necessary for blood coagulation?
Hemophilia
,Hemophilia is a group of bleeding disorders in which there is a deficiency of one of the clotting factors necessary for blood coagulation. Aplastic anemia is
characterized by anemia, leukopenia, and decreased platelet count. Sickle cell anemia occurs when normal hemoglobin is replaced by abnormal hemoglobin.
Apheresis refers to the process of removing blood from a patient, usually before stem cell transplantation or chemotherapy.
Which symptom is seen in a child with disseminated intravascular coagulation (DIC)?
Increased tendency to bleed
A child with DIC has an increased tendency to bleed as a result of excess thrombin and destruction of platelets. Rickettsial infections may sometimes cause
DIC. It is not a symptom of DIC. Mucosal inflammation is not a symptom of DIC. It is caused by chemotherapy. Yellow, fatty bone marrow indicates the
presence of aplastic anemia.
The nurse observes that a child experiences nausea and vomiting after chemotherapy. Which intervention does the nurse implement to prevent these side
effects?
Administers the antiemetic before chemotherapy begins
The nurse administers the antiemetic before chemotherapy begins to prevent nausea and vomiting. Dexamethasone (Decadron) is administered with serotonin-
receptor antagonists to delay emesis before the chemotherapy. The nurse provides frequent mouthwashes with normal saline to relieve mucosal ulceration
caused by chemotherapy. However, mouthwash does not prevent the side effects of chemotherapy. Administering fewer fluids after the chemotherapy session
will not help to prevent nausea and vomiting because they are caused by chemical reactions.
A child diagnosed with lymphoma is receiving extensive radiation therapy. The most common side effect of this treatment is:
fatigue.
Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be distressing especially because it means that they cannot keep up
with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of
certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.
The most important nursing consideration when caring for a child with sickle cell anemia is to:
teach parents and child how to minimize crises.
Parents need specific instructions about changes in the child's condition that they should watch for, penicillin administration, adequate hydration, and
environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple
blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly
prepared to care for them.
The nursing instructor is teaching a student how to administer iron dextran injections to a child with severe anemia. Which instruction does the nurse give after
the student administers the injection?
"Do not massage the injection site."
The nursing instructor tells the student to avoid massaging the injection site to minimize skin staining and irritation. The nurse places the patient in an
appropriate position before administering the injection. It is necessary to rotate sites because of the potential for tissue damage. The nurse disposes of the
syringe safely after administering the medication to avoid stick injuries.
The nurse finds that a child is pale, gets easily fatigued, and has lack of energy. The nurse asks the parents to get a complete blood count (CBC) test. What does
the nurse suspect from these symptoms?
Anemia
Paleness, fatigue, and lack of energy are the symptoms of anemia that can be confirmed after a CBC test. Sickle cell anemia is diagnosed by chest pain,
elevated temperature, painful joints, or hypoxia. Splenic sequestration is a symptom of sickle cell anemia, which causes an enlarged spleen. Chest syndrome is
a symptom of sickle cell anemia with signs of hypoxia, chest pain, fever, cough, and wheezing.
The nurse suspects that a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be to:
stop transfusion and maintain a patent intravenous line with normal saline and new tubing.
Stopping the transfusion is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.
Notifying the physician and taking vital signs should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should
not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.
The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains
the rationale for the nurses' action?
"We are trying to control her pain by giving her a combination of medications in small, frequent doses so she can still drink her bottle and be awake
some of the time."
The most common and debilitating symptom experienced by patients with sickle cell disease is a vasoocclusive crisis (VOC), which is accompanied by severe
pain. Combinations of medications in smaller, more manageable dosing commonly are used to enhance the pain management effect. Patient-controlled
analgesia (PCA) has been used successfully for sickle cell–related pain when the child is able to understand and push the button to receive the medication. It is
the health team's responsibility to manage the infant's pain. Tolerance to pain medication does not happen in short-term acute illnesses. It occurs more in
chronic conditions.
, Which is an ideal treatment for a child after splenectomy?
Prophylactic antibiotics
Prophylactic antibiotics are administered to the child to prevent the severe infections that the child is at risk for after a splenectomy. Iron dextran injection is
used to treat severe anemia. Diphenhydramine (Benadryl) is used to relieve pain in a child with mucosal ulceration. Intravenous heparin is used to inhibit
thrombin formation in patients with immune thrombocytopenia (ITP).
The parent of a 6-month-old infant asks the nurse about the food that can be included in the child's diet. What does the nurse suggest?
"Include cereals in the diet."
Cereals are the first semisolid foods that should be given to an infant at 6 months of age. This helps the infant accept food other than milk and prevents the risk
for anemia. The nurse does not advise feeding only breast milk because it may induce nutritional anemia. Cow's milk puts the child at risk for gastrointestinal
blood loss because of the presence of heat-labile protein in the milk. Carrots and peas are solid foods that are not digested by the infants at 6 months.
Which interventions does the nurse implement to alleviate neurotoxic effects in a child after chemotherapy? Select all that apply.
Administers stool softeners
Provides a footboard or high-top shoes
Provides support during ambulation
Provides a soft or liquid diet
The nurse administers stool softeners for severe constipation caused by decreased bowel innervations. Use of a footboard or high-top shoe prevents footdrop
that may occur from prolonged bed rest. The client needs support during ambulation because there may be weakness and numbing of the extremities. A soft or
liquid diet is provided for severe jaw pain. Mesnex (mesna) is prescribed for sterile hemorrhagic cystitis caused by chemotherapy.
The nurse is caring for a child with leukemia. Which interventions does the nurse implement to reduce the risk for hemorrhage in the child? Select all that
apply.
Avoids skin punctures when possible
Removes urine immediately after voiding
Asks the child to avoid running or biking
Provides meticulous mouth care
The nurse avoids skin punctures whenever possible to prevent bleeding and reduce the risk for infection. The nurse removes urine and feces immediately
because the rectal area is prone to ulceration, which may cause bleeding. Moreover, the nurse asks the child to avoid activities such as running and biking that
may increase the chances of injury, resulting in risk for hemorrhage. The nurse provides meticulous mouth care to the child because there is gingival bleeding
and mucositis frequently. The nurse does not give a platelet transfusion during a nosebleed; instead, the nurse uses local measures such as applying pressure to
the bleeding site to stop the bleeding.
An infant with sickle cell anemia (SCA) is prescribed the hemoglobin electrophoresis test. What is the purpose of this test?
To detect different types of hemoglobin
A hemoglobin electrophoresis test is used to detect different types of hemoglobin in the child. It further helps determine whether the child has SCA, the
homozygous form of the disease, or sickle cell C disease, the heterozygous form. A transcranial Doppler (TCD) test is used to identify whether the child with
SCA is at risk for cerebrovascular accident. Sickledex is used to confirm the presence of sickle cell anemia. Hemoglobin electrophoresis test is not used to rule
out disorders other than SCA.
The nurse finds that the hemoglobin levels in a child with anemia did not improve after taking oral iron supplements. What actions does the nurse take? Select
all that apply.
Ask the parents if they administered the prescribed doses.
Assess whether the child has gastrointestinal problems.
Assess the child for chronic hemoglobinuria.
If the hemoglobin levels in the child do not increase 1 month after taking oral iron supplements, the nurse should assess for noncompliance. The nurse should
ask the parents if the prescribed dose consistency was maintained to assess the cause of iron deficiency. The nurse also assesses whether the child has any
gastrointestinal problems that may have caused bleeding and blood loss. The nurse assesses whether the child has chronic hemoglobinuria, that is, the presence
of protein hemoglobin in urine; this may cause iron deficiency. Providing iron-rich foods will be inadequate if the child has problems such as bleeding or
hemoglobinuria. The nurse does not advise to provide fresh cow's milk because it is a poor source of iron and interferes with the absorption of iron. Fresh cow's
milk is also avoided in infants younger than 12 months because of risk for gastrointestinal blood loss.
A 7-month-old girl with sickle cell anemia is not consuming enough fluid orally as she is recovering. What suggestions by the nurse would help the parents best
as they prepare to care for their infant daughter after discharge? Select all that apply.
Count the number of bottles or ounces of fluid needed daily.
Teach the parents which foods have a high source of fluid.
The nurse suspects that a child with enlarged lymph nodes and fever has leukemia. Which test does the nurse evaluate to confirm the condition?
Bone marrow biopsy
Leukemia is confirmed when the bone marrow biopsy indicates that the bone marrow is hypercellular, with primarily blast cells. Peripheral blood smear is not a
definite diagnosis of leukemia because it reveals immature forms of leukocytes, frequently combined with low blood counts. Lumbar puncture is performed
after a bone marrow biopsy to determine whether there is any involvement of the central nervous system. A tourniquet test helps identify an abnormal platelet
count.
After determining a 7-month-old African American infant girl has sickle cell anemia and is having a crisis, the health care team begins therapy. What activities
would the nurse determine as priorities for this infant?
administering pain medication, initiating intravenous (IV) fluids and electrolytes, and administering oxygen
Because this infant is experiencing a vasoocclusive crisis, IV fluids and electrolytes, oxygen, and pain medication must be administered immediately to
decrease the sickling and to decrease the pain. Knowing the triggers for sickling leads to interventions to reduce the sickling. There is no need to immobilize
the infant's upper extremities. There may be a need for elbow restraints depending on where the IV site is, but not immobilization. Antibiotics might be
administered if infection is expected, but this needs to be determined first. Blood products might be administered to provide blood that is not sickling. A
transcranial Doppler test is not indicated at this time because the infant is too young and a cerebrovascular accident (CVA) is not suspected. Penicillin might be
the antibiotic used after determining that an infection is present. Demerol is contraindicated because of the side effects it can cause in children with sickle cell
anemia. The urine output will be monitored by weighing the diaper without the risk of infection because of an indwelling catheter. Rest is indicated for healing
and to conserve energy in this very ill child.
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include:
using good handwashing.
Good handwashing is the most effective means of preventing disease transmission. There is no indication that fluids should be reduced. Strict isolation is not
necessary. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine.
Nursing considerations related to the administration of chemotherapeutic drugs include:
many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates.
Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving
these drugs and be prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be
thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some
chemotherapeutic and immunologic agents.
The parents of a child taking oral iron supplements report that the child's stools are a tarry green color. What is the best response the nurse provides to the
parents?
"Tarry green color is expected with oral iron supplements."
Tarry green stools indicate that the child is taking an adequate doses of oral iron. The symptoms of iron toxicity are stomach pain, nausea, and vomiting. Asking
the parents to change the timing of the dose is not appropriate; it must be administered as prescribed. The medication should be stopped immediately if there
are any allergic symptoms or toxicity. Tarry green stools is not a side effect of taking oral iron supplements.
The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they:
help the body stop bleeding by forming a clot (scab) over the hurt area.
Platelets help the body stop bleeding by forming a clot over the hurt area. Keeping germs from causing infection is the function of white blood cells. The liquid
portion of blood is plasma. Carrying oxygen from the lungs to all parts of the body is the function of red blood cells.
The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a/an:
normally expected change caused by the iron preparation.
An adequate dosage of iron turns the stools a tarry green color. If the stools do not become a tarry green color, it may indicate administration issues.
The parent of a child with immune thrombocytopenia (ITP) asks the nurse what kind of sport activity will be beneficial for the child. What does the nurse
respond?
"Encourage swimming or walking."
A child with ITP is at risk for bleeding and easy bruising. Hence, the nurse advises the parents to encourage noncontact sports such as swimming and walking.
Gymnastics increase the risk for injury and are avoided. The nurse does not advise to stop all kinds of sport activity because it is not beneficial for the child's
physical development. Quiet indoor activities are beneficial for the child; however, any kind of vigorous physical activity indoors may also increase the risk for
injury.
Which condition in a child indicates a deficiency of one of the factors (proteins) necessary for blood coagulation?
Hemophilia
,Hemophilia is a group of bleeding disorders in which there is a deficiency of one of the clotting factors necessary for blood coagulation. Aplastic anemia is
characterized by anemia, leukopenia, and decreased platelet count. Sickle cell anemia occurs when normal hemoglobin is replaced by abnormal hemoglobin.
Apheresis refers to the process of removing blood from a patient, usually before stem cell transplantation or chemotherapy.
Which symptom is seen in a child with disseminated intravascular coagulation (DIC)?
Increased tendency to bleed
A child with DIC has an increased tendency to bleed as a result of excess thrombin and destruction of platelets. Rickettsial infections may sometimes cause
DIC. It is not a symptom of DIC. Mucosal inflammation is not a symptom of DIC. It is caused by chemotherapy. Yellow, fatty bone marrow indicates the
presence of aplastic anemia.
The nurse observes that a child experiences nausea and vomiting after chemotherapy. Which intervention does the nurse implement to prevent these side
effects?
Administers the antiemetic before chemotherapy begins
The nurse administers the antiemetic before chemotherapy begins to prevent nausea and vomiting. Dexamethasone (Decadron) is administered with serotonin-
receptor antagonists to delay emesis before the chemotherapy. The nurse provides frequent mouthwashes with normal saline to relieve mucosal ulceration
caused by chemotherapy. However, mouthwash does not prevent the side effects of chemotherapy. Administering fewer fluids after the chemotherapy session
will not help to prevent nausea and vomiting because they are caused by chemical reactions.
A child diagnosed with lymphoma is receiving extensive radiation therapy. The most common side effect of this treatment is:
fatigue.
Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be distressing especially because it means that they cannot keep up
with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of
certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.
The most important nursing consideration when caring for a child with sickle cell anemia is to:
teach parents and child how to minimize crises.
Parents need specific instructions about changes in the child's condition that they should watch for, penicillin administration, adequate hydration, and
environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple
blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly
prepared to care for them.
The nursing instructor is teaching a student how to administer iron dextran injections to a child with severe anemia. Which instruction does the nurse give after
the student administers the injection?
"Do not massage the injection site."
The nursing instructor tells the student to avoid massaging the injection site to minimize skin staining and irritation. The nurse places the patient in an
appropriate position before administering the injection. It is necessary to rotate sites because of the potential for tissue damage. The nurse disposes of the
syringe safely after administering the medication to avoid stick injuries.
The nurse finds that a child is pale, gets easily fatigued, and has lack of energy. The nurse asks the parents to get a complete blood count (CBC) test. What does
the nurse suspect from these symptoms?
Anemia
Paleness, fatigue, and lack of energy are the symptoms of anemia that can be confirmed after a CBC test. Sickle cell anemia is diagnosed by chest pain,
elevated temperature, painful joints, or hypoxia. Splenic sequestration is a symptom of sickle cell anemia, which causes an enlarged spleen. Chest syndrome is
a symptom of sickle cell anemia with signs of hypoxia, chest pain, fever, cough, and wheezing.
The nurse suspects that a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be to:
stop transfusion and maintain a patent intravenous line with normal saline and new tubing.
Stopping the transfusion is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.
Notifying the physician and taking vital signs should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should
not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.
The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains
the rationale for the nurses' action?
"We are trying to control her pain by giving her a combination of medications in small, frequent doses so she can still drink her bottle and be awake
some of the time."
The most common and debilitating symptom experienced by patients with sickle cell disease is a vasoocclusive crisis (VOC), which is accompanied by severe
pain. Combinations of medications in smaller, more manageable dosing commonly are used to enhance the pain management effect. Patient-controlled
analgesia (PCA) has been used successfully for sickle cell–related pain when the child is able to understand and push the button to receive the medication. It is
the health team's responsibility to manage the infant's pain. Tolerance to pain medication does not happen in short-term acute illnesses. It occurs more in
chronic conditions.
, Which is an ideal treatment for a child after splenectomy?
Prophylactic antibiotics
Prophylactic antibiotics are administered to the child to prevent the severe infections that the child is at risk for after a splenectomy. Iron dextran injection is
used to treat severe anemia. Diphenhydramine (Benadryl) is used to relieve pain in a child with mucosal ulceration. Intravenous heparin is used to inhibit
thrombin formation in patients with immune thrombocytopenia (ITP).
The parent of a 6-month-old infant asks the nurse about the food that can be included in the child's diet. What does the nurse suggest?
"Include cereals in the diet."
Cereals are the first semisolid foods that should be given to an infant at 6 months of age. This helps the infant accept food other than milk and prevents the risk
for anemia. The nurse does not advise feeding only breast milk because it may induce nutritional anemia. Cow's milk puts the child at risk for gastrointestinal
blood loss because of the presence of heat-labile protein in the milk. Carrots and peas are solid foods that are not digested by the infants at 6 months.
Which interventions does the nurse implement to alleviate neurotoxic effects in a child after chemotherapy? Select all that apply.
Administers stool softeners
Provides a footboard or high-top shoes
Provides support during ambulation
Provides a soft or liquid diet
The nurse administers stool softeners for severe constipation caused by decreased bowel innervations. Use of a footboard or high-top shoe prevents footdrop
that may occur from prolonged bed rest. The client needs support during ambulation because there may be weakness and numbing of the extremities. A soft or
liquid diet is provided for severe jaw pain. Mesnex (mesna) is prescribed for sterile hemorrhagic cystitis caused by chemotherapy.
The nurse is caring for a child with leukemia. Which interventions does the nurse implement to reduce the risk for hemorrhage in the child? Select all that
apply.
Avoids skin punctures when possible
Removes urine immediately after voiding
Asks the child to avoid running or biking
Provides meticulous mouth care
The nurse avoids skin punctures whenever possible to prevent bleeding and reduce the risk for infection. The nurse removes urine and feces immediately
because the rectal area is prone to ulceration, which may cause bleeding. Moreover, the nurse asks the child to avoid activities such as running and biking that
may increase the chances of injury, resulting in risk for hemorrhage. The nurse provides meticulous mouth care to the child because there is gingival bleeding
and mucositis frequently. The nurse does not give a platelet transfusion during a nosebleed; instead, the nurse uses local measures such as applying pressure to
the bleeding site to stop the bleeding.
An infant with sickle cell anemia (SCA) is prescribed the hemoglobin electrophoresis test. What is the purpose of this test?
To detect different types of hemoglobin
A hemoglobin electrophoresis test is used to detect different types of hemoglobin in the child. It further helps determine whether the child has SCA, the
homozygous form of the disease, or sickle cell C disease, the heterozygous form. A transcranial Doppler (TCD) test is used to identify whether the child with
SCA is at risk for cerebrovascular accident. Sickledex is used to confirm the presence of sickle cell anemia. Hemoglobin electrophoresis test is not used to rule
out disorders other than SCA.
The nurse finds that the hemoglobin levels in a child with anemia did not improve after taking oral iron supplements. What actions does the nurse take? Select
all that apply.
Ask the parents if they administered the prescribed doses.
Assess whether the child has gastrointestinal problems.
Assess the child for chronic hemoglobinuria.
If the hemoglobin levels in the child do not increase 1 month after taking oral iron supplements, the nurse should assess for noncompliance. The nurse should
ask the parents if the prescribed dose consistency was maintained to assess the cause of iron deficiency. The nurse also assesses whether the child has any
gastrointestinal problems that may have caused bleeding and blood loss. The nurse assesses whether the child has chronic hemoglobinuria, that is, the presence
of protein hemoglobin in urine; this may cause iron deficiency. Providing iron-rich foods will be inadequate if the child has problems such as bleeding or
hemoglobinuria. The nurse does not advise to provide fresh cow's milk because it is a poor source of iron and interferes with the absorption of iron. Fresh cow's
milk is also avoided in infants younger than 12 months because of risk for gastrointestinal blood loss.
A 7-month-old girl with sickle cell anemia is not consuming enough fluid orally as she is recovering. What suggestions by the nurse would help the parents best
as they prepare to care for their infant daughter after discharge? Select all that apply.
Count the number of bottles or ounces of fluid needed daily.
Teach the parents which foods have a high source of fluid.
