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An iron deficiency The most common cause of insufficient erythropoiesis is iron deficiency.

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A 1-year-old female is diagnosed with anemia secondary to insufficient erythropoiesis. When the parents asked what caused this, how should the nurse respond? The most likely causes(s) is (are):

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Iron deficiency As many as one-third of infants with severe iron deficiency anemia have chronic intestinal blood loss induced by exposure to a heat-labile protein in cow's milk. Such exposure causes an inflammatory gastrointestinal reaction that damages the mucosa and results in diffuse hemorrhage.

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A 12-month-old toddler weighing 18 pounds is brought to the clinic because of weakness, slow physical growth, and developmental delays. His mother reports that the only food he will consume is cow's milk. Considering this information, the nurse decides that the child probably has ____ anemia.

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5 When hemoglobin levels fall below 5 g/dL, pallor, anorexia, tachycardia, and systolic murmurs may occur.

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A 16-month-old female presents with tachycardia, pallor, anorexia, and systolic murmur. The nurse is checking the lab results, and the hemoglobin determination indicates a level below ___ g/dL

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Mother is Rh-negative, and fetus is Rh-positive. Maternal-fetal incompatibility exists if mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative.

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Which mother is at most risk for a maternal-fetal blood incompatibility?

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Hydrops fetalis Fetuses that do not survive anemia in utero usually are stillborn, with gross edema in the entire body, a condition called hydrops fetalis.

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A 22-year-old female gives birth at 20 weeks' gestation to a stillborn fetus. Physical exam of the fetus by the nurse reveals gross edema of the entire body and anemia. This condition is referred to as:

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Valine Hb S is formed by a genetic mutation in which one amino acid (valine) replaces another (glutamic acid).

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Sickle cell disease is characterized by the presence of Hb S. A nurse is trying to differentiate between Hb S and normal Hb. Which of the following amino acids is present in Hb S and not present in normal Hb?

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Noth his mother and father Sickle cell is a recessive disorder inherited from both parents.

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A 10-year-old male is diagnosed with sickle cell anemia. When the parents ask who is responsible for this disease, what is the nurse's best response? He most likely inherited it from:

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African-Americans In the United States, sickle cell disease is most common in African-Americans.

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In the United States, which group of people should be assessed first for sickle cell disease?

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Hb S and Hb A In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A), not Hb S, for both.

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A 25-year-old female has a child that is diagnosed with sickle cell anemia. She does not have the disease. Which of the following characterizes the genetic makeup of the parents with regard to this trait?

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Oxygen tension is low Sickling occurs when oxygen tension is low.

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When should the nurse start closely monitoring the patient with sickle cell anemia? If:

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Spleen Sickled cells undergo hemolysis in the spleen or become sequestered there, causing blood pooling and infarction of splenic vessels.

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A 12-year-old male is diagnosed with sickle cell anemia. A blood smear reveals severely sickled cells. A nurse recalls the sickled cells will be removed from circulation mostly by the:

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Pain Vaso-occlusive crisis is extremely painful and may last for days or even weeks, with an average duration of 4 to 6 days.

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Which major symptom in a patient with sickle cell anemia indicates to the nurse, the patient is experiencing a vaso-occlusive crisis?

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Sequestration crisis Sequestration occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

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For which type of sickle cell crisis should the nurse assess for in young children?

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Aplastic crisis Aplastic anemia is caused by diminished erythropoiesis despite an increased need for new erythrocytes.

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A 6-year-old male presents with fatigue, jaundice, and irritability. A blood smear shows the presence of sickled cells. Erythropoiesis is comprised in this child; which crisis should the nurse monitor the patient for?

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Infection Infection is the most common cause of death related to sickle cell disease.

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A 5-year-old female dies from sickle cell disease. The pediatrician will document the most likely cause of death is:

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Autosomal recessive Feedback: The alpha and beta thalassemias are inherited autosomal recessive disorders.

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A geneticist is discussing thalassemias. Which information should be included? The alpha and beta thalassemias are inherited in an _____ fashion.

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Hemoglobin synthesis Thalassemia would be secondary to defective hemoglobin synthesis.

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A 2-year-old male presented with growth and maturation retardation and splenomegaly. He died shortly after arriving at the ER. Autopsy revealed thalassemia secondary to defective:

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Alpha thalassemia major Alpha thalassemia major causes hydrops fetalis and fulminant intrauterine congestive heart failure. In addition to edema and massive ascites, the fetus has a grossly enlarged heart and liver.

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A 38-year-old female gives birth to a stillborn fetus. Autopsy reveals cardiomegaly, hepatomegaly, edema, and ascites. Which of the following does the nurse suspect caused the death?

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Alpha major Hydrops fetalis is due to alpha thalassemia major.

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If an infant has hydrops fetalis, which type of thalassemia does the nurse suspect?

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VIII Hemophilia A is a deficiency in factor VIII.

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The mother of a 3-year-old child speaks to the pediatrician because the child took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia A resulting from a deficiency in factor:

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Christmas disease Hemophilia B is also known as Christmas disease.

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A nurse wants to chart the other name for hemophilia B. Which term should the nurse write?

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Idiopathic thrombocytopenic purpura (ITP) A decreased platelet count is the cause of ITP.

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A 3-year-old child presents with bruising on the legs and trunk and a petechial rash. The mother also reports frequent nosebleeds. Lab tests reveal a decreased platelet count. Which is the most likely diagnosis the nurse will see documented on the chart?

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Virtually induced antibody destruction of platelets In approximately 70% of cases of ITP, there is an antecedent viral disease.

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A 5-year-old male is diagnosed with idiopathic thrombocytic purpura (ITP). Which information should the nurse give the staff regarding the cause of this condition?

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Spontaneous nosebleeds, bruising, petechiae Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP.

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Which of the following clusters of symptoms would lead the nurse to suspect a child has idiopathic thrombocytopenic purpura (ITP)?

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Intracranial bleeding Although the incidence is less than 1%, intracranial hemorrhage is the most serious complication of ITP.

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A 1-year-old is diagnosed with idiopathic throbocytopenia purpura (ITP). The nurse assesses for the most serious concern, which is development of:

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Acute lymphoblastic leukemia (ALL) Approximately 80% to 85% of leukemias in children are ALL.

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A nurse monitors for the most common childhood cancer, which is:

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Acute myelogenous leukemia (AML) AML is attributable to prior chemotherapy.

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A 10-year-old male with Down syndrome undergoes chemotherapy for cancer. Following treatment, monitoring for which condition is priority?

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Lymphoblastic non-Hodgkin lymphoma (NHL) Lymphoblastic NHL shows chromosomal translocations, particularly chromosomes 7 and 14.

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A 10-year-old female is diagnosed with malignancy in the brain and lung. DNA analysis reveals translocation at chromosome 7 and 14. The most likely medical diagnosis is the primary care provider will make is:

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AIDS Children with AIDS have an increased risk of developing NHL.

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Which condition makes the patient most prone for developing non-Hodgkin lymphoma (NHL)?

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Painless adenopathy in cervical nodes Painless adenopathy in the lower cervical chain, with or without fever, is the most common symptom in children with Hodgkin lymphoma.

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What is a priority assessment for Hodgkin lymphoma in children?

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Coombs Routine evaluation of fetuses at risk for HDN includes the Coombs test.

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Which laboratory test will assist the nurse in identifying infants who are prone to develop hemolytic disease of the newborn (HDN)?

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- It is most common between the ages of 6 months and 2 years - It may be related to socioeconomic factors - It is difficult to diagnose in early stages Iron deficiency anemia is the most common blood disorder of infancy and childhood, with the highest incidence occurring between 6 months and 2 years of age. Incidence is not related to gender or race, but socioeconomic factors are important because they affect nutrition. The symptoms of mild anemia—listlessness and fatigue—usually are not present or are undetectable in infants and young children who are unable to describe these symptoms. Therefore, parents generally do not note any change in the child's behavior or appearance until moderate anemia has developed.

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A nurse is planning care for a child with iron deficiency anemia. Characteristics of iron deficiency anemia include which of the following? (Select all that apply.)

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- Fatigue - Pallor - Petechiae Pallor, fatigue, petechiae, purpura, bleeding, and fever generally are present. Jaundice is not.

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A 5-year-old male is diagnosed with leukemia. Which of the following symptoms would the nurse expect? (Select all that apply.)

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