Nokea
An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication?
- A. Air embolism
- B. Allergic reaction
- C. Hemolytic reaction
- D. Circulatory overload
Correct Answer: D
Rationale: Circulatory overload presents with precordial pain, dyspnea, distended neck veins, cyanosis, and dry cough due to fluid volume excess. Air embolism causes sudden respiratory distress, allergic reactions involve urticaria and wheezing, and hemolytic reactions include fever and shock.
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In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxia-ischemia cycle. What information should the nurse share with parents in a teaching plan?
- A. Encourage drinking.
- B. Keep accurate records of output.
- C. Check for moist mucous membranes.
- D. Monitor the concentration of the childs urine.
Correct Answer: C
Rationale: Checking for moist mucous membranes assesses hydration in SCA, where impaired kidney function prevents urine concentration. General encouragement to drink is vague, output records don?t reflect fluid needs, and urine concentration is unreliable due to kidney dysfunction.
Iron overload is a side effect of chronic transfusion therapy. What treatment assists in minimizing this complication?
- A. Magnetic therapy
- B. Infusion of deferoxamine
- C. Hemoglobin electrophoresis
- D. Washing red blood cells (RBCs) to reduce iron
Correct Answer: B
Rationale: Deferoxamine infusions chelate and excrete excess iron, minimizing overload from chronic transfusions. Magnetic therapy is ineffective, hemoglobin electrophoresis is diagnostic, and washing RBCs removes other components, not iron.
For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention?
- A. Antibiotics
- B. Antiretroviral drugs
- C. Iron supplementation
- D. Immunosuppressive therapy
Correct Answer: D
Rationale: Immunosuppressive therapy (e.g., antilymphocyte globulin, cyclosporine) treats aplastic anemia, likely an autoimmune condition, improving prognosis. Antibiotics treat infections, not the condition; antiretrovirals and iron are irrelevant to aplastic anemia management.
The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor?
- A. Hemoglobin
- B. Tissue hypoxia
- C. Reticulocyte count
- D. Number of RBCs
Correct Answer: B
Rationale: Tissue hypoxia triggers the kidneys to release erythropoietin, stimulating bone marrow to produce RBCs. Hemoglobin levels indirectly influence this through oxygen delivery, reticulocyte count monitors production, and RBC numbers don?t directly control production.
What explanation provides the rationale for why iron-deficiency anemia is common during infancy?
- A. Cows milk is a poor source of iron.
- B. Iron cannot be stored during fetal development.
- C. Fetal iron stores are depleted by 1 month of age.
- D. Dietary iron cannot be started until 12 months of age.
Correct Answer: A
Rationale: Cows milk, common in diets of 12-36-month-olds, is low in iron, increasing anemia risk. Fetal iron stores, dependent on maternal stores, last 5-6 months, and iron-fortified foods can be introduced before 12 months via breastfeeding or formula.