Olivia McRitchie
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NCLEX (Pediatrics) Nursing Test sobre Exemplar 2.8: Sickle Cell Disease, creado por Olivia McRitchie el 06/11/2019.

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Exemplar 2.8: Sickle Cell Disease

Pregunta 1 de 38

1

What form of sickle cell disease does this describe?

-Most common in the US
-Heterozygous condition in which child inherits one sickle cell gene and one normal hemoglobin gene.
-Child is carrier and rarely has symptoms.

Selecciona una de las siguientes respuestas posibles:

  • Sickle cell disease HbAS

  • Sickle cell anemia HbSS

  • Sickle cell syndrome HbSC

  • Hb S beta thalassemia

Explicación

Pregunta 2 de 38

1

What form of sickle cell disease does this describe?

-Homozygous condition
-Child is subject to sickle cell crisis

Selecciona una de las siguientes respuestas posibles:

  • Sickle cell trait HbAS

  • Sickle cell anemia HbSS

  • Sickle cell syndrome HbSC

  • Hb S beta thalassemia

Explicación

Pregunta 3 de 38

1

What form of sickle cell disease does this describe?

-The child inherits a sickle cell gene from one parent and an abnormal hemoglobin gene from the other.
-Most often produces a less severe form of SCD

Selecciona una de las siguientes respuestas posibles:

  • Sickle cell trait HbAS

  • Sickle cell anemia HbSS

  • Sickle cell syndrome HbSC

  • Hb S beta thalassemia

Explicación

Pregunta 4 de 38

1

What form of sickle cell disease does this describe?

-Child inherits a sickle cell gene from one parent and a gene for beta thalassemia from the other.
-Manifestations of SCD can range from mild to severe.

Selecciona una de las siguientes respuestas posibles:

  • Sickle cell trait HbAS

  • Sickle cell anemia HbSS

  • Sickle cell syndrome HbSC

  • Hb S beta thalassemia

Explicación

Pregunta 5 de 38

1

You are delivering teaching to the parents of a child newly diagnosed with sickle cell anemia.

Which of the following statements shows that MORE teaching is needed?

Selecciona una de las siguientes respuestas posibles:

  • "This disorder happens when some of the red blood cells get less oxygen and take on a sickle shape, meaning that they have a crescent shape."

  • "Red blood cells that become sickles become unable to flex. They can block small blood vessels and cause oxygen to not reach certain tissues."

  • "My child may experience blocking of his spleen. This may lead to it being removed, which causes the immune system to become lower."

  • "My child's red blood cells shouldn't become sickled unless he's feverish or placed in physically stressful situations."

Explicación

Pregunta 6 de 38

1

Bacterial infections are the leading cause of death in young children with sickle cell disease.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 7 de 38

1

Select the statements that show that the parents of a child with sickle cell anemia understands how to prevent a sickle cell (vaso-occlusive) crisis.

Selecciona una o más de las siguientes respuestas posibles:

  • "Fevers can cause our child to be hospitalized because of a sickle cell crisis."

  • "We should teach our child relaxation techniques very early on in life. Physical and emotional stress can cause a crisis."

  • "Visiting our family members in Colorado shouldn't be a huge problem."

  • "Our child's asthma is so mild that we don't even keep an albuterol inhaler around anymore."

  • "We're so close to the school that our child walks to school. We just need to bundle him up more when it's cold outside."

Explicación

Pregunta 8 de 38

1

Dehydration can predispose an individual to a sickle cell crisis.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 9 de 38

1

Once cells are sickled, they cannot resume a normal shape.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 10 de 38

1

Which of the following is the PRIORITY intervention when caring for a patient coming to ER due to a sickle cell crisis?

Selecciona una de las siguientes respuestas posibles:

  • Place the patient on a nasal cannula running at 2L

  • Start a normal saline IV

  • Take a CBC w/differential

  • Contact with the physician

Explicación

Pregunta 11 de 38

1

Sickle cell anemia is an autonomic recessive genetic defect.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 12 de 38

1

You have a teenage patient with sickle cell anemia in the hospital for a sickle-cell crisis. The patient is in an anatomy and physiology class, and asks you what happens to her red blood cells biologically when she doesn't have enough oxygen.

Select the MOST ACCURATE teaching to give to this patient.

Selecciona una de las siguientes respuestas posibles:

  • "You have 2 copies of a gene called Hb S. This changes the structure of something in hemoglobin called the 'beta chain'. When you don't get enough oxygen, Hb S becomes rod-like and forms long chains that deform the red blood cell."

  • "You have 2 copies of a gene called Hb S. This slightly changes the structure of your red blood cells.

  • "You have 1 copy of a gene called Hb S. This changes your hemoglobin so that it forms rod-like chains and doesn't carry oxygen correctly."

  • "You have 1 copy of a gene called Hb S. This changes the structure of the beta chain in hemoglobin. When you don't get enough oxygen, Hb S crystallizes into rod-like structures that form long chains which deform the erythrocyte."

Explicación

Pregunta 13 de 38

1

You are explaining what a sickle-cell crisis is to the parents of a child recently diagnosed with sickle cell anemia.

Which of the following statements shows that teaching has been received?

Selecciona una de las siguientes respuestas posibles:

  • "Because our child's red blood cells become sickle-shaped when they lack oxygen, they clump together and stop blood flow in smaller blood vessels, leading to oxygen loss in these tissues."

  • "Because our child's red blood cells are always sickle-shaped, they clump together and stop blood flow in smaller blood vessels, leading to oxygen loss in these tissues."

  • "Because our child's red blood cells become sickle-shaped when they lack oxygen and have no possibility of going back to normal, they clump together and stop blood flow in smaller blood vessels, leading to oxygen loss in these tissues."

  • "Because our child's red blood cells become sickle-shaped when they don't have enough fluid, they clump together and stop blood flow in smaller blood vessels, leading to oxygen loss in these tissues."

Explicación

Pregunta 14 de 38

1

Which of the following patients is MOST LIKELY to have sickle cell disease?

Selecciona una de las siguientes respuestas posibles:

  • A child with 2 parents who are directly from South Africa

  • A child with one parent from Ethiopia and one parent from Jamaica.

  • A mixed Ugandan-Swedish child.

  • A mixed Ugandan-Saudi Arabian child.

Explicación

Pregunta 15 de 38

1

Which of the following is NOT a potential clinical manifestation of a vaso-occlusive sickle cell crisis?

Selecciona una de las siguientes respuestas posibles:

  • Stroke, caused by cerebral occlusion.

  • Extreme pain

  • Fever

  • Tissue engorgement

  • Painful swelling of joints in hands and feet

  • Severe abdominal pain

  • Priapism (in males)

  • Profound anemia

Explicación

Pregunta 16 de 38

1

What type of sickle cell crisis is the most common?

Selecciona una de las siguientes respuestas posibles:

  • Vaso-occlusion (thrombotic)

  • Splenic sequestration

  • Aplastic crises

  • Acute chest syndrome

Explicación

Pregunta 17 de 38

1

What conditions can precipitate a thrombotic (vaso-occlusion) sickle cell crisis?

Selecciona una o más de las siguientes respuestas posibles:

  • Dehydration

  • Exposure to cold

  • Acidosis

  • Localized hypoxemia

  • Fever

  • Emotional or physical stress

Explicación

Pregunta 18 de 38

1

What are the causes of a thrombotic (vaso-occlusion) sickle cell crisis?

Selecciona una de las siguientes respuestas posibles:

  • Stasis of blood with clumping of cells in the microcirculation, ischemia, and hypoxemia.

  • Pooling of blood in the spleen

  • Diminished production and increased destruction of red blood cells.

  • Medical professionals are unsure of the cause.

Explicación

Pregunta 19 de 38

1

What are the clinical manifestations of a splenetic sequestration sickle cell crisis?

Selecciona una o más de las siguientes respuestas posibles:

  • Profound anemia

  • Hypovolemia

  • Shock

  • Pallor

  • Fatigue

Explicación

Pregunta 20 de 38

1

You have a young child with sickle cell disease that has profound anemia, hypovolemia, severe abdominal pain, and shock. You suspect that the patient may have splenic sequestration.

What do you know can result from this condition if not treated promptly?

Selecciona una de las siguientes respuestas posibles:

  • Stroke

  • Aplastic crisis

  • Cardiovascular collapse and death

  • Pulmonary failure and death

Explicación

Pregunta 21 de 38

1

Why can splenic sequestration result in cardiovascular collapse?

Selecciona una de las siguientes respuestas posibles:

  • It's caused by blood pooling in the spleen, and the spleen can only hold so much of the body's blood supply that cardiovascular collapse can result.

  • It causes stasis of blood with clumping of cells in the microcirculation, leading to thrombosis and infarction of cardiac tissue and resulting in cardiac arrest.

  • It causes diminished production and increased destruction of red blood cells, leading to profound enough anemia to cause shock and cardiovascular collapse.

  • It causes pulmonary infiltrates of abnormal blood cells, leading to cardiovascular and pulmonary collapse.

Explicación

Pregunta 22 de 38

1

What are the clinical manifestations of an aplastic sickle cell crisis?

Selecciona una o más de las siguientes respuestas posibles:

  • Profound anemia

  • Pallor

  • Fatigue

  • Shock

  • Hypovolemia

Explicación

Pregunta 23 de 38

1

Aplastic sickle cell crises are often triggered by the influenza virus.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 24 de 38

1

Which of the following is NOT a clinical manifestation of acute chest syndrome?

Selecciona una de las siguientes respuestas posibles:

  • Fever

  • Cough

  • Chest and back pain

  • Dyspnea

  • Hypoxemia

  • Painful swelling of the hands and feet.

Explicación

Pregunta 25 de 38

1

What is a common cause of hospitalization for sickle cell disease?

Selecciona una de las siguientes respuestas posibles:

  • Vaso-occlusion (thrombotic)

  • Splenic sequestration

  • Aplastic crises

  • Acute chest syndrome

Explicación

Pregunta 26 de 38

1

What can occur if acute chest syndrome is not treated?

Selecciona una o más de las siguientes respuestas posibles:

  • Pulmonary infection

  • Pulmonary infarct

  • Fat embolism

  • Cardiovascular collapse

  • Stroke

Explicación

Pregunta 27 de 38

1

You can usually tell that a newborn has sickle cell disease immediately after birth.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 28 de 38

1

Which of the following is UNTRUE about children with sickle cell disease?

Selecciona una de las siguientes respuestas posibles:

  • They can experience chest tightness and shortness of breath, which are diagnostic for acute chest syndrome.

  • Sickling is inhibited by high levels of fetal hemoglobin, so affected children are usually asymptomatic until 4-6 months of age.

  • 10% of children with sickle cell disease will have a stroke.

  • Children with the sickle cell trait will usually develop minor symptoms when confronted with abnormally low oxygen conditions.

Explicación

Pregunta 29 de 38

1

A child presents to the ED with hypoxia, lethargy, fatigue, shortness of breath, tachypnea, and decreased O2 stat.

What clinical manifestation of sickle cell disease is this child experiencing?

Selecciona una de las siguientes respuestas posibles:

  • Dyspnea due to inadequate delivery of oxygen to cells, tissues, and organs.

  • Anemia due to increased RBC destruction, impaired RBC production, or both.

  • Impaired circulation due to impaired flow of sickled RBCs

  • Risk for infection due to inadequate circulation

  • Pain due to vascular occlusion by RBCs

Explicación

Pregunta 30 de 38

1

Which of the following is NOT a proper intervention for a nurse treating a patient with dyspnea?

Selecciona una de las siguientes respuestas posibles:

  • Place patient on a nasal cannula running at 2L.

  • Elevate head of bed until patient can breathe comfortably.

  • Obtain consent to administer a blood transfusion.

  • Monitor VS, including O2 stat, and auscultate lung sounds every 4 hrs, or less as indicated.

  • Discuss with the physician the possibility of bone marrow or stem cell transplantation.

Explicación

Pregunta 31 de 38

1

You have a child presenting with hypoxia, lethargy, fatigue, pallor, shortness of breath, dyspnea, and tachycardia. Labs were taken, and the RBC and Hgb was low.

What clinical manifestation is this child presenting with?

Selecciona una de las siguientes respuestas posibles:

  • Dyspnea due to inadequate delivery of oxygen to cells, tissues, and organs,

  • Anemia due to increased RBC destruction, impaired RBC production, or both.

  • Impaired circulation due to impaired flow of sickled RBCs.

  • Risk for infection due to inadequate circulation.

  • Pain due to vascular occlusion by RBCs.

Explicación

Pregunta 32 de 38

1

Select the BEST interventions for a patient repeatedly presenting to the hospital with anemia.

Selecciona una o más de las siguientes respuestas posibles:

  • Obtain consent to administer a blood transfusion.

  • Discuss with the physician the possibility of a bone marrow or stem cell transplant.

  • Elevate the head of the bed.

  • Begin an IV line and obtain an order for maintenance fluids.

  • Encourage the client to adhere to current vaccination recommendations.

Explicación

Pregunta 33 de 38

1

You have a 3-year-old child presenting to the ED with impaired oxygenation, tachypnea, tachycardia, and edema. A CT scan shows that the child has splenic sequestration. In addition, the child's hands and feet are swollen, and the child is in pain and has a fever.

Which of the following is NOT an appropriate intervention for this patient?

Selecciona una de las siguientes respuestas posibles:

  • Obtain consent for a blood transfusion.

  • Open an IV line and obtain an order for maintenance fluids.

  • Politely ask that the parents not argue in front of their child, as it seems to upset him a great deal.

  • Prepare the child for an emergency splenectomy.

  • Alleviate pain with ice packs.

Explicación

Pregunta 34 de 38

1

You are caring for a child with sickle cell disease that has tested positive for pneumonia.

Which of the following is your priority intervention?

Selecciona una de las siguientes respuestas posibles:

  • Administer O2 via nasal cannula set at 2 L/min.

  • Administer antibiotics, as ordered.

  • Encourage the parents to continue the vaccine regimen.

  • Initiate droplet precautions.

Explicación

Pregunta 35 de 38

1

Which of the following is NOT an appropriate way to help a child with sickle cell disease with pain?

Selecciona una de las siguientes respuestas posibles:

  • Encourage the parents to keep giving their child oral fluids.

  • Start an IV line and obtain orders for maintenance fluids.

  • Obtain orders for PRN IV push or IM morphine.

  • Obtain an order for supplemental oxygen.

  • Administer hydroxyurea, as ordered.

  • Encourage the parents to massage the places on the child's body where it hurts.

  • Raise the head of the bed to a semi-Fowler's position.

Explicación

Pregunta 36 de 38

1

In the U.S., newborn screening for sickle cell disease is mandatory.

Selecciona uno de los siguientes:

  • VERDADERO
  • FALSO

Explicación

Pregunta 37 de 38

1

Which of the following is TRUE about pharmacological therapy in children with sickle cell disease?

Selecciona una de las siguientes respuestas posibles:

  • Oxygen is only implicated if the child is experiencing dyspnea.

  • Oral and IV fluids can prevent crises, but they do not work as a form of treatment when a child is having a crisis.

  • Hydroxyurea is a cytotoxic drug that decreases production of abnormal blood cells, but it has a long enough list of side effects that it's rarely given.

  • Treatment in children between 2 months and 5 years of age usually includes daily administration of prophylactic penicillin.

  • Pain management in these children is about the same as it is with any other patient.

Explicación

Pregunta 38 de 38

1

What are the complications associated with repeated blood transfusions?

Selecciona una o más de las siguientes respuestas posibles:

  • Hemosiderosis

  • Hypervolemia

  • Alloimmunization to red cell and platelet antigens

  • Frequent headaches

  • Infection

Explicación

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