A nurse is caring for a 7-year-old child who has a fever, tachycardia, and low oxygen saturation. The nurse reviews the child's laboratory results and notes the following:
- WBC count 15,000/mm^3^ (normal range: 5,000 to 10,000/mm^3^)
- Hgb 8 g/dL (normal range: 10 to 15.5 g/dL)
- Hct 32% (normal range: 32% to 44%)
The nurse should suspect that the child has which of the following conditions?
Leukemia.
Sickle cell anemia.
Hemophilia.
Iron deficiency anemia.
The Correct Answer is B
Choice A reason: Leukemia is not a probable condition, as it is a cancer of the white blood cells that causes abnormal proliferation and accumulation of immature or dysfunctional white blood cells. The child has a high WBC count, which can indicate leukemia, but not necessarily. The child does not have other signs of leukemia, such as bleeding, bruising, bone pain, or lymphadenopathy.
Choice B reason: Sickle cell anemia is a possible condition, as it is an inherited disorder that affects the shape and function of the red blood cells, causing them to become sickle-shaped and rigid. The child has a low Hgb and Hct, which can indicate anemia, and a fever, tachycardia, and low oxygen saturation, which can indicate a sickle cell crisis. A sickle cell crisis is a condition where the sickle-shaped red blood cells block the blood flow and cause tissue ischemia and inflammation.
Choice C reason: Hemophilia is not a likely condition, as it is an inherited disorder that affects the clotting factors, causing impaired blood clotting and increased risk of bleeding. The child has a low Hgb and Hct, which can indicate anemia, but not necessarily hemophilia. The child does not have other signs of hemophilia, such as bleeding, bruising, hemarthrosis, or hematuria.
Choice D reason: Iron deficiency anemia is not a definite condition, as it is a type of anemia that occurs when the body does not have enough iron to produce hemoglobin, the protein that carries oxygen in the blood. The child has a low Hgb and Hct, which can indicate iron deficiency anemia, but not necessarily. The child does not have other signs of iron deficiency anemia, such as pallor, fatigue, weakness, or pica.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Tremors are not a likely finding in a child with hyperglycemia, or high blood glucose. Tremors are more commonly associated with hypoglycemia, or low blood glucose, as the body releases adrenaline to stimulate the release of glucose from the liver. Tremors may also be caused by anxiety, caffeine, or certain medications.
Choice B reason: Shallow respirations are not a likely finding in a child with hyperglycemia, unless the child has developed diabetic ketoacidosis (DKA), a serious complication of diabetes that occurs when the body breaks down fat for energy and produces ketones, which are acidic substances that can cause metabolic acidosis. In DKA, the child may have rapid and deep breathing, also known as Kussmaul respirations, as the body tries to eliminate excess carbon dioxide and acid. However, DKA usually occurs when the blood glucose level is above 300 mg/dL, and the child may also have other signs and symptoms, such as nausea, vomiting, abdominal pain, fruity breath, and confusion.
Choice C reason: Pallor is not a likely finding in a child with hyperglycemia, as the blood flow to the skin is not affected by high blood glucose. Pallor is more commonly associated with anemia, shock, or hypoxia, which are conditions that reduce the oxygen-carrying capacity of the blood or the blood flow to the tissues.
Choice D reason: Lethargy is a likely finding in a child with hyperglycemia, as high blood glucose can cause dehydration, electrolyte imbalance, and impaired brain function. The child may feel tired, weak, and drowsy, and have difficulty concentrating or staying awake. Lethargy may also indicate that the child is at risk of developing DKA, which can lead to coma and death if not treated promptly.
Correct Answer is A
Explanation
Choice A reason: This is a contraindication for the MMR immunization, which is a live attenuated vaccine. A child who has a congenital immunodeficiency may not be able to mount an adequate immune response to the vaccine and may be at risk of developing the diseases from the vaccine.
Choice B reason: This is not a contraindication for the MMR immunization. A mild fever after a previous immunization is not a sign of an allergic reaction or a serious adverse effect. The child can still receive the MMR immunization as long as they do not have a moderate or severe illness.
Choice C reason: This is not a contraindication for the MMR immunization. Taking antibiotics for otitis media does not interfere with the effectiveness or safety of the vaccine. The child can still receive the MMR immunization as long as they do not have a moderate or severe illness.
Choice D reason: This is not a contraindication for the MMR immunization. A mild cough and a low-grade fever are not signs of a moderate or severe illness that would prevent the child from receiving the vaccine. The child can still receive the MMR immunization as long as they do not have any other contraindications.
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