Page 915 - Saunders Comprehensive Review For NCLEX-RN

considerably in severity and frequency; these include vaso-occlusive crisis, splenic
sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be
precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional
stress. The mother of a child with sickle cell disease should encourage fluid intake of
1.5 to 2 times the daily requirement to prevent dehydration.
Test-Taking Strategy: Note the strategic words, need for further instruction. These
words indicate a negative event query and ask you to select an option that is an
incorrect statement. Recalling that fluids are a main component of treatment in sickle
cell anemia to prevent crisis will direct you to the correct option. Remember that
fluids are required to prevent dehydration.
Level of Cognitive Ability: Evaluating
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching and Learning
Content Area: Pediatrics: Hematological
Health Problem: Pediatric-Specific: Anemias
Priority Concepts: Client Education; Clotting
References: Hockenberry, Wilson, Rodgers (2017), pp. 791-792.

307. Answer: 3

Rationale: Hemophilia refers to a group of bleeding disorders resulting from a
deficiency of specific coagulation proteins. The primary treatment is replacement of
the missing clotting factor; additional medications, such as agents to relieve pain,
may be prescribed depending on the source of bleeding from the disorder. A child
with hemophilia A is at risk for joint bleeding after a fall. Factor VIII would be
prescribed intravenously to replace the missing clotting factor and minimize the
bleeding. Factor X and iron are not used to treat children with hemophilia A.
Test-Taking Strategy: Focus on the child’s diagnosis. Eliminate options 2 and 4
because they are comparable or alike. Recalling that a child with hemophilia A is
missing clotting factor VIII will direct you to the correct option from those
remaining.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Pediatrics: Hematological
Health Problem: Pediatric-Specific: Bleeding Disorders
Priority Concepts: Clinical Judgment; Clotting
Reference: McKinney et al. (2018), pp. 1130, 1132.

308. Answer: 2

Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a
decreased supply of iron for the manufacture of hemoglobin in red blood cells. An
oral iron supplement should be administered through a straw or medicine dropper
placed at the back of the mouth, because the iron stains the teeth. The parents should
be instructed to brush or wipe the child’s teeth or have the child brush the teeth after
administration. Iron is administered between meals because absorption is decreased

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