Difficulty: Medium
Average Score: 80%
Simulated
Passage / Scenario
Nurses Notes0830:
Child was brought in by parents for unexplained bruising and red spots on the child's shoulders, thighs, and back. Parents report child has had a cold for more than 2 months and over-the-counter medications have not helped relieve the cold symptoms. Lung sounds clear. Child moves all extremities well with some swelling noted in knees and elbows. Abdomen soft with active bowel sounds.
1000:
Parents report child had small nosebleed "a few minutes ago" and child states. "My arms and legs hurt all over." Child's nosebleed has been resolved with only small amount of blood noted on tissues.
Vital Signs
0830:
Temperature 38┬░ C (100.4┬░ F)
Heart rate 100/min
Respiratory rate 20/min
Blood pressure 102/64 mm Hg
Oxygen saturation 98% on room air
1000:
Temperature 38.3┬░ C (101┬░ F) Heart rate 112/min Respiratory rate 24/min
Blood pressure 104/62 mm Hg
Oxygen saturation 97% on room air
Diagnostic Results
WBC count 15.000/mm3 (5,000 to 10,000/mm3)
Hgb 8 g/dL (10 to 15.5 g/dL)
Hct 32% (32% to 44%)
The nurse is reviewing the data collection findings and diagnostic results. For each data collection finding, click to specify if the finding is consistent with leukemia, sickle cell anemia, or hemophilia. Each finding may support more than 1 disease process.
Correct answer
A,B,C,D,E
Rationale
Reported pain is consistent with leukemia (bone pain) and sickle cell anemia (vaso-occlusive crises). Bleeding and bruising align with leukemia (thrombocytopenia) and hemophilia (clotting factor deficiency). Elevated temperature suggests infection in leukemia or sickle cell anemia. High WBC count is typical in leukemia due to abnormal white cells.