Chp 30 thrombocytopenia
Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? Add the blood transfusion as a secondary line to the existing IV. Stay with the patient for 60 minutes after starting the transfusion. Check the identifying information on the unit of blood against the patient's ID bracelet. Prime new primary IV tubing with lactated Ringer's solution to use for the transfusion.
Check the identifying information on the unit of blood against the patient's ID bracelet. Rationale: The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's solution because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.
When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? Lactated Ringer's 5% dextrose in water 0.9% sodium chloride 0.45% sodium chloride
0.9% sodium chloride Rationale: The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood because they will cause RBC hemolysis.
A patient has a prescription written at 1000 for two units of packed red blood cells. If the transfusion is picked up from the laboratory at 1015, the nurse should plan to hang the unit no later than what time? 1 1030 2 1045 3 1100 4 1115
2 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank, which would be at 1045. 1030, 1100, and 1115 are not consistent with this policy.
The nurse provides education to a patient with thrombocytopenia about precautions to be taken at home. The nurse identifies that further teaching is needed when the patient performs which action? 1 Drinks 14 glasses of water daily 2 Shaves once a day using an electric razor 3 Uses an alcohol based mouthwash twice a day 4 Brushes teeth with a soft-bristle toothbrush twice a day
3 A patient with thrombocytopenia should not use alcohol-based mouthwashes, because alcohol-based mouthwashes will dry the mouth and increase bleeding. Patients with thrombocytopenia should drink plenty of fluids to prevent constipation. Patients with thrombocytopenia should shave using an electric razor, not blades, to prevent the risk for injury. Patients with thrombocytopenia should use a soft-bristle toothbrush to prevent gum injury.
A patient who is receiving heparin therapy manifests signs of heparin overdose. The nurse should make preparations to administer which medication? 1 Lepirudin 2 Rituximab 3 Prednisone 4 Protamine sulfate
4 Protamine sulfate reverses the anticoagulant effects of circulating heparin during severe clotting. Lepirudin is given to maintain anticoagulation. Rituximab is given to reduce the immune recognition of platelets. Prednisone is used to suppress the phagocytic response of splenic macrophages.
A patient with immune thrombocytopenic purpura (ITP) is scheduled for a splenectomy. The goal of the surgery is complete remission. The nurse recognizes that the surgery is an appropriate treatment plan because of what splenic function? 1 The spleen sequesters total platelets. 2 The spleen does not contain macrophages. 3 The spleen does not synthesize any antibodies. 4 The spleen affects the platelet-macrophage interaction.
4 Splenectomy causes complete remission in a patient with immune thrombocytopenic purpura (ITP) because the structural features of the spleen enhance the interaction between antibody-coated platelets and macrophages. The spleen sequesters approximately one third of the platelets, so removal of the spleen increases the number of platelets in circulation. The spleen contains abundant macrophages that sequester and destroy platelets. The spleen synthesizes some antibodies and thus antiplatelet antibodies decrease after splenectomy.
The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? Unit secretary A physician's assistant Another registered nurse An unlicensed assistive personnel
Another registered nurse Rationale: Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.
Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? Add the blood transfusion as a secondary line to the existing IV. Stay with the patient for 60 minutes after starting the transfusion. Check the identifying information on the unit of blood against the patient's ID bracelet. Prime new primary IV tubing with lactated Ringer's solution to use for the transfusion.
Check the identifying information on the unit of blood against the patient's ID bracelet.
The nurse receives a provider's order to transfuse fresh frozen plasma to a patient with acute blood loss. Which procedure is most appropriate for infusing this blood product? Hang the fresh frozen plasma with lactated Ringer's solution. Fresh frozen plasma must be given within 24 hours after thawing. Infuse the fresh frozen plasma at a rate of 50 mL/hr for the duration. Hang the fresh frozen plasma as a piggyback to a primary IV solution without KCl.
Fresh frozen plasma must be given within 24 hours after thawing. Rationale: The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.
The blood bank notifies the nurse that 2 units of blood ordered for a patient is ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? Immediately pick up both units of blood from the blood bank. Infuse the blood slowly for the first 15 minutes of the transfusion. Regulate the flowrate so that each unit takes at least 4 hours to transfuse. Set up the Y-tubing of the blood set with dextrose in water as the flush solution
Infuse the blood slowly for the first 15 minutes of the transfusion. Rationale: Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging 1 unit of blood. Only 1 unit of blood can be picked up at a time, it must be infused within 4 hours, and it cannot be hung with dextrose
The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? Administer heparin. Administer whole blood. Treat the causative problem. Administer fresh frozen plasma.
Treat the causative problem. Rationale: Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.
The assessment findings of a patient with hemophilia A include ecchymosis and subcutaneous hematomas. The patient is prescribed desmopressin acetate. The nurse recognizes that the medication is expected to produce what therapeutic outcome? 1 Increase in factor VIII 2 Increase platelet count 3 Increase in hemoglobin 4 Increase in neutrophil count
1 Ecchymosis and subcutaneous hematomas are the clinical manifestations of bleeding in a patient with hemophilia A. Desmopressin acetate is used to stimulate an increase in factor VIII in patients with hemophilia. An increase in platelet count is a therapeutic outcome related to corticosteroids and immunosuppressants, which are used in the treatment of thrombocytopenia. An increase in hemoglobin is seen in the patients who are receiving erythropoietin therapy for anemia. Granulocyte colony-stimulating factors such as filgrastim and pegfilgrastim are used in the treatment of neutropenia. These drugs stimulate the production of neutrophils, thereby increasing the neutrophil count.
The nurse reviews the blood test reports of four patients and determines that which patient is most likely to have an increased heart rate? 1 Patient A hemoglobin 80 2 Patient B hemoglobin 50 3 Patient C hemoglobin 100 4 Patient D hemoglobin 110
1 Hemoglobin content of less than 60 g/dL indicates severe anemia, which can result in tachycardia, or increased heart rate. Patient B is showing symptoms of tachycardia and increased pulse pressure. Patient A has a hemoglobin content between 60 and 100 g/dL, which indicates moderate anemia but is not associated with an increased heart rate. Patients C and D have a hemoglobin content between 100 and 120 g/dL, which indicates mild anemia.
A patient is diagnosed with heparin-induced thrombocytopenia. The nurse anticipates that which therapies will be prescribed, to maintain anticoagulation? Select all that apply. 1 Warfarin 2 Plasmapheresis 3 Protamine sulfate 4 Platelet transfusion 5 Low-molecular-weight heparin
1,2,3 In HIT, platelet count decreases and hemoglobin level remains normal. Warfarin is given to the patient when the platelet count reaches 150,000/μL. If there is severe clotting, plasmapheresis is preferred to treat the patient in order to clear the platelet-aggregating IgG from the blood. Protamine sulfate is given to interrupt the circulating heparin. Platelet transfusions would not be effective to treat HIT, because this may enhance thromboembolic events. Heparin and low-molecular-weight heparin should be discontinued, because they may further potentiate thrombocytopenia.
The nurse notes a provider's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? 11:45 AM 12:00 noon 12:30 PM 3:30 PM
12:00 noon Rationale: The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.
Before starting a transfusion of packed red blood cells, the nurse would arrange for a peer to monitor their other assigned patients for how many minutes when the nurse begins the transfusion? 5 15 30 60
15 Rationale: As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.
A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? 1 Glossitis 2 Palpitations 3 Dyspnea at rest 4 Roaring in the ears
2 An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.
The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse should plan to stay in the patient's room until what time? 1 1040 2 1045 3 1050 4 1055
2 As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.
The nurse reviews the medical records of four patients and identifies that which patient's prescription requires immediate correction? 1 Patient A hemoglobin 80 2 Patient B hemoglobin 50 3 Patient C hemoglobin 100 4 Patient D hemoglobin 110
2 Patient B has thrombocytopenia, which is characterized by an abnormally low level of platelets and the patient is prescribed aspirin. This reduces platelet adhesiveness and contributes to bleeding. Therefore the nurse anticipates that patient B's prescription requires immediate correction. Desmopressin acetate is a synthetic analog of vasopressin and is used to treat hemophilia A. Lepirudin is a thrombin inhibitor, and is used to treat heparin-induced thrombocytopenia (HIT). Corticosteroids such as methylprednisolone are effective in treating immune thrombocytopenic purpura (ITP).
The nurse reviews a patient's pre-op prescription which states: "Infuse one unit of fresh frozen plasma (FFP) before arrival to the operating room." To complete this prescription safely, the nurse should take which action? 1 Infuse the FFP over four hours and then take the patient to the operating room. 2 Infuse the FFP as rapidly as the patient will tolerate. 3 Administer the FFP as an IV piggyback to the primary IV solution. 4 Administer the FFP as an IV piggyback to lactated Ringer's solution.
2 The fresh frozen plasma should be administered as rapidly as possible and should be used within six hours. Fresh frozen plasma is infused with the use of any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infusing, unless a second IV line has been started for the transfusion.
The nurse provides care for a patient with immune thrombocytopenic purpura (ITP) that has a platelet count of 90,000/mcL of blood. What could be the reason for this condition in the patient? 1 Destruction of platelets 2 Decreased production of platelets 3 Enhanced aggregation of platelets 4 Increased consumption of platelets
2 The normal platelet count is in the range of 150,000 to 450,000 platelets/mcL of blood. A decreased blood platelet count indicates thrombocytopenia in the patient. A patient with ITP will have thrombocytopenia because of decreased platelet production. Ingestion of herbs results in thrombocytopenia by destroying the platelets. Enhanced aggregation of platelets is associated with thrombotic thrombocytopenic purpura (TTP). Increased consumption of platelets will cause heparin-induced thrombocytopenia (HIT).
The nurse reviews the laboratory test results for a patient with upper gastrointestinal bleeding and notes that the hemoglobin level is 8.7 g/dL and the hematocrit is 26%. The nurse should place highest priority on initiating interventions that will reduce which symptom? 1 Nausea 2 Dizziness 3 Headache 4 Constipation
2 The patient with a low hemoglobin and hematocrit (normal values 13.5% to 17% and 40% to 54%, respectively, for males) is anemic and would be most likely to experience fatigue and dizziness. This symptom develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Constipation, nausea, and headache are not associated with decreased hemoglobin and hematocrit levels
A patient's laboratory findings show an elevated hemoglobin and RBC count with microcytosis, as well as an elevated WBC count with basophilia. The nurse should provide what interventions? Select all that apply. 1 Monitoring liver function tests 2 Evaluating fluid intake and output 3 Assessing the patient's nutritional status 4 Initiating active and passive leg exercises 5 Instructing the patient to avoid high altitudes
2,3,4 In polycythemia vera, laboratory findings show an elevated hemoglobin and RBC count with microcytosis, as well as an elevated WBC count with basophilia. Fluid intake and output should be evaluated to avoid fluid overload, because this may further complicate circulatory congestion. Nutritional status should be assessed regularly, because inadequate food intake may result in gastrointestinal symptoms such as fullness, pain, and dyspepsia. Active and passive leg exercises should be initiated to prevent thrombus formation. Liver function tests should be monitored regularly in patients who require lifelong supplementation of iron. Patients with sickle cell disease should be advised to avoid high altitudes, because this may lead to hypoxia
A patient is scheduled to receive a transfusion of two units of packed red blood cells. The nurse would ask which health team member to assist in checking the unit before administration? 1 The unit secretary 2 The physician's assistant 3 Another registered nurse (RN) 4 The unlicensed assistive personnel (UAP)
3 Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. If there is not another nurse available, a health care provider could check the blood with the nurse. The unit secretary and UAP are not licensed to perform this duty.
The diagnostic reports of a patient with severe bleeding reveal elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT). The nurse suspects that the patient is experiencing which condition? 1 Heparin-induced thrombocytopenia (HIT) 2 Immune thrombocytopenic purpura (ITP) 3 Disseminated intravascular coagulation (DIC) 4 Thrombotic thrombocytopenic purpura (TTP)
3 Disseminated intravascular coagulation (DIC) increases the prothrombin time (PT) and activated partial thromboplastin time (aPTT) because of impaired synthesis of clotting factors. The PT and aPTT are normal in heparin-induced thrombocytopenia (HIT), immune thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP).
The nurse reviews a patient's medical record and suspects heparin-induced thrombocytopenia (HIT). Which finding supports the nurse's conclusion? 1 Patient has a viral infection. 2 Patient has hemolytic anemia. 3 Patient has a platelet count of 100,000/µL. 4 Patient has systemic lupus erythematosus.
3 Long-term heparin therapy can causes heparin-induced thrombocytopenia (HIT) that results in decrease in the platelet count. A platelet count of 100,000/µL indicates HIT. Immune thrombocytopenic purpura (ITP) will be suspected if the patient has a viral infection. Thrombotic thrombocytopenic purpura (TTP) will be suspected if the patient has hemolytic anemia and an autoimmune disorder like systemic lupus erythematosus.
A patient is diagnosed with coagulopathy and receives a prescription for warfarin therapy. The nurse provides dietary education. Which statement made by the patient indicates that the teaching was effective? 1 "Vitamin K is only in fruits and salad." 2 "I can eat as many green, leafy vegetables as I want." 3 "I need to have a consistent amount of vitamin K in my diet." 4 "I should avoid green, leafy vegetables, and I cannot eat salad regularly."
3 Patients on warfarin therapy must be taught to identify foods high in vitamin K and to consume consistent amounts daily. Patients should be advised not to eat large amounts of green, leafy vegetables sporadically as this decreases the effectiveness of warfarin. A balanced diet that includes a consistent amount of vitamin K is necessary to maintain good health. As such, patients should not avoid foods containing vitamin K. Vitamin K is found in many fruits, vegetables, and meats.
A patient with thrombocytopenia experiences a nosebleed. What is the priority nursing intervention? 1 Notify the primary health care provider. 2 Tap the patient's nose gently with a tissue. 3 Place ice bags over the bridge of the patient's nose. 4 Position the patient's head upwards and apply pressure to nostrils
3 The primary nursing intervention for a patient with thrombocytopenia and nosebleed is to prevent excessive blood loss. Positioning the patient's head upwards and applying pressure on the nostrils will reduce the flow of blood and will decrease bleeding. The primary health care provider is called if the bleeding does not stop after 10 minutes. The patient's nose will be tapped gently if the patient has a feeling of discomfort in the nose after reducing the risk of excessive blood loss. If the bleeding continues after positioning the patient's head upward, then ice bags should be placed over the bridge of the patient's nose to decrease bleeding.
When thrombotic thrombocytopenic purpura (TTP) is left untreated, the nurse identifies that the patient is at risk for what complication? 1 Venous thrombosis 2 Acute hemarthrosis 3 Irreversible renal failure 4 Decreased platelet production
3 Thrombotic thrombocytopenic purpura (TTP) causes irreversible renal failure because of prolonged vasoconstriction if left untreated in a patient. Venous thrombosis is observed in heparin-induced thrombocytopenia (HIT). Acute hemarthrosis is a complication of hemophilia. Decreased platelet production is the cause of immune thrombocytopenic purpura (ITP).
The nurse creates patient teaching information related to heparin therapy. The nurse recalls that heparin should never be given to a patient with a history of what? 1 Splenomegaly 2 Thromboembolism 3 Hepatic encephalopathy 4 Heparin-induced thrombocytopenia (HIT)
4 With HIT, heparin causes decreased platelet counts and increases the risk for hemorrhage. Patients who have had HIT should never be given heparin or low-molecular heparin (LMWH). This should be clearly marked in the patient's medical record. Splenomegaly is an enlarged spleen; this often occurs with anemia and autoimmune disorders. Hepatic encephalopathy occurs in alcoholic clients when brain tissue is destroyed due to decreased thiamine. Thromboembolism is another term for blood clot; heparin is used to treat clots and would not cause them.
The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse assess first? A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL
A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL Rationale: A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.
The nurse is caring for a patient with a diagnosis of immune thrombocytopenic purpura (ITP). What is a priority nursing action in the care of this patient? Administration of packed red blood cells Administration of oral or IV corticosteroids Administration of clotting factors VIII and IX Maintenance of reverse isolation and application of standard precautions
Administration of oral or IV corticosteroids Rationale: Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.
