N201 MEDSURG 2: THROMBOCYTOPENIA
What is the mainstay treatment for Immune Thrombocytopenia (ITP)?
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.
A patient with thrombocytopenia with active bleeding is to receive 2 units of platelets. To administer the platelets, what should the nurse do? a. Check for ABO compatibility. b. Agitate the bag periodically during the transfusion. c. Take vital signs every 15 minutes during the procedure. d. Refrigerate the second unit until the first unit has transfused.
b. Agitate the bag periodically during the transfusion.
Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenia purpura (ITP)? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injection. c. Use rinses rather than a soft toothbrush for oral care. d. Restrict activity to passive and active range of motion.
b. Avoid intramuscular (IM) injection. (gateway for bleeding)
A patient has a platelet count of 50,000/µL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy
b. Corticosteroids Rationale: b. Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary leakage. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy and severely reduced platelet counts.
Following a splenectomy for the treatment of ITP, what laboratory test result would the nurse expect to find? a. Decreased RBCs b. Decreased WBCs c. Increased platelets d. Increased immunoglobulins
c. Splenectomy may be indicated for treatment for ITP, and when the spleen is removed, platelet counts increase significantly in most patients. In any of the disorders in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.
A nurse is caring for a patient with a history of thrombocytopenia. The patient has several complications while in the hospital and needs to be on bedrest for several days. The nurse understands that one main goal is to prevent bleeding in this patient. Which intervention needs to be considered for this patient who needs additional bed rest at home?
Avoid herbal medications and supplementsTo prevent bleeding complications in this patient, it will be important for the nurse to instruct the patient and caregiver to avoid taking herbal medications.
Which diagnostic test can detect destruction of circulating platelets as the cause of thrombocytopenia?1Hemoglobin2Bone marrow analysis3Prothrombin time (PT)4Peripheral blood smear
Correct2When destruction of circulating platelets is the cause, bone marrow analysis shows megakaryocytes (precursors of platelets) to be normal or increased, even though circulating platelets are reduced. Prothrombin time (PT) is used to assess secondary hemostasis. Peripheral blood smear is used to distinguish acquired disorders from congenital disorders. Hemoglobin measures the amount of protein in the red blood cells that carries oxygen to the body's organs and tissues and transports carbon dioxide from the organs and tissues back to the lungs.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
44-year-old patient presents to the emergency department with a fever, blood clots, and history of an abnormal enzyme deficiency. The patient has not taken any medications in the past month. Why is this patient also likely to experience pain with the condition?
This patient is presenting with signs of thrombotic thrombocytopenic purpura (TTP).This patient is presenting with signs of TTP that include fever (without an identifiable cause) and history of an enzyme deficiency (ADAMTS13) needed to break down von Willebrand factor. TTP patients need to be monitored for microthrombi that can cause ischemia and pain.
A patient presents with symptoms of thrombocytopenia and a platelet count of 50,000/µL. To differentiate thrombocytopenia from a myeloproliferative disorder, which diagnostic study would the nurse anticipate being prescribed for this patient?
-Bone marrow biopsyA bone marrow biopsy may be necessary to rule out leukemia, aplastic anemia, and other myeloproliferative disorders and can be used to differentiate thrombocytopenia from other myeloproliferative disorders.
Which sign would the nurse expect to assess in the client diagnosed with immune thrombocytopenic purpura (ITP)? a. Petechiae on the anterior chest, arms, and neck. b. Capillary refill of less than three (3) seconds. c. An enlarged spleen. d. Pulse oximeter reading of 95%.
A) Petechiae on the anterior chest, arms, and neck.
The nurse should question which therapy that is listed on a treatment plan for a patient who has thrombotic thrombocytopenic purpura (TTP)?1Plasmapheresis2Rituximab therapy3Platelet transfusion4Corticosteroid therapy
Correct3Administration of platelets or platelet transfusion is contraindicated in a patient who has thrombotic thrombocytopenic purpura (TTP) because it leads to new vWF-platelet complexes and increased clotting. Plasmapheresis supplies the appropriate vWF and enzyme (ADAMTS13) and removes large vWF molecules that bind with platelets; therefore it reverses the platelet consumption in the patient. Rituximab and corticosteroids are used in the treatment of TTP.
A patient that experiences prolonged bleeding is diagnosed with thrombocytopenia. The nurse expects what assessment findings? Select all that apply.Correct 1FaintingCorrect 2Dizziness3Bradycardia4HypertensionCorrect 5Abdominal pain
Abdominal painA patient with thrombocytopenia will experience fainting, dizziness, and abdominal pain because of prolonged bleeding. A patient with thrombocytopenia will have tachycardia and hypotension because of decreased quantity of blood.Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.
The nurse caring for a patient with heparin-induced thrombocytopenia (HIT) identifies risk for hemorrhaging as the priority nursing diagnosis. Identify at least 5 nursing interventions that should be implemented.
Any 5 of these are appropriate: Heparin administration must be discontinued and expect a direct or indirect thrombin inhibitor to be ordered. Monitor for signs and symptoms of bleeding (check IV sites, wounds, any secretions). Monitor ordered coagulation studies. Avoid injections. Use an electric razor. Protect the patient from trauma. Administer ordered blood products. Instruct the patient and caregiver to avoid aspirin and other anticoagulants. Instruct the patient to avoid high contact activities (many sports).
Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenia? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet d. Pace a No Visitor sign on the door.
Check temperature every 4 hours. (precursor of WBC, cells that fights infections,
The nurse provides education regarding daily activities to a patient with thrombocytopenia. Which patient activity indicates understanding of the teaching?1Flossing using thick tape floss2Shaving using an electric razor3Wearing flip flops to go walking4Brushing using a stiff-bristle toothbrush
Correct 2A patient with thrombocytopenia has a decreased number of platelets, and therefore prolonged bleeding will be observed even for minor injuries. Shaving using an electric razor blade decreases the risk of cuts and wounds resulting in decreased bleeding. Therefore this activity of the patient indicates understanding of the nurse's teaching. Walking with flip flops can cause the patient to trip, causing the risk for cuts or wounds and increased bleeding. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Brushing using a stiff-bristle toothbrush causes injury to the gums and is not safe; therefore the nurse needs to perform more patient teaching.
THhe nurse recognizes that which medication may benefit a patient with immune thrombocytopenic purpura (ITP) by increasing the platelet production?1Danazol2Eltrombopag3Tranexamic acid4Desmopressin acetate
Correct2Eltrombopag is a thrombopoietin receptor agonist that acts by increasing platelet production. Danazol is an androgen that acts by increasing CD4+T cells. Tranexamic acid is an antifibrinolytic drug that acts by inhibiting plasminogen activation in the fibrin clot. Desmopressin acetate is a synthetic analog of vasopressin that acts on platelets and endothelial cells to release von Willebrand factor (vWF).Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.
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?1Destruction of platelets2Decreased production of platelets3Enhanced aggregation of platelets4Increased consumption of platelets
Correct2The 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).
patient experiences a minor bleeding episode during a dental procedure. The nurse recognizes that which therapy will be beneficial?1Tranexamic acetate2Fresh frozen plasma3Desmopressin acetate4Epsilon-aminocaproic acid
Correct3Desmopressin acetate is used to treat minor bleeding episodes and dental procedures. Tranexamic acetate is the antifibrinolytic used to stabilize the clot in patients with epistaxis and menorrhagia. Fresh frozen plasma is used as replacement therapy in treating hemophilia. Epsilon-aminocaproic acid is the antifibrinolytic used for clot stability in patients with difficult episodes of epistaxis and menorrhagia.Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call
patient experiences thrombocytopenia. The nurse should monitor the patient for which major complication?1Fatigue2Weakness3Hemorrhage4Abdominal pain
Correct3The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.
The nurse is reviewing the lab reports of several patients. Which report is consistent with a diagnosis of thrombocytopenia?1Hemoglobin 132Hemoglobin 163Platelets 20,000/µL4Platelets 1,000,000/ µL
Correct3Thrombocytopenia means there are low levels of circulating platelets. A platelet count below 150,000/ µL is considered low. As such, a platelet count of 20,000/µL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12-17 g/dL depending on the sex of the patient. Hemoglobin levels of 13 g/dL and 16 g/dL are normal.
A patient experiences thrombocytopenia due to consumption of certain herbs. The nurse suspects that which mechanism of thrombocytopenia occurred?1Altered platelet aggregation2Adequate platelet production3Decreased platelet production4Accelerated platelet destruction
Correct4Ingestion of herbs may cause accelerated platelet destruction due to drug-dependent antibodies. Altered platelet aggregation is the cause of thrombotic thrombocytopenic purpura (TTP). Adequate platelet production will not cause thrombocytopenia in the patient. Decreased platelet production contributes to idiopathic thrombocytopenic purpura.
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?1The spleen sequesters total platelets.2The spleen does not contain macrophages.3The spleen does not synthesize any antibodies.4The spleen affects the platelet-macrophage interaction.
Correct4Splenectomy 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.Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.
A patient with leukemia is admitted for severe hypovelemia after prolonged diarrhea. THe platelet count is 43,000/uL. What is the best action for the nurse to take? a) Insert two 18 gauge IV catheters b) Administer prescriber enoxaparin c) Monitor the pt's temperature every 2 hrs d) Check stools for presence of frank or occult blood.
D) Check stools for presence of frank or occult blood. Rationale: A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids and medications, IV access should be provided through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is contraindicated in patients with thrombocytopenia. Monitoring temperature would be indicated in a patient with leukopenia.
When thrombotic thrombocytopenic purpura (TTP) is left untreated, the nurse identifies that the patient is at risk for what complication?1Venous thrombosis2Acute hemarthrosisCorrect3Irreversible renal failure4Decreased platelet production
Decreased platelet productionThrombotic 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)
he nurse recognizes that which drug is directly myelosuppressive and may cause patient thrombocytopenia?1Abciximab2Cimetidine3Ganciclovir4Haloperidol
Ganciclovir is an antiinfective drug that causes thrombocytopenia; it is directly myelosuppressive. Abciximab is a platelet glycoprotein inhibitor that causes thrombocytopenia. Cimetidine is a histamine H2-receptor antagonist that causes thrombocytopenia. Haloperidol is an antipsychotic drug that causes thrombocytopenia.
A patient diagnosed with metastasizing cancer has a history of immune thrombocytopenic purpura (ITP) controlled with prednisone. Which information will need to be covered in the education plan for this patient?
Information on chemotherapy since some drugs will cause thrombocytopeniaSome chemotherapy drugs can lead to thrombocytopenia, and therefore, the patient will need education on this therapy.
A patient with a platelet count of 52,000/mm3 is diagnosed with thrombocytopenia. The nurse expects what clinical manifestations? 1Weakness and fatigue 2Bruising and petechiae 3Dizziness and vomiting 4Lightheadedness and nausea
Lightheadedness and nauseaA low platelet count, known as thrombocytopenia, may be accompanied by signs of hemorrhage, such as bruising and petechiae. A normal platelet count is 150,000 to 400,000/mm3. The symptoms listed in the other answer options are not directly associated with thrombocytopenia.
A patient with leukemia asks the nurse, "What causes the reddish-purplish colored spots on my skin?" The nurse should explain that the spots are due to what condition?Correct1Low platelet count2Low neutrophil count3Low erythrocyte count4Low lymphocyte count
Lukemia is associated with bone marrow failure and a low platelet count. A low platelet count results in bleeding, which causes red- to purple-colored spots on the skin. A low neutrophil count is not associated with red- to purple-colored spots on the skin. A low erythrocyte count results in anemia, which causes weakness and pallor. A low lymphocyte count results in immunosuppression, leading to infection and fever.Test-Taking Tip: Remember the various conditions associated with changes that occur in the different blood cells in the body.
A patient presents to the clinic with possible immune thrombocytopenic purpura (ITP) due to a rash on the upper legs and arm and is also recovering from a bad case of strep throat. The patient has no significant medical history. The nurse should anticipate which medication will be administered to this patient?
PrednisoneThis patient is presenting with signs of ITP. Many cases will resolve on their own, but if needed, the best medication for this patient would be a low-dose steroid.
A patient who is receiving heparin therapy manifests signs of heparin overdose. The nurse should make preparations to administer which medication?1Lepirudin2Rituximab3PrednisoneCorrect4Protamine sulfate
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 diagnosed with immune thrombocytopenic purpura (ITP) will be undergoing a splenectomy. A family member asks why this procedure is necessary. Which response by the nurse is appropriate?
Removal of the spleen will stop the unwarranted destruction of your platelets."Since ITP is autoimmune in nature, a person with chronic ITP may benefit from the removal of the spleen since it is a major source of autoantibody production.
Which drug that is used for patients with thrombotic thrombocytopenic purpura (TPP) has the ability to decrease the level of inhibitory ADAMTS13 IgG antibodies?Correct1Rituximab2Prednisone3Argatroban4Intravenous immunoglobulin
Rituximab has the ability to decrease the level of inhibitory ADAMTS13 IgG antibodies, thus reducing the immune recognition of platelets. Prednisone has the ability to suppress the phagocytic response of splenic macrophages. Argatroban is a direct thrombin inhibitor. IV immunoglobulin acts by competing with the antiplatelet antibodies for macrophage receptors in the spleen.
patient with a history of chronic immune thrombocytopenic purpura (ITP) comes to the nurse for dietary advice. As a health care provider, you understand that an important goal for this patient is to reduce mouth soreness and irritation. Which intervention would be helpful for this patient?
Soft, bland foodA diet of soft, bland foods will be most helpful to patients and help prevent mouth discomfort and irritation.
Which information obtained by ten nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/L. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.
The patient is difficult to arouse. (Platelet count < 50k is risk for thrombocytopenia)
A pt present with throbocytopenia secondary to heparin adminitration. THe nurse should assess the pt for w/c potential complications
Venous thrombosis is the major clinical complication of heparin-induced thrombocytopenia and can lead to further life-threatening complications.Correct--Altered cognitive statusNeurologic abnormalities, resulting in altered cognitive status, can occur as part of thrombotic stroke. This is a complication of heparin-induced thrombocytopenia.
A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan? a. Apply pressure to needlestick sites for 10 min. b. Assess core temperatures using a rectal thermometer. c. Measure abdominal girth twice weekly. d. Monitor for the presence of WBCs in the urine.
a. Apply pressure to needlestick sites for 10 min.
1. A 19-year-old woman with immunize thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the healthcare provider before obtaining and administering platelets? a. The platelet count is 42,000/mL. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mmHg. d. Blood oozing from the venipuncture site.
a. The platelet count is 42,000/mL. Rationale: - Administer platelet transfusion if platelets <10K & active hemorrhage) -Petechiae on the chest is sign of fat embolus associated with hip fracture or surgery
Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patient on strict bed rest to prevent injury c. Monitoring the patient for headaches, vertigo, or confusion d. Removing the oral crusting and scabs with a soft brush 4 times a day
c. The major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. Cerebral hemorrhage may be fatal, and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.
Which laboratory results will the nurse expect to show a decrease value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time (PT) b. Erythrocytes count c. Fibrinogen degradation products d. Activated partial thromboplastin time (aPTT)
d) Activated partial thromboplastin time (aPTT) (Heparin directly affects Extrinsic pathway and common pathway in coagulation cascade, start it with factor 7, and inhibits thrombin, = no fibrin produce)
A patient is diagnosed with thrombotic thrombocytopenic purpura (TTP) and asks the nurse what to expect regarding treatment. Identify the treatments the nurse should review in the order that they would be administered.
he first step in treating thrombotic thrombocytopenic purpura is to treat the underlying causes such as infection. Infection would be treated with antibiotics.If treating the cause did not address the problem, plasmapheresis or plasma exchange would be performed.Rituximab may be used for patients refractory to plasma exchange.Finally, splenectomy may be considered in patients who are refractory to plasma exchange or immunosuppression.
The nurse reviews a patient's medical record and suspects heparin-induced thrombocytopenia (HIT). Which finding supports the nurse's conclusion?1Patient has a viral infection.2Patient has hemolytic anemia.Correct3Patient has a platelet count of 100,000/µL.4Patient has systemic lupus erythematosus.
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.
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?1Drinks 14 glasses of water daily2Shaves once a day using an electric razorCorrect3Uses an alcohol based mouthwash twice a day4Brushes teeth with a soft-bristle toothbrush twice a day
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 with thrombocytopenia experiences a nosebleed. What is the priority nursing intervention?1Notify the primary health care provider.2Tap the patient's nose gently with a tissue.3Place ice bags over the bridge of the patient's nose.4Position the patient's head upwards and apply pressure to nostrils.
Correct4The 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.
