Platelet and Coagulation Disorders (Exam 5)

b, e (Fresh-frozen plasma is a type of blood product that contains the fluid portion of blood and not the blood cells. A unit of FFP contains a mixture of water, protein, and a small amount of carbohydrates. It is often administered as treatment when a client has trouble with blood clotting.)

A client has an order to receive one unit of fresh-frozen plasma (FFP). Based on the nurse's understanding of this blood product, the nurse knows that which of the following are true regarding FFP? Select all that apply. a. FFP is packed in a preservative solution b. FFP usually contains water, proteins, and a small amount of carbohydrates c. FFP often contains a certain amount of red blood cells to distribute hemoglobin d. FFP cannot be administered to someone who is immunocompromised e. FFP is often used to treat acute coagulopathy states

a, b, c, e (A client with thrombocytopenia has reduced platelets in the blood and must be monitored carefully for signs of bleeding. Purpura would be a sign that the client has low platelets. A client with thrombocytopenia has reduced platelets in the blood and must be monitored carefully for signs of bleeding. The client must avoid NSAIDs because this will increase the bleeding risk. A client with thrombocytopenia has reduced platelets in the blood and must be monitored carefully for signs of bleeding. A client with thrombocytopenia has reduced platelets in the blood and must be monitored carefully for signs of bleeding. Urine output should be monitored, and pink, red or brown urine should be noted as this means there is blood in the urine.)

A client presents to the emergency department with thrombocytopenia. Likely nursing interventions include which of the following? Select all that apply. a. Observe for purpura and open wounds b. Monitor urine output c. Withhold aspirin d. Monitor for mental status changes e. Monitor for bleeding

b (This occurs because the activation of the clotting cascade causes mini clots to form all throughout the vasculature of the body.)

A client with difficulty breathing gets a CT scan that shows multiple clots in the lungs as well as in the heart and kidneys. Which blood clotting condition does this client most likely have? a. Wiskott-Aldrich syndrome b. Disseminated intravascular coagulation c. Hemophilia d. Idiopathic thrombocytopenic purpura

a (The increased clotting and bleeding will produce these symptoms, among others, in clients with DIC.)

A nurse is assessing a postpartum client for possible Disseminated Intravascular Coagulation. Which symptoms would the nurse expect to find? a. Petechiae, purpura b. Headache, decreased urinary output c. Boggy uterus, pain d. Lung crackles, hypertension

d (Purpura is a condition that develops when the capillaries leak blood under the skin. It causes dark red or purple flat macules on the skin and it may be associated with low platelet levels in the bloodstream. Purpura can develop from a number of conditions including vitamin C deficiency (scurvy), cytomegalovirus, rubella, and some blood clotting disorders.)

A nurse is caring for a 6-year-old child who has severe vitamin C deficiency. The nurse notes that the child's skin has areas of purpura. This condition of most likely described as which of the following? a. Dilated blood vessels under the skin b. Yellow or brown, flat, irregularly-shaped lesions c. Clusters of blood vessels around body orifices d. Dark red, flat, scattered macules

b, c, e (Clotting times would be increased because of the body using up clotting factors and not being able to clot anymore. Normal PT is 11-14 seconds, this is prolonged, therefore would be evidence of DIC. Platelets would be decreased due to being used up. Normal platelets are 100K-450K. This is low, therefore would be evidence of DIC. Clotting times would be prolonged because the body is no longer able to clot effectively. Normal PTT is 25-35 seconds. This result is lengthened, therefore possible evidence of DIC.)

A nurse is caring for a client that delivered a fetal demise 3 hours ago is bleeding heavily. The providers believe she has disseminated intravascular coagulation and has ordered labs to be drawn. What results would the nurse expect to see if DIC is occurring? Select all that apply. a. Hemoglobin 13.2 b. PTT 56 seconds c. PT 19 seconds d. INR 1.2 e. Platelets 50,000

d (The nurse will monitor the client for signs of hypovolemic shock, dehydration, and sepsis, and be prepared to give blood as ordered. Fluid and electrolytes can be given and the nurse should instruct the client on proper eating habits, but these are not the priority in this situation.)

A nurse is caring for a client with a gastric ulcer who begins to have active bleeding. Which of the following is the priority nursing intervention? a. on proper eating habits b. Give NSAIDs for pain c. Give fluid and electrolytes d. Give blood if low hemoglobin

c (A thrombosis is a blood clot, and platelets clot blood. Therefore, thrombocythemia is a condition in which there are too many platelets in the blood. In essential thrombocythemia, the body produces excessive platelets, and diagnosis is confirmed when the number of platelets per microliter of blood is between 450,000 and 600,000. There are also increased megakaryocytes (which produce platelets) in bone marrow aspirate, but the thrombin level and erythrocyte count are normal.)

A nurse is caring for a client with essential thrombocythemia. What diagnostic finding will the nurse expect to see? a. Elevated erythrocyte count b. Elevated thrombin level c. Platelet count greater than 450,000 d. Decreased megakaryocytes in bone marrow

a (This is the correct explanation of what is happening to the client in DIC.)

A nurse is caring for a postpartum client with disseminated intravascular coagulation. The client's family wants to understand what this means. What is the best response by the nurse? a. "She is bleeding heavily because of an overreaction of her clotting system" b. "She is bleeding heavily because her immune system is attacking her platelets" c. "She is bleeding because there was too much trauma during delivery" d. "She is bleeding heavily, but we can control it easily"

d (Blood transfusions are relatively common procedures in hospital nursing. The nurse who administers blood products should be familiar with the risks of transfusion reactions and the institution's transfusion protocol. Prior to starting a transfusion, however, the first action of the nurse is to verify that an order exists and check the details of the order against the blood product.)

A nurse is preparing to give blood products to a client who is experiencing excess bleeding after surgery. Prior to administration, which action should the nurse perform first? a. Document the client's vital signs b. Prime the IV tubing with normal saline c. Gather appropriate equipment for blood product administration d. Ensure that there is an order for the transfusion

a, b, e (a 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.)

A patient that experiences prolonged bleeding is diagnosed with thrombocytopenia. The nurse expects which assessment findings? Select all that apply a. fainting b. dizziness c. bradycardia d. hypertension e. abdominal pain

b (drug induced thrombocytopenia affects the platelet aggregation, and normal function is restored when new platelets are formed. Vitamin C, aspirin in low doses, and quinine in tonic water can cause thrombocytopenia.)

A patient that receives baby aspirin therapy has developed thrombocytopenia. The nurse recognizes that normal platelet function will be restored when which condition occurs? a. when vitamin C is given b. When new platelets are formed c. When aspirin is given in low doses d. When quinine is given in tonic water

b, e (a 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. Weakness, dizziness, and vomiting are not directly associated with thrombocytopenia.)

A patient with a platelet count of 52,000/mm3 is diagnosed with thrombocytopenia. The nurse would expect which clinical manifestations? Select all that apply a. weakness b. bruising c. dizziness d. vomiting e. petechiae

aPTT

Activated partial thromboplastin time - measures number of seconds for a clot to form normally 25 to 35 seconds for anticoagulant therapy 1.5 to 2.5 times the control in seconds

d (This could be a possible sign of Disseminated Intravascular Coagulation. Further assessment, testing, and monitoring should be performed.)

After shift change, a nurse takes over care for a postpartum client who had been bleeding moderately and is staying on the labor unit for closer watching. What assessment finding should the nurse be the most concerned about? a. Client is passing large clots b. Client has not voided since straight cath two hours ago c. Bleeding has not stopped yet d. Client has some bleeding around her IV site

a, b, d (In DIC, the consumption of platelets decreases the platelet counts, leading to bleeding. Depletion of coagulation factors may prevent clotting and increase the risk for bleeding. The FSPs may disintegrate any clot formed, thus increasing the risk for bleeding. Fibrinolysis in the microcirculation and thrombotic occlusion of microcirculation in organs are the factors that cause thrombotic manifestations in a patient with DIC.)

Bleeding manifestations in a patient with disseminated intravascular coagulation (DIC) may be caused by which pathophysiologic factors? Select all that apply a. consumption of platelets b. depletion of coagulation factors c. fibrinolysis in the microcirculation d. formation of fibrin split products (FSPs) e. thrombotic occlusion of microcirculation in organs.

b (cryoprecipitates may be required in DIC disorder when the fibrinogen levels are less than 100 mg/dL. This therapy helps to replace factor VIII, which plays a major role in clotting. Cryoprecipitates do not replace factors V, X, and XII.)

Cryoprecipitate therapy is helpful in the treatment of disseminated intravascular coagulation (DIC) disorder because it replaces which factor? a. factor V b. factor VII c. factor X d. factor XII

b (one unit contains approximately 250 mL of fresh frozen plasma)

How many milliliters comprise one unit of fresh frozen plasma? a. 60mL b. 250mL c. 350mL d. 400mL

0.7, 1.8, 2, 3

INR-international normalized ratio-reports relationship of patients PT to a normal control Normally _____ to ______ To monitor warfarin therapy: goal is ___ to _______

INR

International normalized ratio-reports relationship of patients PT to a normal control Normally 0.7 to 1.8 To monitor Warfarin therapy, goal is 2 to 3

thrombocytopenia

Nursing concepts Priority nursing concepts for a patient with ___________ -Clotting: we want to monitor for bleeding, monitor lab values, platelet count, Hgb and Hct, transfuse platelets, make sure compatible with patient, institute bleeding precautions.

11, 16, 1.5, 2.0

PT-prothrombin time-used to monitor warfarin therapy and screen for vitamin K deficiency Normally ________ to ______ seconds For anticoagulant therapy _______ to ______ times control

c (DIC increases the PT and aPTT b/c of impaired synthesis of clotting factors. The PT and aPTT are normal in HIT, ITP, and TTP.)

The diagnostic reports of a patient with severe bleeding reveal elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT). The nurse suspects which condition? a. heparin induced thrombocytopenia (HIT) b. immune thrombocytopenic purpura (ITP) c. disseminated intravascular coagulation (DIC) d. Thrombotic thrombocytopenic purpura (TTP)

DIC (disseminated intravascular coagulation)

The following are clinical manifestations/S/S of _____ -Pallor, weakness -Risk for hypovolemic shock -abnormal labs: increased aPTT, PT, thrombin time and decreased platelets -dyspnea -chest pain -anxiety -confusion (b/c of clots or b/c of excessive bleeding) -Ecchymosis: petechiae, purpura, hematomas (retroperitoneal hematomas seen often) -Bleeding: hemoptysis, hematemesis, melena, occult blood in stool, hematuria -they will bleed from every IV site, every skin tear.

DIC (disseminated intravascular coagulation)

The following are manifestations of _______ -Acute _______ develops quickly (over hours or days) and must be treated right away. The condition begins with excessive blood clotting in the small blood vessels and quickly leads to serious bleeding. Sepsis is most common cause of acute _______ -Chronic _____ develops slowly (over weeks to months). It lasts longer and usually isnt recognized as quickly as acute_____. Chronic _______ causes excessive blood clotting, but usually doesn't lead to bleeding. cancer is the most common cause of chronic ______ -Bleeding manifestations-external hemorrhage; petechiae, purpura and ecchymoses; oral, GI, GU, and rectal bleeding; bleeding after injections and venipunctures -Thrombotic manifestations-acute kidney injury, respiratory and hepatic dysfunction, cardiac tamponade, hemothorax, intracerebral hematoma, gangrene and loss of fingers or toes, pulmonary embolus, MODS

DIC (disseminated intravascular coagulation)

The following describe Nursing Concepts for ________ -Priority nursing concepts for a pt. with _____________ -Clotting; we want to replace their clotting factor and stop the clotting cascade so that we can stop the entire process -Perfusion- keep them hemodynamically stable while we sort out the cause

thrombocytopenia

The following describes Assessment of a patient with _____________ Abnormal labs: -decreased Platelet count (these are responsible for clotting so if we see too few in our system we are going to see bleeding; not usually as severe as DIC -decreased Hgb & Hct Bleeding: petechiae Epistaxis Gi bleeding (emesis, melena, occult blood, coughing up blood) Hematuria

ITP (immune thrombocytopenic purpura)

The following describes Collaborative Care for ________ Diagnostics = . low platelet count and large numbers of megakaryocytes (immature platelets) Corticosteroids-prednisone IV immunoglobulin and IV anti-Rho Splenectomy (high risk for infection) Platelet transfusion if life-threatening bleeding episode (usually less than 10,000)

DIC (Disseminated Intravascular Coagulation)

The following describes Key points for _______ 1. clotting cascade: overactiviation ----> microclots 2. Factors consumed: clotting factors used up, unable to clot 3. Massive hemorrhage - severe bleeding from everywhere 4. Treat Cause: ID and treat cause, replace factors and RBCS 5. Prevent shock: monitor bleeding, I&O, hemodynamics

thrombocytopenia

The following describes Therapeutic management for _____________ -Bone marrow aspiration (from one of the major flat bones, most common locations = sternum, tibia, posterior iliac crest, anterior iliac crest) -Platelet transfusions; when platelets are low enough: Must have ABO compatibility just like RBCS -Avoid antiplatelet meds: especially if thats the med that caused it: aspirin, Plavix, heparin; if caused by heparin itself, the patient will be listed as allergic to heparin and should never have it again. -Bleeding precautions; this means electric razors only, soft toothbrush, avoid falls, especially at home.

DIC (disseminated intravascular coagulation)

The following describes ______ -Disruption of hemostasis characterized by widespread intravascular clotting and bleeding -In ____, the increased clotting uses up platelets and clotting factors in the blood: _____ can cause life-threatening bleeding -Pt. has both clotting and hemorrhage within circulatory system at the same time -Risk factors of _____: SEPSIS is most common cause, disease processes such as malignancies or autoimmune diseases, trauma, infections and obstetric complications.

DIC (disseminated intravascular coagulation)

The following describes ______ What happens in ________ is the clotting cascade gets activated. Platelets clump together, clotting factors activate each other down the cascade until it finally activates fibrin and thrombin to form a clot. So in _______ the clotting factor goes haywire. Clots begin to form everywhere in the body. All the small blood vessels, throughout the body, it is systemic and widespread activation of the clotting cascade. So there are little clots everywhere in the body and as that happens those clotting factors are used up/or consumed. Once that happens the patient is no longer able to form a clot so the patient begins to bleed profusely and have massive hemorrhage. -Also known as consumption coagulopathy -wide spread activation of the clotting cascade . blood clots in small vessels . clotting factors are used up . severe bleeding and massive hemorrhage -Risk factors-anything that initiates the clotting cascade.; most common is postpartum patients; also sepsis/septic shock; surgery; traumatic injury; also patients with liver disease b/c they already have issues with their clotting factors so they are more susceptible to ______.

TTP (thrombotic thrombocytopenic purpura)

The following describes ________ -an acquired Thrombocytopenia -A rare disorder in which platelets clump together abnormally in capillaries and too few platelets remain in circulation -Increased clotting that occurs in TTP also uses up platelets in blood. With fewer platelets available in the blood, bleeding problems can occur -Most often due to deficiency of plasma enzyme that usually breaks down von Willenbrand clotting factor (vWF) into normal size -Medical emergency because bleeding and clotting occur simultaneously

HIT (heparin-induced thrombocytopenia)

The following describes _________ -Thrombocytopenia that develops as a result of an abnormal response to heparin -Thrombocytopenia and thrombosis develop -Can be mild and self limiting or serve an dresult in DVT, PE, stroke and organ failure -Clinical manifestations: bleeding arterial thrombosis-severe pain, paresthesias, pallor, cool skin, no pulse distal of clot venous thrombosis- edema, redness, warmth of affected area

thrombocytopenia

The following describes ___________ -Decrease in circulating platelets (<100,000 mL)- by definition: But usually seen low around <40,000 -Causes: . decreased production (eg. aplastic anemia where bone marrow stops producing all the blood cells all together) . increased destruction (sometimes in autoimmune disease like lupus) . medication induced (meds like heparin can induce)

platelet transfusion

The following describes a _______ __________ -Used to treat acute bleeding due to thrombocytopenia -Prepared from fresh whole blood-one unit contains 30 to 60mL of platelet concentrate -Platelets do not have to be the same blood type as the patient -Usually comes in 200-300 mL bags -They are fragile and must be infused immediately after being brought to the patients room, usually over 15-20 minutes -Use a special transfusion set with a smaller filter and shorter tubing (standard transfusion sets are not used with platelet; because the filter traps the platelets and the longer tubing increases platelet adherence to the lumen -Take vital signs before, 15 min after at the completion -May premedicate with diphenhydramine (benadryl) and acetaminophen (tylenol) to reduce the chances of a reaction -Expected increase in platelets after one unit infused is 10,000/mL

TTP (thrombotic thrombocytopenic purpura)

The following describes collaborative care for ________ Treat underlying cause Plasmapheresis (plasma exchange) Infusions of fresh frozen plasma Corticosteroids Immunosuppressive therapy No platelet transfusions- could cause new clotting Tissues become ischemic, leading to kidney failure, MI and stroke

DIC (disseminated intravascular coagulation)

The following describes signs and symptoms of _______ The symptoms of _________ are often those of the underlying inciting condition 1. bleeding . GI bleed . petechiae and ecchymosis . intravenous (IV) lines and catheters bleed . Surgical sites, drains, and tracheostomies and within serous cavities 2. renal failure 3. pulmonary involvement . dyspnea, hemoptysis, and cough 4. jaundice

thrombocytopenia

The following describes the key points for _______ 1. low platelets - decreased ability to form a clot (usually <100,000) 2. signs of bleeding - petechiae, epistaxis, hemat-anyting; hematuria, hematemesis, hemoptysis etc 3. replenish platelets- platelet transfusions, avoid antiplatelet meds; like aspirin, clopidagrel, plavix etc. 4. bleeding precautions-education patients, monitor for s/s bleeding

DIC (disseminated intravascular coagulation)

The following describes the therapeutic management for patients with ______________ -Stay calm b/c this can be scary b/c of he massive bleeding -Medical care: . determine and treat underlying cause . replace clotting factors: fresh frozen plasma, factor VII . Administer heparin drip: stop consumption of clotting factors (this seems counterintuitive b/c you have a pt is hemorrhaging but the goal here is to stop consumption of the clotting factors and stop the clotting cascade. So if we can stop the clotting cascade and replace the ones they lost, then they will have enough clotting factors to clot again and they can be weaned off the heparin . Blood transfusion -Nursing Care: . monitor for bleeding . monitor I and O . monitor hemodynamics (b/c risk for shock) . Initiate bleeding precautions: NO INVASIVE PROCEDURES unless medically necessary, like a lost airway; NO Peripheral IVS NO NG tubes NO Foleys NO venipuncture NO Central lines NO ARTERIAL lines. None of those until the ______ is under control If current lines are working, do not add more.

a ( The normal range of platelet count is 150,000/uL to 350,000/uL, and the normal range of fibrinogen level is 200 to 400 mg/dL. In a pt with acute DIC disorder the platelet and fibrinogen levels are decreased. In patient 1, the platelet count of 40,000/uL and fibrinogen levels of 80mg/dL indicate DIC. Patients 2,3, and 4 have normal values of platelet count and fibrinogen levels, and are not associated with any hematologic disorders.)

The lab results of which patient are indicative of acute DIC a. patient 1, platelet count 40,000/uL, fibrinogen levels 80mg/dL b. Patient 2, platelet count 150,000/uL, fibrinogen 200mg/dL c. Patient 3, platelet count 210,000/uL, fibrinogen 300 mg/dL d. Patient 4, platelet count 350,000/uL, fibrinogen 400 mg/dL

c (the signs of hemorrhage that are manifested by changes in mucous membranes include epistaxis and gingival oozing. The signs of hemorrhage such as pallor, purpura, and hematoma are associated with the integumentary system.)

The nurse assesses a patient and identifies signs of hemorrhage based on which changes in the mucous membranes? a. pallor b. purpura c. epistaxis d. hematoma

b, c, e (pulmonary manifestations, such as hemoptysis, are a sign of hemorrhage in DIC disorder. Hypotension and increased abdominal girth are also bleeding manifestations. Renal manifestations such as azotemia and integumentary manifestations such as focal ischemia are signs of microvascular thrombosis that are observed in a patient with DIC disorder.)

The nurse assesses a patient with disseminated intravascular coagulation (DIC) and expects to find which signs of hemorrhage? Select all that apply a. azotemia b. hemoptysis c. hypotension d. focal ischemia e. abdominal distention

c (in polycythemia vera, a hemoglobin and hematocrit are increased b/c of a hyperproliferation of red blood cells. Orthopnea, peripheral edema, and increased C-reactive protein are not associated with polycythemia vera.)

The nurse caring for a patient with polycythemia vera would expect which assessment finding? a. orthopnea b. peripheral edema c. increased hemoglobin d. increased c-reactive protein

D (patients with thrombocytopenia should avoid aspirin because it reduces platelet adhesiveness contributing to bleeding blowing the nose forcefully should be avoided the patient should gently pat it with that issue if needed patient should not perform vigorous exercise or lift weights if the patient is weak and at risk for falling supervised the patient went out of bed instruct patients not to shave with a blade an electric razor should be used)

The nurse instructs a patient with thrombocytopenia about safety measures. Which statement made by the patient indicates the need for further instruction? A I want to avoid blowing my nose B at the gym I will not lift weights C I will use an electric razor to shave D I will take aspirin if I have a headache.

d (DIC would reflect an increased PTT, because in this condition, the client's clotting time increases due to the depletion of coagulation factors.)

The nurse is caring for a client who is 32 weeks pregnant and diagnosed with disseminated intravascular coagulation. Which of the following lab values is NOT consistent with this client's condition? a. Increased clotting time b. Decreased hematocrit c. Decreased platelets d. Decreased PTT

a (Clients with immune thrombocytopenic purpura have bleeding problems and are treated with immunoglobulin and steroids. Treatment with corticosteroids slows the rate of platelet destruction, and helps reduce bleeding and bruising. Immunoglobulins suppress anti-platelet antibodies.)

The nurse is caring for a client with immune thrombocytopenic purpura. Which of the following interventions would the nurse expect to employ? a. Administer immunoglobulin and steroids b. Administer fresh frozen plasma c. Monitor for fever d. Monitor for thromboses

d (If a client's platelet count drops below 100,000 cells/microliter, the client is considered to have thrombocytopenia and needs platelets.)

The nurse is caring for a client with thrombocytopenia. Which of the following substances would the nurse expect to administer for this client? a. Whole blood b. Packed RBCs c. Albumin d. Platelets

a, c, e, f

The nurse knows that if there are increased levels of aPTT, PT or INR, she should observe the patient for which signs and symptoms? Select all that apply a. abnormal bleeding purpura b. elevated temperature c. hematuria d. syncope e. nosebleeds f. hematemesis

b (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 vasopression 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 the medical records of four patients and identifies which patients prescription requires immediate correction Patient A: hgb 80, medication desmopressin acetate Patient B: hgb 50, medication aspirin patient C: hgb 100, medication Lepirudin Patient D: hgb 110, medication methylprednisolone

a, c, d, e, f

The nurse should observe and should teach the patient with thrombocytopenia to observe for which of the following, select all that apply a. hematuria b. hives c. melena d. nosebleeds e. gingival bleeding (gums) f. bruising

b (damage to mucous membranes results in epistaxis or gingival oozing, indicating hemorrhage or bleeding in a patient with DIC. The integumentary, GI, and pulmonary manifestation associated with the signs of microvascular thrombosis in a pt. with DIC include cyanosis, abdominal pain, and acute respirator distress syndrome (ARDS), respectively.)

The nurse teaches a group of student nurses about the microvasculature in patients with disseminated intravascular coagulation (DIC). Which statement made by a student indicates the need for further teaching? a. I should check the integumentary system to assess for gangrene b. I should check the mucous membrane surfaces to assess for oozing c. I should check the GI system to assess for abdominal pain d. I should check the pulmonary function to assess for acute respiratory distress syndrome (ARDS)

d (hemolytic processes such as transfusion of mismatched blood are the risk factors that predispose a patient to acute DIC disorder. It enters the common pathway via the intrinsic pathway and causes thrombosis in vessels of the major organs. Heparin and AT III (ATnativ) therapies would be beneficial to the patient in this situation b/c they reduce the formation of clots and stop bleeding. RBC transfusions, fresh frozen plasma, and platelet transfusions are blood products that are administered if the bleeding occurs due to deficiency of clotting factors due to thrombocytopenia.)

The nurse would anticipate the administration of which product for a pt. with thrombosis in the vessels of the major organs due to disseminated intravascular coagulation (DIC)? a. red blood cell (RBC) transfusions b. fresh frozen plasma c. platelet transfusions d. heparin and antithrombin II (ATnativ)

c (the major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in the blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.)

The nurse would monitor a patient with thrombocytopenia for which major complication? a. fatigue b. weakness c. hemorrhage d. abdominal pain

b, c, e (Because the patient has a low platelet count there is an increased risk for bleeding the Primary Health care provider should be notified if any symptoms of internal bleeding appear I headache or subtle confusion may indicate vascular ischemic problems the patient may experience abdominal pain due to internal bleeding Pruritis and elation are usually not seen in thrombocytopenia they do not indicate bleeding)

When caring for a patient with a platelet count of 40,000 slash UL it is important for the nurse to notify the health care provider for which assessment findings select all that apply A pruritis B headache C abdominal pain D elation of mood E subtle confusion

electric razor

When teaching your patient with thrombocytopenia about shaving you should instruct them to use an ______ _______ to avoid cuts.

injury

When teaching your patient with thrombocytopenia, you should teach them to avoid contact sports or anything that could cause ________.

a (a patient with DIC disorder may have bleeding and thrombotic manifestations. Thrombotic manifestations occur due to fibrin or platelet deposition in the microvasculature. Decreased urinary output or oliguria is a sign of thrombotic manifestation. Presence of blood in urine (hematuria) or presence of blood ins tools indicates that the patient is exhibiting bleeding manifestations. Increased body temperature is a clinical manifestation seen in a patient with neutropenia caused by infections)

Which assessment finding in a patient with disseminated intravascular coagulation (DIC) disorder is a thrombotic manifestation? a. decreased UOP b. presence of blood in urine c. presence of blood in stools d. increased body temperature

d (bleeding in a person with no previous history of obvious cause should be questioned b/c it may be on of the first manifestations of acute DIC. the patient will not have bradypnea or wheezing. Tachycardia and hypotension are found in patients with DIC (not bradycardia and hypertension)

Which assessment finding may indicate the development of disseminated intravascular coagulation (DIC) in a patient who experienced an anaphylactic reaction? a. scattered wheezes b. increasing bradypnea c. bradycardia and hypertension d. blood oozing from venipuncture sites

b, c (TTP is characterized by hemolytic anemia, which increases reticulocytes b/c of bleeding. Hemoglobin is decreased in TTP b/c of bleeding. The laboratory reports that a patient with TTP will show decreased haptoglobin, increased schistocytes, and increased indirect bilirubin.

Which assessment findings indicate that a patient may be experiencing thrombotic thrombocytopenic purpura (TTP)? Select all that apply a. increased haptoglobin b. increased reticulocytes c. decreased hemoglobin d. decreased schistocytes e. decreased indirect bilirubin

b ( the nurse assesses parameters such as petechiae and injection sites to determine the signs of external bleeding. The nurse should assess other parameters such as heart rate, mental status, and abdominal girth to determine the signs of internal bleeding.)

Which assessment would the nurse perform to determine the presence of external bleeding? a. heart rate b. petechiae c. mental status d. abdominal girth

b (DIC disorder may cause bleeding episodes due to deficiency in plasma clotting factors. Fresh frozen plasma is rich in clotting factors and replaces the deficiency. Antithrombin III may be used in patients with a fulminant DIC. Cryoprecipitates may be used in patients with a fibrinogen level of 50mg/dL. Pooled platelets may be used in patients who have a platelet count of 30,000/uL with bleeding.)

Which condition associated with disseminated intravascular coagulation (DIC) may require treatment with fresh frozen plasma a. fulminant DIC b. deficiency in clotting factors c. fibrinogen level of 50 mg/dL d. platelet count of 30,000/uL and bleeding

c (imbalance in the coagulation system may cause DIC disorder. Bone marrow failure, recessive inheritance, and deficit of intrinsic factor due to immune reaction are not associated with DIC. Bone marrow failure is the etiology associated with aplastic anemia. Recessive inheritance may cause sickle cell anemia. Deficit of intrinsic factor due to immune reaction is the etiology associated with pernicious anemia.)

Which condition may contribute to the development of disseminated intravascular coagulation (DIC)? a. bone marrow failure b. recessive inheritance c. Imbalance in the coagulation system d. deficit of intrinsic factor due to immune reaction

d (chronic and subacute DIC disorder is mostly commonly see in patients with long-standing illnesses such as malignant disorders. Acute DIC is seen in patients with cardiogenic shock and bacterial infections. Patients with metabolic disorders are not at increased risk for DIC)

Which condition places a patient at risk for developing chronic or subacute disseminated intravascular coagulation (DIC) disorder? a. cardiogenic shock b. bacterial infection c. metabolic disorder d. malignant disorder

a (the d-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. fibrinogen and platelets are reduced. PT, partial thromboplastin time (PTT), activated partial thromboplastin time (aPTT), and thrombin time are all prolonged. FDP elevated as the breakdown products from fibrinogen and fibrin are formed.)

Which diagnostic finding would the nurse expect to find in a patient with acute disseminated intravascular coagulation (DIC) who experiences bleeding? a. Elevated D-dimers b. Elevated fibrinogen c. Reduced prothrombin time (PT) d. Reduced fibrin degradation products (FDPs)

b (the major cause of morbidity and mortality from polycythemia vera is related to thrombosis (e.g., stroke). Leukemia may develop in some patients with polycythemia vera; however, the incidence is low. The patients may develop heart failure, but it is not common. Pulmonary edema is not common in patients with polycythemia vera.)

Which disorder is the most common cause of mortality in patients with polycythemia vera? a. leukemia b. thrombosis c. heart failure d. pulmonary edema

d (bleeding from an IV site is one of the clinical manifestations of DIC. Extensive bruising in the areas of injury, ecchymosis in areas where there is no trauma, and petechiae are the other clinical manifestations of DIC. Therefore, the nurse interprets that the patient has DIC based on these findings. The most obvious symptom of hemophilia is bleeding into the joints or hemarthrosis. Pain in the pelvis, spine, and ribs are the signs and symptoms seen in a patient with multiple myeloma. Most patients with thrombocytopenia are asymptomatic. However, purpura and ecchymosis are the signs and symptoms of thrombocytopenia.)

Which disorder would the nurse suspect when a patient has petechiae and continuous bleeding from the IV site? a. hemophilia b. multiple myeloma c. thrombocytopenia d. disseminated intravascular coagulation (DIC)

a (quinine, which is used in many herbal preparations and tonic water, accelerates platelet destruction caused by drug-dependent antibodies. Antibodies attack the platelets when the offending agent binds to the platelet surface. Aspirin alters platelet aggregation. Antiinfectives such as ganciclovir and chemotherapeutic drugs such as vincristine decrease platelet count by myelosuppression. Acetaminophen does not affect blood coagulation in and of itself.)

Which drug is a likely cause of thrombocytopenia? a. quinine b. vincristine c. ganciclovir d. acetaminophen

C (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 H 2-receptor antagonist that causes thrombocytopenia. Haloperidol is an antipsychotic drug that causes thormbocytopenia)

Which drug is directly myelosuppressive and may induce thrombocytopenia? a. abciximab b. cimetidine c. ganciclovir d. haloperidol

a (rituximab has the ability to decrease the level of inhibitory ADAMTS13 lgG 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.)

Which drug used for patients with thrombotic thrombocytopenic purpura (TPP) decreases the level of inhibitory ADAMTS13 immunoglobulin G (IgG) antibodies? a. rituximab b. prednisone c. argatroban d. IV immunoglobulin

a (desmopression acetate is a synthetic analog of vasopression. This drug acts on platelets and endothelial cells and stimualtes the release of vWF. vWF binds with factor VIII and increases its concentration to promote clotting. The drug does not suppress vWF but instead stimulates its release. Antifibrinolytic therapy inhibits plasminogen activation in the fibrin clot and stabilizes clots in areas of increased fibrinolysis. Desmopression acetate is not an antifibrinolytic agent.)

Which effect does desmopressin acetate have on clotting factors? a. it stimulates an increase in factor VIII b. It suppresses the the von Willebrand factor c. it inhibits plasminogen activation in the fibrin clot d. it stabilizes clots in the areas of increased fibrinolysis

c (accumulation of FSPs during DIC predisposes the patient to hemorrhage. Depletion of clotting factors, activation of fibrinolytic system, and depression of clotting inhibitory mechanisms are the other events that occur during DIC and predispose the patient to hemorrhage.)

Which event that occurs during disseminated intravascular coagulation (DIC) may predispose a patient to hemorrhage? a. Augmentation of clotting factors b. deactivation of the fibrinolytic system c. accumulation of fibrin split products (FSPs) d. stimulation of clotting inhibitory mechanisms

a (the factor assays laboratory tests measures prothrombin (PT) levels and factors such as V, VII, X and XII. Misleading results may occur because levels of factors V and VII rise with inflammation. Factors VI, X, and XII are not affected by inflammation and are not associated with false-positive results.)

Which factor rises with inflammation and may produce a false-positive result when used to diagnose disseminated intravascular coagulation (DIC)? a. factor V b. factor VI c. factor X d. factor XII

a,b,c,d (risk factors associated with acute DIC include severe head injury, abruptio placentae, extensive burns, and septicemia. ARDS is not a risk factor for acute DIC.)

Which factors put a patient at risk for developing acute disseminated intravascular coagulation (DIC)? Select all that apply a. septicemia b. an extensive burn c. abruptio placentae d. severe head trauma e. acute respiratory distress syndrome (ARDS)

b (the types of DIC disorders include acute, chronic, and subacute types. The risk factors that predispose a patient to subacute DIC disorder include obstetric conditions such as a retained dead fetus. Toxins from snakebites, hemolytic processes such as transfusion of mismatched blood, and malignancy due to tumor lysis syndrome may predispose a patient to acute DIC.)

Which finding increases a patients risk for subacute disseminated intravascular coagulation (DIC)? a. toxins from a snakebite b. a retained dead fetus c. transfusion of mismatched blood d. malignancy due to tumor lysis syndrome

c (long-term heparin therapy can cause HIT that results in a decrease in platelet count. A platelet count of 100,000/uL indicates HIT. Immune thrombocytopenic purpura (IP) 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.)

Which finding supports heparin-induced thrombocytopenia (HIT) a. a patient has a viral infection b. a patient has hemolytic anemia c. a patient as a platelet count of 100,000/uL d. A patient as systemic lupus erythematosus

d (DIC disorder is a disorder in which underlying disease stimulates the coagulation system leading to diffuse clotting and hemorrhage. It is a disorder in which the underlying disease depletes clotting factors in blood. DIC is a disorder in which tissue factor released at the site of injury leads to overstimulation of the coagulation process in the vasculature. The coagulation pathway is not genetically altered in DIC.)

Which information would the nurse include when preparing to discuss the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? a. the coagulation pathway is overstimulated b. DIC is due to the depletion of hemolytic factors c. The coagulation pathway is genetically altered d. DIC is a secondary disease of clotting and hemorrhage

b (as a part of collaborative care, it is necessary to diagnose DIC disorder quickly through oxygenation or volume replacement to control the thrombosis of bleeding. If chronic DIC disorder is diagnosed in a patient who is not bleeding no therapy for DIC disorder is required. Treatment of the underlying disease is sufficient to reverse DIC disorder. If the patient with DIC disorder is bleeding, the therapy requires providing support with necessary blood products that aim to treat the primary disorder.)

Which information would the nurse include when teaching nursing students about treatment for disseminated intravascular coagulation (DIC)? a. therapy is essential for chronic DIC b. oxygenation helps to stabilize the patient with DIC c. treatment for the underlying disease cannot reverse DIC d. blood products are not effective in treatment the patient with DIC who has a bleeding disorder.

b, d, f (the nurse should instruct the patient to shave only with an electric shaver and avoid using blades. The patient should avoid blowing the nose forcefully; instead, gently pat it with a tissue. The patient should always walk with sturdy shoes for safety. The patient should drink plenty of fluids to prevent constipation. The patient should avoid using a suppository without the permission of the health care provider; the patient may be prescribed stool softeners. Alcohol-based mouthwashes should be avoided b/c they can dry the gums and increase bleeding.)

Which instructions would the nurse include when educating a patient with chemotherapy induced thrombocytopenia? Select all that apply a. reduce water intake b. walk with sturdy shoes c. use a suppository if required d. avoid blowing the nose forcefully e. use an alcohol-based mouthwash f. shave only with an electric shaver

a (DIC disorder manifests as microvascular thrombosis due to thrombotic occlusion of microcirculation of all organs. The integumentary manifestations associated with microvascular thrombosis include cyanosis, ischemic tissue necrosis, and hemorrhagic necrosis. The integumentary manifestations associated with DIC-related hemorrhage include petechiae, ecchymosis, and venipuncture oozing.)

Which integumentary manifestation indicates microvascular thrombosis in a patient who is at risk for developing disseminated intravascular coagulation (DIC) disorder? a. cyanosis b. petechiae c. ecchymosis d. oozing venipuncture

c (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)

Which intervention would the nurse anticipate incorporating into the plan of care for a patient newly diagnosed with disseminated intravascular coagulation (DIC)? a. administer heparin b. administer whole blood c. treat the causative problem d. administer fresh frozen plasma

B (A patient with thrombocytopenia has a very low platelet count and an impaired clotting mechanism an injury even a minor one could cause spontaneous hemorrhage internally or externally quiet pain medication and emulation are not priority aspects of nursing care regarding thrombocytopenia)

Which intervention would the nurse consider to be the highest priority when caring for a patient with thrombocytopenia a. maintaining a quiet environment b. protecting the patient from injury c. administering pain medication PRN d. encouraging the patient to ambulate as much as can be tolerated

c, d, e (the patient with chronic DIC disorder may experience episodes of bleeding due to microvascular thrombosis and hemorrhage. Gingival oozing is a sign of hemorrhage in DIC. Oozing of blood from the gums should be reported to determine the effectiveness of the therapy. Using a soft toothbrush to clean the teeth reduces damage to mucosal surfaces. Hematuria is also a sign of hemorrhage in a patient with DIC disorder. Therefore, instructing the pt to observe stools and urine for the presence of blood with help in the effective management of the pts. condition. Routine blood tests include complete blood count (CBC), blood smears, prothrombin time (PT), and partial thromboplastin time (PTT), D-dimer, and fibrinogen. Hematocrit levels and white blood cell counts should be monitored in a pt. with neutropenia.)

Which interventions would the nurse anticipate incorporating in the plan of care for a pt. with chronic disseminated intravascular coagulation (DIC) disorder? Select all that apply a. routine hematocrit tests b. routine white blood cell counts c. instructing the pt. to report oozing of blood from the bums d. instructing the pt. to use a soft toothbrush to clean teeth e. instructing the pt. to observe stools and urine for the presence of blood

a (In a patient with DIC disorder, the values that measure clotting mechanism such as thrombin time, prothrombin time (PT), and partial thromboplastin time (PTT) are usually prolonged. Peripheral blood smear test detects the presence of schistocytes, or fragmented erythrocytes. These schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Elevated D-dimers soluble fibrin monomer, and FSPs are not indicative of partial occlusion of small vessels by fibrin thrombi. However, elevated D-dimers, positive soluble fibrin monomer, and elevated FSPs indicate the degree of fibrinolysis.)

Which lab finding indicates partial occlusion of small vessels in a patient with acute disseminated intravascular coagulation (DIC) disorder? a. schistocytes b. elevated D-dimers c. soluble fibrin monomer d. reduced fibrin split products (FSPs)

c (thrombocytopenia means that there are low levels of circulating platelets. A platelet count below 150,000/uL is considered low. As such, a platelet count of 20,000/uL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12 to 17 g/dL, depending on the sex of the patient. Hemoglobin levels of 13 g/dL and 16 g/dL are normal)

Which lab result is consistent with a diagnosis of thrombocytopenia? a hemoglobin 13 b. hemoglobin 16 c. platelets 20,000/uL d. platelets 1,000,000/uL

d (multiple traumatic injuries are predisposing factors for the development of DIC disorder. The presence of blood in the urine and feces is a bleeding manifestation associated with DIC. the nurse expects decreased protein C and S levels in the lab report of this patient due to depletion of clotting factors. The nurse finds elevated D-dimers in the laboratory report of patient with DIC disorder. Increased hematocrit is found in the lab report of a patient with polycythemia vera. Reduced platelet count may be found in a patient with DIC disorder)

Which lab result may be found in patients with disseminated intravascular coagulation (DIC) disorder? a. decreased D-dimers b. increased hematocrit c. increased platelet count d. decreased protein C and S

b (fragmented erythrocytes or schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Peripheral blood smear test detects the presence of fragmented erythrocytes. Factor assays, soluble fibrin monomer, and FSPs tests do not detect the presence of fragmented erythrocytes; however, they are useful in determining the degree of fibrinolysis.)

Which lab test can confirm the presence of fragmented erythrocytes in a patient suspected of having acute disseminated intravascular coagulation (DIC)? a. factor assays b. peripheral blood smear c. soluble fibrin monomer d. fibrin split products (FSPs)

d (bone marrow examination is performed to rule out production problems such as leukemia, aplastic anemia, and other myeloproliferative disorders as the cause of thrombocytopenia. Therefore to confirm that the absence of decreased number of megakaryocytes to be the cause of thrombocytopenia, bone marrow examination will be done. PT will be tested to assess secondary hemostasis. A peripheral blood smear will be done to distinguish immune thrombocytopenic purpura (ITP) from congenital disorders. 14C serotonin release assay assists with the diagnosis of ITP.)

Which lab test would provide information about the number of megakaryocytes in a patient with thrombocytopenia? a. prothrombin time (PT) b. peripheral blood semar c. 14C serotonin release assay d. Bone marrow examination

b, c, d (the lab report of a patient with acute DIC disorder may show reduced plasminogen levels due to imbalance in the coagulation system. The other results that are indicative of acute DIC include reduced antithrombin III (ATIII) levels, reduced fibrinogen and platelet levels, and reduced protein C and protein S levels. Elevated FSPs and elevated D-dimers (Cross-linked fibrin fragments) are also indicative of acute DIC disorder)

Which laboratory levels may be decreased in acute disseminated intravascular coagulation (DIC)? Select all that apply a. fibrin split products (FSPs) b. antithrombin III (AT III) levels c. Fibrinogen and platelet levels d. protein C and protein S levels e. D-dimers (cross-linked fibrin fragments

a, c, e (the normal hemoglobin value is in the range of 12 to 13 g/dL. Therefore hemoglobin value of 9 g/dL is a result of thrombocytopenia. Thrombocytopenia is deficiency of platelets in the blood. The normal bleeding time is in the range of 3 to 10 minutes. Because platelets are involved in clotting, a deficiency of platelets increases the bleeding time. A bleeding time of 20 minutes is due to the deficiency of platelets. When thrombocytopenia is caused by the destruction of platelets, the megakaryocyte count will be normal or increased in bone marrow examination. Thrombocytopenia is associated with a reduced hemoglobin level in the patient. The normal range of platelet count is in the range of 150,000 to 450,000/UL, so a platelet count of 200,000/uL is normal. The normal hematocrit value is in the range of 42% to 54%)

Which laboratory result indicates thrombocytopenia? Select all that apply a. hemoglobin value is 9 g/dL b. platelet count is 200,000/uL c. bleeding time is 20 minutes d. hematocrit value is 42% e. levels of megakaryocytes are elevated

b (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 most often will exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes. Five minutes is too short a time.)

Which length of time would the nurse stay at the bedside of a patient when initiating a unit of packed red blood cells? a. 5 minutes b. 15 minutes c. 30 minutes d. 60 minutes

b (ineffective peripheral tissue perfusion and acute pain are the nursing diagnoses related to a patient with chronic DIC disorder. The priority nursing intervention while caring for the patient is to examine for cyanosis of the extremities. Cyanosis is related to the widespread clotting that occurs along with thrombi or emboli and impairs tissue perfusion. bleeding causes a drop in BP. Elevation in BP is not associated with DIC. in DIC, bowel sounds would be decreased due to thrombotic occlusion of blood vessels. PT is prolonged in a patient with DIC disorder)

Which manifestation would the nurse monitor for in a patient with chronic disseminated intravascular coagulation (DIC) disorder? a. hyperactive bowel sounds b. cyanosis of the extremeties c. elevation of BP d. decreased prothrombin time (PT)

a, b, d (A low platelet count is called thrombocytopenia. Because the patient has developed thrombocytopenia after five days of heparin therapy the patient is experiencing heparin induced thrombocytopenia. this can be managed by using protamine sulfate which counteracts the effects of heparin heparin should be discontinued to reduce the risk of bleeding a direct thrombin inhibitor should be administered to maintain anticoagulation platelet transfusions may increase the risk of thromboembolic events and should be avoided low molecular weight heparin is not indicated because it can worsen the risk for bleeding)

Which measures would the nurse anticipate incorporating into the plan of care for a patient who is receiving heparin therapy and has a platelet count of 50,000/UL select all that apply a. discontinuing heparin b. administering protamine sulfate c. administering a platelet transfusion d administering a direct thrombin inhibitor e changing the prescription to a low molecular weight heparin

d ( during an acute sickle cell crisis, optimal pain control usually includes large doses of continuous (rather than PRN) opioid analgesics along with breakthrough analgesia, often in the form of PCA. Morphine and hydromorphone are the drugs of choice. Acetaminophen is appropriate for minor pain or fever, not for severe pain. Meperidine is contraindicated b/c high doses can lead to the accumulation of toxic metabolite, normeperidine, which can cause seizures.)

Which medication is most appropriate for the nurse to administer to a patient in acute sickle cell crisis who reports a pain level of 10? a. acetaminophen (Tylenol) oral tablets every six hours b. Oral morphine tablets, every four hours, PRN c. IV meperidine (Demerol), every four hours, PRN d. Hydromorphone (Dilaudid) via patient-controlled analgesia (PCA)

b (Eltrombopag is a thrombopoietin receptor agonists that acts by increasing platelet production. Danazol is an androgen that actus 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).

Which medication may benefit a patient with immune thrombocytopenic purpura (ITP) by increasing the platelet production? a. Danzol b. Eltrombopag c. Tranexamic acid d. Desmopressin acetate

C (abruptio placentae can involve massive blood loss in consequent loss of clotting factors and components resulting in DIC without immediate intervention the patient is at high risk for profound hypovolemic shock maintaining an accurate input and output log instructing the patient and measures to prevent bleeding and assessing the patient's discharge needs are all appropriate but are of lower priority in lot of the patients urgent care need)

Which nursing action is the has priority for a obstetric patient who had a placental abruption and is experiencing acute hemorrhage due to DIC? A maintaining the patient's intake and output accurately B instructing the patient regarding measures to prevent bleeding C assessing the patient for signs and symptoms of hypovolemic shock D assessing the patient's discharge needs in regard to caring for a newborn

d (SLE is the risk factor that predisposes a patient to chronic DIC disorder. Heat stroke, septic abortion, and glomerulonephritis are the risk factors that predispose a patient to acute DIC disorder.)

Which occurrence may predispose a patient to developing chronic disseminated intravascular (DIC) disorder? a. heat stroke b. septic abortion c. glomerulonephritis d. systemic lupus erythematosus (SLE)

a, c, b, d (In DIC disorder, the tissue factor is released at the site of injury. Abundant intravascular thrombin, which is a powerful coagulant, is produced. It catalyzes the conversion of fibrinogen to fibrin and enhances platelet aggregation. Widespread fibrin and platelet deposition occurs in capillaries and arterioles, resulting in thrombosis. These events lead to MODS.)

Which order would the nurse place the events associated with disseminated intravascular coagulation (DIC) disorder that lead to multiple organ dysfunction syndrome (MODS)? a. release of tissue factor at the site of injury b. conversion of fibrinogen to fibrin c. abundant production of intravascular thrombin d. deposition of platelets in capillaries and arterioles

a, e (the nurse should assess the parameters such as fibrinogen levels and PTT while monitoring a patient for the development of DIC disorder. Hemoglobin levels, RBC count, and WBC count are not altered in a patient with DIC. therefore the nurse need not assess these parameters in a patient with DIC)

Which parameters would the nurse assess while monitoring a patient for the development of disseminated intravascular coagulation (DIC) disorder? Select all that apply. a. fibrinogen levels b. hemoglobin levels c. red blood cell (RBC) count d. white blood cell (WBC) count e. partial thromboplastin time (PTT)

d (thrombotic manifestations occur as a result of fibrin or platelet deposition in the microvasculature. The pulmonary manifestation associated with thrombosis in the microvasculature ARDS. Bleeding manifestations occur due to the depletion of platelets and coagulation factors. Pulmonary manifestations associated with hemorrhage include orthopnea and hemoptysis. Bradypnea does not occur with disseminated intravascular coagulation (DIC)

Which pulmonary manifestation is a result of deposition of platelets in the microvasculature? a. orthopnea b. hemoptysis c. bradypnea d. acute respiratory distress syndrome (ARDS)

a, c, d, e (The patient with suspected DIC shows bleeding manifestations due to depletion of platelets and coagulation factors. Neurologic manifestations include headaches, changes in vision, and dizziness. Renal manifestations associated with this disorder include hematuria. Therefore the nurse should ask the patient questions regarding the occurrence of frequent headaches, changes in vision or dizziness, and changes in urine or stools. Tachypnea is a manifestation associated with DIC; the nurse should ask the patient about this symptom. The patient with DIC does not necessarily have changes in weight.)

Which questions would the nurse ask to determine the presence of bleeding in a patient suspected of having disseminated intravascular coagulation (DIC)? Select all that apply a. do you get frequent headaches b. has your appetite or weight changed c. have you noticed changes in vision or dizziness d. have you noticed changes in your urine or stools e. are you experiencing breathing that is faster than normal?

c (ischemic tissue necrosis, such as gangrene, is a sign of microvascular thrombosis associated with the integumentary system. Paralytic ileus is associated with the GI system. ECG changes and venous distention are associated with the cardiovascular system.)

Which sign of microvascular thrombosis observed in a patient with disseminated intravascular coagulation (DIC) disorder is associated with the integumentary system? a. paralytic ileus b. venous distention c. ischemic tissue necrosis d. electrocardiogram (ECG)changes

c (DIC is a disorder that results from depletion of coagulation or clotting factors. Therefore, this statement by the student nurse requires correction. The disorder causes bleeding manifestations or hemorrhage due to depletion of platelets. DIC is a disorder that results from abnormally initiated and accelerated clotting due to stimulation by a disease process or disorder. Therefore, these statements by the student nurse do not require correction.)

Which statement made by a student nurse indicates the need for additional teaching regarding the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? a. it is stimulated by a disease process or disorder b. bleeding occurs as a result of depletion of platelets c. it results from surplus production of clotting factors d. DIC results from abnormally initiated and accelerated clotting

b (neutropenia is the reduction in the number of neutrophils in the blood. This leaves the patient prone to infection. The risk of infection can be reduced by placing a patient in a private room. Restriction of all visitors is not necessary; however, visitors with signs and symptoms of infections, such as a cough or fever, should be restricted. Use of an electric shaver would be recommended for a patient taking anticoagulants but is not required for this condition. Wearing a gown and gloves when in direct contact with the patient is not necessary; however, meticulous hand hygiene is a must. If the patient is in protective isolation, as mask will need to be worn.)

Which strategy is most important for a nurse to include when planning are for a patient who has neutropenia? a. restricting all visitors b. placing the patient in a private room c. advising the patient to use only an electric shaver d. wearing a gown and gloves when in direct contact with the patient

b, c, d (therapies with blood products such as platelets, cryoprecipitates, and fresh frozen plasma are reserved for pts. with life-threatening hemorrhage. Heparin is used in the treatment of DIC only when the benefits of using it outweigh the risks. Antithrombin II (ATnativ) is used in the treatment of a pt. with fulminant DIC.)

Which therapies would the nurse anticipate incorporating into the plan of care for a pt. with DIC with a life-threatening hemorrhage? a. heparin b. platelets c. cryoprecipitates d. fresh frozen plasma e. antithrombin II (ATnativ)

a (oral anticoagulants are administered in DIC to decrease bleeding episodes. Uncontrolled bleeding episodes indicate a chronic type of DIC and unresponsiveness to oral anticoagulants. Therefore heparin should be administered to maintain hemostasis. Therapy with blood products such as platelets, cryoprecipitates, and fresh frozen plasma are usually reserved for a patient with life-threatening hemorrhage.)

Which therapy is appropriate for chronic disseminated intravascular coagulation (DIC) a. heparin b. platelets c. cryoprecipitate d. fresh frozen plasma

a, e (A patient with DIC disorder may show thrombotic manifestations due to fibrin or platelet deposition in the microvasculature. Thrombotic manifestations include shortness of breath and an increase in heart rate, which are called dyspnea and tachycardia, respectively. The other thrombotic manifestations include cyanosis and abdominal pain. Dizziness, joint pains, and vision changes are manifestations of bleeding that occur due to depletion of platelets and coagulation factors.)

Which thrombotic manifestations would the nurse monitor for in a patient who is at risk for disseminated intravascular coagulation (DIC)? Select all that apply a. cyanosis b. dizziness c. joint pains d. vision changes e. abdominal pain

d (the liquid portion of whole blood is separated from cells and frozen to obtain fresh frozen plasma. It is rich in clotting factors. Therefore the nurse administers frozen plasma to the patient. Albumin is prepared from plasma, but it is not rich in clotting factors. Platelets and frozen RBCs will not help provide clotting factors to the patient.)

Which type of blood product would the nurse anticipate incorporating into the plan of care for a patient with disseminated intravascular coagulation (DIC)? a. albumin b. platelets c. frozen red blood cells (RBCs) d. fresh frozen plasma

small gauge

You should avoid IM and SQ injections with patients who have thrombocytopenia but if they have to have an injection make sure to choose a ______ _______ needle.

vitamin K

______ ______ should be administered IM if PT (prothrombin time) is >40 seconds or when there is much bleeding

PT (prothrombin time)

______ is used to monitor warfarin therapy and screen for vitamin K deficiency Normally 11 to 16 seconds For anticoagulant therapy 1.5 to 2.0 times control

25, 35, 1.5, 2.5

aPTT -activated partial thromboplastin -measures number of seconds for a clot to form Normally _________ to _____ seconds For anticoagulant therapy _____ to ________ times the control in seconds

Thrombocytes

another name for platelets =

thrombocytopenia

low platelet count =

d (ingestion of drugs 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 experiences thrombocytopenia due to consumption of certain drugs. The nurse suspects that which mechanism of thrombocytopenia occurred? a. altered platelet aggregation b. adequate platelet production c. decreased platelet production d. accelerated platelet destruction

d (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 who is receiving heparin therapy manifests signs of heparin overdose. Which medication would the nurse anticipate administering? a. lepirudin b. rituximab c. prednisone d. protamine sulfate

c, d (corticosteroids reduce capillary leakage by altering capillary permeability. Corticosteroids also depress antibody formation by decreasing immunoglobulin synthesis and by lympholytic action. Rituximab has the ability to lyse activated B cells. Danazol increases CD4 +T cells. Romiplostim increases platelet production)

A patient with initial symptoms of immune thrombocytopenic purpura (ITP) receives corticosteroid therapy. The nurse recalls that the medication will produce which results? Select all that apply a. lyse activated b cells b. increased cd4 +T cells c. reduced capillary leakage d. depressed antibody formation e. increased platelet production

D (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.)

A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea. The platelet count is 43,000/uL. It is most important for the nurse to take which action?? A. insert two 18 gauge IV catheters B. Administer prescribed enoxaparin C. Monitor the patients temperature every 2 hours D. check stools for presence of occult blood

PT

Prothrombin time - used to monitor warfarin therapy and screen for vitamin K deficiency Normally 11 to 16 seconds For anticoagulant therapy: 1.5 to 2.0 times control

b,c,d,a

The events associated with the development of disseminated intravascular coagulation (DIC) occur in which order? a. consumption of platelets and coagulation proteins b. thrombolytic occlusion of microcirculation of all organs c. fibrinolysis in the microcirculation d. circulation of fibrin degradation products

thrombocytopenia

The following are symptoms of ________________ -Epistaxis -bleeding gums -petechiae-pinpoint flat round red spots under the skin surface caused by intradermal hemorrhage (bleeding into the skin) -Purpura- bleeding into the surface of the skin. The area of the skin with purpura is greater than 3 millimeters in diameter -Ecchymosis- medical term form the common bruise which is caused by bleeding into the skin, differing from petechiae only in size (that is larger than 3 mm diameter) -Prolonged bleeding from venipuncture or IM injection sites -Tachycardia, hypotension, weakness, fainting, dizziness, abdominal pain -Hemorrhage: joints, retina, brain

DIC (disseminated intravascular coagulation)

The following describes Collaborative Care for _________ Diagnostics: prolonged PT and PTT, fibrinogen level reduced, platelets < 100,000; fibrin split products elevated; factor assays for V, VII,VIII, X, XIII all reduced. D-Dimer elevated D-Dimer test measures amount of fibrin degradation that occurs - it confirms presence of fibrin split products and is more specific for dx of DIC than fibrin split products Treat underlying cause If bleeding: fresh frozen plasma, platelets, cryoprecipitate to replace factor VIII and fibrinogen •If thrombosis: heparin or low-molecular-weight heparin If chronic _____ and pt. not bleeding, no therapy

DIC (disseminated intravascular coagulation)

The following describes Nursing Interventions for the patient with ________ Assess for complications: tachycardia, change in mental status, ↑abdominal girth, pain Administer blood products, cryoprecipitate and fresh frozen plasma promptly and safely ORGAN function diminishes due to inadequate perfusion caused by microthrombi occlusion- can affect kidneys, lungs, brain Apply other precautions as with pt. who has thrombocytopenia Changes must be reported to physician immediately Headache, visual changes and alteration in LOC can indicate cerebral ischemia An extremity that has become pale, cold and pulseless indicates arterial impairment Decreased bowel sounds and bleeding from GI tract may mean mesenteric occlusion, a surgical emergency Decrease in urinary output may mean renal artery thrombosis and renal failure may develop- acute tubular necrosis can occur--urinary output should be done q1h- may need hemodialysis O2 as ordered- any change in status must be reported Notify physician promptly if any new pain or sudden increase in pain- pain may result from lack of appropriate blood flow to body tissues

thrombocytopenia

The following describes collaborative care for __________ -Based on etiology of the disorder .ITP . TTP . HIT -removal or treatment of the underlying cause or disorder may be sufficient -Avoid aspirin and other medications that affect platelet function or production

HIT (heparin-induced thrombocytopenia)

The following describes the Collaborative care for ________ Discontinue Heparin; even heparin flushes for CVADs Thrombin inhibitor- lepirudin, argatroban or fondaparinux Start Warfarin when platelets 150,000 Plasmapheresis (plasma exchange), protamine, thrombolytic agents and surgery to remove clots No platelets transfusions-may cause more thromboembolic episodes Avoid aspirin Should never be given heparin in any form ever again. Flag medical record as an allergy to heparin

Thrombocytopenia

The following describes the Etiology and Pathophysiology of ____________ -reduction of platelets -Results in abnormal hemostasis: prolonged or spontaneous bleeding -Primarily an acquired disorder: commonly from ingestion of certain herbs or drugs -Inherited -Acquired: immune thrombocytopenia purpura (ITP), thrombotic thrombocytopenia purpura (TTP), heparin induced thrombocytopenia (HIT)

thrombocytopenia

The following describes the Nursing Management for ___________ -The the pt to avoid meds that interfere with platelet function; aspirin, NSAIDS such as Advil and Aleve -Check for occult blood emesis, urine and stool -Advise to avoid contact sports and hazardous activities -No IM injections but if patient absolutely has to have IM or SQ injection, use small gauge needle and apply pressure to venipuncture site for 5 minutes, arterial puncture for 10 minutes -Avoid rectal temperature, urinary catherization's and parenteral injections -Avoid biopsy or lumbar puncture if platelet count less than 50,000 -Assess for neurologic changes; headache, visual changes, altered mental status, decreasing LOC, seizures -Assess abdomen; epigastric pain, absent bowel sounds, increasing abdominal girth, guarding or rigidity

ITP (immune thrombocytopenic purpura)

The following describes which type of acquired thrombocytopenia? -Autoimmune disorder in which platelet destruction is accelerated; platelets coated with antibodies; function normally but seen as "foreign" and destroyed by spleen. Platelets normally live 8-10 days in ITP only live 1-3 days -Most common among women ages 20-40 and in people with other autoimmune disorders -Most often are asymptomatic -Most common symptom is bleeding: nosebleeds gums oral mucosa bleeding into skin as petechiae purpura ecchymosis prolonged bleeding after venipuncture or IM injection; internal bleeding-joints, retina, brain -major complication is hemorrhage-cerebral hemorrhage can be fatal

150,000, 450,000

The normal platelet count is in the range of ________ to __________ platelets/mcL of blood.

c (the platelet count of 150,000/mcL in a patient who is on heparin therapy indicates for heparin induced thrombocytopenia (HIT) and requires warfarin therapy. Thrombolytic agents should be used to treat a thromboembolic event. Plasmapheresis should be performed during severe clotting. The platelet count of 180,000/mcL does not indicate the need for warfarin therapy in the patient. Warfarin reverses HIT and prevents microvascular thrombosis in the patient.)

The nurse anticipates a prescription for warfarin therapy based on which assessment finding? a. signs of thrombolytic agents b. signs of severe blood clotting c. platelet count of 150,000/mcL d. Platelet count of 180,000/mcL

a, b, e (when thrombocytopenia occurs with anemia characterized by altered red blood cell (RBC) morphology such as spherocytes, fragmented cells, and pronounced reticulocytes, a diagnosis of TTP is suspected. Deficiency of a plasma enzyme ADAMTS13 is seen in TTP. Rituximab can be used refractory to plasma exchange in patients with TTP because it decreases the level of inhibitory ADAMTS13 immunoglobulin G (IgG) antibodies. Plasmapheresis (plasma exchange) is useful to reverse platelet consumption by supplying the appropriate von Willebrand factor (vWF) and enzyme ADAMTS13. A splenectomy is useful for a patients refractory to plasma exchange or immunosuppression. Platelet transfusions are contraindicated in patients with TTP b/c they may lead to new vWF-platelet complexes and increased clotting. IVIG is beneficial in patients with immune thrombocytopenic purpura (ITP), not TTP.)

The nurse anticipates the inclusion of which treatment options into the plan of care for a patient with a diagnosis of thrombotic thrombocytopenic purpura (TTP)? Select all that apply. a. rituximab b. plasmapheresis c. IV immunoglobulin (IVIG) d. Platelet transfusion as an initial treatment e. splenectomy if refractory to plasma exchange or immunosuppression

c (ecchymosis are large purplish lesions that are caused by hemorrhage. Therefore the skin manifestations of patient C indicate ecchymosis. Small, flat, pinpoint microhemorrhages indicate petechiae. Reddish skin bruises indicate purpura. Red or reddish-brown microhemorrhages indicate petechiae.)

The nurse is assessing skin manifestations in four patients who have thrombocytopenia. Which patient has developed ecchymosis? Patient A: small, flat pinpoint microhemorrhages patient B: reddish skin bruises patient C: large purplish lesions caused by hemorrhage Patient D: red or reddish brown microhemorrhages

treat the causative problem (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 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.

b (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.)

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? a. Administration of packed red blood cells b. Administration of oral or IV corticosteroids c. Administration of clotting factors VIII and IX d. Maintenance of reverse isolation and application of standard precautions

B (viral infections compromise the immune system and contribute to the development of ITP. Hereditary thrombocytopenia is observed in the patient with inherited thrombocytopenia. HIT is observed in the patient who is on long-term heparin therapy. TTP is observed in a patient with hemolytic anemia.)

The nurse is caring for a patient with a viral infection and recognizes that the patient is at risk for which type of thrombocytopenia? a. hereditary thrombocytopenia b. immune thrombocytopenic purpura (ITP) c. Heparin-induced thrombocytopenia (HIT) d. Thrombotic thrombocytopenic purpura (TTP)

b (In DIC, there is an acceleration of clotting with subsequent decreases in clotting factors and platelets, so the blood is not properly clotting. The decrease in clotting factors and platelets results in significant uncontrolled bleeding. HELLP syndrome is a complication of pregnancy and a risk factor for DIC.)

The nurse is teaching a group of nursing students about disseminated intravascular coagulation (DIC). Which statement made by a student indicates the need for further teaching? a. Platelets are depleted in DIC b. The blood is clotting during DIC c. HELLP syndrome is a risk factor for DIC d. Coagulation factors are depleted in DIC

b (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 a the patient. A patient with ITP will have thrombocytopenia b/c 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 provides care for a patient with immune thrombocytopenic purpura (ITP) who has a platelet count of 90,000/mcL of blood. Which occurrence could be the reason for this condition? a. destruction of platelets b. decreased production of platelets c. enhanced aggregation of platelets d. increased consumption of platelets

C (TTP is an uncommon syndrome associated with hemolytic-uremic syndrome b/c both disorders are acute and characterized by thrombocytopenia and microangiopathic hemolytic anemia. TTP is caused by the deficiency of a plasma enzyme (ADAMTS13), not by a helicobacter pylori infection. TTP is considered a medical emergency b/c bleeding and clotting occur simultaneously. TTP is associated with increased platelet aggregation; this causes the formation of microthrombi, which can get deposited in arterioles and capillaries.)

The nurse provides education about thrombotic thrombocytopenic purpura (TTP) to a group of nursing students and would include which information? a. it is caused by helicobacter pylori infection b. it is not considered as a medical emergency c. it is associated with hemolytic-uremic syndrome d. it is associated with decreased platelet aggregation

b (a 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 for cuts and wounds, resulting in decreased bleeding. Therefore this activity of the patient indicates understanding of the nurses teaching. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Walking with flip-flops can cause the patient to trip, causing the risk for cuts or wounds and increased 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.)

The nurse provides education regarding daily activities to a patient with thrombocytopenia. Which activity identified by the patient indicates understanding of the teaching? a. flossing using thick tape floss b. shaving using an electric razor c. wearing flip-flops to go walking d. brushing using a stiff-bristle toothbrush

a, e (flossing is usually safe for patients with low platelet counts only if it is done gently using thin tape floss. Apply firm pressure to the nostrils and bridge of the nose would be beneficial to stop or decrease a nosebleed. Alcohol-based mouthwashes should not be used b/c they may dry the gums and increase bleeding. Patients with low platelet counts should not use tampons b/c they may increase the risk for bleeding. Therefore it is advisable to use sanitary pads during menstruation. Suppositories cannot be sued without the permission of the health care provider b/c improper use may increase the risk of bleeding in patients with low platelet counts)

The nurse provides education to a patient with low platelet count about precautions to be take. Which statements made by the patient indicate effective learning? Select all that apply a a. i will floss gently using thin tape floss b. I will use alcohol based mouthwash c. I will use tampons instead of sanitary pads d. I will use a suppository laxative if experiencing constipation e. I will apply firm pressure to the nostrils and bridge of the nose if a nosebleed occurs

c (a patient with thrombocytopenia should not use alcohol-based mouthwashes b/c 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.)

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? a. Drinks 14 glasses of water daily b. shaves once a day using an electric razor c. uses an alcohol based mouthwash twice a day d. brushes teeth with a soft bristle toothbrush twice a day

(Platelet destruction and vascular endothelial injury are the two major responses to an immune-mediated response to heparin. Initially, PF4 binds to heparin. This complex then binds to the platelet surface, and more PF4 are released. B/c of this, a positive feedback loop is created. Antibodies are created against the complex,and they are removed prematurely from circulation, leading to thrombocytopenia and platelet-fibrin thrombi)

The nurse recalls that the events that lead to heparin-induced thrombocytopenia occur in which order? a. antibodies are created against the complex b. complex binds to platelet surface c. antibodies are prematurely removed from circulation d. complex binds to heparin e. positive feedback loop is created f. platelet factor 4 (PF4) binds to heparin

d (Splenectomy causes complete remission in a patient with ITP b/c 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 recognizes that a splenectomy is an appropriate treatment plan for a patient with immune thrombocytopenic purpura (ITP) because of which splenic function? a. the spleen sequesters total platelets b. the spleen does not contain macrophages c. the spleen does not synthesize any antibodies d. the spleen affects the platelet-macrophage interaction

a (desmopressin acetate is realtively short-lived and therefore should be given in repeated doses to prolong its beneficial effects. Effectiveness of desmopressin acetate within 30 minutes does not indicate the need for repeated dosing. Increased stimulation of factor VIII and its action on platelets and endothelial cells do not indicate the need for repeated dosing.)

The nurse recognizes that desmopressin acetate needs to be given to a patient in repeated doses for which reason? a. it is relatively short lived b. it is effective within 30 minutes c. it stimulates an increase in factor VIII d. it acts on platelets and endothelial cells

a, b, d (Argatroban should be administered to a patient who had developed HIT to maintain anticoagulation. Plasmapheresis should be performed to clear platelet-aggregating immunoglobulin G from the blood. Heparin should be immediately discontinued when HIT is first recognized to prevent further complications. Vascular catheters should also be removed. Platelet transfusions will not be beneficial in the patient b/c they may enhance thromboembolic events)

The nurse suspects heparin-induced thrombocytopenia (HIT) in a patient who is receiving heparin therapy. Which interventions would the nurse anticipate incorporating into the plan of care? Select all that apply a. administering argatroban b. performing plasmapheresis c. apply vascular catheters d. discontinuing heparin therapy e. administering platelet transfusions

c (administration of platelets or platelet transfusion is contraindicated in a patient who has TTP b/c it leads to new von Willebrand factor (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.)

The nurse would question which therapy that is listed on a treatment plan for a patient who has thrombotic thrombocytopenic purpura (TTP)? a. plasmapheresis b. rituximab therapy c. platelet transfusion d. corticosteroid therapy

Elevated D-Dimers (The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.)

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? Elevated D-dimers Elevated fibrinogen Reduced prothrombin time (PT) Reduced fibrin degradation products (FDPs)

c (eltrombopag (thrombopoietin receptor antagonist) increases platelet production and is therefore beneficial for this patient. Lepirudin is a direct thrombin inhibitor, which is beneficial for the treatment of heparin-induced thrombocytopenia (HIT). Vincristine is a chemotherapeutic agent, which is used in the treatment of thrombotic thrombocytopenic purpura (TTP). Fondaparinux is an indirect thrombin inhibitor and is used for the treatment of HIT.

The platelet count of a patient with chronic immune thrombocytopenic purpura (ITP) has decreased despite immunoglobulin and immunosuppressant drug therapy. The patient is not a candidate for a splenectomy. Which medication would the nurse anticipate incorporating into the patients plan of care? a. lepirudin b. vincristine c. eltrombopag d. fondaparinux

aspirin

When teaching your patient with thrombocytopenia about medications to avoid you should instruct them to avoid _____

c (TTP causes irreversible renal failure b/c 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).)

When thrombotic thrombocytopenic purpura (TTP) is left untreated, the nurse identifies that the patient is at risk for which complication a. venous thrombosis b. acute hemarthrosis c. irreversible renal failure d. decreased platelet production

a (intramuscular injection should be avoided in a patient with thrombocytopenia b/c hematomas may develop on the injected site due to improper clotting of blood. Ice packs should be applied after injection to provide comfort. Applying direct pressure on the injected site will reduce the risk of hematoma, so direct pressure should not be avoided. Using a large-gauge needle for subcutaneous injection will cause bleeding.)

Which action by the nurse indicates an understanding of proper care for a patient with thrombocytopenia? a. applies ice on an injection site b. gives an intramuscular injection c. avoids direct pressure on an injection site d. Uses a large gauge needle for a subcutaneous injection

d (cryoprecipitate is a blood product prepared from fresh frozen plasma and is available in 10 to 20 mL/bag. Platelets are prepared from fresh whole blood in which an apheresed single donation contains 200 to 400 mL of platelets. Frozen RBCs are prepared from RBCs using glycerol for protection and can be stored for 10 years. Packed RBCs are prepared from whole blood by sedimentation or centrifugation and contain 250 to 350 mL in one unit)

Which blood product is prepared from fresh frozen plasma? a. platelets b. frozen red blood cells c. packed rbcs d. cryoprecipitate

c (to determine the signs of external bleeding in a patient with DIC disorder, the nurse assesses the integumentary system. The nurse assesses the neurologic, cardiovascular, and GI systems for internal bleeding)

Which body system would the nurse assess to determine the signs of external bleeding in a patient with disseminated intravascular coagulation (DIC) disorder? a. neurologic b. cardiovascular c. integumentary d. gastrointestinal

a (acute hemarthrosis is characterized by bleeding into the joint spaces, as seen in hemophilia. bleeding in the joints causes local inflammation. The image shows inflammation of the knee joint and is therefore acute hemarthrosis. Severe ecchymosis causes accumulation of waste blood due to hematomas. Therefore the image for severe ecchymosis will show red coloration on the body. HIT will show skin necrosis. Acute idiopathic thrombocytopenic purpura will show purplish petechiae.)

Which condition is depicted in the attached photo?? a. acute hemarthrosis b. severe ecchymosis c. heparin-induced thrombocytopenia (HIT) d. acute idiopathic thrombocytopenic purpura

b, d (Platelet administration is indicated in a patient with a blood platelet count of 8,000/uL to maintain normal platelet count. Administering platelets is beneficial if a patient has anticipated bleeding before a procedure to prevent the risk of hemorrhage. Immunosuppressive therapy is indicated when refractory cases are observed. Splenectomy is indicated when the patient does not respond to drug therapy. Administration of platelets is contraindicated in a patient with TTP b/c it may lead to new von Willebrand factor-platelet complexes and increased clotting.)

Which conditions warrant platelet administration for a patient experiencing thrombocytopenia? Select all that apply a. when refractory cases are observed b. when the platelet count in the patient is 8,000/uL c. when the patient does not respond to drug therapy d. when there is anticipated bleeding before a procedure e. when the patient has thrombotic thrombocytopenic purpura (TTP)

b (when 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. 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. PT is used to assess secondary hemostasis. Peripheral blood smear is used to distinguish acquired disorders from congenital disorders.)

Which diagnostic test can detect destruction of circulating platelets as the cause of thrombocytopenia? a. hemoglobin b. bone marrow analysis c. prothrombin time (PT) d. Peripheral blood smear

c, e (Tranexamic acid and epsilon-aminocaproic acid are antifibrinolytic drugs that inhibit fibrinolysis by inhibiting plasminogen activation in the fibrin clot and enhance clot stability. Therefore these drugs can be used in the treatment of epistaxis (nosebleed) and menorrhagia (excessive bleeding during menstruation). Rituximab is used to lyse activated B cells. Cyclosporine and cyclophosphamide are immunosuppressive drugs that are used to suppress the immune system during organ transplantation.)

Which drugs would the nurse anticipate incorporating into the plan of care for a patient reporting bleeding form the nose and abnormally heavy bleeding during menstruation? Select all that apply a. rituximab b. cyclosporine c. tranexamic acid d. cyclophosphamide e epsilon-aminocaproic acid

c, e, f (Self-care measures to reduce the risk of bleeding include avoiding blowing the nose forcefully. It is also important to notify the health care provider of any black, tarry stools, as this is a sign of upper GI bleeding. The pt. should notify the health care provider of difficulty speaking or sudden weakness in the extremities. This can indicate that the patient may be experiencing an intracerebral hemorrhage. Patients with thrombocytopenia should not use a razor blade to shave; an electric razor is preferred due to bleeding potential. Patients with thrombocytopenia should not take aspirin or ibuprofen, as these drugs increase the risk of bleeding. Constipation should be avoided by increasing fluid intake and using stool softeners. Enemas and rectal suppositories should be avoided b/c their use may result in bleeding)

Which instructions would the nurse include when discharging a patient with thrombocytopenia? Select all that apply a. use a high-quality disposable razor for shaving b. take aspirin or ibuprofen to treat minor discomforts c. avoid blowing your nose forcefully. instead, gently pat it with a tissue d. use a small volume enema or rectal suppository to treat constipation e. notify your health care provider if you have black, tarry bowel movements f. notify your health care provider i you have difficulty speaking or sudden weakness in the arm or leg.

d (bone marrow examination is performed to rule out production problems such as leukemia, aplastic anemia, and other myeloproliferative disorders as the cause of thrombocytopenia. Therefore to confirm that the absence or decreased number of megakaryocytes to be the cause of thrombocytopenia, bone marrow examination will be done. PT will be tested to assess secondary hemostasis. A peripheral blood smear will be done to distinguish immune thrombocytopenic purpura (ITP) from congenital disorders. 14C serotonin release assay assists with the diagnosis of ITP)

Which laboratory test would provide information about the number of megakaryocytes in a patient with thrombocytopenia? a. prothrombin time (PT) b. Peripheral blood smear c. 14C serotonin release assay d. Bone marrow examination

d (the primary nursing intervention for a patient with thrombocytopenia and nosebleed is to prevent excessive blood loss. Positioning the patients head upwards and applying pressure on the nostrils will reduce the flow of blood and decrease bleeding. The health care provider is called if the bleeding does not stop after 10 minutes. The patients 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 patients head upward, then ice bags should be placed over the bridge of the patients nose to decrease bleeding.)

Which nursing intervention is the priority when caring for a patient with thrombocytopenia who experiences a nosebleed? a. notify the health care provider b. tap the patients nose gently with a tissue c. place ice bags over the bridge of the patients nose d. position the head upwards an apply pressure to nostrils

d (TTP is seen primarily in adults between 20 and 50 years of age, with a slight female predominance. Therefore a 35 year old female adult is more likely to have TTP. A 12 year old male child, a 30 year old adult male, and a 10 year old female child are less likely to to have TTP than a 35 year old female adult)

Which patient is most likely to experience thrombotic thrombocytopenic purpura? (TTP) a. a 12 year old male child b. a 30 year old male adult c. a 10 year old female child d. a 35 year old female adult

a (D-dimer is a polymer resulting from the breakdown of fibrin. Thrombin is an enzyme in blood plasma that causes clotting of blood by converting fibrinogen to fibrin. Fibrinogen is a soluble protein present in blood plasma, from which fibrin is produced by the action of the enzyme thrombin. Prothrombin is a clotting factor that is needed for the normal clotting of blood)

Which product results form the breakdown of fibrin? a. d dimer b. thrombin c. fibrinogen d. prothrombin

d (TTP is caused due to the deficiency of plasma enzyme ADAMTS13. ITP is caused by decreased platelet production. Without the enzyme, unusually large amount of von Willebrand factor will attach to activated platelets and promote platelet aggregation. Increased use of heparin causes HIT. Overstimulation of proteins involved in clotting factors can result in DIC)

Which syndrome is caused by the deficiency of plasma enzyme ADAMTS13? a. immune thrombocytopenia purpura (ITP) b. Heparin-induced thrombocytopenia (HIT) c. Thrombotic thrombocytopenic purpura (TTP) d. Disseminated intravascular coagulation (DIC)

c (TTP is caused due to the deficiency of plasma enzyme ADAMTS13. ITP is caused by decreased platelet production. Without the enzyme, unusually large amounts of von Willebrand factor will attach to activated platelets and promote platelet aggregation. Increased use of heparin causes HIT. Overstimulation of proteins involved in clotting factors can result in DIC)

Which syndrome is caused by the deficiency of plasma enzyme ADAMTS13? a. immune thrombocytopenic purpura (ITP) b. Heparin induced thrombocytopenia (HIT) c. Thrombotic thrombocytopenic purpura (TTP) d. Disseminated intravascular coagulation (DIC)

a,b,c (In HIT, platelet count decreases and hemoglobin level remains normal. Warfarin is given to the patient when the platelet count reaches 150,000/jL. If there is severe clotting, then plasmapheresis is preferred to treat the patient to clear the platelet-aggregating immunoglobulin G (IgG) from the blood. Protamine sulfate is given to interrupt the circulating heparin. Platelet transfusions would not be effective to treat HIT b/c this may enhance thromboembolic events. Heparin and low molecular weight heparin should be discontinued b/c they may further potentiate thrombocytopenia.)

Which therapies would the nurse expect to incorporate into the plan of care for a patient diagnosed with heparin-induced thrombocytopenia (HIT)? Select all that apply a. warfarin b. plasmapheresis c. protamine sulfate d. platelet transfusion e. low-molecular-weight heparin

a (heparin therapy is used in the treatment of DIC disorder only when the benefits outweigh the risks. Heparin, if not used with caution, may cause uncontrolled bleeding, which may be life-threatening. Blood product support with platelets, cryoprecipitate, and fresh frozen plasma are usually reserved for a patient with life-threatening hemorrhage. If bleeding occurs due to thrombocytopenia, that is, if the platelet count is less than 20,000/uL or 50,000/uL, then platelets are administered. Cryoprecipitates are administered if the fibrinogen level is below 100mg/dL. Fresh frozen plasma is administered if bleeding occurs due to deficiency of plasma clotting factors)

Which therapy for disseminated intravascular coagulation (DIC) disorder may be prescribed for a patient when the benefits outweigh the risk? a. heparin b. platelets c. cryoprecipitates d. fresh frozen plasma

c (desmopression 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)

Which therapy would be beneficial for a patient who experiences a minor bleeding episode during a dental procedure? a. tranexamic acetate b. fresh frozen plasma c. desmopressin acetate d. epsilon-aminocaproic acid

INR (international normalized ratio)

______ reports relationship of patients PT to a normal control normally 0.7 to 1.8 To monitor warfarin therapy, goal is 2 to 3

aPTT (activated partial thromboplastin time)

_________ measures number of seconds for a clot to form Normally 25 to 35 seconds For anticoagulant therapy 1.5 to 2.5 times the control in seconds

Echymosis

a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.: common bruise

petechiae

a small red or purple spot caused by bleeding into the skin.

purpura

multiple pinpoint hemorrhages and accumulation of blood under the skin