Blood/ clotting practice questions

A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication to be effective? A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5

A

Which sign would the nurse expect to assess in the client diagnosed with ITP? A. Petechiae on the anterior chest, arms, and neck B. Capillary refill of less than 3 seconds C. Increased platelets count D. Pulse oximeter reading of 95%

A

The clients CBC indicates RBC 6,000,000, Hbg 14.2g/dL, Hct 42%, platelets 69,000. Which intervention should the nurse implement? A. Teach the client to use a soft bristle toothbrush B. Monitor client for elevated temp C. Check the clients BP D. Hold venipuncture sites for 1 minute

A The client has a low platelet count which indicates thrombocytopenia. They should be on bleeding precautions. Puncture sites should have pressure applied for more than 5 minutes

Which nursing action is indicated for the patient with thrombocytopenia? A. Avoid intramuscular injections. B. Encourage the patient to drink plenty of fluids. C. Place the patient on isolation precautions. D. Encourage frequent rest periods.

A Because the patient with thrombocytopenia has a reduced number of platelets, clotting times will be longer. IM injections can cause bleeding in the deep muscle tissue.

The nurse recognizes that a deficiency in a clotting factor may cause which finding(s)? (Select all that apply.) A. Easy bruising and cutaneous hematoma formation with minor trauma (e.g., an injection) B. Bleeding from the gums and prolonged bleeding following minor injuries or cuts C. Enhanced platelet aggregation and increased clumping of RBCs D. Fibrin molecules form fibrin threads to increase wound healing E. Yellowish skin color

AB Deficiencies in clotting factors lead to increased bleeding leading to easy bruising, hematoma formation, and prolonged bleeding. Platelet aggregation will be decreased and wound healing delayed with low clotting factors. Yellowish skin is related to hepatic disease.

Prothrombin turns into _________ with the assistance of clotting factor V. A. fibrinogen B. fibrin C. thrombin D. vitamin K

C Thrombin....Prothrombin turns into thrombin by clotting factor V. When thrombin is on board it is responsible for turning fibrinogen to fibrin. Fibrin is one of the main ingredients for clot formation.

15 minutes after the nurse has initiated a transfusion of packed RBCs, the client becomes restless and complains of itching on the trunk and arms. Which interventions should the nurse implement first? A. Collect urine for analysis B. Notify the lab of the reaction C. Administer an antihistamine D. Stop the transfusion

D

What blood type is known as the "universal donor"? A. Type A B. Type B C. Type AB D. Type O

D

The nurse is caring for the following clients. Which client should the nurse assess first? A. The client whose PTT is 38 seconds B. The client whose hemoglobin is 14 G/DL and hematocrit is 48% C. The client whose platelet count is 75,000 per cubic milliliter of blood D. The client whose red blood cell count is 4.8 million

C

What blood type is known as the "universal recipient"? A. Type A B. Type B C. Type AB D. Type O

C

The nurse is caring for the following clients. Which client should the nurse assess first? A. The client whose partial thromboplastin time (PTT) is 65 seconds. B. The client whose hemoglobin is 14 g/dL and hematocrit is 45%. C. The client whose platelet count is 75,000 per cubic millimeter of blood. D. The client whose red blood cell count is 4.8 × 10^6/mm3.

C A range for the normal PTT is 60-70 seconds. These are normal hemoglobin/hematocrit levels for either a male or female client. A platelet count of less than 150,000 per cubic millimeter of blood indicates thrombocytopenia. This is a normal red blood cell count.

The nurse is preparing to administer the oral anticoagulant warfarin (Coumadin) to a client who has a PT/PTT of 22/39 and an INR of 2.8. What action should the nurse implement? A. Assess the client for abnormal bleeding. B. Prepare to administer vitamin K (AquaMephyton). C. Administer the medication as ordered. D. Notify the HCP to obtain an order to increase the dose.

C The client would not be experiencing abnormal bleeding with this INR. This is the antidote for an overdose of anticoagulant and the INR does not indicate this. A therapeutic INR is 2 to 3; therefore, the nurse should administer the medication. There is no need to increase the dose; this result is within the therapeutic range.

The nurse is caring for clients on a medical floor. After the shift report, which client should be assessed first? A. The client who is two-thirds of the way through a blood transfusion and has had no complaints of dyspnea or hives. B. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae covering the body. C. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood. D. The client diagnosed with Crohn's disease who is complaining of perineal discomfort.

C The likelihood of a client who has already received more than half of the blood product having a transfusion reaction is slim. The first 15 minutes have passed and to this point the client is tolerating the blood. Clients diagnosed with leukemia have a cancer involving blood cell production. These are expected findings in a client diagnosed with leukemia. This client has a potential for hemorrhage and is reporting blood in the vomitus. This client should be assessed first. Crohn's disease involves frequent diarrhea stools, leading to perineal irritation and skin excoriation. This is expected and not life threatening. Clients "1," "2," and "3" should be seen before this client.

A patient is ordered to receive a blood transfusion because of anemia. What is the recommended minimum gauge of the IV catheter to administer blood? A. 16 B. 18 C. 20 D. 22

C An 18 to 20 gauge catheter is recommended for infusion of packed RBCs in the adult population to prevent red blood cell lysis. The 20 gauge is smaller gauge and is acceptable. A 16 gauge is larger and not required for blood administration, and a 22 gauge is too small and would result in cell lysis.

Nurse Paulo has received a blood unit from the blood bank and has rechecked the blood bag properly with nurse Edward. Prior the facilitation of the blood transfusion, nurse Paulo priority check which of the following? A. Intake and output. B. NPO standing order. C. Vital signs. D. Skin turgor.

C The nurse must assess the vital signs before and 15 minutes after the procedure so that any changes during the transfusion may indicate a transfusion reaction is happening.

The nurse is caring for a clients on a medical floor. After the shift report, which client should be assessed first? A. The client who is 2/3 of the way through a blood transfusion and has no complaints of dyspnea or hives B. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae covering the body C. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood D. The client diagnosed with Crohns disease who is complaining of perineal discomfort

C A. The patient is tolerating the blood transfusion and still has blood left to go B. this is an expected finding with a client with leukemia C. this client has a potential for hemorrhaging this client should be assessed first D. this is an expected finding with Crohn's disease not life-threatening

The client is placed on neutropenia precautions. Which intervention should the nurse teach the client? A. Shave with a electric razor and use a soft toothbrush B. Eat plenty of fresh fruits and veggies C. Perform perineal care after every bowel movement D. Some blood in the urine is normal

C The client is at risk for infection

A client has an order to receive a one unit of packed RBC's. The nurse make sure which of the following intravenous solutions to hang with the blood product at the client's bedside? A. 0.9% sodium chloride. B. 5% dextrose in 0.9% sodium chloride. C. Balanced Multiple Maintenance Solution with 5% Dextrose. D. 5% dextrose in 0.45% sodium chloride.

A

A client is receiving a first-time blood transfusion of packed RBC. How long should the nurse stay and monitor the client to ensure a transfusion reaction will not happen? A. 15 minutes. B. 30 minutes. C. 45 minutes. D. 60 minutes

A

The nurse is assisting the HCP with a bone marrow biopsy. Which intervention is a priority in postprocedure? A. Apply pressure to site for 5-10 minutes B. Medicate for pain with morphine IVP C. Maintain head of bed in high fowlers D. Apply oxygen via nasal cannula

A

The client with O+ blood is in need of an emergency transfusion but the laboratory does not have any O+ blood available. Which potential unit of blood could be given to the client? A. The O- unit. B. The A+ unit. C. The B+ unit. D. Any Rh+ unit.

A . O- (O-negative) blood is considered the universal donor because it does not contain the antigens A, B, or Rh. (AB1 is considered the universal recipient because a person with this blood type has all the antigens on the blood.)A+ blood contains the antigen A that the client will react to, causing the development of antibodies. The unit being Rh+ is compatible with the client.B+ blood contains the antigen B that the client will react to, causing the development of antibodies. The unit being Rh+ is compatible with the client.This client does not have antigens A or Bon the blood. Administration of these types would cause an antigen-antibody reaction within the client's body, resulting in massive hemolysis of the client's blood and death

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse should assess which PRIORITY item? A. Vital signs B. Skin color C. Urine output D. Latest hematocrit level

A A change in vital signs during the transfusion from baseline may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs BEFORE the procedure and again after the first 15 minutes. The other options do not identify assessments that are a priority just before beginning a transfusion.

The nurse is assisting the HCP with a bone marrow biopsy. Which intervention postprocedure has priority? A. Apply pressure to site for five (5) to 10 minutes. B. Medicate for pain with morphine slow IVP. C. Maintain head of bed in high Fowler's position. D. Apply oxygen via nasal cannula at five (5) L/min.

A After a bone marrow biopsy, it is important that the client form a clot to prevent bleeding. The nurse should hold direct pressure on the site for five (5) to 10 minutes. The nurse might premedicate for pain, but once the procedure is completed, a mild oral medication is usually sufficient to relieve any residual discomfort. The head of the bed can be in any position of comfort for the client.The procedure is performed on the iliac crest or the sternum and does not cause respiratory distress.

The client with O positive blood is in need of an emergency transfusion but the laboratory does not have any O positive blood available. Which potential unit of blood could be given to the client? A. The O negative unit B. The A positive unit C. The B positive unit D. Any RH positive unit

A O negative blood is considered the universal donor

A patient started receiving their first unit of blood at 1000. It is now 1010 and the patient is reporting itching, chills, and a headache. In addition, the patient's temperature is now 99.8'F from 98'F. Your next nursing action is: A. Stop the transfusion B. Notify the physician C. Decrease the rate of the transfusion D. Reassure the patient that this is normal and will resolve in 30 minutes.

A The patient is possibly having a transfusion reaction. FIRST, the nurse should STOP the transfusion and then disconnect the IV tubing at the access site and replace it with NEW tubing. In addition, have normal saline infusing to keep the vein open. THEN the nurse will notify the physician and blood bank.

The nurse in an outpatient clinic is scanning the laboratory reports that were just faxed to the office. A PT reported as an INR of 2.5 is evidence of an appropriate therapeutic outcome for which patient? A. A patient who is undergoing warfarin (Coumadin) therapy B. A patient who just received 24 hours of subcutaneous heparin injections C. A patient who is scheduled for a liver biopsy D. A patient who has a diet rich in vitamin K

A The INR is used to evaluate the effectiveness of warfarin (Coumadin) therapy and is considered therapeutic when between 2.0 and 3.0. The INR is not used to assess effectiveness of heparin therapy. This is a high INR and would be a contraindication for a liver biopsy due to increased chance of hemorrhage. Increased INR is associated with vitamin K deficiency.

The nurse is initiating a blood transfusion. Which interventions should the nurse implement? Select all that apply. A. Assess the client's lung fields. B. Have the client sign a consent form. C. Start an IV with a 22-gauge IV catheter. D. Hang 250 mL of D5W at a keep-open rate. E. Check the chart for the HCP's order.

ABE The nurse must make a decision on the amount of blood to infuse per hour. If the client is showing any sign of heart or lung compromise, the nurse would infuse the blood at the slowest possible rate Blood products require the client to give specific consent to receive blood. The IV should be started with an 18-gauge catheter if possible; the smallest possible catheter is a 20-gauge. Smaller gauge catheters break down the blood cells. Blood is not compatible with D5W; the nurse should hang 0.9% normal saline (NS) to keep open. The nurse should verify the HCP's order before having the client sign the consent form.

The client has a hematocrit of 22.3% and a hemoglobin of 7.7 G/DL. The HCP has ordered two units of packed red blood cells to be transfused. Which interventions should the nurse implement? Select all that apply. A. Obtain a signed consent B. Initiate a 22 gauge IV C. Assess the clients lungs D. Check for allergies E. Hang a keep open IV of D5W

ACD The client must give permission to receive blood. Most blood products require at least 18-20 gauge IV to allow red blood cells to follow through the cannula. The nurse must do assessment before giving blood. Checking for allergies is important prior to administering any medication or blood. A keep open IV of normal saline would be hung not D5W

A patient needs 2 units of packed red blood cells. The patient is typed and crossmatched. The patient has B+ blood. As the nurse you know the patient can receive what type of blood? Select all that apply: A. B- B. A+ C. O- D. B+ E. O+ F. A- G. AB+ H. AB-

ACDE The patient must receive blood from either a donor that has O or B blood. Since the patient is B+ (Rh factor is positive), they can receive both negative or positive blood. So, the patient can receive B-, B+, O-, and O+ blood.

What is function of the bone marrow? A. Provide nutrients to the bone B. Produce blood cells C. Provide supporting structure to the bone D. Ensure bone has enough oxygen

B

Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? A. The blood will coagulate if left out of the refrigerator for greater than four (4) hours. B. The blood has the potential for bacterial growth if allowed to infuse longer. C. The blood components begin to break down after four (4) hours. D. The blood will not be affected; this is a laboratory procedure

B Blood will coagulate if left out for an extended period, but blood is stored with a preservative that prevents this and prolongs the life of the blood.Blood is a medium for bacterial growth, and any bacteria contaminating the unit will begin to grow if left outside of a controlled refrigerated temperature for longer than four (4) hours, placing the client at risk for septicemia.Blood components are stable and do not break down after four (4) hours.These are standard nursing and laboratory procedures to prevent the complication of septicemia.

Your patient is being evaluated for a bleeding disorder. The physician orders an aPTT blood test. Which statement is TRUE about this coagulation test? A. The aPTT is an important result used to assess the effectiveness of Warfarin. B. The aPTT assesses the intrinsic pathway of coagulation and common pathways. C. The aPTT is measured in milliseconds. D. The aPTT only assesses clotting factor VII.

B The aPTT assess the intrinsic pathway of coagulation and common pathways. The aPTT assesses the intrinsic pathway of coagulation and common pathways. Therefore, clotting factors I, II, V, X (which are part of common pathways) and clotting factors XII, XI, IX, VIII (which are part of intrinsic pathway) are assessed. The intrinsic pathway is activated when there is inside injury within the vascular system. The aPTT is an important result used to assess the effectiveness of Heparin (NOT Warfarin), and it's measured in SECONDS (not milliseconds).

The nurse observes petechiae and purpura on a newly admitted patient and correlates these findings to which diagnostic result? A. Hematocrit: 27% B. Platelets: 7,000/mm3 C. White blood cells: 5,000/mm3 D. Prothrombin time: 20 sec

B The normal platelet count is 100,000 to 300,000, and with low platelet counts (7000 in this example), the patient is at increased risk of bleeding. Hematocrit reflects the percentage of red blood cells. White blood count is used to assess for infection and inflammation. The normal prothrombin time is 10 to 14 seconds, and a prolonged PT may indicate a lack of clotting factors.

The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 × 106/mm3, WBC count 150 × 103/mm3, platelets 22 × 103/mm3, K+ 3.8 mEq/L, and Na+ 139 mEq/L. Based on these results, which intervention should the nurse teach the client? A. Encourage the client to eat foods high in iron. B. Instruct the client to use an electric razor when shaving. C. Discuss the importance of limiting sodium in the diet. D. Instruct the family to limit visits to once a week.

B The anemia that occurs in leukemia is not related to iron deficiency and eating foods high in iron will not help.The platelet count of 22 X 10^3/mm3 indicates a platelet count of 22,000. The definition of thrombocytopenia is a count less than 100,000. This client is at risk for bleeding. Bleeding precautions include decreasing the risk by using soft-bristle toothbrushes and electric razors and holding all venipuncture sites for a minimum of five (5) minutes. The sodium level is within normal limits. The client is encouraged to eat whatever he or she wants to eat unless some other disease process limits food choices. The client is at risk for infection, but unless the family or significant others are ill, they should be encouraged to visit whenever possible.

The nurse is assigned to a patient with thrombocytopenia. What is the priority goal of nursing care? A. Prevention of infection B. Prevention of injury C. Prevention of dehydration D. Prevention of nutritional deficit

B Thrombocytopenia (low platelet count) places the patient at an increased risk of bleeding. Infection prevention is the priority in the patient with low white blood cell count. Dehydration is associated with fluid loss. Nutritional deficits may impair red blood cell production.

If a hemolytic transfusion reaction is suspected, what is the nurse's priority action? A. Slow the transfusion and notify the provider. B. Stop the transfusion but maintain the infusion with 0.9% sodium chloride. C. Stop the transfusion and change the infusion site. D. Send a blood specimen for repeated blood typing.

B : The infusion needs to be stopped to avoid administration of any further blood product, but the IV needs to be maintained in case immediate venous access is required for emergency medications.

Nurse Jay is caring for a client with an ongoing transfusion of packed RBC's when suddenly the client is having difficulty of breathing, skin is flushed and having chills. Which action should nurse jay take first? A. Administer oxygen. B. Place the client on droplight. C. Check the client's temperature. D. Stop the transfusion.

D

The client receiving a unit of blood begins to chill and develop hives. Which actions should be the nurses first response? A. Notify the laboratory and health care provider B. Administer Benadryl C. Assess the client for further complications D. Stop the transfusion

D

Which nursing intervention takes highest priority when caring for a newly admitted client who's receiving a blood transfusion? A. Warming the blood prior transfusion. B. Informing the client that the transfusion usually takes 4 to 6 hours. C. Documenting blood administration in the client chart. D. Instructing the client to report any itching, chest pain, or dyspnea.

D This will help the nurse take immediate action in case a reaction happens during a transfusion