blood transfusions complications /Hematology/ DIC/ITP/HIT

A client has a thrombus lodged in the pulmonary artery. Which of these pharmacologic agents prevent further thrombus development?

- IV Heparin

The patient is receiving a transfusion of packed red blood cells, which of these clinical manifestations would alert the nurse to the development of transfusion related acute lung injury (TRALI)?

- Pink frothy sputum

1. Patient with heparin, you need to monitor aPTT and it should be: -

1.5-2 times greater than normal value

Accepted treatments for disseminated intravascular coagulation (DIC) may require (Select all that apply.) a. platelet infusions. b. administration of fresh frozen plasma. c. cryoprecipitate. d. packed RBCs. e. heparin.

A- platelet transfusions B- Administration of frozen plasma C- Cryoprecipitate D- Packed RBC's E- Heparin

A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, "I have low platelets, so why not give me a transfusion of exactly what I'm missing?" How should the nurse best respond? A. "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." B. "A platelet transfusion often blunts your body's own production of platelets even further." C. "Finding a matching donor for a platelet transfusion is exceedingly difficult." D. "A very small percentage of the platelets in a transfusion are actually functional."

A. "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body."

The results of a patient's most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This patient should undergo testing for which of the following potential causes? Select all that apply. A. Hepatitis B. Acute renal failure C. HIV D. Malignant melanoma E. Cholecystitis

A. Hepatitis C. HIV

The nurse is caring for a client with a diagnosis of disseminated intravascular coagulopathy (DIC). The clients spouse asks why heparin has been ordered. The nurse's response would incorporate which of the following points? (Reviews and rationales) A. Maintain tissue perfusion B. Preventing occlusion in the microcirculation C. Preserving the myocardium D. Dissolving clots that have formed in the large vessels E. Preventing deep vein thrombosis

A. Maintain tissue perfusion B. Preventing occlusion in the microcirculation E. Preventing deep vein thrombosis

The client admitted with full-thickness burns may be developing DIC. Which signs/symptoms would support the diagnosis of DIC? A. Oozing blood from the IV catheter site. B. Sudden onset of chest pain and frothy sputum. C. Foul-smelling, concentrated urine. D. A reddened, inflamed central line catheter site.

A. Oozing blood from the IV catheter site.

Which sign would the nurse expect to assess in the client diagnosed with idiopathic thrombocytopenic purpura (ITP)? A. Petechiae on the anterior chest, arms, and neck. B. Capillary refill of less than three (3) seconds. C. An enlarged spleen. D. Pulse oximeter reading of 95%.

A. Petechiae on the anterior chest, arms, and neck.

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of what assessment parameters? A. Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT) B. Platelet count, blood glucose levels, and white blood cell (WBC) count C. Thrombin time, calcium levels, and potassium levels D. Fibrinogen level, WBC count, and platelet count

A. Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT)

A client has a thrombus lodged in the pulmonary artery. Which of these pharmacologic agents should be used to dissolve the thrombus? -

Alteplase (TPA)

A nurse writes nursing diagnosis in planning care for a client who has DIC. Which of the following nursing diagnosis should be listed as the priority? -

Altered tissue perfusion related to abnormal clotting and micro emboli

Which laboratory result would the nurse expect in the client diagnosed with DIC? A. A decreased prothrombin time (PT). B. A low fibrinogen level. C. An increased platelet count. D. An increased white blood cell count.

B. A low fibrinogen level.

A patient's blood work reveals a platelet level of 17,000/mm3 . When inspecting the patient's integumentary system, what finding would be most consistent with this platelet level? A. Dermatitis B. Petechiae C. Urticaria D. Alopecia

B. Petechiae

The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (PRBCs) has begun, the patient is having difficulty breathing and complains of severe chest tightness. What is the most appropriate initial action for the nurse to take? A. Notify the patient's physician B. Stop the transfusion immediately C. Remove the patient's IV access D. Assess the patient's chest sounds and vital signs

B. Stop the transfusion immediately

A transfusion of fresh frozen plasma is administered to a client with DIC. Which of the following outcomes indicates to the nurse that this treatment is effective? -

Bleeding from iv site stops

DIC, what is the process going on? -

Body is clotting and using up all the clotting factors which in turn causes bleeding

A patient's low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, what action should the nurse perform? A. Have the patient identify his or her blood type in writing. B. Ensure that the patient has granted verbal consent for transfusion. C. Assess the patient's vital signs to establish baselines. D. Facilitate insertion of a central venous catheter.

C. Assess the patient's vital signs to establish baselines.

7. A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. A. Antihypertensives B. Penicillins C. Sulfa-containing medications D. Aspirin-based drugs E. NSAIDs

C. Sulfa-containing medications D. Aspirin-based drugs E. NSAIDs

A patient is to receive a blood transfusion. Based on the standards of practice which of these actions should a nurse implement to ensure that the correct blood is admitted to your patient? -

Check the name and DOB to the blood product and medical # to that with the patient id band (Not sure)

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? A. A 35-year-old pregnant client with placenta previa. B. A 42-year-old client with a pulmonary embolus. C. A 60-year-old client receiving hemodialysis 3 days a week. D. A 78-year-old client diagnosed with septicemia.

D. A 78-year-old client diagnosed with septicemia.

An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which of the following ICU patients most likely faces the highest risk of DIC? A. A patient with extensive burns B. A patient who has a diagnosis of acute respiratory distress syndrome C. A patient who suffered multiple trauma in a workplace accident D. A patient who is being treated for septic shock

D. A patient who is being treated for septic shock

A patient is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? A. Assess for edema B. Assess skin integrity frequently C. Assess the patient's level of consciousness frequently D. Closely monitor intake and output

D. Closely monitor intake and output

A patient's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin (Coumadin), an anticoagulant. When assessing the therapeutic response to this medication, what is the nurse's most appropriate action? A. Assess for signs of myelosuppression. B. Review the patient's platelet level. C. Assess the patient's capillary refill time. D. Review the patient's international normalized ratio (INR).

D. Review the patient's international normalized ratio (INR).

Which of the following lab values should the nurse expect in a client with DIC? SATA -

Decreased Platelets (70,000) - Increase Fibrinogen Degradation Products - Increased PT & PTT

Family member of a client diagnosed with DIC asks the nurse to explain what this means. The nurse evaluates that this family members understand the disorder if they best describe it as: -

Disorder of clot formation, which consumes clotting factors and leads to excessive bleeding

Regimen to hanging blood, prioritization: -

First get consent - Type and cross patient's blood - Right before hanging blood you will take VS - Give patient antihistamine before hanging the blood - After all of this is done then you can hang the blood

Client with DIC who is bleeding would likely have which of the following hemodynamic parameters? -

Heart rate of 125 BPM

A nurse is preparing to transfuse 1 unit packed red blood cells to a patient with anemia. Which of these measures should the nurse implement to decrease the possibility of a blood transfusion reaction? -

Infuse the blood at 5 ml / min for the first 15 min.

How do you know if the patient is getting better with DIC -

Less bleeding from the IV site

Which of these lab results would be most important for the nurse to assess in a client who has been diagnosed with HIT? -

Low platelets

DIC -

Microthrombi

A nurse is caring for a client who has been admitted with severe sepsis. Which of the following signs would lead to nurse to suspect that DIC may be occurring? -

Occult blood in stool and oozing blood from intravenous site

Which of the following lab values should the nurse expect in DIC?

PT 25 - increased PTT 105 - increased Thrombin time - increased Fibrinogen degradation products - positive Positive d - dimer Decreased platelets low fibrinogen levels

A nurse is assessing a patient with autoimmune thrombocytopenia purpura. Which of these lab test should the nurse plan on monitoring frequently to determine if the treatment if effective? -

Platelet count

Fresh frozen plasma is given to the client with DIC to? -

Replace the clotting factor

When administering a blood transfusion, the patient develops a rapid HR, and a different breathing pattern. What should the nurse do?

SATA - Give epinephrine - Assess VS - Stop Infusion

Which of these assessments found client diagnosed with HIT requires immediate nursing interventions? -

ST segment elevation

The nurse counsels a client with ITP that if medication therapy is not effective, the surgical procedure that is most likely to be used in the treatment is? -

Splenectomy

A patient on Coumadin what would you teach these patients in regards to discharge teaching: -

Stay away from green leafy vegetables - Drink fluids - Monitor PTT/INR

A nurse is caring for a patient who is experiencing chills and develops a rash during a blood transfusion. Which of these actions should the nurse implement first? -

Stop the transfusion

A patient who is receiving a blood transfusion suddenly exhibits signs of transfusion reaction. -

Stop the transfusion, maintain a patent IV with NS, monitor pt VS, send blood immediately to the blood bank, file a blood transfusion report

A patient is receiving 1 unit of PRBC's and 15 min into the infusion, the patient develops SOB and flank pain. Which of these nursing actions should the nurse implement first? -

Stop the transfusion.

A nurse is caring for patient diagnosed with severe anemia who is to receive blood transfusion therapy. Which of the signs should alert the nurse of possible complications? -

The patient reports lower back pain

When hanging blood, the nurse 1 needs to make sure that she: -

Verifies the blood with two nurses (Her and another nurse)

The nurse is caring for a client who has autoimmune thrombocytopenia purpura. which intervention does the nurse implement for this client?

avoid IM injections

A transfusion of fresh frozen plasma is administered to a client with disseminated intravascular coagulation dic - which outcome indicates to the nurse that the treatment is getting better?

bleeding from iv sites stops

Which of the following lab tests would be most important for a nurse to assess for a client who is suspected of having heparin induced thrombocytopenia ?

decreased platelet by 50%

The nurse is preparing to transfuse a third unit of RBC to a patient , which lab result is the nurse most concerned about?

potassium 5.8

A patient is receiving a transfusion of 2 units of PRBC's. During the infusion of the 2nd unit the nurse observes the patient has distended neck veins in sitting position. Which action should the nurse take initially? -

slow the infusion rate

Frozen plasma is given to DIC patient because

to replace clotting factor