Patho Ch22 Hemostasis

The nurse is caring for a patient who has experienced tissue damage due to a fall from a skateboard. Which action initiates the intrinsic pathway of clot formation? Release of tissue factor by damaged endothelial cells Platelets and red blood cells sticking to fibrin strands; platelets contracting Prothrombin activator converting prothrombin into thrombin Activation of proenzymes exposed to collagen fibers at the injury site

Activation of proenzymes exposed to collagen fibers at the injury site The intrinsic pathway of clot formation involves the activation of proenzymes exposed to collagen fibers at the injury site. The release of tissue factor by damaged endothelial cells is part of the extrinsic pathway of clot formation. Prothrombin activator converts prothrombin into thrombin is a later phase of the combined pathway. Platelets and red blood cells sticking to fibrin strands, resulting in the contraction of platelets, is a later stage of clot formation. The vascular phase of hemostasis lasts for roughly 30 minutes after the injury occurs. It is dominated by the response of the endothelial cells and the contraction, or vascular spasm, of smooth muscle of the vessel walls. The platelet phase of hemostasis begins with the attachment of platelets to sticky endothelial surfaces, the basement membrane, exposed collagen fibers, and each other.

The mother of a patient with immune thrombocytopenia purpura (ITP) asks for more information about the disorder. Which response should the nurse make to the mother? "Platelets are not completely formed in the bloodstream." "Platelets are destroyed by antibodies triggered by the immune system." "Platelets are prematurely destroyed by natural cell death." "An increased production of platelets results in increased clotting."

"Platelets are destroyed by antibodies triggered by the immune system." Immune thrombocytopenia purpura (ITP) is an autoimmune disorder in which the immune system develops antibodies against and destroys platelets. The result is thrombocytopenia without anemia. This disease is chronic and may experience remissions and relapses over time. Platelets are formed normally and are not destroyed by natural cell death, but by the body's immune system. The increased production of platelets is associated with hypercoagulopathic states.

The family of a patient with disseminated intravascular coagulation (DIC) asks why the patient is bleeding if the condition is a result of massive clotting. Which response should the nurse make to the family? "The bleeding occurs due to the liver's inability to produce clotting factors." "The bleeding occurs due to the abnormal function of platelets that form clots." "This condition quickly uses up the blood's clotting factors, leaving the patient vulnerable to bleeding." "The bleeding occurs due to the lack of fibrinolysis of newly formed clots."

"This condition quickly uses up the blood's clotting factors, leaving the patient vulnerable to bleeding."

The nurse prepares teaching material for a pregnant patient with von Willebrand disease. Which information should the nurse delete before providing to the patient? "Use a firm toothbrush." "Use an electric razor." "Accident-proof your environment." "Avoid aspirin-containing products."

"Use a firm toothbrush." The patient with a bleeding disorder should have a safe environment to include the use of a soft toothbrush, electric razor, and avoid products that contain aspirin.

A patient seeks medical attention for injuries sustained from a bicycle injury. One abrasion on the patient's elbow is forming a clot. Which phase of blood clot formation should the nurse suspect this wound is entering? Coagulation phase Vascular phase Aggregation phase Intrinsic pathway

Coagulation phase In the coagulation phase, fibrin forms a layer over the platelet plug that occurs in the aggregation phase, which forms the blood clot. Aggregation phase involves an accumulation of platelets to form a plug. Vascular phase involves a contraction of the vessel in response to injury. The intrinsic pathway is not a phase of clot formation, but describes one of the mechanisms.

A patient receiving chemotherapy asks about an increased amount bruises and bleeding. Which abnormal laboratory test result should the nurse expect for this patient? Decreased PT Decreased platelets Increased D-dimer Increased PTT

Decreased platelets Chemotherapy increases the risk of platelet destruction. The decreased platelets result in increased bruising and bleeding. An increased PTT is the result of a lack of clotting factors, and is not associated with chemotherapy. A decreased PT increases the risk of the development of blood clots, and does not result in bruising and bleeding. Increased D-dimer indicates an increased risk of clotting propensity and is not associated with chemotherapy.

The nurse is planning care for a patient with von Willebrand disease. For which treatment should the nurse prepare the patient? Warfarin Plasmapheresis Anticoagulants Desmopressin

Desmopressin Desmopressin is used in the treatment of vWF to increase vWF factor, as well as factor VIII, to treat spontaneous bleeding. Plasmapheresis is the treatment for thrombocytopenia purpura. Anticoagulants are used to treat thrombocythemia. Warfarin is used as an emergency treatment of disseminated intravascular coagulation (DIC).

A patient recovering from an emergency C-section develops shortness of breath, hemoptysis, and dyspnea. Laboratory testing shows prolonged PT and PTT, and petechiae are noted at the site of the blood pressure cuff after measuring vital signs. Which condition should the nurse suspect is developing in the patient? Disseminated intravascular coagulation Hemophilia Sickle cell disease Thrombocytopenia

Disseminated intravascular coagulation The manifestations of disseminated intravascular coagulation usually include unexplained bleeding or bruising, and respiratory symptoms. Prolonged PT and PTT are noted in laboratory testing. Thrombocytopenia is a marked elevation in platelets that manifests as vision disturbances and headache. Sickle cell disease is a genetic anomaly that causes hemoglobin to become misshapen and ineffective at carrying oxygen. Hemophilia is a genetic bleeding disorder that is the result of a lack of one or more clotting factors.

The nurse is caring for a patient receiving a blood transfusion. Which assessment finding should indicate that the patient is experiencing disseminated intravascular coagulation (DIC)? Dyspnea and crackles in the lungs Fever, chills, and headache Dyspnea, hemoptysis, and shortness of breath Hypertension and flushed skin

Dyspnea, hemoptysis, and shortness of breath

The nurse is caring for a patient experiencing symptoms of a blood clot in the lungs. Which laboratory test result should the nurse expect that indicates an increase in clotting ability? Increased PT Decreased factor assays Decreased vitamin B12 Elevated D-dimer

Elevated D-dimer An elevated D-dimer indicates significant increase in clotting propensity and increased risk for forming blood clots. An elevated PT indicates a delay in clotting time. Decreased vitamin B12 can indicate a type of anemia, but not an alteration in clotting propensity. Decreased factor assays may indicate clotting abnormalities that occur as a result of a genetic defect.

A patient has a D-dimer lab value of >0.5 ug/mL. Which health problem should the nurse suspect is occurring in this patient? Excessive bleeding Slow clotting Excessive clotting Undegraded clots

Excessive clotting Increased values in the D-dimer lab study are associated with disorders of excessive clotting. Decreased levels are associated with bleeding because the clots are not degraded effectively. Slow clotting, excessive bleeding, and undegraded clots are not associated with increased values of the laboratory test.

A patient with a known history of hemophilia A is brought to the emergency department following a motor vehicle crash. Which treatment should the nurse anticipate the healthcare provider to prescribe for this patient? Platelets Factor VIII vWF factor Anticoagulant

Factor VIII Hemophilia A is associated with a lack of factor VIII. This is usually home-administered, but may be required in an emergency after trauma. Anticoagulants are not indicated, because they will increase bleeding. Platelets will not be effective without the necessary clotting factors. vWF factor will be effective if the patient has a known von Willebrand disease. Factor VIII and factor XI hemophilia are both on the X chromosome, which means these conditions mostly affect men. Women are carriers, and have a 50% chance of passing along the defective gene to their male offspring.

A newborn who has had excessive bleeding following injections and lab testing is being tested for possible hemophilia. Which laboratory tests should the nurse anticipate being prescribed for this patient? Factor assays White blood cell count Platelet count D-dimer

Factor assays Factor assays are used to determine the level of an individual clotting factor present. In cases of hemophilia A, usually factor VIII is absent. D-dimer is not an indication of a lack of clotting factor. Platelet count is not diagnostic for hemophilia. White blood cell count detects the possible presence of infection or inflammation, but not hemophilia.

The dressing covering a newborn's circumcision is saturated with blood 10 minutes after the procedure is completed. Which bleeding disorder should the nurse suspect? Sickle cell disease Thrombocytopenia Disseminated intravascular coagulation (DIC) Hemophilia

Hemophilia Excessive bleeding following circumcision is an early indication of hemophilia. A saturated bandage 10 minutes following the procedure should indicate the need for further testing. Excessive bleeding is not an indication of sickle cell anemia, which is associated with abnormally shaped hemoglobin. Thrombocytopenia is defined as a decrease in the number of circulating blood platelets and is the most common cause of abnormal bleeding. Disseminated intravascular coagulation (DIC) is a hypercoagulopathic state following extreme illness or injury.

Which statement explains the pathophysiological process of thrombocythemia? Increased platelets interfere with the clotting process. Abnormally shaped cells occlude blood vessels and cause tissue ischemia. It is a life-threatening hypercoagulopathic state that results in hemorrhage. Prolonged clotting time results in risk of hemorrhage.

Increased platelets interfere with the clotting process. Thrombocythemia involves an increase in platelets, which overwhelms and disrupts the clotting process, when platelets are unable to stick to each other. Abnormally shaped blood cells describes sickle cell disease. Prolonged clotting time describes increased levels of PT and PTT. Thrombocythemia is not life-threatening. Treatment involves biological agents and low-dose anticoagulants.

The nurse is planning care for a patient with sickle cell disease.Which outcome should the nurse identify as a goal of treatment for this patient? Replace deficient clotting factors, and increase thrombin production. Increase utilization of vitamin K, and make clotting more effective. Reduce platelet bindings, and inhibit platelet activation. Prevent clot formation, and decrease hematocrit.

Individuals with sickle cell disease have increased production of thrombin, and loss of anticoagulant proteins. Decreasing platelets will help prevent harmful clot formation, which can lead to stroke or thrombus formation. Increasing thrombin production is not appropriate, because thrombin production is already increased. Decreasing the hematocrit may be a side effect of fluid administration, but it is not the goal of pharmaceutic intervention in sickle cell disease. Vitamin K will help stimulate clotting factors, which are not compromised in those with sickle cell disease.

A patient is having blood drawn for a complete blood count prior to hip replacement surgery. Which platelet count makes a patient more susceptible to severe or prolonged bleeding after an invasive procedure? Lower than 150,000/mm3 Lower than 200,000/mm3 Lower than 100,000/mm3 Lower than 250,000/mm3

Lower than 100,000/mm3

A patient is being treated for sickle cell disease. Which manifestation should the nurse expect to assess in this patient? Elevated D-dimer Increased bruising Hypotension Pain in joints

Pain in joints

A patient is being treated for sickle cell disease. Which manifestation should the nurse expect to assess in this patient? Elevated D-dimer Increased bruising Hypotension Pain in joints

Pain in joints The hypoxia that can result from groups of sickle cells clumping together and obstructing blood flow often results in tissue ischemia, which can lead to the development of a significant level of pain in the back, chest, and extremities. The pain is accompanied by other signs of ischemic damage, such as swelling, tenderness, a rapid respiratory rate, and hypertension. Hypotension is not a manifestation of sickle cell disease. Increased bruising or bleeding can indicate an abnormal clotting factor level, but not sickle cell disease. Elevated D-dimer shows increased clotting propensity, but not sickle cell disease.

Which lab value indicates to the nurse that treatment for sickle cell disease has been effective? D-dimer increases Platelet levels decrease Prothrombin time decreases White blood cells increase

Platelet levels decrease The pharmacologic goal of treatment for sickle cell disease is to decrease platelet binding and inhibit platelet aggregation. This includes reducing platelets. White blood cell count is not associated with the treatment of sickle cell disease. Prothrombin time should increase with successful treatment, and D-dimer should decrease as clotting propensity decreases.

A patient recovering from abdominal surgery develops shortness of breath and dyspnea and is diagnosed with disseminated intravascular coagulation (DIC). Which treatment should the nurse anticipate the healthcare provider to prescribe for this health problem? Platelets Red blood cells Plasma Factor VIII

Platelets Platelets are given as emergency treatment for disseminated intravascular coagulation (DIC), which is a life-threatening condition. Plasma is not given, because the pathology of DIC is not associated with fluid volume deficit. Red blood cells are not indicated, because it is not hemoglobin that is compromised but clotting ability. Factor VIII is only used if the associated factor is not present, such as in hemophilia. Interventions for disseminated intravascular coagulation (DIC) include the following: Vital signs Intake and output Monitoring circulatory status Administering platelets and other blood factors Using anticoagulation during the clotting

The nurse reviews information collected during a patient assessment. Which condition increases this patient's risk for developing disseminated intravascular coagulation (DIC)? Seasonal allergies Asthma Pregnancy Fibromyalgia

Pregnancy Complications of pregnancy and childbirth can lead to an increased risk for the development of disseminated intravascular coagulation (DIC). Several medical conditions are known to trigger DIC, including sepsis, shock, and trauma. The development of DIC is not associated with fibromyalgia, seasonal allergies, or asthma.

A patient has a series of coagulation tests prescribed to monitor a bleeding disorder. Which laboratory test measures the amount of time it takes to form a blood clot after the addition of tissue factor? Prothrombin time Clotting time Bleeding time Partial thromboplastin time

Prothrombin time Prothrombin time is the study showing the time it takes to form a clot after the addition of tissue factor, measuring the extrinsic pathway. Partial thromboplastin time measures the efficiency of the contact activation, or intrinsic pathway, in clot formation. Clotting time and bleeding time both measure the amount of time required for a volume of blood to form a stable clot.

The nurse is caring for a patient who is receiving chemotherapy for prostate cancer. For which bleeding disorder should the nurse assess that may be precipitated by the chemotherapy? Secondary thrombocytopenia Immune thrombocytopenic purpura Von Willebrand disease Hemophilia

Secondary thrombocytopenia Secondary thrombocytopenia may be precipitated by interventions and treatments such as chemotherapy, radiation therapy, and massive blood transfusions. Hemophilia, including von Willebrand disease, refers to a group of disorders that are inherited. Immune thrombocytopenic purpura (ITP) is one of two types of primary thrombocytopenia, which often follows a viral illness.

In order to minimize the risk of bleeding, a patient with thrombocytopenia purpura must undergo plasmapheresis. Which outcome describes the goal of treatment of thrombocytopenia purpura with the use of plasmapheresis? Increase the production of fibrin, which forms clots over areas of injury. Slow the destruction of platelets, and decrease the concentration of autoimmune antibodies. Replenish vitamin K, which is a nutrient needed for clotting. Increase clotting time by increasing the number of clotting factors.

Slow the destruction of platelets, and decrease the concentration of autoimmune antibodies. Plasmapheresis is the treatment of choice for thrombocytopenia purpura. The goal is to reduce the number of autoimmune antibodies and slow the destruction of platelets. Plasmapheresis does not increase the number of clotting factors or increase clotting time. Plasmapheresis is not associated with levels of vitamin K. Plasmapheresis does not affect the production of fibrin.

The nurse is caring for a patient with a primary disorder of hemostasis. Which clinical manifestation should the nurse expect to observe? Pale skin and decreased blood pressure Increased heart rate and respiratory rate Spontaneous bleeding from mucous membranes and frequent bruising Flushed skin and high blood pressure

Spontaneous bleeding from mucous membranes and frequent bruising Primary disorders are centered on platelet function and are usually genetic. Clinical manifestations include frequent bleeding and bruising from mild pressure, and excessive blood loss after injury. Flushed skin and changes in vital signs are not associated with a primary disorder of hemostasis.

The nurse observes that a patient has developed small pinprick hemorrhages around the eyes and under the site of the blood pressure cuff. Which health problem should the nurse suspect in this patient? Sickle cell disease Disseminated intravascular coagulation Thrombocytopenia purpura Von Willebrand disease

Thrombocytopenia purpura

A patient develops thrombocytopenia purpura after receiving a bone marrow transplantation. Which manifestation should the nurse expect to assess in this client? Decreased PT and PTT Tiny pinprick hemorrhages around areas of pressure or minor trauma Nausea Pain in joints

Tiny pinprick hemorrhages around areas of pressure or minor trauma Thrombocytopenia purpura is characterized by pinprick hemorrhages that appear as tiny bruises in areas of mild pressure. Pain in joints is associated with sickle cell disease. Decreased PT and PTT indicate a hypercoagulopathy. Nausea is not a symptom of this disorder. The five clinical manifestations of thrombocytopenia purpura are as follows: Microangiopathic hemolytic anemia Thrombocytopenia Renal insufficiency Fever Mental status changes

A patient with known sickle cell disease is complaining of pain in the joints. Which process should the nurse suspect as causing this symptom? Decreased platelet production resulting in lack of clotting ability Increased clotting propensity due to abnormality in clotting factors Internal bleeding at various sites of minor trauma Tissue ischemia due to hypoxia from misshapen cells

Tissue ischemia due to hypoxia from misshapen cells

A nurse is caring for a surgical patient with a markedly increased partial prothrombin time (PTT). Which situation represents the greatest risk to this patient? Uncontrolled bleeding Decreased platelets Possibility of hypercoagulation Formation of deep vein thrombus

Uncontrolled bleeding An elevated partial prothrombin time (PPT) indicates prolonged bleeding and alteration in clotting ability. This puts the patient at increased risk for uncontrolled bleeding. An elevated PTT does not indicate any increase in possible clotting and does not affect platelet counts.

A patient seeks medical attention for a two-inch laceration on the thigh. Which phase of blood clot formation involves vasospasm and platelets traveling to the site of the injury? Coagulation phase Healing phase Aggregation phase Vascular phase

Vascular phase A blood vessel will constrict and spasm immediately after an injury. This is the initial phase, or vascular phase, of clot formation. The aggregation phase occurs when platelets begin to clump together to form a plug. The coagulation phase consists of platelets forming protein fibers to form a layer over the injury to stop bleeding. The healing phase consists of the phases after the clot formation occurs.

The nurse prepares diet teaching for a patient with a bleeding disorder. Which vitamin should the nurse explain that is required by a number of clotting factors to function properly? Vitamin K Vitamin E Vitamin C Vitamin B12

Vitamin K is required by a number of factors for effective clotting. Dietary deficiencies of vitamin K can lead to clotting disorders. A deficiency of vitamin B12 is a type of anemia, but does not influence clotting. Vitamin E has numerous healing properties in epithelial tissues but is not associated with clotting. Vitamin C has a number of health benefits, but is not associated with clotting.

A pregnant patient with a familial history of hemophilia is undergoing prenatal testing to determine if the fetus has inherited the bleeding disorder. Which form of hemophilia has the highest incidence in the United States? Hemophilia B Von Willebrand disease Hemophilia A Hemophilia C

Von Willebrand disease Von Willebrand disease affects approximately 1-2% of both men and women with hemophilia. The incidence of hemophilia A is about 1 in 50,000 male births, and the incidence of hemophilia B is about 1 in 30,000 male births.