Pathophysiology PrepU Chp 12

A 44-year-old Caucasian woman is being treated in an airport infirmary after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT), and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points be the airport medical staff would be most appropriate?

"A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies."

The father of a 2-year-old boy recently diagnosed with hemophilia A asks the nurse how to prevent complications for his son. The best response would be:

"Avoid administering aspirin and nonsteroidal anti-inflammatory drugs."

A client is newly diagnosed with impaired platelet function, thrombocytopathia. Which of the following questions is most appropriate for the nurse to ask in order to determine the possible cause of this problem?

"Have you been taking aspirin or any nonsteroidal anti-inflammatory drugs (NSAIDs)?"

The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be:

"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."

The parent of a 5 year old who was admitted with a sudden onset of purpura following the flu and who was diagnosed with acute idiopathic thrombocytopenic purpura (ITP) is very concerned that the child will have ITP for the rest of his life. The best response for the nurse to make is which of the following?

"It is usually self-limiting."

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC?

"So much clotting takes place that there are no available clotting components left, and bleeding ensues."

A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be:

"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."

A client tells the nurse that he has recently begun to take over-the-counter (OTC) calcium supplements to ensure that his blood will clot. The best response by the nurse would be:

"This is not necessary, unless it has been prescribed by your health care provider."

A 36-year old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize?

"We need to ensure your birth control pills don't contain estrogen."

A 38-year-old female is considering the use of oral contraceptives as a method of birth control. She asks her health care provider if any risks would be involved. The best response would be:

"Yes, risks increase with age."

In which of the following patients would diagnostic investigations be least likely to reveal increased thrombopoietin production?

A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia.

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?

Alters vitamin K, reducing its ability to participate in the coagulation of the blood

How does low-dose aspirin therapy impact clot formation?

Aspirin is a platelet aggregation inhibitor.

The nurse reviews the lab results of a client who has a thrombocyte count of 60,000/µL. The client is at risk for:

Bleeding

A client with von Willebrand disease is admitted to the hospital for an elective surgical procedure. The nurse caring for this client will review which of the following labs to monitor the client's coagulation?

Bleeding time

A client has been diagnosed with inherited hypercoagulability. Select the most likely cause.

Factor V gene mutation

Which of the following patients would be at risk for developing nonthrombocytopenic purpura? Select all that apply.

Child adopted from India and displaying malaise, lethargy and petechiae all over body. 55 year old patient diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump and moon face.

Fibrinolysis is part of the hemostasis process and requires a series of steps. Which of the following is TRUE of the process?

Circulating plasmin is rapidly inactivated, which limits the fibrinolytic process to the local clot.

Thrombocytosis is used to describe elevations in the platelet count above 1,000,000/μL. It is either a primary or a secondary thrombocytosis. Secondary thrombocytosis can occur as a reactive process due to what?

Crohn disease

A patient is admitted to the hospital to rule out secondary thrombocytosis after suffering recurrent episodes of deep-vein thrombosis and pulmonary embolisms. The admitting nurse is obtaining a medical history. Which of the following conditions would make anticoagulation contraindicated?

Crohn's disease

A client with hemophilia Type A comes to the emergency department with severe pain and swelling in the right knee. The nurse anticipates the administration of which of the following to reduce musculoskeletal damage?

Factor VIII replacement therapy

A 57-year-old man is diagnosed with thrombocytopenia. The nurse knows that thrombocytopenia refers to a decrease in the number of circulating platelets. The nurse also knows that thrombocytopenia can result from what?

Decreased platelet production

A newborn has a clotting disorder that results in the body being unable to produce fibrin. Which of the following could be the cause?

Deficiency of fibrinogen

A nurse is caring for a client receiving heparin therapy who has developed heparin-induced thrombocytopenia. Which of the nursing interventions does the nurse anticipate?

Discontinuation of heparin therapy

Disseminated intravascular coagulation is a grave coagulopathy resulting from the overstimulation of clotting and anticlotting processes in response to what?

Disease or injury

A client is admitted to the hospital with a diagnosis of deep vein thrombosis and started on intravenous heparin therapy. Seven days later, the client's lab values identify a rapid decrease in platelets. The health care provider recognizes this as:

Drug-induced thrombocytopenia

A patient has been placed on Bactrim as treatment for community-acquired methicillin-resistant Staphylococcus aureus MRSA for 10 days. After taking the medication for 8 day, the patient comes to the doctor's office complaining of multiple nosebleeds over the past day. Laboratory work shows a platelet count of 80,000/μL. The nurse practitioner suspects which of the following conditions?

Drug-induced thrombocytopenia

Nursing students are discussing the normal stages of hemostasis, in particular the first stage, which involves vasoconstriction of the blood vessel. The students note that endothelial injury initiates release of which of the following?

Endothelin 1

A pregnant woman contacts her physician because she has developed sudden, severe pain and swelling in her left lower leg. The physician explains to her that her past medical includes an inherited defect in factor V Leiden, which predisposes her to the development of which of the following?

Excessive clotting

There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?

Extrinsic and intrinsic pathways

The nurse is caring for a postsurgical client who is recovering from knee replacement surgery secondary to rheumatoid arthritis. When planning the client's care, the nurse should include what action?

Frequent assessment for signs of thrombosis or hemorrhage.

The nurse is preparing a patient for a total hip replacement by reviewing preoperative and postoperative instructions. The postoperative antcoagulation protocol is reviewed with the patient because the patient will be immobile for an extended amount of time. The nurse stresses the need for compliance with this protocol to avoid the development of deep-vein thrombosis. Which of the following would be the most effective initial treatment as a thrombosis prophylactic?

Heparin therapy

A nurse is caring for a client receiving heparin therapy. Five days after the start of therapy the nurse notices a sudden decrease in the platelet count. Which of the following complications of heparin therapy can cause platelets to decrease?

Heparin-induced thrombocytopenia

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB physician has called in a specialist who thinks the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?

Immediately discontinue the heparin therapy.

Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team?

Increased thrombopoietin levels

A medical surgical nurse is studying risk factors for the development of secondary thrombocytosis before taking a certification exam. Which of the following situations would the nurse determine would increase a patient's risk? Select all that apply.

Inflammatory bowel disease Lung cancer Rheumatoid arthritis

A nurse orienting to the surgical suite is studying medications that affect platelet function and notes that the most common medications are which of the following?

Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin

The school nurse has several children with hemophilia A. After recess, one hemophilia student comes to the school nurse complaining of pain in their knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should:

Notify parents to pick up child and possibly administer Factor VIII.

A 40-year-old patient has been admitted to the cardiac intensive care unit after having an anterior wall myocardial infarction (MI). The nurse is reviewing modifiable risk factors with the patient to avoid the redevelopment of thromboembolic complications, possibly leading to a second MI. Which of the following increases this risk?

Oral contraceptives

The nurse is reviewing hospital discharge instructions with a patient who has been diagnosed with secondary thrombocytosis and who also suffers from chronic ulcerative colitis, making anticoagulation inadvisable. The nurse stresses to the patient that the patient should avoid which of the following? Select all that apply.

Oral contraceptives Smoking Immobilization

A 75-year-old patient with a history of heart valve replacement arrives at the outpatient clinic with multiple red pinpoint lesions. The nurse identifies the lesions as being which of the following?

Petechiae

When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?

Plasminogen.

A nurse is caring for a patient who recently received GPIIb/IIIa inhibitors and is concerned that the patient has developed thrombocytopenia as demonstrated by which of the following?

Platelet count less than 50,000/μL

A young man has been diagnosed with hemophilia, and the nurse is planning his discharge teaching. The nurse knows to include what in her discharge teaching?

Prevent trauma to the body.

Heparin is an anticoagulant given by injection to prevent the formation of blood clots. How does heparin work?

Promotes the inactivation of clotting factors

Coagulation activated by the extrinsic pathway is initiated when:

Release of thromboplastin from the injured vessel wall

A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely occurring, resulting in the drug's therapeutic effect?

Suppression of fibrin formation.

A client with Von Willebrand disease type 3 comes to the clinic for an examination. Which problem reported by this client is most important for the nurse to communicate to the physician?

Tarry stools

A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of:

The reduction of clotting factors synthesized in the liver

A nurse is assisting a client with self-care and observes the following:

Thrombocytopenia

A nurse is treating a client with aplastic anemia. Due to the replacement of normal bone marrow with malignant cells, the nurse teaches the client to prevent scratches, scrapes, and cuts. What root cause likely underlies the client's increased risk for hemorrhage?

Thrombocytopenia

A new leukemia patient begins hemorrhaging from every orifice. The physician is concerned that the patient has developed Disseminated Intravascular Coagulation (DIC). The nurse should anticipate which of the following orders to be prescribed for this patient? Select all that apply.

Transfuse fresh frozen plasma. Transfuse 2 units of platelets.

A client diagnosed with autosomal dominant von Willebrand factor disease (vWF) is experiencing mild to moderate bleeding. The health care provider would classify the diagnosis as:

Type 2

Select the first stage of hemostasis.

Vessel spasm

A client with an apparent clotting disorder is admitted to hospital. His health record reveals that he has been treated for complications of chronic alcoholism for the past 10 years. The nurse should suspect what cause of his clotting disorder?

Vitamin K deficiency

A nurse is counseling parents of a 5-year-old child who has just been diagnosed with hemophilia A and who has a 25% level of factor VIII. The nurse stresses that there are many precautions the parents can take to decrease the frequency and duration of bleeding episodes. Which of the following would be a reasonable precaution for this child?

Wear a helmet while riding a bicycle.

A nurse is caring for a client in the intensive care unit who has sustained severe trauma and now has developed disseminated intravascular coagulation (DIC). The nurse is aware that the client is experiencing:

Widespread coagulation and bleeding in the vascular compartment

A teenage girl, seen in the clinic, is diagnosed with nonthrombocytopenic purpura. The girl states, "You have taken a lot of blood from me. Which of my tests came back abnormal?" How should the nurse respond?

Your CBC with differential showed a normal platelet count.

A client suffered a laceration in his workshop and lost a significant amount of blood. The clots that formed have begun to retract. The process of clot dissolution has begun, which starts with:

activation of plasminogen.

A 10-month-old infant has begun to take his first steps and his mother has brought him for assessment because of swelling in his ankles and knees. The mother also states that he was eager to walk but has now regressed and cries when she tries to encourage it. The clinician should:

assess the child for signs and symptoms of hemophilia A.

Many different proteins, enzymes, and hormones are involved in maintaining hemostasis. Which protein is required for platelet adhesion?

von Willebrand factor