PrepU CH. 12

How does low-dose aspirin therapy impact clot formation?

Aspirin is a platelet aggregation inhibitor.

A group of nursing students studying platelet disorders lists which of the following potential causes of thrombocytopenia that affect bone marrow function? Select all the apply.

Chemotherapy Aplastic anemia Radiation therapy Leukemia

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

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

Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?

Irreversible acetylation of platelet cyclooxygenase activity has occurred.

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

A patient in the hospital following a repair of a left hip fracture is refusing to wear the intermittent pneumatic compression stockings ordered by the physician. The nurse explains to the patient that the compression stockings are essential in preventing which of the following?

Venous thrombosis

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.

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

Factor V gene mutation

A patient with a history of acquired idiopathic thrombocytopenic purpura (ITP) arrives at the emergency department complaining of fatigue, shortness of breath, and multiple nosebleeds during the previous week. The platelet level is 10,000/μL, and the hemoglobin is significantly below normal. The nurse would anticipate which of the following interventions?

Immune globulin infusion

A patient is being discharged from the hospital following a myocardial infarction (MI) and asks the nurse why two blood thinners are ordered. The nurse explains that the acetylsalicylic acid (ASA) and clopidogrel (Plavix) are both ordered to reduce the risk of which of the following events?

Myocardial events

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

An intensive care nurse is caring for a patient who has been admitted for a deep-vein thrombus and who has a history of immune-mediated heparin-induced thrombocytopenia (HIT). The nurse would expect the patient to be discharged with a prescription for which of the following medications?

Low-molecular-weight heparin

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

In a client with DIC, microemboli form, causing obstruction of blood vessels and tissue hypoxia. Common clinical signs may be due to what? (Select all that apply.)

Respiratory failure Renal failure Circulatory failure

In which client would diagnostic investigations be most likely to reveal increased thrombopoietin production?

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

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 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 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

A postpartum client develops uncontrolled postpartum bleeding, oozing from IV sites, a blood pressure of 82/40, and respiratory distress. Which of the following complications does the nurse suspect is occurring?

Disseminated intravascular coagulation

The spouse of a patient with a history of hepatitis C who is admitted to the hospital with upper gastrointestinal bleeding asks the nurse why these bleeding episodes occur. Having reviewed the patient's laboratory work, and noting a severe vitamin K deficiency, the best response would be that the low vitamin K levels will contribute to which of the following?

Inactive clotting factors

A nurse is preparing a presentation on factors that lead to increased coagulation and thrombosis. Which of the following factors should be included in the teaching plan? Select all that apply.

Inflammatory bowel disease Steroid therapy Oral contraception Smoking

A critical care nurse is preparing a case study on the treatment of acute coronary syndrome (ACS), which describes glycoprotein factor (GPIIb/IIIa) inhibitors and their role in decreasing thrombosis by doing which of the following?

Interfering with the ability of platelets to bind to one another

A neonatal nurse is caring for a newborn and is preparing to give the infant an injection of vitamin K to prevent possible bleeding due to a vitamin K deficiency. The nurse realizes this is necessary because the infant is lacking which of the following?

Intestinal bacteria

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

A nurse is assessing a child brought to the clinic with multiple petechiae and excessive bruising covering his body. Laboratory tests reveal a low platelet count. The nurse is aware that these clinical manifestations are caused due to of which of the following pathological processes?

Platelets function to form the platelet plug to help control bleeding after injury. Without enough platelets, the blood cannot clot properly and bleeding occurs.

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

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.

A client exhibits petechiae and purpura and has been diagnosed with immune thrombocytopenic purpura (ITP). What pathophysiologic event may have caused the client's disease?

Destruction of platelets in the client's spleen.

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

A 30-year-old woman who is 2 months pregnant is discussing concerns with her physician regarding potential complications that may arise because she has lupus and has already had two miscarriages. The physician is concerned that the lupus has caused the development of which of the following?

Secondary antiphospholipid syndrome

A client has sought care because his gums began bleeding when he was flossing his teeth and they have now been bleeding for several hours. Laboratory testing has revealed a platelet count of 60 x 109/l and a diagnosis of thrombocytopenia. Which of the nurse's assessment questions address the possible etiology of this health problem?

"What medications are you currently taking?"

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.

A patient is in the cardiac ICU following a massive myocardial infarction (MI) and is receiving both acetylsalicylic acid (ASA) and ticlopidine (Ticlid) to prevent further cardiac compromise. The nurse is reviewing the patient's laboratory work and notes a significant decrease in the patient's white blood cells and platelets. Which of the following events does the nurse suspect?

Adverse reaction to the Ticlid

A nurse is reviewing the health history and medication list of a client admitted with thrombocytopathia. The nurse determines which of the client's home medications predisposes the client to bleeding? Select all that apply.

Aspirine Hydrochlorothiazide Colchicine Amiodarone

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."

The process of clot retraction squeezes serum from the clot, thereby joining the edges of the broken vessel. Through the action of actin and myosin, filaments in platelets contribute to clot retraction. Failure of clot retraction is indicative of what?

A low platelet count

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

At her first prenatal visit, a pregnant woman who is 5' 1" and weighs 180 lb asks the nurse why her physician has ordered a protein C resistance blood test. The nurse's best response is to rule out which of the following?

Factor V Leiden

A patient undergoing chemotherapy has a critically low platelet count. The nurse expects to administer which of the following to stimulate platelet cell production?

Oprelvekin (Neumega) which is a thrombopoietin

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

Plasminogen.

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 nurse is discussing precautions that are necessary to avoid excessive bleeding with a patient who has been diagnosed with Type 1 von Willebrand disease. The nurse reassures the patient that typically which of the following happens?

There is no treatment except to avoid aspirin.

Select the first stage of hemostasis.

Vessel spasm

The coagulation cascade is the third component of the hemostatic process. The other two are: (Select all that apply.)

Vessel spasm Platelet aggregation

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)?"

Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of Von Willebrand disease?

"Make sure that you avoid taking aspirin."

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

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

A nurse working in an ambulatory care unit is working with a patient who has recently been diagnosed with a V Leiden mutation. The nurse tells the patient the importance of smoking cessation to avoid which of the following?

Deep-vein thrombosis (DVT)

The admitting nurse on a hospital medical-surgical unit is admitting a 90-year-old patient with a history of congestive heart failure, coronary artery disease, prostate cancer, diabetes, and hypercholesteremia. The nurse realizes that the client is at high risk for thromboembolic complications due to a medical history with conditions that could increase platelet function. Which of the following conditions would contribute to this risk? Select all that apply.

Diabetes • Hypercholesteremia • Prostate cance

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 with chronic idiopathic thrombocytopenia purpura (ITP) asks the nurse at the doctor's office what causes all the nosebleeds that have been occurring. The nurse's best response would be the presence of which of the following?

Immune cells that destroy the platelets

The nurse is assessing lab values of a client with disseminated intravascular coagulation (DIC). The nurse would anticipate the results to include:

Increased prothrombin time (PT)

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 nurse is caring for a patient who was recently diagnosed with primary thrombocytosis. The patient does not understand why hydroxyurea is given. The best explanation would be that this medication decreases which of the following?

Platelet counts

A nurse is caring for a patient on a cardiac step-down unit who is recovering from a myocardial infarction (MI) and is getting ready to be discharged. The nurse is reviewing the physician's discharge instructions with the patient when the patient asks why aspirin is ordered every day and at such a low dose. The most accurate response by the nurse is that the purpose of the daily aspirin is to do which of the following?

Prevent arterial thrombi formation

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

Promotes the inactivation of clotting factors

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

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

von Willebrand factor

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

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 young woman diagnosed with prostacyclin deficiency is admitted to the hospital with recurrent deep-vein thrombosis and an ovarian infarction asks the nurse why she keeps having these problems. Understanding the role of prostacyclin in hemostasis, the nurse explains that prostacyclin enables which of the following?

Blood vessel vasodilation and inhibition of platelet aggregation

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.

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 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 medical student is familiarizing herself with recent overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history?

A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use.

A student asks a nurse educator why a platelet will stick in the injured site but not in the normal uninjured blood vessel. What would be the best response?

Adhesion occurs when the platelet receptor binds to vWF at the injury site.

A client with a diagnosis of hemophilia A has been admitted with bilateral knee pain. The nurse should anticipate performing what intervention during the client's treatment?

Administration of factor VIII and implementation of fall prevention measures

A patient with a history of antiphospholipid syndrome is admitted to the emergency deparatment with acute onset of both renal and liver failure, along with signs of a cerebrovascular accident. The admitting nurse is concerned that the patient has developed which of the following?

Catastrophic antiphospholipid syndrome

A nurse is caring for a patient who suffered a massive heart attack followed by the development of congestive heart failure (CHF). As the nurse is reviewing with the patient medications taken at home, the patient states concern that the doctor discontinued the Nexium. The nurse explains that taking Nexium with some medications can cause adverse cardiac events. Which of the following medications would be of possible concern?

Clopidogrel

A nurse is reviewing the health history and medication list of a client admitted with thrombocytopathia. The nurse determines which of the client's home medications predisposes the client to bleeding? Select all that apply.

Colchicine Amiodarone Asprin Hydrochlorothiazide

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 home health care nurse is visiting a patient who was recently discharged from the hospital taking warfarin therapy following a massive pulmonary embolism. The patient asks why more frequent blood tests are being done, as an antibiotic was started. The best response from the nurse would be that antibiotics can do which of the following?

Decrease intestinal flora

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 patient recently admitted to the emergency department with drug-induced thrombocytopenia and a platelet count of 50,000/μL. The patient 's medications include quinidine, Bactrim, Nexium, and oral contraceptives. The nurse anticipates which of the following initial courses of treatment?

Discontinuation of all medications

A patient has been placed on Bactrim as treatment for community-acquired methicillin-resistant <ital>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

The mother of a 3-year-old brings the child to the clinic because it took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia B. The nurse teaches the mother that this disease is caused by a deficiency in which of the following factors?

Factor IX

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

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.

When platelets adhere to the vessel wall, they release growth factors that cause smooth muscle to grow. This is a major factor in causing atherosclerosis. What are the factors that influence platelets to adhere to the vessel wall? (Select all that apply.)

Hemodynamic stress, high cholesterol, diabetes, and smoking.

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.

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 nurse is caring for a patient with sepsis who was recently transferred to the intensive care unit following the development of disseminated intravascular coagulation (DIC). The nurse understands that DIC is most likely secondary to the infection causing the release of cytokines, which can cause which of the following?

Petechiae, purpura, and renal failure

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.

Coagulation activated by the extrinsic pathway is initiated when:

Release of thromboplastin from the injured vessel wall

A 25-year-old woman with primary antiphospholipid syndrome is discussing with her physician the possibility of becoming pregnant. The physician shares with the woman which of the following possible complications? Select all that apply.

Spontaneous miscarriage Premature delivery Placental insufficiency

A client has an impaired platelet function that may have developed from inheritance, drugs, disease, or extracorporeal circulation. The health care provider would document this as:

Thrombocytopathia

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

The nurse is preparing to administer medication to a client. Select the medication that the nurse would administer to prevent platelet aggregation.

Ticlopidine (Ticlid)

A client presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which diagnosis should the medical team first suspect?

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