Ch. 22- Learning: Alterations of Hemostasis
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? A. "Platelets are destroyed by antibodies triggered by the immune system." B. "Platelets are not completely formed in the bloodstream." C. "An increased production of platelets results in increased clotting." D. "Platelets are prematurely destroyed by natural cell death."
A. "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 dressing covering a newborn's circumcision is saturated with blood 10 minutes after the procedure is completed. Which bleeding disorder should the nurse suspect? A. Hemophilia B. Sickle cell disease C. Thrombocytopenia D. Disseminated intravascular coagulation (DIC)
A. 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.
A patient is being treated for sickle cell disease. Which manifestation should the nurse expect to assess in this patient? A. Pain in joints B. Elevated D-dimer C. Hypotension D. Increased bruising
A. 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? A. Platelet levels decrease B. D-dimer increases C. Prothrombin time decreases D. White blood cells increase
A. 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.
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? A. Vitamin K B. Vitamin E C. Vitamin C D. Vitamin B12
A. Vitamin K - 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 patient receiving chemotherapy asks about an increased amount bruises and bleeding. Which abnormal laboratory test result should the nurse expect for this patient? A. Increased PTT B. Decreased platelets C. Decreased PT D. Increased D-dimer
B. 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? A. Anticoagulants B. Desmopressin C. Warfarin D. Plasmapheresis
B. 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 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? A. vWF factor B. Factor VIII C. Platelets D. Anticoagulant
B. 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.
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? A. Von Willebrand disease B. Thrombocytopenia purpura C. Sickle cell disease D. Disseminated intravascular coagulation
B. Thrombocytopenia purpura - Thrombocytopenia purpura is characterized by tiny pinprick hemorrhages or bruises, especially in areas of pressure or minor trauma. - Disseminated intravascular coagulation is a life-threatening hypercoagulopathic state. - Sickle cell disease is characterized by pain in joints and tissue ischemia due to vascular occlusion. - Von Willebrand disease is similar to hemophilia, and is often associated with internal bleeding.
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? A. Coagulation phase B. Vascular phase C. Aggregation phase D. Healing phase
B. 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.
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? A. Hemophilia B B. Hemophilia A C. Von Willebrand disease D. Hemophilia C
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. - The incidence of hemophilia B is about 1 in 30,000 male births.
The nurse prepares teaching material for a pregnant patient with von Willebrand disease. Which information should the nurse delete before providing to the patient? A. "Avoid aspirin-containing products." B. "Use an electric razor." C. "Accident-proof your environment." D. "Use a firm toothbrush."
D. "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 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? A. Lower than 100,000/mm3 B. Lower than 150,000/mm3 C. Lower than 250,000/mm3 D. Lower than 200,000/mm3
A. Lower than 100,000/mm3 - Patients with a platelet count lower than 100,000/mm3 are more susceptible to prolonged bleeding after an invasive procedure. - The severity of the bleeding is directly related to the platelet count, and a platelet count between 150,000/mm3 and 400,000/mm3 is generally considered healthy.
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? A. "The bleeding occurs due to the abnormal function of platelets that form clots." B. "The bleeding occurs due to the lack of fibrinolysis of newly formed clots." C. "This condition quickly uses up the blood's clotting factors, leaving the patient vulnerable to bleeding." D. "The bleeding occurs due to the liver's inability to produce clotting factors."
C. "This condition quickly uses up the blood's clotting factors, leaving the patient vulnerable to bleeding." As a result of the massive fibrinolysis, fibrin degradation products (FDPs) are released. FDP is a potent anticoagulant. With the depletion of clotting factors and platelets, along with the release of FDP, clots can no longer form, and hemorrhage occurs. The bleeding is not due to the liver's inability to produce clotting factors or the abnormal function of platelets.
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? A. Intrinsic pathway B. Vascular phase C. Coagulation phase D. Aggregation phase
C. 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.
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? A. Decreased vitamin B12 B. Increased PT C. Elevated D-dimer D. Decreased factor assays
C. 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? A. Slow clotting B. Excessive bleeding C. Excessive clotting D. Undegraded clots
C. 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 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? A. D-dimer B. Platelet count C. Factor assays D. White blood cell count
C. 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.
Which statement explains the pathophysiological process of thrombocythemia? A. It is a life-threatening hypercoagulopathic state that results in hemorrhage. B. Abnormally shaped cells occlude blood vessels and cause tissue ischemia. C. Increased platelets interfere with the clotting process. D. Prolonged clotting time results in risk of hemorrhage.
C. 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.
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? A. Plasma B. Red blood cells C. Platelets D. Factor VIII
C. 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.
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? A. Clotting time B. Partial thromboplastin time C. Prothrombin time D. Bleeding time
C. 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 planning care for a patient with sickle cell disease. Which outcome should the nurse identify as a goal of treatment for this patient? A. Increase utilization of vitamin K, and make clotting more effective. B. Replace deficient clotting factors, and increase thrombin production. C. Reduce platelet bindings, and inhibit platelet activation. D. Prevent clot formation, and decrease hematocrit.
C. Reduce platelet bindings, and inhibit platelet activation. 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.
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? A. Increase clotting time by increasing the number of clotting factors. B. Replenish vitamin K, which is a nutrient needed for clotting. C. Slow the destruction of platelets, and decrease the concentration of autoimmune antibodies. D. Increase the production of fibrin, which forms clots over areas of injury.
C. 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? A. Pale skin and decreased blood pressure B. Flushed skin and high blood pressure C. Spontaneous bleeding from mucous membranes and frequent bruising D. Increased heart rate and respiratory rate
C. 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.
A patient develops thrombocytopenia purpura after receiving a bone marrow transplantation. Which manifestation should the nurse expect to assess in this client? A. Pain in joints B. Nausea C. Tiny pinprick hemorrhages around areas of pressure or minor trauma D. Decreased PT and PTT
C. 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.
A patient with known sickle cell disease is complaining of pain in the joints. Which process should the nurse suspect as causing this symptom? A. Internal bleeding at various sites of minor trauma B. Decreased platelet production resulting in lack of clotting ability C. Tissue ischemia due to hypoxia from misshapen cells D. Increased clotting propensity due to abnormality in clotting factors
C. Tissue ischemia due to hypoxia from misshapen cells - 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. - Increased clotting propensity indicates an increased likelihood of clot formation in the vascular system, as indicated by elevated D-dimer. - Decreased platelet production describes thrombocytopenia and is not descriptive of sickle cell disease. - Internal bleeding at various sites is also descriptive of thrombocytopenia.
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? A. Release of tissue factor by damaged endothelial cells B. Prothrombin activator converting prothrombin into thrombin C. Platelets and red blood cells sticking to fibrin strands; platelets contracting D. Activation of proenzymes exposed to collagen fibers at the injury site
D. 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 nurse reviews information collected during a patient assessment. Which condition increases this patient's risk for developing disseminated intravascular coagulation (DIC)? A. Asthma B. Fibromyalgia C. Seasonal allergies D. Pregnancy
D. 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 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? A. Hemophilia B. Thrombocytopenia C. Sickle cell disease D. Disseminated intravascular coagulation
D. 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)? A. Fever, chills, and headache B. Dyspnea and crackles in the lungs C. Hypertension and flushed skin D. Dyspnea, hemoptysis, and shortness of breath
D. Dyspnea, hemoptysis, and shortness of breath - Blood transfusion is a risk factor for the development of disseminated intravascular coagulation (DIC). Dyspnea, hemoptysis and shortness of breath are clinical manifestations seen in patients experiencing DIC. - Fever, chills, and headache are clinical manifestations of febrile reaction to the transfusion, not of DIC. - Dyspnea and crackles in the lungs are clinical manifestations of pulmonary edema due to fluid overload from the blood transfusion. - Hypertension and flushed skin may indicate a hemolytic reaction due to blood incompatibility. Pallor, not flushed skin, is a clinical manifestation of DIC.
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? A. Von Willebrand disease B. Immune thrombocytopenic purpura C. Hemophilia D. Secondary thrombocytopenia
D. 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.
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? A. Formation of deep vein thrombus B. Decreased platelets C. Possibility of hypercoagulation D. Uncontrolled bleeding
D. 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.
