EAQ Hematologic Problems

The nurse is teaching the parents of a toddler with a recent diagnosis of hemophilia about the disease. Which area of the body would the nurse include as the most common site for bleeding? 1 Brain 2 Joints 3 Kidneys 4 Abdomen

2 Joints The joints are the most commonly involved areas because of weight bearing and constant movement. Neither the brain, kidneys, nor abdomen is the most common site; however, bleeding may occur in any of these areas.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother states that the toddler is very active and is difficult, constantly saying "no". Which response would the nurse communicate that would be an appropriate response? 1 "Toddlers are curious, trying to make decisions and be independent." 2 "Saying 'no' at this stage is a signal that the child may need some therapy." 3 "You must show the child from a young age that you are the boss and in charge." 4 "Responsible parenting means you must protect the child from all future injuries."

1 "Toddlers are curious, trying to make decisions and be independent." Toddlers are curious, trying to make decisions and being independent, and learning autonomy, which is a normal developmental stage for this age group. Saying "no" is the toddler's means of developing independence rather than a need for therapy. The developmental task according to Erikson is autonomy verses shame, so caregivers need to allow some independence. No person can protect absolutely another individual from all injuries.

Which finding would the nurse expect when assessing the nasal passages of a client with thrombocytopenia? 1 Blood clots 2 Nasal polyps 3 Purulent discharge 4 Pale, swollen turbinates

1 Blood clots Thrombocytopenia increases risk for epistaxis and the nurse may see bleeding or clots. Nasal polyps are not associated with thrombocytopenia. Purulent discharge may occur with foreign bodies in the nose or sinus infection, but would not be expected with thrombocytopenia. Pale and swollen turbinates are caused by allergies and not associated with thrombocytopenia.

Which parent education would the nurse provide the pregnant mother whose son was recently diagnosed with hemophilia about the chances that her next child will also be affected? 1 There is a 5% chance that the baby will be affected. 2 There is a 25% chance that the baby will be affected. 3 There is a 50% chance that the baby will be affected. 4 There is a 75% chance that the baby will be affected.

2 There is a 25% chance that the baby will be affected. Hemophilia is an X-linked recessive disorder. The mother is usually the carrier, and the father is unaffected. Before the sex of the unborn child is known, the odds are 25%; 50% of pregnancies will result in boys, and a boy has a 50% chance of having hemophilia. The laws of Mendelian genetics do not include a 5% probability of inheritance of hemophilia. A 50% or 75% chance is too high; there is only a 25% chance that the fetus will be affected.

Which medication would the nurse expect to administer to control bleeding in a child with hemophilia A? 1 Albumin 2 Fresh frozen plasma 3 Factor VIII concentrate 4 Factors II, VII, IX, X complex

3 Factor VIII concentrate Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation.

Which postpartum client is at the highest risk for disseminated intravascular coagulation (DIC)? 1 Gravida III with twins 2 Gravida V with endometriosis 3 Gravida II who had a 9-lb baby 4 Gravida I who has had an intrauterine fetal death

4 Gravida I who has had an intrauterine fetal death Intrauterine fetal death is one of the risk factors for DIC; other risk factors include abruptio placentae, amniotic fluid embolism, sepsis, and liver disease. Multiple pregnancy, endometriosis, and increased birthweight are not risk factors for DIC.

The nurse is conducting discharge teaching with an adolescent with hemophilia. Which statement by the client indicates a need for further teaching? 1 "I'll use a straight razor when I start shaving." 2 "I plan on trying out for the swim team next year." 3 "If I injure a joint, I'll keep it still, elevate it, and apply ice." 4 "If I get a little scratch, I can apply gentle pressure for 10 to 15 minutes."

1 "I'll use a straight razor when I start shaving." A straight razor should not be used by the adolescent with hemophilia, so further teaching is required. The adolescent with hemophilia should be taught to use an electric razor for shaving. Contact sports should be avoided, but swimming is a recommended activity, so trying out for the swim team indicates that the adolescent understands the teaching. If a superficial injury occurs, gentle, prolonged pressure should be applied until the bleeding has stopped. If a muscle or joint injury occurs, the area should be immobilized, elevated, and iced. Both statements indicate that the adolescent has understood the teaching.

A client with mild preeclampsia is admitted to the labor and birthing suite. Which signs or symptoms would the client be likely to display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply. One, some, or all responses may be correct. 1 Headache 2 Constipation 3 Right upper quadrant abdominal pain 4 Vaginal bleeding 5 Nausea and vomiting

1 Headache 3 Right upper quadrant abdominal pain 5 Nausea and vomiting Headache, right upper quadrant abdominal pain, and nausea and vomiting are all indications of increasing severity of preeclampsia and HELLP syndrome. Constipation and vaginal bleeding are not related to preeclampsia.

The parents of a child who has just been diagnosed with hemophilia A ask the nurse what symptoms of bleeding they should look for in the future. Which symptoms would the nurse list? Select all that apply. One, some, or all responses may be correct. 1 Nosebleeds 2 Blood in the urine 3 Painful and swollen joints 4 Easy bruising 5 Frequent fevers 6 Fast clotting of injuries 7 Dark-colored tarry stools

1 Nosebleeds 2 Blood in the urine 3 Painful and swollen joints 4 Easy bruising 7 Dark-colored tarry stools Epistaxis, also known as nosebleeds, is a common symptom of a lack of clotting factor. Hematuria (blood in the urine) may be grossly apparent. The child may experience joint pain and deformities from bleeding into joints. Excessive bruising will occur from bleeding into tissue with seemingly minor injuries. Dark-colored tarry consistency stools are indicative of gastrointestinal bleeding. Frequent fevers are not associated with hemophilia. Prolonged clotting times occur with this condition.

Which nursing intervention is the priority when the nurse notices that the client receiving a blood transfusion is having an acute hemolytic reaction? 1 Stop the blood transfusion immediately. 2 Report to the primary health care provider. 3 Recheck identifying tags and numbers on the client. 4 Maintain a patent intravenous (IV) line with saline solution.

1 Stop the blood transfusion immediately. An incompatible blood transfusion can result in an acute hemolytic reaction in the client. During acute hemolytic reactions, the nurse would stop a blood transfusion as a priority nursing intervention. After stopping the blood transfusion, the nurse would report it to the primary health care provider. The nurse can then recheck the client's identifying tags and numbers and maintain a patent IV line with saline solution.

In which order will the nurse take these actions when caring for a client who is having a hemolytic reaction to a transfusion of packed red blood cells? 1.Stop the transfusion. 2.Change the intravenous (IV) administration set. 3.Run 0.9% normal saline at a rapid rate. 4.Notify the primary health care provider and blood bank

1.Stop the transfusion. 2.Change the intravenous (IV) administration set. 3.Run 0.9% normal saline at a rapid rate. 4.Notify the primary health care provider and blood bank The priority is to stop the transfusion to prevent further hemolysis. The next action would be to change the IV administration set to prevent infusing any blood product remaining in the tubing. Running normal saline rapidly will help decrease shock and hypotension. Notifying the primary health care provider and blood bank would be the last step because these can be done after taking action to prevent further complications of hemolysis.

The mother of a toddler with hemophilia A asks the nurse, "Can I give my child ibuprofen for fever or pain?" How will the nurse respond? 1 "Ibuprofen is a good choice for fever or pain." 2 "Give your child acetaminophen. Ibuprofen may cause bleeding." 3 "No. I'll explain why your child isn't allowed pain medications." 4 "You seem concerned about giving medications to your child."

2 "Give your child acetaminophen. Ibuprofen may cause bleeding." The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects

When a client is admitted to the emergency department with disseminated intravascular coagulation caused by sepsis, which prescribed action will the nurse take first? 1 Apply antiembolism stockings. 2 Draw blood for culture and sensitivity. 3 Administer vancomycin 1 gram intravenously. 4 Transfer the client to the intensive care unit.

2 Draw blood for culture and sensitivity. Treatment of disseminated intravascular coagulation focuses on treatment of the cause of the abnormal coagulation, so rapid initiation of antibiotic therapy is essential. However, blood cultures are drawn before antibiotic administration to ensure that appropriate antibiotics can be prescribed. Antiembolism stockings are needed to help prevent venous thrombosis, but are not the priority action. The client needs to be transferred to the intensive care unit, but the nurse would not wait for the transfer to obtain cultures and administer antibiotics.

A client who is underweight has autoimmune hemolytic anemia that has been unresponsive to corticosteroids. A splenectomy is scheduled. For which complication would the nurse assess the client in the immediate postoperative period? 1 Dehiscence 2 Hemorrhage 3 Wound infection 4 Abscess formation

2 Hemorrhage A client is at risk for hemorrhage because of the vascularity of the spleen. Dehiscence is not expected; it usually occurs in obese clients. Wound infection is a complication that will take days to develop. Abscess formation is a complication that will take days to develop.

For which medication would the nurse monitor a client closely for hemolytic anemia? 1 Tacrolimus 2 Methyldopa 3 Azathioprine 4 Procainamide

2 Methyldopa Hemolytic anemia is an autoimmune disorder in which destruction of red blood cells occurs before the end of their normal lifespan. This disorder may result after administration of methyldopa. Tacrolimus may cause adverse effects such as nephrotoxicity, lymphoma, and leukopenia. Azathioprine, administered as an immunosuppressant, may cause bone marrow suppression. Procainamide can induce the formation of antinuclear antibodies and cause a lupus-like syndrome.

A client develops hemolytic anemia. Which client medication can cause this adverse effect? 1 Famotidine 2 Methyldopa 3 Levothyroxine 4 Ferrous sulfate

2 Methyldopa Methyldopa is associated with acquired hemolytic anemia and should be discontinued to prevent progression and complications. Famotidine will not cause these symptoms; it decreases gastric acid secretion, which will decrease the risk of gastrointestinal bleeding. Ferrous sulfate is an iron supplement to correct, not cause, anemia. Levothyroxine is not associated with red blood cell destruction.

Which education would the nurse provide to the family of a 10-year-old child diagnosed with hemophilia about the genetic inheritance of the condition? 1 It follows the Mendelian law of inherited disorders. 2 The mother is a carrier of the disorder but usually is not affected by it. 3 It is an autosomal dominant disorder in which the woman carries the trait. 4 A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier.

2 The mother is a carrier of the disorder but usually is not affected by it. The hemophilia gene is carried on the X chromosome but is recessive. The female is the carrier (an unaffected XO and an affected XH). If the male receives the affected XH (XHYO), he will have the disorder. Hemophilia is carried by the female; the Mendelian laws of inheritance are not sex specific. Hemophilia is a sex-linked recessive disorder. Only females carry the trait; usually males are affected.

A 2-year-old child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor vehicle collision. The toddler has several bruises but no other apparent injuries. Which is the nurse's specific concern regarding this child? 1 Possibility of falls 2 Undetected injury 3 Low fluid volume 4 Development of infection

2 Undetected injury Although the child has no apparent injuries, internal bleeding may have occurred. The child should be monitored for internal bleeding in case there is an undetected injury. Although all 2-year-olds are at risk for falls, falls are not the greatest danger for this child at this time. Although all toddlers are at risk for fluid imbalances because of their larger percentage of body fluid to body mass, this is not a priority at this time. A child with hemophilia is at no greater risk for infection than any other child; the skin is intact, so this is not a priority.

Which assessment finding indicates that disseminated intravascular coagulation (DIC) is occurring in a postpartum client who has experienced an abruptio placentae? 1 Boggy uterus 2 Hypovolemic shock 3 Multiple vaginal clots 4 Bleeding at the venipuncture site

4 Bleeding at the venipuncture site Bleeding at the venipuncture site indicates afibrinogenemia; massive clotting in the area of the separation has resulted in a decrease in the circulating fibrinogen level. A boggy uterus indicates uterine atony. Although hypovolemic shock may occur with DIC, there are other causes of hypovolemic shock, not just DIC. Blood clots indicate an adequate fibrinogen level; however, vaginal clots may indicate a failure of the uterus to contract and should be explored further.

An adolescent is admitted with an acute hemophilia episode. For which are rest, ice, compression, and elevation most helpful? 1 Encouraging immobilization 2 Decreasing swelling and inflammation 3 Providing pain relief and reducing anxiety 4 Controlling bleeding and retaining joint function

4 Controlling bleeding and retaining joint function Rest, ice, compression, and elevation (RICE) therapy is implemented to support joints and prevent bleeding into joints during an acute hemophilia episode. Reducing inflammation is not the goal of treatment for the hemophiliac process. Total immobilization is not required. Pain may be relieved to some degree but is not assured.