Med Surg - Chapter 39 - Assessment of the Hematologic System

The nurse is caring for a patient with chronic kidney disease. On reviewing the patient's laboratory results, the nurse finds that the red blood cell (RBC) count is greatly reduced. Which drug does the nurse anticipate the health care provider prescribing? 1 Heparin 2 Epoetin alfa 3 Chloramphenicol 4 Mefenamic acid

2 Epoetin alfa The patient has chronic kidney disease and is unable to produce adequate amounts of the hormone erythropoietin. The patient will likely be prescribed a synthetic erythropoietin like epoetin alfa to stimulate the production of RBCs. Heparin is an anticoagulant drug and does not play a role in the synthesis of RBCs. Chloramphenicol is an antibiotic that causes bone marrow suppression. This drug would further inhibit the production of RBCs and should not be prescribed. Mefenamic acid causes destruction of RBCs and should not be prescribed to the patient.

A patient sustains a cut while using a knife. What triggers the clotting mechanism in this situation? 1 Exposure of platelets to oxygen 2 Exposure of platelets to collagen 3 Exposure of platelets to tissue fluid 4 Exposure of platelets to sweat on the skin

2 Exposure of platelets to collagen Trauma or an external wound activates the extrinsic pathway of blood clotting. The exposure of platelets to collagen begins the process of platelet aggregation. Oxygen, tissue fluid, or sweat does not play a role in the activation of the clotting mechanism.

The nurse is caring for a patient with a thrombotic stroke in the emergency department. The nurse anticipates the administration of which drug to the patient within the first 6 hours? 1 Anticoagulants 2 Fibrinolytics 3 Platelet inhibitors 4 Antibiotics

2 Fibrinolytics Fibrinolytic drugs will be administered to the patient within the first 6 hours after stroke. Fibrinolytic drugs are also known as thrombolytic drugs or "clot busters" because they selectively break down fibrin threads present in the formed clots. Fibrinolytics are used as first-line therapy for problems caused by small, localized clots such as myocardial infarction and thrombotic strokes. Anticoagulant drugs interfere with the clotting cascade and prevent formation of new clots. Platelet inhibitors prevent platelet activation or aggregation. Antibiotics can lead to clotting problems or bone marrow depression.

A newly admitted patient has an elevated reticulocyte count. Which disorder does the nurse suspect in this patient? 1 Aplastic anemia 2 Hemolytic anemia 3 Infectious process 4 Leukemia

2 Hemolytic anemia Elevated reticulocyte count in an anemic patient indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in patients with infection. A low white blood cell count is expected in patients with leukemia.

Which condition is detected by using the Coombs test? 1 Hemophilia 2 Hemolytic anemia 3 Polycythemia vera 4 Megaloblastic anemia

2 Hemolytic anemia The Coombs test is used to detect antibodies against red blood cells (RBCs) that may be attached to a person's RBCs. The presence of these antibodies can cause hemolytic anemia. Anti-RBC antibodies are not found in conditions like hemophilia, polycythemia vera, or megaloblastic anemia; using the Coombs test would not detect these conditions.

Which area of the body is utilized to assess capillary refill in an older adult? 1 Nails 2 Lips 3 Ear lobes 4 Conjunctiva

2 Lips In an older adult, the lips may be used to test capillary refill because they have a rich vascular supply. In older adults, the nails become thickened and discolored, making it difficult to assess capillary refill on the nail beds. Earlobes are not richly supplied by blood; capillary refill is not tested in this area. Testing capillary refill on conjunctiva could damage the conjunctiva, so capillary refill is not tested in this area.

Which condition causes an increase in systolic blood pressure? 1 Iron deficiency anemia 2 Polycythemia vera 3 Sickle cell disease 4 Von Willebrand's disease

2 Polycythemia vera Systolic blood pressure is increased in conditions such as polycythemia vera. In this condition, the red blood cell (RBC) levels in the blood are increased. This increases the viscosity of the blood, which ultimately causes an increase in blood pressure. In iron deficiency anemia, there is a drop in systolic blood pressure. In sickle cell disease and Von Willebrand's disease, the systolic blood pressure is not affected.

Which test is the patient required to take to calculate the international normalized ratio (INR)? 1 Anti-factor Xa test 2 Prothrombin time (PT) test 3 Platelet aggregation test 4 Partial thromboplastin time (PTT) test

2 Prothrombin time (PT) test INR is calculated by dividing the patient's prothrombin time by the established standard prothrombin time. The patient must therefore first undergo a PT test; the INR would then be calculated based on the results. The anti-factor Xa is a test used for monitoring heparin levels in patients who are receiving unfractionated heparin or low molecular weight heparin. The platelet aggregation test determines the ability of platelets to clump. The PTT test is performed to assess the function of the intrinsic clotting system.

Deficiencies of protein C and protein S predispose an individual to which condition? 1 Hemophilia 2 Pulmonary embolism 3 Internal hemorrhage 4 Iron deficiency anemia

2 Pulmonary embolism Protein C and protein S are anti-clotting factors. A deficiency of these factors would increase the risk for pulmonary embolism. Hemophilia and internal hemorrhage are caused by a decreased ability of the blood to clot. Protein C and protein S are not related to the production of red blood cells (RBCs) or hemoglobin, and therefore do not cause any risk for iron deficiency anemia.

The nurse is assessing the laboratory data of a male patient. Which blood test result would help to confirm the diagnosis of polycythemia vera? 1 Hematocrit of 50% 2 Reticulocyte count of 13% 3 Platelet count of 200,000/mm 3 4 Red blood cells count of 5.8 million/µL

2 Reticulocyte count of 13% Normal reticulocyte count is 0.5%-2.0% of RBCs. An elevated reticulocyte count indicates polycythemia vera. Hematocrit, platelet count, and red blood cell (RBC) count, which are within the normal range, are not associated with polycythemia vera.

The nurse is performing an abdominal assessment on a patient to detect an enlarged liver. Which area does the nurse palpate in this assessment? 1 Left upper quadrant of the abdomen 2 Right upper quadrant of the abdomen 3 4 to 5 cm below the right costal margin 4 Epigastrium

2 Right upper quadrant of the abdomen An enlarged liver can be palpated in the right upper quadrant of the abdomen. An enlarged spleen can be palpated in the left upper quadrant; however, the splenic area should not be palpated on any patient with a suspected hematologic problem because it could easily rupture. The normal liver may be palpable as much as 4 to 5 cm below the right costal margin. The liver is not palpable in the epigastrium.

A patient is scheduled for radioisotopic imaging. What action does the nurse take when preparing the patient for this test? 1 Ask the patient to arrive at the hospital an hour before the test. 2 Tell the patient that a radioactive isotope will be administered by IV. 3 Inform the patient that the test will take about 20 minutes. 4 Assist the patient to lie with the head elevated at 30 degrees.

2 Tell the patient that a radioactive isotope will be administered by IV. The nurse tells the patient that a radioactive isotope will be administered by IV 3 hours before the test. The patient must be present at the hospital at least 3½ hours before the test. The test takes about an hour, during which the patient must lie still in a supine position.

The prothrombin time (PT) of a patient's blood sample is 14 seconds. What does the nurse interpret from this lab result? 1 The patient is at high risk for infection. 2 The patient is at an increased risk for bleeding. 3 The patient is at risk for excessive clotting. 4 The patient's blood has reduced oxygen content.

2 The patient is at an increased risk for bleeding. The PT test is used to assess the time taken by the blood to clot. It reflects the level of clotting factors II, V, VII, and X. The normal duration of clotting is 11 and 12.5 seconds. This patient has a prothrombin time of 14 seconds, which indicates that the duration of clotting is delayed and the patient is at an increased risk for bleeding. The patient would be at risk for contracting infections if the white blood cell count is reduced. The patient would be at a risk for excessive clotting if the PT is markedly reduced. Decreased hemoglobin content in the blood indicates that the patient has reduced oxygen content.

A patient has impaired platelet aggregation. The nurse identifies that what assessment finding may be the cause of this condition? 1 The patient takes a vitamin K supplement. 2 The patient takes an anti-inflammatory agent. 3 The patient has a white blood cell count of 4700 cells/microliter. 4 The patient has a red blood cell count of 4.6 million cells/microliter.

2 The patient takes an anti-inflammatory agent. Anti-inflammatory agents reduce platelet aggregation. Vitamin K causes hemolysis, but it does not impair platelet aggregation. The normal range of white blood cell count is from 5000 to 10,000 cells/microliter and the normal red blood cell count is 4.7 to 6.1 million cells/microliter. Although the patient has a slightly decreased white and red blood cell count, this would not cause impaired platelet aggregation.

A patient on anticoagulant therapy is being discharged. Which statement indicates that the patient has a correct understanding of this therapy's purpose or action? 1 "It is to dissolve blood clots." 2 "It might cause me to get injured more often." 3 "It should prevent my blood from clotting." 4 "It will thin my blood."

3 "It should prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots. Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when the patient is injured. Anticoagulants do not cause any change in the thickness or viscosity of the blood.

After reviewing the laboratory test results, the nurse calls the health care provider about which patient? 1 49-year-old with hemophilia and a platelet count of 150,000/mm 3 2 52-year-old who has had a hemorrhage with a reticulocyte count of 0.8% 3 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm 3 4 44-year-old receiving warfarin with an International Normalized Ratio (INR) of 3.0

3 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm 3 The patient with a fever neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level. A platelet count of 150,000/mm 3 in the 49-year-old is normal. An elevated reticulocyte count in the 52-year-old is expected after hemorrhage.

Which drug is known as a "clot buster"? 1 Aspirin 2 Warfarin 3 Alteplase 4 Prasugrel

3 Alteplase Fibrinolytic drugs are also known as "clot busters." Alteplase is a common fibrinolytic drug. Aspirin, warfarin, and prasugrel are "clot preventers" and not "cot busters" because they prevent clot formation but cannot break down a clot once it has formed. Aspirin and prasugrel prevent clot formation by inhibiting platelet aggregation. Warfarin prevents clot formation by inhibiting the activation of vitamin K, which is necessary for clot formation.

The nurse is caring for a patient after a bone marrow biopsy. What action does the nurse take? 1 Covers the site with dressing to control bleeding 2 Administers an aspirin to relieve pain 3 Applies ice packs over the site 4 Instructs the patient to inspect the site every 4 hours

3 Applies ice packs over the site Ice packs are applied over the site to limit bruising. The site is covered with a dressing after active bleeding is controlled. A mild analgesic without aspirin is administered to the patient to overcome discomfort; aspirin is not administered as it promotes bleeding. The patient should inspect the site every 2 hours for active bleeding or bruising.

A patient has impaired liver function. For which life-threatening complication is this patient at risk? 1 Hemolysis of blood 2 Excessive platelet production 3 Decreased clotting ability of the blood 4 Abnormal formation of red blood cells

3 Decreased clotting ability of the blood The liver is responsible for the production of prothrombin and other blood clotting factors. Impaired liver function would weaken the production of these factors, decreasing the blood's clotting ability. The liver does not play a role in maintaining the integrity of red blood cells (RBCs); therefore, impaired liver function does not cause hemolysis of the blood. The liver does not play a role in the production of platelets; impaired liver function would not increase platelet production. Unlike a damaged kidney, impaired liver function does not interfere in the process of erythropoeisis. Abnormal formation of RBCs is not associated with impaired liver function.

The nurse is caring for a patient scheduled for a splenectomy. What procedural implication should the nurse share with the patient?? 1 Decreased production of erythropoietin 2 Decreased production of prothrombin 3 Decreased immune function 4 Decreased production of platelets

3 Decreased immune function A splenectomy results in reduced immune function because the spleen destroys old or imperfect red blood cells (RBCs), breaks down hemoglobin released from these destroyed cells, stores platelets, and filters antigens. A person undergoing a splenectomy will be less able to remove disease-causing organisms, increasing the risk for infection and sepsis. Production of erythropoietin is not affected as it is produced by the kidneys. Prothrombin is produced by the liver and its production is not affected by splenectomy. Platelets are produced in the bone marrow and not affected by splenectomy.

The nurse is assessing a dark-skinned patient for anemia. What finding establishes the presence of bruises in the patient? 1 Pinpoint hemorrhagic lesions on the palms 2 Pallor of the mouth mucosa 3 Pallor of the conjunctiva 4 Darker, palpable areas on the skin

4 Darker, palpable areas on the skin Bruises are seen as darker areas of the skin and palpated as slight swelling or irregular skin. Petechiae are identified as pinpoint hemorrhagic lesions on the palms. Decreased hemoglobin levels and poor tissue oxygenation cause pallor of the mouth mucosa and conjunctiva.

Which clotting factor is absent in patients with hemophilia B? 1 Factor I—fibrinogen 2 Factor III—tissue thromboplastin 3 Factor VIII—antihemophilic factor 4 Factor IX—plasma thromboplastin component

4 Factor IX—plasma thromboplastin component Absence of factor IX—plasma thromboplastin component causes hemophilia B. When factor IX is activated, it activates factor X to convert prothrombin to thrombin. Factor I—fibrinogen is converted to fibrin by the enzyme thrombin. Factor III—tissue thromboplastin interacts with factor VII to initiate the extrinsic clotting cascade. Lack of factor VIII—antihemophilic factor is the basis for classic hemophilia or hemophilia A.

What percentage of patients diagnosed with hemophilia account for the form of hemophilia called "Christmas disease"? 1 20% 2 30% 3 50% 4 80%

1 20% In patients with hemophilia, 20% develop hemophilia type B, also called "Christmas disease." There is no form of hemophilia associated with 30% or 50% of patients with the diagnosis. In patients with hemophilia, 80% have hemophilia A.

A patient has a bone marrow biopsy done. Which nursing intervention is the priority postprocedure? 1 Applying pressure to the biopsy site 2 Inspecting the site for ecchymoses 3 Sending the biopsy specimens to the laboratory 4 Teaching the patient about avoiding vigorous activity

1 Applying pressure to the biopsy site The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses, sending specimens to the laboratory, and teaching the patient about activity levels will be done after hemostasis has been achieved.

What is the most common symptom of anemia? 1 Fatigue 2 Headache 3 Palpitations 4 Sore tongue

1 Fatigue Fatigue is the most common symptom of anemia. Oxygen-carrying capacity is reduced in anemic patients because of either a decrease in the number of red blood cells (RBCs) or a dysfunction in RBCs. The tissues are therefore not supplied with adequate oxygen and less energy is produced. Headaches, palpitations, and a sore tongue are less common symptoms associated with anemia.

Which medication is used to resolve deep vein thrombosis (DVT)? 1 Fibrinolytics 2 Anticoagulants 3 Platelet inhibitors 4 Anti-inflammatories

1 Fibrinolytics Fibrinolytic drugs break down the fibrin threads present in formed blood clots that are found in the deep veins of the leg. Anticoagulants prevent new clots from forming and limit the progression of the existing thrombus; Anticoaglulants do not cause the breakdown of an existing thrombus. Platelet inhibitors inhibit platelet activity, but do not help in breaking down clots. Anti-inflammatory drugs also inhibit platelet aggregation, but do not break down existing clots.

What is the physiologic response to hypoxia? 1 Increase in formation of red blood cells. 2 Destruction of red blood cells. 3 Decrease in blood flow to the tissues. 4 Increase in blood flow to the tissues.

1 Increase in formation of red blood cells. Hypoxia refers to a decreased oxygen saturation of the blood. Decreased oxygen levels stimulate the kidneys to produce erythropoetin, a hormone responsible for erythropoeisis (formation of red blood cells [RBCs]). The body's physiological response to hypoxemia is increased RBC formation. Hypoxia does not cause destruction of RBCs; it causes the formation of RBCs. The rate of blood flow to a particular tissue is not accelerated or decelerated in hypoxia.

According to the blood cell differentiation pathways, which cell is the precursor of the macrophage? 1 Myeloblast 2 Promyeloblast 3 Committed myeloid stem cell 4 Committed lymphoid stem cell

1 Myeloblast In blood differentiation pathway, myeloblasts differentiate to form macrophages. Promyeloblasts differentiate to form neutrophils, eosinophils, and basophils. Committed myeloid stem cells differentiate to form red blood cells (RBCs), platelets, and myeloblasts. The committed lymphoid stem cell is the precursor for the formation of lymphocytes.

A patient has undergone a splenectomy. The patient is at risk for what condition? 1 Sepsis 2 Anemia 3 Dysrhythmia 4 High blood pressure

1 Sepsis The spleen plays a major role in the body's immune function. The patient who has undergone a splenectomy has a reduced immune function, which would increase the patient's susceptibility to infection. The nurse should continuously monitor the patient for signs of infection or sepsis. A splenectomy does not cause changes in the production of red blood cells (RBCs) or hemoglobin; therefore, the patient is less likely to have anemia. Removal of the spleen does not interfere with cardiac function; the patient is thus unlikely to develop dysrhythmias. Removal of the spleen does not cause hypertension.

Which drug is considered a "blood thinner"? 1 Warfarin 2 Altretamine 3 Azathioprine 4 Chlorpropamide

1 Warfarin Anticoagulants, fibrinolytics, and platelet inhibitors are known as blood thinners. Warfarin is an anticoagulant drug. Altretamine and azathioprine are drugs that cause bone marrow suppression. Chlorpropamide comes under the category of drugs that cause hemolysis.

A patient with anemia asks the nurse, "Do most people have the same number of red blood cells?" How does the nurse respond? 1 "No, they don't." 2 "The number varies with gender, age, and general health." 3 "Yes, they do." 4 "You have fewer red blood cells because you have anemia."

2 "The number varies with gender, age, and general health." Telling the patient that the number of red blood cells (RBCs) varies with gender, age, and general health is the most educational and reasonable response to the patient's question. Although telling the patient that people do not have the same number of RBCs is true, it is not informative, and there is a better answer. While it may be true that the patient has fewer red blood cells because of anemia, it does not answer the patient's general question.

The nurse is teaching a patient about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? 1 "The doctor will place a small needle in your back and will withdraw some fluid." 2 "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." 3 "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area." 4 "You will be sedated, so you will not be aware of anything."

2 "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." It is accurate to describe a crunching sound or scraping sensation. Proper expectations minimize the patient's fear during the procedure. A very large-bore needle is used for a bone marrow biopsy, not a small needle; the puncture is made in the hip or in the sternum, not the back. The nurse, or sometimes a family member, is available to the patient for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site. A local anesthetic agent is injected into the skin around the site. The patient may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam) but will not be completely sedated.

What is the approximate rate of platelet production per day in a patient weighing 165 lbs? 1 150 billion 2 187 billion 3 160 million 4 180 million

2 187 billion Bone marrow normally releases about 2.5 billion platelets/day/kg of body weight. The body weight of 165 lbs is equal to 75 kg and 2.5 X 75 kg is 187 approximately. Thus, the rate of production of platelets per day in a patient weighing 165 lbs is 187 billion per day. The values 150 billion, 160 million, and 180 million are below the normal rate of production when calculated.

The nurse is assessing a patient with anemia for respiratory impairment. What does the nurse incorporate in the assessment? 1 Determine if the patient can speak a five-word sentence without being short of breath. 2 Assess the lungs for the presence of adventitious lung sounds. 3 Determine if the patient sleeps on two to three pillows at night. 4 Observe for the use of accessory muscles during expiration.

3 Determine if the patient sleeps on two to three pillows at night. When the patient is anemic, the nurse should assess the respiratory system for impairment. Orthopnea (difficulty breathing while lying down) can be a sign of breathing problems. Respiratory impairment can be assessed by asking the patient if he or she elevates the head of the bed by using more than one pillow at night to make it easier to sleep. The patient would be considered short of breath if he or she cannot complete a 10-word sentence without stopping to breathe. Although it is important for the nurse to auscultate lung sounds, adventitious lung sounds are present with airway constriction or fluid volume overload, not anemia. If the patient is having difficulty breathing, the nurse would see accessory muscles being used on inspiration, not expiration.

Which action does the nurse delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a female patient with anemia? 1 Asking the patient about the amount of blood loss with each menstrual period 2 Checking for sternal tenderness while applying fingertip pressure 3 Determining the respiratory rate before and after the patient walks 20 feet 4 Monitoring her oral mucosa for pallor, bleeding, or ulceration

3 Determining the respiratory rate before and after the patient walks 20 feet Assessment of the respiratory rate before and after ambulation is within the scope of practice for UAP; UAP will report this information to the RN. Asking the patient about the amount of blood loss with each menstrual period, checking for sternal tenderness, and monitoring oral mucosa require skilled assessment techniques and knowledge of normal parameters and should be done by the RN.

Which plasma protein plays a major role in the formation of a blood clot? 1 Albumin 2 Globulin 3 Fibrinogen 4 Platelet

3 Fibrinogen Fibrinogen is an inactive plasma protein that is activated to form fibrin. Fibrin molecules form a meshwork for the formation of a clot. Albumin is a plasma protein that does not play a role in the clotting process but is responsible for maintaining the osmotic pressure of blood. Globulin does not play a role in the clotting process but has other functions such as transporting antibodies. Platelets are not plasma proteins, but they do have a major role in the formation of a clot.

The nurse is assessing a patient with dark skin for jaundice. Which body area should the nurse inspect? 1 Soles of the feet 2 Palms of the hand 3 Roof of the mouth 4 Skin of the face

3 Roof of the mouth Yellow discoloration of the mucus membrane is one of the symptoms of jaundice, so this may be more easily seen on the roof of the mouth of patients with dark skin . The nurse may inspect the soles of the feet or the palms of the hands for bruising. Darker skin will make yellow discoloration difficult to detect on the skin of the face.

What rationale supports the nurse asking an anemic patient about personal resources, such as finances and social support? 1 To assess the genetic risk 2 To assess the family history 3 To assess the nutrition status 4 To assess the alcohol consumption

3 To assess the nutrition status The nurse may ask about the personal resources, such as finances and social support, of the patient to assess the patient's nutritional status. A person with a low income may have a diet deficient in necessary nutrients (like iron and protein) because foods containing these substances are more expensive. Asking about finances and social support does not give the nurse insight about genetic risk, family history, or alcohol consumption.

Which blood component is responsible for providing immunity? 1 Red blood cells 2 Platelets 3 White blood cells 4 Albumin

3 White blood cells White blood cells (WBCs) are responsible for providing immunity and starting the inflammatory response. Red blood cells (RBCs) carry oxygen and carbon dioxide and are responsible for gas exchange in the capillaries. Platelets are important for blood clotting. Albumin is a plasma protein and helps maintain oncotic pressure in the vascular compartment.

The nurse is assessing the nutritional status of a patient with anemia. How does the nurse obtain information about the patient's diet? 1 Asks the patient to rate his or her diet on a scale of 1 (poor) to 10 (excellent) 2 Determines who prepares the patient's meals and plans an interview with him or her 3 From a prepared list, finds out the patient's food preferences 4 Have the patient write down everything he or she has eaten for the past week

4 Have the patient write down everything he or she has eaten for the past week Having the patient provide a list of items eaten in the past week is the most accurate way to find out what the patient likes and dislikes, as well as what the patient has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food-preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the patient goes "out" for meals. Determining food preferences from a prepared list provides information about what the patient enjoys eating, not necessarily what the patient has been eating; for instance, the patient may like steak but may be unable to afford it.

A patient with an injury and having uncontrolled bleeding arrives at the hospital and is placed on anticoagulant therapy. Which elevated blood test result confirms the reason for uncontrolled bleeding? 1 Iron level 2 Hematocrit 3 Anti-factor Xa 4 Prothrombin time

4 Prothrombin time Uncontrolled bleeding is due platelet impairment. Prothrombin time is a test that evaluates the clotting time. If the clotting time is more than normal, it indicates uncontrolled bleeding. Iron levels are decreased in cases of hemorrhage or bleeding. The hematocrit is the percentage of red blood cells in the total blood volume. The anti-factor Xa test measures the amount of anti-activated factor X (anti-Xa) in blood, which is affected by heparin.

Which action does the nurse delegate to an unlicensed assistive personnel (UAP)? 1 Drawing a partial thromboplastin time (PTT) from a saline lock on a patient with a pulmonary embolism 2 Performing a capillary fragility test to check vascular hemostatic function on a patient with liver failure 3 Referring a patient with a daily alcohol consumption of 12 beers for counseling 4 Reporting any bleeding noted when catheter care is given to a patient with a history of hemophilia

4 Reporting any bleeding noted when catheter care is given to a patient with a history of hemophilia Reporting findings during routine care is expected and required of unlicensed staff members. Drawing a partial thromboplastin time, performing a capillary fragility test, and referring a patient for alcohol counseling are more complex and should be done by licensed nursing staff.

What component in food may help to increase the rate of blood coagulation? 1 Vitamin B 12 2 Folic acid 3 Iron 4 Vitamin K

4 Vitamin K Foods high in vitamin K such as green leafy vegetables may help to enhance the rate of blood clotting. Vitamin B 12, folic acid, and iron are all required to form hemoglobin and red blood corpuscles.

The nurse is reviewing a patient's laboratory reports that reveal a decreased platelet aggregation. Which condition might this indicate? 1 Hemophilia 2 Warfarin therapy 3 Thrombophilia 4 Von Willebrand's disease

4 Von Willebrand's disease Von Willebrand's disease is caused due to a decreased ability of platelets to aggregate. Hemophilia is caused by reduced levels or reduced functioning of clotting factors. Warfarin therapy does not affect platelet aggregation; it prevents coagulation by inhibiting the formation of clotting factors. Thrombophilia is a condition in which an abnormality of blood coagulation increases the risk of thrombosis.