Thrombocytopenia

The nurse identifies that the stages of chemotherapy for the treatment of leukemia are administered in what order? Correct 1. Induction therapy Correct 2. Intensification therapy Correct 3. Consolidation therapy Correct 4. Maintenance therapy

The first stage of chemotherapy is induction therapy, which involves treatment with high doses of drugs to attain remission. The second stage of chemotherapy is intensification therapy. This involves an increase in the dose of drugs given during the induction phase. The next stage of chemotherapy is consolidation, aimed at removing the tumor cells, which are clinically and pathologically not evident. The final stage of chemotherapy is maintenance therapy, which involves treatment with low doses of drugs every three to four weeks for a prolonged period.

The nurse recognizes that which drug is directly myelosuppressive and may cause patient thrombocytopenia? 1 Abciximab 2 Cimetidine 3 Ganciclovir 4 Haloperidol

Correct3 Ganciclovir is an antiinfective drug that causes thrombocytopenia; it is directly myelosuppressive. Abciximab is a platelet glycoprotein inhibitor that causes thrombocytopenia. Cimetidine is a histamine H2-receptor antagonist that causes thrombocytopenia. Haloperidol is an antipsychotic drug that causes thrombocytopenia.

A patient experiences thrombocytopenia. The nurse should monitor the patient for which major complication? 1 Fatigue 2 Weakness 3 Hemorrhage 4 Abdominal pain

Correct3 The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.

The nurse reviews documentation of assessment findings of a patient with severe anemia. The nurse should question which assessment finding? 1 Pallor 2 Pruritus 3 Jaundice 4 Hyperpigmentation

Correct4 Common integumentary changes observed in anemia include pallor, jaundice, and pruritus. Pallor results from reduced amounts of hemoglobin and reduced blood flow to the skin. Jaundice occurs when hemolysis of RBCs results in an increased concentration of serum bilirubin. Pruritus occurs because of increased serum and skin bile salt concentration. Hyperpigmentation is usually not associated with anemia.

A patient with cancer experiences fever, drenching night sweats, and weight loss. The laboratory reports show intrathoracic involvement. The nurse should monitor the patient for which complication? 1 Bone pain 2 Paraplegia 3 Renal failure 4 Superior vena cava syndrome

Correct4 Fever, drenching night sweats, and weight loss are clinical manifestations of Hodgkin's lymphoma. Intrathoracic involvement results in superior vena cava syndrome due to intravascular thrombosis. Bone pain occurs as a result of bone involvement. Paraplegia may occur with extradural involvement due to spinal cord compression. Renal failure may occur due to enlarged peritoneal nodes.

A patient with cancer who is receiving methotrexate therapy has developed anemia. The nurse recognizes that which therapies may benefit this patient? Select all that apply. 1 Oral iron 2 Epoetin alfa 3 Oral folic acid 4 Blood transfusion 5 Parenteral vitamin B12

Correct 2, 3 Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia. Therefore folic acid therapy is given to treat the patient. Oral iron is administered to patients with iron deficiency anemia, which is seen mostly in premenopausal and pregnant women. Blood transfusions are required to keep the approximate hemoglobin level to at least 10 g/dL in the case of thalassemia and severe anemia. Parenteral vitamin B12 is administered to treat cobalamin deficiency caused by pernicious anemia. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

The nurse reviews the laboratory test results for a patient with upper gastrointestinal bleeding and notes that the hemoglobin level is 8.7 g/dL and the hematocrit is 26%. The nurse should place highest priority on initiating interventions that will reduce which symptom? 1 Nausea 2 Dizziness 3 Headache 4 Constipation

Correct2 The patient with a low hemoglobin and hematocrit (normal values 13.5% to 17% and 40% to 54%, respectively, for males) is anemic and would be most likely to experience fatigue and dizziness. This symptom develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Constipation, nausea, and headache are not associated with decreased hemoglobin and hematocrit levels. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

The nurse is reviewing the lab reports of several patients. Which report is consistent with a diagnosis of thrombocytopenia? 1 Hemoglobin 13 2 Hemoglobin 16 3 Platelets 20,000/µL 4 Platelets 1,000,000/ µL

Correct3 Thrombocytopenia means there are low levels of circulating platelets. A platelet count below 150,000/ µL is considered low. As such, a platelet count of 20,000/µL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12-17 g/dL depending on the sex of the patient. Hemoglobin levels of 13 g/dL and 16 g/dL are normal.

The nurse assesses a patient with pernicious anemia and expects to find what classic sign of this condition? 1 Diarrhea 2 Indigestion 3 Flushed skin 4 Red, beefy tongue

Correct4 The decreased absorption of vitamin B12 resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B12 from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

The nurse recognizes that which medication may benefit a patient with immune thrombocytopenic purpura (ITP) by increasing the platelet production? 1 Danazol 2 Eltrombopag 3 Tranexamic acid 4 Desmopressin acetate

Correct2 Eltrombopag is a thrombopoietin receptor agonist that acts by increasing platelet production. Danazol is an androgen that acts by increasing CD4+T cells. Tranexamic acid is an antifibrinolytic drug that acts by inhibiting plasminogen activation in the fibrin clot. Desmopressin acetate is a synthetic analog of vasopressin that acts on platelets and endothelial cells to release von Willebrand factor (vWF). Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

A patient is scheduled to receive two units of packed red blood cells. The prescription was written at 1000. The nurse picks the transfusion up from the laboratory at 1130 and recognizes that it must be initiated no later than what time? 1 1145 2 1200 3 1230 4 1530

Correct2 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank. Because the blood was picked up at 1130, 1200 is the latest it can be hung. It is okay to hang the blood at 1145. It is too late to hang the blood at 1230 or at 1530

A patient experiences thrombocytopenia due to consumption of certain herbs. The nurse suspects that which mechanism of thrombocytopenia occurred? 1 Altered platelet aggregation 2 Adequate platelet production 3 Decreased platelet production 4 Accelerated platelet destruction

Correct4 Ingestion of herbs may cause accelerated platelet destruction due to drug-dependent antibodies. Altered platelet aggregation is the cause of thrombotic thrombocytopenic purpura (TTP). Adequate platelet production will not cause thrombocytopenia in the patient. Decreased platelet production contributes to idiopathic thrombocytopenic purpura.

The nurse provides education regarding daily activities to a patient with thrombocytopenia. Which patient activity indicates understanding of the teaching? 1 Flossing using thick tape floss 2 Shaving using an electric razor 3 Wearing flip flops to go walking 4 Brushing using a stiff-bristle toothbrush

Correct 2 A patient with thrombocytopenia has a decreased number of platelets, and therefore prolonged bleeding will be observed even for minor injuries. Shaving using an electric razor blade decreases the risk of cuts and wounds resulting in decreased bleeding. Therefore this activity of the patient indicates understanding of the nurse's teaching. Walking with flip flops can cause the patient to trip, causing the risk for cuts or wounds and increased bleeding. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Brushing using a stiff-bristle toothbrush causes injury to the gums and is not safe; therefore the nurse needs to perform more patient teaching. Test-Taking Tip: A patient with thrombocytopenia has decreased number of platelets and therefore activities that expose the patient at a risk of bleeding should be avoided. Use this concept to answer the question correctly.

A patient experiences a decreased neutrophil count (neutropenia). To prevent complications, which interventions should the nurse include in the patient's discharge teaching? Select all that apply. 1 Encourage the patient to eat raw eggs. 2 Encourage the patient to wash hands frequently. 3 Encourage the patient to frequent crowded areas. 4 Advise the patient to notify the health care provider if a fever develops. 5 Advise the patient to brush the teeth four times a day with a soft toothbrush.

Correct 2, 4, 5 Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The self-care instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the healthcare provider. Eating raw eggs and staying in crowded areas increase the risk of acquiring infections, and should be avoided.

The nurse recognizes that which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow? 1 Acute lymphocytic leukemia (ALL) 2 Acute myelogenous leukemia (AML) 3 Chronic lymphocytic leukemia (CLL) 4 Chronic myelogenous leukemia (CML)

Correct1 Acute lymphocytic leukemia is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? 1 A 59-year-old man whose alcoholism has precipitated folic acid deficiency 2 A 23-year-old African American man who has a diagnosis of sickle cell disease 3 A 30-year-old woman with a history of "heavy periods" accompanied by anemia 4 A 3-year-old child whose impaired growth and development is attributable to thalassemia

Correct2 A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? 1 Glossitis 2 Palpitations 3 Dyspnea at rest 4 Roaring in the ears

Correct2 An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

The nurse recalls that the role of folic acid in erythropoiesis is what? 1 Aids in absorption of iron 2 Promotes RBC maturation 3 Promotes hemoglobin synthesis 4 Aids in mobilization of iron from tissue to plasma

Correct2 Folic acid promotes maturation of red blood cells (RBC). Ascorbic acid aids in the absorption of iron. Iron and pyridoxine promote hemoglobin synthesis. Copper helps in the mobilization of iron from tissue to plasma.

A patient receives a prescription for ferrous gluconate. The nurse should provide education related to what potential side effect? 1 Hypotension 2 Constipation 3 Clay-colored stool 4 Abdominal swelling

Correct2 Iron supplements such as ferrous gluconate reduce peristalsis and result in constipation. Ferrous gluconate does not reduce blood pressure and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling.

The nurse prepares to administer a unit of fresh frozen plasma to a patient and notes that it contains what quantity? 1 60 mL 2 250 mL 3 350 mL 4 400 mL

Correct2 One unit contains approximately 250 mL of fresh frozen plasma.

The nurse reviews a patient's pre-op prescription which states: "Infuse one unit of fresh frozen plasma (FFP) before arrival to the operating room." To complete this prescription safely, the nurse should take which action? 1 Infuse the FFP over four hours and then take the patient to the operating room. 2 Infuse the FFP as rapidly as the patient will tolerate. 3 Administer the FFP as an IV piggyback to the primary IV solution. 4 Administer the FFP as an IV piggyback to lactated Ringer's solution.

Correct2 The fresh frozen plasma should be administered as rapidly as possible and should be used within six hours. Fresh frozen plasma is infused with the use of any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infusing, unless a second IV line has been started for the transfusion.

The nurse provides care for a patient with immune thrombocytopenic purpura (ITP) that has a platelet count of 90,000/mcL of blood. What could be the reason for this condition in the patient? 1 Destruction of platelets 2 Decreased production of platelets 3 Enhanced aggregation of platelets 4 Increased consumption of platelets

Correct2 The normal platelet count is in the range of 150,000 to 450,000 platelets/mcL of blood. A decreased blood platelet count indicates thrombocytopenia in the patient. A patient with ITP will have thrombocytopenia because of decreased platelet production. Ingestion of herbs results in thrombocytopenia by destroying the platelets. Enhanced aggregation of platelets is associated with thrombotic thrombocytopenic purpura (TTP). Increased consumption of platelets will cause heparin-induced thrombocytopenia (HIT).

A patient with anemia experiences fatigue when performing activities of daily living. Which nursing intervention is appropriate to include in the patient's plan of care? 1 Encourage frequent visitors. 2 Assist the patient in prioritizing activities. 3 Assist the patient in walking immediately after meals. 4 Ensure that all physical activities are completed in the morning.

Correct2 The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning. The caregiver should limit the number of visitors so that the patient receives adequate rest.

Which diagnostic test can detect destruction of circulating platelets as the cause of thrombocytopenia? 1 Hemoglobin 2 Bone marrow analysis 3 Prothrombin time (PT) 4 Peripheral blood smear

Correct2 When destruction of circulating platelets is the cause, bone marrow analysis shows megakaryocytes (precursors of platelets) to be normal or increased, even though circulating platelets are reduced. Prothrombin time (PT) is used to assess secondary hemostasis. Peripheral blood smear is used to distinguish acquired disorders from congenital disorders. Hemoglobin measures the amount of protein in the red blood cells that carries oxygen to the body's organs and tissues and transports carbon dioxide from the organs and tissues back to the lungs. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

The nurse is preparing to administer two units of blood to a patient. The nurse should take which action to prevent an adverse effect during this procedure? 1 Immediately obtain both units of blood from the blood bank. 2 Infuse the blood slowly for the first 15 minutes of the transfusion. 3 Regulate the flow rate so that each unit takes at least four hours to transfuse. 4 Prepare a solution of dextrose in water to be administered after the transfusion is complete.

Correct2 Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse initially should infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within four hours, and cannot be hung with dextrose.

The nurse should question which therapy that is listed on a treatment plan for a patient who has thrombotic thrombocytopenic purpura (TTP)? 1 Plasmapheresis 2 Rituximab therapy 3 Platelet transfusion 4 Corticosteroid therapy

Correct3 Administration of platelets or platelet transfusion is contraindicated in a patient who has thrombotic thrombocytopenic purpura (TTP) because it leads to new vWF-platelet complexes and increased clotting. Plasmapheresis supplies the appropriate vWF and enzyme (ADAMTS13) and removes large vWF molecules that bind with platelets; therefore it reverses the platelet consumption in the patient. Rituximab and corticosteroids are used in the treatment of TTP.

A patient is diagnosed with acute lymphocytic leukemia (ALL). The nurse identifies that which assessment finding is associated with the diagnosis? Incorrect1 Lymphadenopathy 2 Gingival hyperplasia 3 Leukemic meningitis 4 Hepatosplenomegaly

Correct3 Central nervous system manifestations, such as leukemic meningitis, are most commonly observed in patients with acute lymphocytic leukemia (ALL). Gingival hyperplasia in patients is associated with acute myelogenous leukemia. Lymphadenopathy is also observed in patients with chronic lymphocytic leukemia. Hepatosplenomegaly is also common in patients with acute myelogenous leukemia and chronic lymphocytic leukemia.

A patient experiences a minor bleeding episode during a dental procedure. The nurse recognizes that which therapy will be beneficial? 1 Tranexamic acetate 2 Fresh frozen plasma 3 Desmopressin acetate 4 Epsilon-aminocaproic acid

Correct3 Desmopressin acetate is used to treat minor bleeding episodes and dental procedures. Tranexamic acetate is the antifibrinolytic used to stabilize the clot in patients with epistaxis and menorrhagia. Fresh frozen plasma is used as replacement therapy in treating hemophilia. Epsilon-aminocaproic acid is the antifibrinolytic used for clot stability in patients with difficult episodes of epistaxis and menorrhagia. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A patient with anemia receives a new prescription for oral iron supplements. What should the nurse include in the medication education related to improving the absorption of the supplement? 1 "Take it with meals." 2 "Take it one hour after eating." 3 "Take it one hour before breakfast, with orange juice." 4 "Take it on an empty stomach with a full glass of water."

Correct3 Iron is absorbed best as ferrous sulfate in an acidic environment. For this reason and to avoid binding the iron with food, iron should be taken about an hour before meals, when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, enhances iron absorption. Gastric side effects, however, may necessitate ingesting iron with meals.

An initial emergency plan of care for a patient with leukemia includes leukapheresis and hydroxyurea. The nurse concludes that the treatments were prescribed based on which laboratory parameter? 1 Hemoglobin of 9 g/dL 2 Platelet count of 90,000/µL 3 WBC count of 120,000 cells/µL 4 Lactate dehydrogenase 300 U/L

Correct3 The initial emergent treatment with leukapheresis and hydroxyurea is indicated if the patient has a high WBC count of 100,000 cells/μL or more. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore a hemoglobin value of 9 g/dL is indicative of severe anemia and a blood transfusion would be beneficial to this patient. The normal range of platelets is 150,000 to 400,000/μL. Therefore the platelet count of 90,000/μL is indicative of thrombocytopenia. Patients with leukemia may have thrombocytopenia due to bone marrow depression. Thrombocytopenia is treated using colony stimulating factors and platelet transfusions. The normal lactate dehydrogenase level is 140 to 280 mcg/dL. This will be elevated due to tissue damage that occurs from cancer cell destruction.

The nurse reviews the history of an older patient and notes increased fatigue, headache, pale skin, and glossitis. The nurse suspects the patient has microcytic, hypochromic anemia and should provide what teaching? 1 Take enteric-coated iron with each meal. 2 Take cobalamin with green leafy vegetables. 3 Take the iron with orange juice one hour before meals. 4 Decrease the intake of the antiseizure medications to improve.

Correct3 With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is absorbed best in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

The treatment plan for a patient with chronic lymphocytic leukemia (CLL) includes a drug that acts by binding to CD52, a panlymphocyte antigen present on both T and B cells. The nurse anticipates that what drug will be prescribed? 1 Lomustine 2 Carboplatin 3 Alemtuzumab 4 Cyclophosphamide

Correct3 Alemtuzumab is used to treat chronic lymphocytic leukemia by binding to CD52, a panlymphocyte antigen present on both T and B cells. Lomustine acts by breaking DNA helix and interfering with DNA replication. Carboplatin acts by binding to DNA and RNA and inhibiting DNA replication. Cyclophosphamide damages DNA by causing breaks in the double-stranded helix.

A patient who is in acute sickle cell crisis cries and reports a pain level of "10" on a 1 to 10 scale. The nurse identifies that which type of medication is most appropriate for the patient? 1 Acetaminophen (Tylenol) oral tablets every six hours. 2 Oral morphine tablets, every four hours, as needed (PRN) 3 Intravenous meperidine (Demerol), every four hours, PRN 4 Hydromorphone (Dilaudid) via patient-controlled analgesia (PCA)

Correct4 During an acute sickle cell crisis, optimal pain control usually includes large doses of continuous (rather than PRN) opioid analgesics along with breakthrough analgesia, often in the form of PCA. Morphine and hydromorphone are the drugs of choice. Acetaminophen is appropriate for minor pain or fever, not for severe pain. Meperidine is contraindicated because high doses can lead to the accumulation of a toxic metabolite, normeperidine, which can cause seizures.

A patient with immune thrombocytopenic purpura (ITP) is scheduled for a splenectomy. The goal of the surgery is complete remission. The nurse recognizes that the surgery is an appropriate treatment plan because of what splenic function? 1 The spleen sequesters total platelets. 2 The spleen does not contain macrophages. 3 The spleen does not synthesize any antibodies. 4 The spleen affects the platelet-macrophage interaction.

Correct4 Splenectomy causes complete remission in a patient with immune thrombocytopenic purpura (ITP) because the structural features of the spleen enhance the interaction between antibody-coated platelets and macrophages. The spleen sequesters approximately one third of the platelets, so removal of the spleen increases the number of platelets in circulation. The spleen contains abundant macrophages that sequester and destroy platelets. The spleen synthesizes some antibodies and thus antiplatelet antibodies decrease after splenectomy. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

To prepare for a patient's transfusion of packed red blood cells, the nurse should select which intravenous solution to use for the procedure? 1 3% normal saline 2 Lactated Ringer's 3 5% dextrose in water 4 0.9% normal saline

Correct4 The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Lactated Ringer's, 5% dextrose in water, and 3% normal saline are not compatible with blood products.

A patient receives a new prescription for a transfusion of two units of packed red blood cells (PRBCs). The nurse should take which action to ensure patient safety? 1 Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. 2 Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction. 3 Select a new primary intravenous (IV) tubing to use for the administration and piggyback with 500 mL of normal saline. 4 Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet.

Correct4 The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion.

A patient with thrombocytopenia experiences a nosebleed. What is the priority nursing intervention? 1 Notify the primary health care provider. 2 Tap the patient's nose gently with a tissue. 3 Place ice bags over the bridge of the patient's nose. 4 Position the patient's head upwards and apply pressure to nostrils.

Correct4 The primary nursing intervention for a patient with thrombocytopenia and nosebleed is to prevent excessive blood loss. Positioning the patient's head upwards and applying pressure on the nostrils will reduce the flow of blood and will decrease bleeding. The primary health care provider is called if the bleeding does not stop after 10 minutes. The patient's nose will be tapped gently if the patient has a feeling of discomfort in the nose after reducing the risk of excessive blood loss. If the bleeding continues after positioning the patient's head upward, then ice bags should be placed over the bridge of the patient's nose to decrease bleeding.