H&I 5 exam 1 clotting TP

A nurse is caring for a patient who has hemophilia. The patient reports pain and swelling in a joint following an injury. Which of the following actions should the nurse take? 1. Obtain blood samples to test platelet function. 2. Prepare for replacement of the missing clotting factor. 3. Administer aspirin for the client's pain. 4. Place the bleeding joint in the dependent position.

2

A patient with thrombocytopenia presents to the primary care center. During assessment, the nurse notices petechiae. Which laboratory result best support's the presence of this disorder of hemostasis? 1. Decreased erythrocyte count 2. A platelet count below 150,000/mm³ 3. An elevated lymphocyte count 4. A hemoglobin values of 14 or more

2

You are working in an intermediate Neurological Intensive Care Unit (NICU). You have 4 patients that are on Heparin. After receiving report, which of the following patients would you see 1st? 1. A patient with an INR of 2.0 . 2. A patient with a platelet count of 80,000 . 3. A patient with an aPTT of 41 seconds. 4. A patient with a PT time of 9 seconds

3

What lab would you check when a patient is receiving heparin? 1. Thrombin 2. aPT 3. Platelets 4. aPTT

4

Which patient will the nurse apply pressure to an injection site for 5 minutes because of an increased risk for bleeding? 1. A 28-year-old who has had type 1 diabetes for 15 years. 2. A 42-year-old newly diagnosed with type 2 diabetes. 3. A 58-year-old with chronic hypertension and heart failure. 4. A 62-year-old with extensive liver damage from cirrhosis

4

Which order would the nurse perform the interventions listed on the plan of care for a patient with hemophilia who developed bleeding after a fall? 1. Administer prescribed analgesic 2. Rest the knee and pack in ice. 3. Administer specific coagulation factor 4. Encourage mobilization as soon as bleeding ceases.

4, 1, 2, 3

Place these pathophysiologic mechanisms of DIC in the order in which they occur. 1. Activation of the fibrinolytic system 2. Breakdown of thrombi; spontaneous hemorrhage 3. Consumption of coagulation factors; failure of regulatory mechanisms 4. Endothelial damage; release of tissue factor 5. Thrombi formation; clots form along epithelial walls

4, 5, 3, 1, 2

What foods are rich is Vitamin K? What would you expect would happen to the warfarin dose if there's an increase in vitamin K foods?

Green leafy vegetables contain the highest amount of vitamin K. (i.e., kale, collard greens, spinach, turnip greens, parsley, Brussels sprouts, broccoli, asparagus, lettuce, cabbage). Vitamin K helps clot your blood. • The warfarin dose would need to be increase

In considering the genetics of sickle cell anemia, you understand that V.L.'s inheritance of sickle cell anemia could have occurred A. If both of her parents had 1 gene for the HgSS B. if both of her parents have the CFTR gene. C. if one of her parents had the gene for HgSS. D. if one of her parents have the CFTR gene and one did not.

a

L.V. continues to have pain (9/10) with the IVP morphine PRN. What action would the nurse take? A. Contact the doctor, for possible PCA pump. B. Give the PRN dose of morphine early. C. Apply cold compress over painful joint D. Encourage ambulating twice around unit.

a

Which diagnostic finding would the nurse expect to find in a patient with acute disseminated intravascular coagulation (DIC) who experiences bleeding? A. Elevated D-dimer B. Elevated fibrinogen C. Reduced prothrombin time (PT) D. Reduced fibrin degradation products (FDPs)

a

tissue factor

a cellular lipoprotein that's exposed when tissue is injured

thrombocytopenia

a platelet count below 150,000

Which factors put a patient at risk for developing acute disseminated intravascular coagulation (DIC)? Select all that apply. A. Septicemia B. An extensive burn C. Abruptio placentae D. Severe head trauma E. Stroke

a, b, c, d

You review the lab work drawn on V.L. Select those results that are abnormal as a result of V.L.'s condition. There are 6 correct answers. A. Hbg 9.8 mg/dL B. Hct 27% C. Reticulocyte count 90,000/µL D. WBC 14,000 µ/L E. pH 7.41 F. PaCO2 38 G. HCO3 22 H. PaO2 74 mmHG I. SaO2 85%

a, b, c, d, h, i

Which parameters would the nurse assess while monitoring a patient for the development of disseminated intravascular coagulation (DIC) disorder? Select all that apply. A. Fibrinogen levels B. Hemoglobin levels C. Red blood cell count (RBC) D. White blood cell count (WBC) E. Partial thromboplastin time (PTT)

a, e

thrombin

activates fibrinogen to fibrin which then joins with other fibrin strands to form a stable clot

Can males with hemophilia A or B transmit the defective gene to a son? A. True B. False

b

Only people of African ancestry have sickle cell disease? A. True B. False

b

The nurse says, "I understand you have sickle cell disease". L.V. states, "I think I'm having a sickling episode. I have a lot pain and I want to get rid of this pain now." The nurse says, I'm going to get some oxygen, start an IV, throat culture, and draw some blood work". The ER physician ordered administration of D5/.45 NaCl at 125 mL/hr, oxygen at 6 L/min via nasal cannula, morphine 2 mg IVP PRN, and 650 mg acetaminophen orally. Of these orders, which is the highest priority to prevent complications related to sickling in this case? A. Oxygen B. IV fluids C. Morphine D. Acetaminophen

b

The nurse assesses a patient with disseminated intravascular coagulation (DIC) and expects to find which signs of hemorrhage? Select all that apply. A. azotemia B. Hemoptysis C. Hypotension D. Focal ischemia E. Abdominal distention

b, c, e

The nurse provides education to a patient with hemophilia about safety measures. Which statements made by the patient indicate an understanding of the teaching? (Select all that apply). A. "I should participate in contact sports." B. I should wear a Medic Alert tag wherever I go." C. "I should wear gloves while doing household chores." D. I should carry an epinephrine injection wherever I go." E. "I should immediately consult my health care provider after severe injury."

b, c, e

fibrinolysis

breaks down fibrin clot

A patient with possible DIC arrives in the ER with a BP of 82/40, T-102 °F, & severe back pain. Which prescribed action will the nurse implement first? A. Administer morphine sulfate 4mg IV. B. Give acetaminophen (Tylenol) 650 mg. C. Infuse normal saline 500 mL over 30 minutes. D. Obtain blood for CBC & coagulation studies.

c

The nurse would monitor a patient with thrombocytopenia for which major complication? A. Fatigue B. Weakness C. Hemorrhage D. Abdominal pain

c

When assessing V.L.'s current understanding of sickle cell anemia, which statement made by her indicates a need for further patient teaching? A. I should alternate my activities with rest periods so that I don't get so tired." B. "I may use the oxycodone until my pain can be controlled with acetaminophen." C. "I should use iron supplements to increase the normal hemoglobin in my blood." D. "I will be sure to get the Pneumovax and H. influenzae vaccines when I completely recover.

c

Which statement made by a student nurse indicates the need for additional teaching regarding the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? A. "It is stimulated by a disease process or disorder." B. "Bleeding occurs as a result of depletion of platelets." C. "It results from the surplus production of clotting factors." D. "DIC results from abnormally initiated and accelerated clotting

c

A patient with a platelet count of 52,000/mm 3 is diagnosed with thrombocytopenia. The nurse would expect which clinical manifestations? (Select all that apply. A. Weakness B. Bruising C. Dizziness D. Vomiting E. Petechiae

c, e

What 2 minerals are coagulation factors dependent on?

calcium and vitamin k

coagulation

complex multi-step process to achieve clot formation

The nurse is carefully monitoring a postpartum patient who experienced abruptio placentae for which sign of DIC? A. Pain and swelling in the leg B. Rapid clotting times C. Increased platelet levels D. Oozing from the injection sites

d

Which patient is most likely to experience hemophilia? Patient finding of: A. Bleeding time is 7 minutes B. Prothrombin time (PT) is 12 seconds C. Platelet level is 150,000/ mm3 D. Partial thromboplastin time (PTT) is 90 seconds

d

Which therapy should the nurse expect to be prescribed first by the healthcare provider for a patient who is bleeding from acute disseminated intravascular coagulation (DIC)? A. Aspirin. B. Whole Blood. C. Low molecular weight heparin D. Fresh frozen plasma.

d

fibrin

fibrous protein that forms strands, stabilizing them in a clot

PT

normal 11-12.5 seconds

aPTT

normal 30-40 seconds

platelets

normal level 150,000 to 400,000 lifespan 8-9 days

hemostasis

physiological process by which bleeding ceases

Why is anemia common in patients with SCD?

sickled RBCs are friable & rupture more easily than normal RBCs. Sickle cells die after about 20 days instead of 120. Vascular occlusions occurring in the kidneys lead to renal failure & result in decrease erythropoietin production.

d-dimer

test used for possible clot

INR

used to standardize the Pt test. normal 0.8-1.1 seconds