Med-Surg Chapter 30-heme-Good with EXP 160ish Q

Five days after the initiation of heparin therapy, a patient's platelet count falls to 50,000/µL. The nurse identifies that which measures are appropriate to reduce the risk of bleeding? Select all that apply.

A low platelet count is called thrombocytopenia. Because the patient has developed thrombocytopenia after five days of heparin therapy, the patient is experiencing heparin-induced thrombocytopenia. This can be managed by using protamine sulfate, which counteracts the effect of heparin. Heparin should be discontinued to reduce the risk of bleeding. A direct thrombin inhibitor should be administered to maintain anticoagulation. Platelet transfusions may increase the risk of thromboembolic events and should be avoided. Low-molecular-weight heparin is not indicated, because it can worsen the risk of bleeding.

A patient is treated with chemotherapy for Burkitt's non-Hodgkin's lymphoma (NHL). The nurse should monitor the patient for what complication?

A patient undergoing chemotherapy for Burkitt's non-Hodgkin's lymphoma (NHL) is at a risk of developing tumor lysis syndrome and would require frequent laboratory studies and monitoring. Renal dysfunction, peripheral neuropathy, and fluid electrolyte imbalances are caused by myeloma proteins, which are associated with multiple myeloma.

A patient completed a course of treatment for Hodgkin's lymphoma. The nurse anticipates that which diagnostic study will be performed to differentiate the residual tumor from fibrotic masses?

A positron emission tomography (PET) scan is used to determine the stage and then assess the patient's response to therapy; it helps to differentiate the residual tumor from fibrotic masses after treatment. Upper endoscopies are used to visualize suspected gastrointestinal involvement in Hodgkin's lymphoma. Peripheral blood analysis is used to evaluate Hodgkin's lymphoma, but is not used to differentiate a residual tumor from fibrotic masses after treatment. MRI is used to rule out central nervous system or bone marrow infiltration in Hodgkin's disease.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells?

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.

The nurse recognizes that which treatment option is appropriate for a patient diagnosed with chronic lymphocytic leukemia (CLL)?

A splenectomy and colony-stimulating factors are beneficial treatment options for chronic lymphocytic leukemia. α-interferons are mostly used for the treatment of chronic myelogenous leukemia. Intrathecal methotrexate is generally the preferred treatment option for patients with acute lymphocytic leukemia, because it is most commonly associated with CNS involvement. Autologous hematopoietic stem cell transplantation (HSCT) is used as a treatment option for patients with acute myelogenous leukemia. However, for patients with chronic lymphocytic leukemia, allogeneic HSCT is used.

The nurse recalls that which type of leukemia accounts for 80% of acute leukemia in adults?

AML accounts for 15%-20% of acute leukemia in children and 80% in adults.

After reviewing the diagnostic reports of a patient, the nurse suspects that a patient is experiencing acute lymphocytic leukemia (ALL) based on which findings? Select all that apply.

Acute lymphocytic leukemia is characterized by lymphoblasts in cerebrospinal fluid and hypercellular bone marrow with lymphoblasts. 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.

The nurse recognizes that which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow?

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.

The nurse expects that a patient will experience central nervous system manifestations with which type of leukemia?

Acute myelogenous leukemia is associated with neurologic manifestations such as CNS involvement and increased intracranial pressure. Acute myelogenous leukemia is associated with gingival hyperplasia, mild hepatosplenomegaly, and anemia. Chronic lymphocytic leukemia is associated with splenomegaly, lymphadenopathy, and hepatomegaly. Chronic myelogenous leukemia is associated with sternal tenderness, weight loss, joint pain, bone pain, and massive splenomegaly.

The nurse suspects heparin-induced thrombocytopenia (HIT) in a patient who is receiving heparin therapy. Which nursing interventions would be beneficial for this patient? Select all that apply.

Argatroban should be administered to a patient who has developed heparin-induced thrombocytopenia (HIT) to maintain anticoagulation. Plasmapheresis should be performed to clear the platelet-aggregating immunoglobulin G from the blood. Heparin should be immediately discontinued when HIT is first recognized to prevent further complications. Vascular catheters should also be removed. Platelet transfusions will not be beneficial in the patient, because they may enhance thromboembolic events.

The nurse presents information to a group of nursing students about treatment for disseminated intravascular coagulation (DIC) and should include what information?

As a part of collaborative care, it is necessary to diagnose disseminated intravascular coagulation (DIC) disorder quickly through oxygenation or volume replacement to control the thrombosis and bleeding. If chronic DIC disorder is diagnosed in a patient who is not bleeding, no therapy for DIC disorder is required. Treatment of the underlying disease is sufficient to reverse DIC disorder. If the patient with DIC disorder is bleeding, the therapy requires providing support with necessary blood products that aim to treat the primary disorder.

The nurse recalls that which tests are considered primary methods for diagnosing leukemias? Select all that apply.

Bone marrow examination and peripheral blood evaluation are considered primary methods for diagnosing and classifying types of leukemias. Lumbar puncture and CT scan are used to detect leukemic cells outside of the blood and bone marrow. Morphologic and histochemical examinations are used to detect cell type and stages of development.

A patient is diagnosed with acute lymphocytic leukemia (ALL). The nurse identifies that which assessment finding is associated with the diagnosis?

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.

Which term is used to indicate the solid masses that result from collection of leukemic cells?

Chloromas refers to the solid masses that result from collection of leukemic cells. Purpura refers to purple spots that occur on the skin as a result of a low platelet count. Petechiae are small red or purple spots on the skin from bleeding. Ecchymosis is discoloration of the skin from bleeding.

The nurse reviews documentation of assessment findings of a patient with severe anemia. The nurse should question which assessment finding?

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.

The nurse recalls that which blood product is prepared from fresh frozen plasma and is available in 10 to 20 mL/bag?

Cryoprecipitate is a blood product prepared from fresh frozen plasma and is available in 10 to 20 mL/bag. Platelets are prepared from fresh whole blood in which an apheresed single donation contains 200 to 400 mL of platelets. Frozen RBCs are prepared from RBCs using glycerol for protection and can be stored for 10 years. Packed RBCs are prepared from whole blood by sedimentation or centrifugation and contain 250 to 350 mL in one unit.

The nurse recalls that which product results from the breakdown of fibrin?

D-dimer is a polymer resulting from the breakdown of fibrin. Thrombin is an enzyme in blood plasma that causes clotting of blood by converting fibrinogen to fibrin. Fibrinogen is a soluble protein present in blood plasma, from which fibrin is produced by the action of the enzyme thrombin. Prothrombin is a clotting factor that is needed for the normal clotting of blood.

The nurse cares for a patient with mild hemophilia A. Which treatment does the nurse anticipate to be prescribed for this patient?

Desmopressin acetate (DDAVP) is beneficial for a patient with mild hemophilia A and certain subtypes of von Willebrand disease. It is a synthetic analog of vasopressin and may be used to stimulate an increase in factor VIII and vWF. Splenectomy is indicated only if the patient does not respond to drug therapy. Intravenous immunoglobulin is used in a patient who is unresponsive to corticosteroids or splenectomy. Romiplostim therapy is used in a patient with chronic immune thrombocytopenic purpura (ITP) who had an insufficient response to the other treatments or who has a contraindication to splenectomy.

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.

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.

The nurse reviews a patient's diagnostic results which reveal the presence of Reed-Sternberg cells. The nurse recalls that the cells are indicative of what condition?

Hodgkin's lymphoma is a malignant condition characterized by proliferation of abnormal giant, multinucleated cells called Reed-Sternberg cells, which are located in lymph nodes.

The nurse cares for a patient with hemophilia that experiences bleeding in a knee joint. What should be included in the initial plan of treatment?

In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

The nurse provides teaching to a group of nursing students about leukostasis and should include what information about the process?

Leukostasis involves thickening of the blood and blocking circulatory pathways by leukemic WBCs in the peripheral blood. Abnormal genes causing cancer are called oncogenes. Solid masses formed from collections of leukemic cells are called chloromas. Accumulation of dysfunctional cells because of loss of regulation in cell division occurs due to leukemia. These are the processes involved in the pathophysiology of leukemia.

The nurse recognizes that which disorder is the most common cause of mortality in patients with polycythemia vera?

The major cause of morbidity and mortality from polycythemia vera is related to thrombosis (e.g., stroke). Leukemia may develop in some patients with polycythemia vera; however, the incidence is low. The patient may develop heart failure, but it is not common. Pulmonary edema is not common in patients with polycythemia vera.

A patient is diagnosed with acute lymphocytic leukemia (ALL). Which diagnostic finding supports the conclusion?

The x-ray of a patient with acute lymphocytic leukemia shows transverse lines of rarefaction at the ends of the metaphysis of the long bones. Low leukocyte alkaline phosphatase is associated with chronic myelogenous leukemia. Acute lymphocytic leukemia is associated with a low platelet and RBC count. Acute myelogenous leukemia is characterized by hypercellular bone marrow with myeloblasts.

The nurse cares for a patient that is newly diagnosed with disseminated intravascular coagulation (DIC). What is the primary goal of the plan of care?

Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

It is suspected that a patient is experiencing tumor lysis. The nurse should prepare the patient for what diagnostic study?

A blood test is instrumental in determining if tumor lysis has occurred due to complications of chemotherapy in non-Hodgkin's lymphoma disease. Barium enemas, upper endoscopies, and CT scans are used to visualize suspected gastrointestinal involvement in non-Hodgkin's lymphoma.

A patient is scheduled for a hematopoietic stem cell transplant (HSCT) and receives preoperative combination chemotherapy. What is the nursing priority?

After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding usually is not a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

The nurse expects to observe which manifestations in a patient who experienced an acute blood loss of 2000 mL? Select all that apply.

Air hunger, clammy skin, and a decreased central venous pressure are the clinical manifestations seen in a patient who has sustained 2000 mL of acute blood loss. Lactic acidosis may occur in cases of 2500 mL of acute blood loss. Rare vasovagal syncope may occur if 500 mL of acute blood loss occurs.

A patient is suspected to have non-Hodgkin's disease. The nurse anticipates a prescription for what diagnostic test to rule out central nervous system (CNS) disease?

An MRI scan is used to diagnose non-Hodgkin's disease and to rule out central nervous system or bone marrow infiltration. A PET scan with CT is used to stage and then assess the response to therapy. Peripheral blood analysis is used to diagnose Hodgkin's lymphoma. Bone marrow examinations are used to diagnose multiple myeloma and leukemia.

After an upper endoscopy with biopsy, a patient is diagnosed with Helicobacter pylori gastric lymphoma. What type of therapy does the nurse expect to find on the patient's treatment plan of care?

Antibiotic or antiviral therapy treats Helicobacter pylori gastric lymphoma by eradicating the microbes. Phototherapy is used to treat a diffuse state of cutaneous T-lymphoma. Radiation therapy is used to treat non-Hodgkin's lymphoma. Topical chemotherapy treats peripheral T- cell lymphoma.

The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse should plan to stay in the patient's room until what time?

As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.

The oncology nurse is administering a chemotherapeutic agent to a patient with relapsed Hodgkin's lymphoma. Which medication administered will most likely have the best outcome for this patient?

Brentuximab vedotin (Adcetris) is a newer agent that is a recommended drug used to treat relapsed or refractory Hodgkin's lymphoma disease by releasing an agent that disrupts the microtubule network. Fludarabine, mitoxantrone, and cyclophosphamide are used as combination chemotherapy to treat non-Hodgkin's lymphoma.

The nurse recalls that which disease originates from B-cell blasts present in the lymph nodes?

Burkitt's lymphoma is a highly aggressive disease that originates from B-cell blasts in lymph nodes. Hodgkin's lymphoma originates from proliferation of Reed-Sternberg cells. Diffuse large B-cell lymphoma originates at lymph nodes of the neck and abdomen. Non-Hodgkin's lymphoma (NHL) originates outside the lymph nodes.

The white blood cell count of a patient with leukemia is 120,000 cells/µL. The nurse identifies that which emergency treatment would be most beneficial for the patient?

Certain patients with leukemia may develop a high white blood cell count with more than 100,000 cells/µL. These patients may require initial emergency treatment with leukapheresis. This procedure involves removal of the white blood cells from the blood. Antitumor antibiotics are given in combination with other chemotherapeutic agents during different stages of chemotherapy but may not be used for emergency treatment. Monoclonal antibodies, like rituximab, are used to treat chronic lymphocytic leukemia, but may not be effective for emergency treatment. Hematopoietic stem cell transplantation is used to eliminate leukemic cells from the body, but may not be effective for emergency treatment.

Which type of lymphoma originates from lymph nodes, usually in the neck or abdomen?

Diffuse large B-cell lymphoma is an aggressive lymphoma that arises in the lymph nodes of the neck or abdomen. Burkitt's lymphoma originates from B-cell blasts in the lymph nodes. Small lymphocytic lymphoma (SLL) and chronic lymphocytic leukemia (CLL) result from malignant proliferation of small B-lymphocytes.

The diagnostic reports of a patient with severe bleeding reveal elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT). The nurse suspects that the patient is experiencing which condition?

Disseminated intravascular coagulation (DIC) increases the prothrombin time (PT) and activated partial thromboplastin time (aPTT) because of impaired synthesis of clotting factors. The PT and aPTT are normal in heparin-induced thrombocytopenia (HIT), immune thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP).

A patient that receives baby aspirin therapy has developed thrombocytopenia. The nurse recognizes that normal platelet function will be restored when what occurs?

Drug-induced thrombocytopenia affects the platelet aggregation and normal function is restored when new platelets are formed. Vitamin C, aspirin in low doses, and quinine in tonic water can cause thrombocytopenia.

The assessment findings of a patient with hemophilia A include ecchymosis and subcutaneous hematomas. The patient is prescribed desmopressin acetate. The nurse recognizes that the medication is expected to produce what therapeutic outcome?

Ecchymosis and subcutaneous hematomas are the clinical manifestations of bleeding in a patient with hemophilia A. Desmopressin acetate is used to stimulate an increase in factor VIII in patients with hemophilia. An increase in platelet count is a therapeutic outcome related to corticosteroids and immunosuppressants, which are used in the treatment of thrombocytopenia. An increase in hemoglobin is seen in the patients who are receiving erythropoietin therapy for anemia. Granulocyte colony-stimulating factors such as filgrastim and pegfilgrastim are used in the treatment of neutropenia. These drugs stimulate the production of neutrophils, thereby increasing the neutrophil count.

The nurse recalls that the role of folic acid in erythropoiesis is what?

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.

The nurse recalls that which therapy is appropriate to be prescribed for both indolent and aggressive non-Hodgkin's lymphoma (NHL)?

Hematopoietic stem cell transplants (HSCT) are used to treat both indolent and aggressive non-Hodgkin's lymphoma (NHL). Radioimmunotherapy and intrathecal chemotherapy are used to treat aggressive lymphoma. Combination chemotherapy with localized radiation is used to treat indolent or low grade NHL.

The nurse assesses a patient with disseminated intravascular coagulation (DIC) and determines that the patient does not evidence signs of life-threatening hemorrhage. The nurse anticipates a prescription for which therapy when the benefit outweighs the risk?

Heparin therapy is used in the treatment of disseminated intravascular coagulation (DIC) disorder only when the benefits outweigh the risks. Heparin, if not used with caution, may cause uncontrolled bleeding, which may be life-threatening. Blood product support with platelets, cryoprecipitate, and fresh frozen plasma is usually reserved for a patient with life-threatening hemorrhage. If bleeding occurs due to thrombocytopenia, that is, if the platelet count is less than 20,000/µL or 50,000/ µL, then platelets are administered. Cryoprecipitates are administered if the fibrinogen level is below 100 mg/dL. Fresh frozen plasma is administered if bleeding occurs due to deficiency of plasma clotting factors.

The nurse recognizes that bleeding manifestations in a patient with disseminated intravascular coagulation (DIC) may be caused by what pathophysiologic factors? Select all that apply.

In disseminated intravascular coagulation (DIC), the consumption of platelets decreases the platelet counts, leading to bleeding. Depletion of coagulation factors may prevent clotting and increase the risk of bleeding. The fibrin split products (FSPs) may disintegrate any clot formed, thus increasing the risk of bleeding. Fibrinolysis in the microcirculation and thrombotic occlusion of microcirculation in organs are the factors that cause thrombotic manifestations in a patient with DIC.

The nurse assesses a patient who has severe anemia and expects to find which manifestations? Select all that apply.

In severe anemia (Hgb less than 6 g/dL [60 g/L]), the patient has many clinical manifestations involving multiple body systems, including jaundice, pruritus, glossitis, smooth tongue, vertigo, dyspnea at rest, and sensitivity to cold. The patient will not have sensitivity to heat.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors?

Infectious agents, such as malaria, are c extrinsic factors that can lead to acquired hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased RBC destruction and are hereditary (intrinsic) factors, Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias.

The nurse assesses tiny red spots on the skin of a patient with leukemia.. The nurse recalls that the events that led to the red spots occur in what chronologic order?

Leukemia is a condition characterized by the proliferation of immature white blood cells that are malignant, or blast, cells. In this condition, blast cells replace bone marrow, causing bone marrow failure and leading to a low platelet count. Low platelet counts are associated with bleeding, which causes red spots on the skin, known as petechiae.

The nurse reviews a patient's medical record and suspects heparin-induced thrombocytopenia (HIT). Which finding supports the nurse's conclusion?

Long-term heparin therapy can causes heparin-induced thrombocytopenia (HIT) that results in decrease in the platelet count. A platelet count of 100,000/µL indicates HIT. Immune thrombocytopenic purpura (ITP) will be suspected if the patient has a viral infection. Thrombotic thrombocytopenic purpura (TTP) will be suspected if the patient has hemolytic anemia and an autoimmune disorder like systemic lupus erythematosus.

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.

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 provides information about non-Hodgkin's lymphoma to a group of nursing students. What is appropriate to be included in the education about the disease?

Non-Hodgkin's lymphomas are a heterogeneous group of malignant neoplasms of primarily B-cell, T-cell, or natural killer (NK) cell origin. Non-Hodgkin's lymphoma is disseminated. Non-Hodgkin's lymphoma is characterized by 40 percent B symptoms and common extra-nodal involvement.

The nurse reviews a patient's medical record and notes the presence of Epstein-Barr (EBV) virus and painless lymph node enlargement in the cervical chain. The nurse expects a prescription for what medication?

Painless lymph node enlargement is a clinical manifestation of non-Hodgkin's lymphoma (NHL), which may be caused by the Epstein-Barr virus. Rituximab treats NHL by acting on CD20 antigens on the surface of normal and malignant B cells. Bleomycin, vinblastine, and doxorubicin are used to treat Hodgkin's lymphoma.

The nurse reviews a patient's history and identifies that what finding is the likely cause of the patient's thrombocytopenia?

Quinine, which is used in many herbal preparations and tonic water, accelerates platelet destruction caused by drug-dependent antibodies. Antibodies attack the platelets when the offending agent binds to the platelet surface. Aspirin alters platelet aggregation. Anti-infectives such as ganciclovir and chemotherapeutic drugs such as vincristine decrease platelet count by myelosuppression. Acetaminophen does not affect blood coagulation in and of itself.

A patient with non-Hodgkin's lymphoma (NHL) develops tumor lysis syndrome. For which complication should the nurse monitor?

Renal failure is a nonspecific manifestation of non-Hodgkin's lymphoma that may occur in patients due to tumor lysis syndrome. Jaundice, bone pain, and paraplegia are unrelated to tumor lysis syndrome

The nurse is reviewing the lab reports of several patients. Which report is consistent with a diagnosis of thrombocytopenia?

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 provides education about thrombotic thrombocytopenic purpura (TTP) to a group of nursing students and should include what information?

Thrombotic thrombocytopenic purpura (TTP) is an uncommon syndrome associated with hemolytic-uremic syndrome because both disorders are acute and characterized by thrombocytopenia and microangiopathic hemolytic anemia. TTP is caused by the deficiency of a plasma enzyme (ADAMTS13). TTP is considered as a medical emergency because bleeding and clotting occur simultaneously. TTP is associated with increased platelet aggregation; this causes the formation of microthrombi, which can get deposited in arterioles and capillaries.

Which syndrome is caused by the deficiency of plasma enzyme ADAMTS13?

Thrombotic thrombocytopenic purpura (TTP) is caused due to the deficiency of plasma enzyme ADAMTS13. Without the enzyme, unusually large amounts of von Willebrand factor will attach to activated platelets and promote platelet aggregation. Increased use of heparin causes heparin-induced thrombocytopenia (HIT). Immune thrombocytopenic purpura (ITP) is caused by decreased platelet production. Overstimulation of proteins involved in clotting factors can result in disseminated intravascular coagulation (DIC).

Which instruction should the nurse give to a patient who is newly diagnosed with acquired immunodeficiency syndrome (AIDS)?

Uncooked meat is a potential source of toxoplasmosis cysts, and although they do not cause disease in healthy people they are a major source of encephalitis in patients with acquired immunodeficiency syndrome. Wearing gloves while preparing meals, restricting visitors, and washing dishes and utensils in diluted bleach solution are unnecessary because human immunodeficiency virus is not spread through any of these means.

When preparing to administer a unit of packed red blood cells, the nurse should inform the patient of the nurse's plan to stay at the bedside for how many minutes after the transfusion begins?

As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction most often will exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes. Five minutes is too short a time.

An adult patient is diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what?

Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell (WBC) count and risk of leukemia cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In asymptomatic patients with chronic lymphocytic leukemia (CLL), but not those with AML, waiting may be done to attain remission.

The nurse provides dietary teaching to a patient with anemia and should include which food sources to promote red blood cell (RBC) maturation? Select all that apply.

Avocado contains niacin, which is required for the maturation of RBC. Red meat is rich in cobalamin (Vitamin B12). Cobalamin is an essential nutrient that plays an important role in erythropoiesis by enhancing the RBC maturation. Therefore, the nurse would expect these two food sources to promote red blood cell (RBC) maturation. Shellfish contains copper, which is an essential nutrient useful for mobilization of iron from tissues to plasma. Bananas and cornmeal are rich in pyridoxine (Vitamin B6), which is essential for hemoglobin synthesis.

The nurse is caring for a young adult recently diagnosed with acute myelogenous leukemia (AML). The onset of the illness was abrupt, and family members are attempting to adjust to the patient's sick role. Identify characteristics of the sick role. Select all that apply

Characteristics of the sick role include dependence, alteration of familial roles and responsibilities, and withdrawing from family and friends. The patient in the sick role does not exercise as much independence as possible. The patient in the sick role does not refuse to follow the primary health care provider's advice regarding work restrictions.

The diagnostic findings of a patient indicate accumulation of small, mature-appearing lymphocytes in the bone marrow. The nurse identifies that the patient is most likely experiencing what disorder?

Chronic lymphocytic leukemia is associated with the accumulation of small, mature-appearing lymphocytes in the bone marrow. Myelogenous leukemia is characterized by the proliferation of myeloblasts. Acute lymphocytic leukemia is characterized by the uncontrolled proliferation of immature small lymphocytes in the bone marrow. Chronic myelogenous leukemia is characterized by the proliferation of mature neoplastic granulocytes in the bone marrow.

A patient is admitted to the emergency department in a state of shock with acute blood loss. The nurse reviews the patient's plan of care and should perform the interventions in what order?

Collaborative care is initially concerned with replacing blood volume to prevent shock. The source of the hemorrhage should then be identified in order to stop the blood loss. Once volume replacement is established, RBC loss is corrected by administering packed RBCs. The patient may also need supplemental iron because the availability of iron affects the marrow production of erythrocytes.

A patient experiences a minor bleeding episode during a dental procedure. The nurse recognizes that which therapy will be beneficial?

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.

A patient is hospitalized with suspected Hodgkin's lymphoma. The nurse expects what assessment finding?

Enlarged lymph nodes are a characteristic of Hodgkin's disease that occurs in the initial stage of development. Skeletal pain is a characteristic of multiple myeloma. B-cell blasts in the lymph nodes indicate Burkitt's lymphoma. Lymphoblasts in the cerebrospinal fluid are a diagnostic finding of acute lymphocytic lymphoma.

A patient with Hodgkin's lymphoma experiences sensory and motor impairment of the lower limbs. What does the nurse suspect to be the cause of this condition?

Impairment of sensory and motor function of the lower extremities is known as paraplegia. Paraplegia occurs with extradural involvement of the lymphoma due to spinal cord compression. Bone involvement causes bone pain. Intrathoracic involvement results in superior vena cava syndrome. Enlarged retroperitoneal nodes may lead to abdominal masses.

A patient with leukemia is undergoing maintenance therapy. The nurse recalls what information about this course of treatment?

In maintenance therapy, treatment is provided every three to four weeks for a prolonged period with lower doses of the drugs. Intensification therapy is the high-dose treatment given immediately after induction therapy. Intensification and consolidation are the terms used to describe post-induction or post-remission therapy; 70 percent of patients diagnosed with leukemia achieve complete remission after induction therapy, not maintenance therapy.

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has what level of severity of anemia?

In mild anemia, hemoglobin is in the range of 10-12 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In severe anemia, it is less than 6 g/dL. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

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?

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.

A patient receives a prescription for ferrous gluconate. The nurse should provide education related to what potential side effect?

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.

Which non-Hodgkin's lymphoma is included in the classification of T-cell and NK-cell lymphomas?

Lymphoblastic lymphoma is an example of immature T-Cell lymphoma. Burkitt's lymphoma, mantle cell lymphoma, and small lymphocytic lymphoma are examples of B-Cell lymphomas.

The nurse reviews a treatment plan of a patient with leukemia that is receiving chemotherapy. The plan includes low doses of chemotherapy every three or four weeks. Which stage of chemotherapy does this indicate?

Maintenance therapy involves treatment with lower doses of drugs given every three to four weeks for a prolonged period. Induction therapy involves an aggressive treatment to destroy leukemic cells in the tissues, peripheral blood, and bone marrow; it aims at attaining remission. Consolidation therapy is used to eliminate leukemic cells that are not clinically or pathologically evident. Intensification therapy is given after induction therapy; it involves high doses of drugs.

A patient takes immunosuppressive medication for the treatment of psoriatic arthritis. The nurse identifies that the patient is at risk for what complication related to this treatment regimen?

Non-Hodgkin's lymphoma can happen to a patient on immunosuppressive medication for the treatment of an autoimmune disorder. Multiple myeloma occurs due to environmental factors such as exposure to radiation, toxic metals, and herbicides. Hodgkin's lymphoma is caused by either an Epstein-Barr infection or a genetic predisposition. Myelodysplastic syndrome occurs in patients who have received radiation therapy or chemotherapy with alkylating agents.

A patient is diagnosed with coagulopathy and receives a prescription for warfarin therapy. The nurse provides dietary education. Which statement made by the patient indicates that the teaching was effective?

Patients on warfarin therapy must be taught to identify foods high in vitamin K and to consume consistent amounts daily. Patients should be advised not to eat large amounts of green, leafy vegetables sporadically as this decreases the effectiveness of warfarin. A balanced diet that includes a consistent amount of vitamin K is necessary to maintain good health. As such, patients should not avoid foods containing vitamin K. Vitamin K is found in many fruits, vegetables, and meats.

The nurse provides discharge teaching to a patient with sickle cell disease (SCD). Which statements made by the patient indicates understanding of the teaching? Select all that apply.

Patients with SCD should avoid crises, but avoiding activities that cause hypoxia. Regular screenings for retinopathy are recommended. The pneumococcal injection is recommended to prevent infection. Eating uncooked seafood increases the risk of infection; this type of product is rich in iron and should be avoided. The patient should not drink orange juice too often, because orange juice is rich in Vitamin C.

Which instruction is beneficial for the nurse to provide to a patient diagnosed with pernicious anemia?

Pernicious anemia is characterized by decreased secretion of hydrochloric acid in the stomach due to autoimmune-mediated destruction of parietal cells and thereby causes an increased risk for gastric cancer. The patient with cobalamin deficiency can develop pernicious anemia, so the patient should consume foods such as red meat, fish, milk and dairy products. Patients with thalassemia may contract hepatitis C from blood transfusions.

The nurse recognizes that which diagnostic study is helpful in determining the clinical stage of Hodgkin's lymphoma?

Positron emission tomography (PET) with CT is helpful to define all sites and determine the clinical stage of Hodgkin's lymphoma. Barium enemas and upper endoscopies are used to diagnose any suspected gastrointestinal involvement in non-Hodgkin's lymphoma. MRI scans are used to rule out central nervous system or bone marrow infiltration.

A patient with acute myelogenous leukemia (AML) has completed the prescribed cycles of cytotoxic chemotherapy, and documentation indicates that the patient is in partial remission. How should the nurse interpret this documentation?

Remission is a phase in which the patient does not exhibit any cancer symptoms. In partial remission, symptoms are absent and the blood smear is normal, but the disease may be evident in the bone marrow. If a patient is in molecular remission, there are no signs of residual leukemia in molecular studies. In minimal residue disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing. A complete remission means that there is no evidence of the disease on physical examination, and the bone marrow and peripheral blood appear normal.

Which drug that is used for patients with thrombotic thrombocytopenic purpura (TPP) has the ability to decrease the level of inhibitory ADAMTS13 IgG antibodies?

Rituximab has the ability to decrease the level of inhibitory ADAMTS13 IgG antibodies, thus reducing the immune recognition of platelets. Prednisone has the ability to suppress the phagocytic response of splenic macrophages. Argatroban is a direct thrombin inhibitor. IV immunoglobulin acts by competing with the antiplatelet antibodies for macrophage receptors in the spleen.

A patient receives a prescription for rituximab. Prior to administering the medication, the nurse should check the patient's history for which condition?

Rituximab is used to treat non-Hodgkin's lymphoma. The nurse should check for hepatitis before administering the medication because this drug may reactivate hepatitis.

The nurse recognizes that which assessment finding is related to cognitive-perceptual health patterns in a patient with leukemia?

Sore throat is an assessment finding related to cognitive-perceptual health patterns in a patient with leukemia. Nausea comes under the nutritional-metabolic health pattern. Epistaxis is an assessment finding related to activity-exercise. Easy bruising also comes under the nutritional-metabolic health pattern.

Positron emission tomography (PET) with computed tomography (CT) scan reveals the presence of mediastinal lymphadenopathy in a patient diagnosed with Hodgkin's disease. The nurse recalls that these procedures can also identify what other abnormalities? Select all that apply.

Spleen infiltration and abnormal lymph node enlargement can be diagnosed by concomitant use of PET and CT scans. PET scans are performed to detect an increased uptake of malignant cells, and CT scans are performed to detect abnormal cell masses that occur in Hodgkin's lymphoma. Magnetic resonance imaging can detect distinct lytic areas of bone erosion. Hypoferremia is detected by blood tests.

The nurse recognizes that a factor assays laboratory test may produce a false positive result when used to diagnose disseminated intravascular coagulation (DIC) disorder. This misleading lab finding is likely related to which factor that rises with inflammation?

The factor assays laboratory tests measure prothrombin (PT) levels and factors such as V, VIII, X, and XII. Misleading results may occur, because factors V and VIII level rises with inflammation. Factors VI, X, and XII are not affected by inflammation and are not associated with false positive results.

The nurse is caring for a patient admitted for treatment of sickle cell disease (SCD). The nurse recalls that with repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially which one?

With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O2, like the lungs, are most often affected and form the basis for many of the complications of SCD. Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

A patient who has been receiving chemotherapy now has severe neutropenia. Which assessment finding requires immediate action by the nurse?

A low-grade fever in neutropenic patients is of great significance because it may indicate infection and lead to septic shock and death unless treated promptly. Neutropenic fever (greater than 100.4° F [38.1° C]) in a severely neutropenic patient is a medical emergency. Patients who have had chemotherapy commonly may experience nausea, anorexia, and fatigue. The blood pressure is normal.

What should the nurse consider to be the highest priority when caring for a patient with thrombocytopenia?

A patient with thrombocytopenia has a very low platelet count and an impaired clotting mechanism. Any injury, even a minor one, could cause spontaneous hemorrhage, internally or externally. Quiet, pain medication, and ambulation are not priority aspects of nursing care in regard to thrombocytopenia.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation?

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 creates a plan of care for a patient with disseminated intravascular coagulation (DIC) and should include what nursing diagnosis that is related to the disease process and therapy?

Anxiety related to fear of the unknown, the disease process, diagnostic procedures, and therapy may be observed in a patient with disseminated intravascular coagulation (DIC). Decreased cardiac output is related to fluid volume deficit. Peripheral edema does not occur with DIC. There is no change in level of consciousness with DIC.

A patient is scheduled to receive a transfusion of two units of packed red blood cells. The nurse would ask which health team member to assist in checking the unit before administration?

Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. If there is not another nurse available, a health care provider could check the blood with the nurse. The unit secretary and UAP are not licensed to perform this duty.

The nurse recalls that which type of deficiency causes hemophilia B in a patient?

Christmas factor, or factor IX, is a clotting protein and its deficiency causes hemophilia B; this leads to prolonged or spontaneous bleeding. Iron deficiency causes anemia. Anti-hemophilic factor, or factor VIII deficiency, causes hemophilia A. Von Willebrand coagulation protein deficiency causes von Willebrand disease.

A patient with initial symptoms of immune thrombocytopenic purpura (ITP) receives corticosteroid therapy. The nurse recalls that the medication will produce which results? Select all that apply.

Corticosteroids reduce capillary leakage by altering capillary permeability. Corticosteroids also depress antibody formation by decreasing immunoglobulin synthesis and by lympholytic action. Rituximab has the ability to lyse activated B cells. Danazol increases CD4+T cells. Romiplostim increases platelet production.

The nurse recognizes that cryoprecipitate therapy is helpful in the treatment of disseminated intravascular coagulation (DIC) because it replaces what factor?

Cryoprecipitates may be required in disseminated intravascular coagulation (DIC) disorder when the fibrinogen levels are less than 100 mg/dL. This therapy helps to replace factor VIII, which plays a major role in clotting. Cryoprecipitates do not replace factors V, X, and XIII.

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?

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 is suspected to have acute disseminated intravascular coagulation (DIC). The nurse expects that which laboratory test will be prescribed to confirm the presence of fragmented erythrocytes?

Fragmented erythrocytes or schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Peripheral blood smear test detects the presence of fragmented erythrocytes. Factor assays, soluble fibrin monomer, and fibrin split products (FSPs) tests do not detect the presence of fragmented erythrocytes; however, they are useful in determining the degree of fibrinolysis.

The nurse is teaching a group of nursing students about disseminated intravascular coagulation (DIC). Which statement made by a student indicates the need for further teaching?

In DIC, there is an acceleration of clotting with subsequent decreases in clotting factors and platelets, so the blood is not properly clotting. The decrease in clotting factors and platelets results in significant uncontrolled bleeding. HELLP syndrome is a complication of pregnancy and a risk factor for DIC.

A nursing student is caring for a patient with thrombocytopenia under the supervision of a registered nurse. Which action by the student indicates an understanding of proper care for this patient?

Intramuscular injection should be avoided in a patient with thrombocytopenia because hematomas may develop on the injected site due to improper clotting of blood. Ice packs should be applied after injection to provide comfort. Applying direct pressure on the injected site will reduce the risk of hematoma, so direct pressure should not be avoided. Using a large-gauge needle for subcutaneous injection will cause bleeding.

A patient experiences acute blood loss following a motor vehicle accident. Which erythrocyte characteristic would the nurse expect to see in the laboratory findings?

Normocytic, normochromic erythrocytes are seen in patients with acute blood loss following an accident. Microcytic, hypochromic erythrocytes are seen in patients with iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, or lead poisoning. Megaloblastic erythrocytes are seen in patients with vitamin B12 deficiency, folic acid deficiency, or liver disease.

A patient with hemophilia has developed inhibitors to factors VIII and IX. The nurse recognizes that which replacement factor will be beneficial for the patient?

NovoSeven is a replacement factor that is beneficial for a patient who has developed inhibitors to factors VIII or IX. Xyntha and alphanate are replacement factors that are beneficial for a patient who has factor VIII deficiency. Mononine is a replacement factor that is beneficial for a patient who has factor IX deficiency.

The nurse reviews the history of a patient with acute disseminated intravascular coagulation (DIC). The nurse identifies which factors that put the patient at risk for DIC? Select all that apply.

Risk factors associated with acute disseminated intravascular coagulation (DIC) include severe head injury, abruptio placentae, extensive burns, and septicemia. ARDS is not a risk factor for acute DIC.

A patient is taking iron tablets for the management of anemia. The nurse is aware that which measures will ensure maximum absorption of iron from the tablets? Select all that apply.

Taking iron tablets an hour before food ensures maximum absorption, because iron will not get bound to food. When iron binds with food, absorption of iron falls. Orange juice and ascorbic acid enhance iron absorption. Taking iron tablets with food can reduce iron absorption. Taking iron tablets before or after exercise does not affect absorption.

A patient experiences thrombocytopenia. The nurse should monitor the patient for which major complication?

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 recognizes that patients with von Willebrand disease are at risk for prolonged bleeding times for what reason?

Von Willebrand disease is characterized by a deficiency of the von Willebrand coagulation protein and variable factor VIII deficiencies and platelet dysfunction. Therefore the bleeding time is prolonged in the patient with von Willebrand disease. Adequate platelet production does not alter the normal bleeding time in a patient. Deficiency in intrinsic clotting system factor will alter the PTT. Impairment of thrombin fibrinogen reaction alters the thrombin time.

A nurse is caring for a patient with anemia that requires lifelong iron supplementation. To ensure maximum effectiveness of the therapy, what should the nurse include in the patient's plan of care? Select all that apply.

While undergoing therapy the nurse should evaluate the improvement in hemoglobin levels during every visit and should take necessary steps if hemoglobin levels do not improve. Long-term iron supplementation can cause liver dysfunction; therefore the patient should be evaluated for liver function abnormalities. Iron therapy should be continued for two to three months after hemoglobin levels return to normal to replenish the iron stores in the body. Iron supplementation should not be stopped once hemoglobin levels are back to normal. Iron therapy is not associated with psychologic problems; hence there is no need to monitor for psychologic changes.

The nurse creates patient teaching information related to heparin therapy. The nurse recalls that heparin should never be given to a patient with a history of what?

With HIT, heparin causes decreased platelet counts and increases the risk for hemorrhage. Patients who have had HIT should never be given heparin or low-molecular heparin (LMWH). This should be clearly marked in the patient's medical record. Splenomegaly is an enlarged spleen; this often occurs with anemia and autoimmune disorders. Hepatic encephalopathy occurs in alcoholic clients when brain tissue is destroyed due to decreased thiamine. Thromboembolism is another term for blood clot; heparin is used to treat clots and would not cause them.

While taking undiluted liquid iron that was prescribed, a patient asks the nurse why it must be drunk through a straw. How should the nurse respond?

An undiluted iron preparation causes staining of the teeth if consumed without using a straw. Such preparations should therefore be taken using a straw. Compared to drinking undiluted liquid iron without a straw, consuming it with a straw does not boost iron absorption, reduce iron absorption, or reduce allergic reactions.

The nurse recognizes that which assessment finding in a patient with disseminated intravascular coagulation (DIC) is a thrombotic manifestation?

A patient with disseminated intravascular coagulation (DIC) disorder may have bleeding and thrombotic manifestations. Thrombotic manifestations occur due to fibrin or platelet deposition in the microvasculature. Decreased urinary output or oliguria is a sign of thrombotic manifestation. Presence of blood in urine (hematuria) or presence of blood in stools indicates that the patient is exhibiting bleeding manifestations. Increased body temperature is a clinical manifestation seen in a patient with neutropenia caused by infections.

A patient who is at risk for disseminated intravascular coagulation (DIC) experiences shortness of breath and increased heart rate. The nurse expects what other symptoms that indicate thrombotic manifestations? Select all that apply.

A patient with disseminated intravascular coagulation (DIC) disorder may show thrombotic manifestations due to fibrin or platelet deposition in the microvasculature. Thrombotic manifestations include shortness of breath and an increase in heart rate, which are called dyspnea and tachycardia, respectively. The other thrombotic manifestations include cyanosis and abdominal pain. Dizziness, joint pains, and vision changes are manifestations of bleeding that occur due to depletion of platelets and coagulation factors.

Which nursing intervention would be helpful to a patient with hemophilia who experiences severe joint bleeding?

A patient with hemophilia who experiences joint bleeding should have the involved joint totally immobilized. Pressure should also be applied with ice to prevent crippling deformities from hemarthrosis. Aspirin should not be given, because it will further increase the bleeding. Physical therapy should be provided after the bleeding stops. Elevating the affected extremity does not stop bleeding in the joint.

The diagnostic findings of a patient indicate uncontrolled proliferation of myeloblasts. The nurse anticipates that what drugs will be prescribed for induction therapy?

Acute myelogenous leukemia (AML) is characterized by the uncontrolled proliferation of myeloblasts. The most common therapy for induction of AML includes a combination of cytarabine and antitumor antibiotics, like idarubicin. Imatinib and dasatinib are used in the treatment of chronic myelogenous leukemia. Rituximab and alemtuzumab are are used in the treatment of chronic lymphocytic leukemia. Carmustine and 6-mercaptopurine are used in the treatment of chronic myelogenous leukemia.

A patient with respiratory distress experiences a white blood cell count of more than 100,000 cells/µL. Immediate treatment has been prescribed. The nurse suspects that the patient is experiencing what condition?

An increase in the white blood cell count in the peripheral blood to more than 100,000 cells/μL causes thickening of the blood and blocks the circulatory pathways. This condition, known as leukostasis, may lead to respiratory distress and can be life threatening. Lymphoma involves malignant neoplasms, which originate in the bone marrow and lymphatic structures, and results in the proliferation of lymphocytes. Thalassemia is a group of diseases involving inadequate production of normal hemoglobin. A decrease in the number of neutrophils is known as neutropenia.

The nurse provides teaching to a group of nursing students about Hodgkin's lymphoma and includes information that the disease most commonly starts in the lymph nodes in what locations?

Hodgkin's lymphoma originates in cervical lymph node in 80% of patients. The mediastinal lymph node is the second most common location that Hodgkin's lymphoma will spread to. Hodgkin's lymphoma also initially occurs in the axillary and inguinal lymph nodes.

Which laboratory report findings support the nurse's conclusion that a patient has thalassemia major? Select all that apply.

Thalassemia major is characterized by the presence of increased bilirubin levels, serum iron levels, and reticulocyte level. Thalassemia major is also characterized by the presence of decreased mean corpuscular volume and total iron-binding capacity.

A patient that reports recent weight loss, fever, and night sweats is diagnosed with chronic lymphocytic leukemia. The nurse expects what dianostic findings? Select all that apply.

Clinical manifestations of CLL include splenomegaly, lymphadenopathy, and hepatomegaly. Diagnostic findings include mild anemia, thrombocytopenia, and total white blood cell (WBC) count greater than 100,000/mcL. Hemoglobin levels decrease. Sternal tenderness does not occur in CLL.

The nurse assesses enlarged retroperitoneal nodes in a patient with Hodgkin's lymphoma. The nurse should monitor the patient for which complication?

Enlarged retroperitoneal nodes may cause palpable abdominal masses, which can interfere with renal function. Spinal cord compression causes paraplegia. If Hodgkin's lymphoma begins to affect the liver, bilirubin levels will increase and the patient will suffer from jaundice. Superior vena cava syndrome can occur due to intrathoracic involvement.

A patient with factor VIII deficiency experiences joint bleeding. Which nursing interventions to include in the patient's plan of care? Select all that apply.

Factor VIII deficiency leads to hemophilia, which is a severe bleeding disorder. When joint bleeding occurs, the joint should be packed in ice to reduce bleeding. Analgesics such as acetaminophen should be provided to reduce pain. When bleeding is stopped, the patient should be encouraged to perform range-of-motion exercises to increase mobilization. Aspirin should be avoided because it may increase bleeding. Weight bearing activity should be performed when the swelling has decreased and muscle strength has returned.

A patient diagnosed with advanced-stage lymphoma reports fever, night sweats, and weight loss. The nurse recognizes that which medication may be beneficial?

Fever, night sweats, and weight loss are B symptoms that occur in patients diagnosed with high-grade lymphoma. Prednisone is an aggressive chemotherapeutic agent used to treat advanced-stage lymphoma. Vincristine, mitaxantrone, and tositumomab are used y to treat non-Hodgkin's lymphoma.

The nurse provides education to a patient with a low platelet count about precautions to be taken. Which statements made by the patient indicates effective learning? Select all that apply.

Flossing is usually safe for patients with low platelet counts only if it is done gently using thin tape floss. Applying firm pressure to the nostrils and bridge of the nose would be beneficial to stop or decrease a nosebleed. Alcohol-based mouth washes should not be used, because they may dry the gums and increase bleeding. Patients with low platelet counts should not use tampons, because they may increase the risk of bleeding. Therefore it is advisable to use sanitary pads during menstruation. Suppositories cannot be used without the permission of the primary health care provider, because improper use may increase the risk of bleeding in patients with low platelet counts.

The nurse recalls that which condition results in anemia due to synthesis of defective DNA in the body?

Folic acid deficiency can cause the synthesis of defective deoxyribonucleic acid (DNA) and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency.

The student nurse lists the obstetric conditions that may predispose a pregnant patient to acute disseminated intravascular coagulation (DIC). Which condition is life-threatening and assumed to be a type of severe preeclampsia?

HELLP syndrome is a life-threatening liver disorder thought to be a type of severe preeclampsia. It is characterized by hemolysis, elevated liver enzymes, and low platelet count. Therefore the student nurse lists HELLP syndrome as an obstetric condition that may predispose a pregnant patient to acute disseminated intravascular coagulation (DIC) disorder. A septic abortion is a form of miscarriage that is associated with a serious uterine infection. An abruptio placenta is the premature separation of the placenta from the uterus. Amniotic fluid embolism is an obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the maternal circulation, causing cardiopulmonary collapse.

The nurse provides education to a group of nursing students about hematopoietic stem cell transplantation (HSCT) therapy as treatment for acute lymphocytic leukemia (ALL). What is appropriate for the nurse to include in the education?

Hematopoietic stem cell transplantation (HSCT) involves removal of the patient's hematopoietic stem cells. Patients with allogeneic HSCT may show signs of infections like pneumonia. There are chances of relapse of leukemia after HSCT therapy. HSCT is associated with complications in patients with allogeneic HSCT. These complications include graft-versus-host disease.

Which statement is true regarding hemophilia?

Hemophilia decreases the clotting ability of the blood in a patient and can be treated by replacement therapy during acute phases of bleeding. Hemophilia is hereditary in nature. Hemophilia is an X-linked recessive genetic disorder. The most common form of hemophilia is hemophilia A

The nurse reviews the medical record of a patient with acute myelogenous leukemia (AML) and expects what finding?

Hypercellular bone marrow with myeloblasts indicates AML. Hypercellular bone marrow with lymphoblasts and presence of lymphoblasts in cerebrospinal fluid are observed in acute lymphocytic leukemia (ALL). An increase in peripheral lymphocytes and lymphocytes in the bone marrow are noted in chronic lymphocytic leukemia (CLL).

Imatinib is prescribed as treatment for leukemia. What is its mechanism of action?

Imatinib is a newer therapeutic agent used as targeted therapy. It acts by targeting BCR-ABL protein. Arsenic trioxide acts by inhibiting angiogenesis and cell proliferation, and causing DNA fragmentation and cell death.

The nurse provides education to a group of student nurses about the staging system of Hodgkin's and non-Hodgkin's lymphomas. Which statement made by a student nurse indicates the need for further teaching?

In stage II of Hodgkin's disease and non-Hodgkin's disease, there is an involvement of two or more lymph nodes on one side of the diaphragm, but not both sides of diaphragm. In stage I, there is an involvement of a single lymph node, generally the cervical node. In stage IV, there is involvement outside the diaphragm, such as the liver or bone marrow. In stage III there is lymph node involvement above and below the diaphragm

The nurse concludes that a patient has von Willebrand disease based on a decreased von Willebrand coagulation protein (vWF) and which other laboratory parameters? Select all that apply.

Increased bleeding time is observed in patients with von Willebrand disease because of structurally defective platelets. The patient with von Willebrand disease will have a deficiency in the intrinsic clotting system factor; therefore the partial thromboplastin time may be prolonged. Decreased factor IX is associated with Hemophilia B. The thrombin time remains normal in patients with von Willebrand disease because it does not impair thrombin-fibrinogen reaction. A decreased platelet count is seen in patients with thrombocytopenia. However, platelet counts remain normal in von Willebrand disease because there will be adequate platelet production.

A patient is undergoing aggressive chemotherapy treatment, during which the patient becomes critically ill. The nurse recognizes that the findings indicate that the patient is in which stage of chemotherapy?

Induction therapy involves an aggressive treatment to destroy leukemic cells in the tissues, peripheral blood, and bone marrow to attain remission. The patient becomes critically ill during this therapy, because the chemotherapeutic agents severely depress the bone marrow. Maintenance therapy involves treatment with lower doses of drugs for a prolonged period. Consolidation therapy is given after remission is achieved and is used to eliminate leukemic cells that are not clinically or pathologically evident. Intensification therapy involves high doses of drugs and is given after induction therapy and after remission is achieved.

A patient is diagnosed with ineffective peripheral tissue perfusion and acute pain. The patient's history includes chronic disseminated intravascular coagulation (DIC). The nurse should monitor the patient for what assessment finding that is associated with DIC?

Ineffective peripheral tissue perfusion and acute pain are the nursing diagnoses related to a patient with chronic disseminated intravascular coagulation (DIC) disorder. The priority nursing intervention while caring for the patient is to examine for cyanosis of the extremities. Cyanosis is related to the widespread clotting that occurs along with thrombi or emboli and impairs tissue perfusion. Bleeding causes a drop in blood pressure. Elevation in blood pressure is not associated with DIC. In DIC, bowel sounds would be decreased due to thrombotic occlusion of blood vessels. Prothrombin time (PT) is prolonged in a patient with DIC.

A patient experiences thrombocytopenia due to consumption of certain herbs. The nurse suspects that which mechanism of thrombocytopenia occurred?

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 cares for a patient with iron-deficiency anemia. Which nursing diagnostic statement associated with the condition is the highest priority?

Iron is necessary for hemoglobin synthesis. Hemoglobin is responsible for oxygen transport in the body. With iron-deficiency anemia a subnormal hemoglobin level cannot carry enough oxygen to the tissues. This results in impaired tissue oxygenation caused by impaired gas exchange. Deficient fluid volume and decreased cardiac output are not directly associated with iron-deficiency anemia. An impaired breathing pattern may develop as a result of impaired gas exchange.

The nurse identifies that which sign of microvascular thrombosis observed in a patient with disseminated intravascular coagulation (DIC) is associated with the integumentary system?

Ischemic tissue necrosis, such as gangrene, is a sign of microvascular thrombosis associated with the integumentary system. Paralytic ileus is associated with the gastrointestinal (GI) system. ECG changes and venous distention are associated with the cardiovascular system.

The nurse provides information to a student nurse about the stages of chemotherapy for a patient with leukemia. Which statement made by the student indicates effective learning?

Maintenance therapy involves treatment with a lower dose of drugs for a prolonged period than what is used in induction therapy. The patient becomes critically ill during induction therapy, because it involves severe bone marrow depression. Induction therapy is an aggressive treatment to destroy leukemic cells and to restore normal hematopoiesis. Consolidation therapy is given to eliminate the leukemic cells that are clinically non-evident.

The nurse is caring for a patient with leukemia. The nurse recalls that which condition may occur due to infiltration of leukemic cells in the patient's body systems?

Meningeal irritation may occur due to infiltration of leukemic cells in patient's body systems such as the central nervous system. Bone marrow failure may lead to replacement of bone marrow with blast cells thereby causing anemia. Leukostasis is thickening of the blood potentially blocking circulatory pathways, which is caused by a high leukemic white blood cell count in the peripheral blood. Bone marrow failure may impair the production of platelets leading to thrombocytopenia.

The nurse provides education to a patient with hemophilia about safety measures. Which statements made by the patient indicates an understanding of the teaching? Select all that apply.

Patients with hemophilia should not participate in contact sports to prevent cuts and abrasions. Patients with hemophilia should wear a Medic Alert tag to ensure that health care providers know about the hemophilia in case of an accident. Patients with hemophilia should wear gloves while doing household chores to prevent any cuts or abrasions. Patients with hemophilia should immediately consult a physician after severe injury because bleeding may cause complications. Patients with hemophilia are at risk for bleeding, not allergic reactions.

Which finding supports the nurse's conclusion that a patient has pernicious anemia?

Pernicious anemia is characterized by the presence of a smooth, beefy-red tongue, and abdominal pain. Platelet function is reduced in the patient with leukemia; therefore, bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron deficiency anemia.

The nurse provides care for a patient experiencing thrombocytopenia. It is likely that platelets administration will be prescribed when what occurs? Select all that apply.

Platelet administration is indicated in a patient with a blood platelet count of 8,000/µL to maintain normal platelet count. Administering platelets is beneficial if a patient has anticipated bleeding before a procedure to prevent the risk of hemorrhage. Immunosuppressive therapy is indicated when refractory cases are observed. Splenectomy is indicated when the patient does not respond to drug therapy. Administration of platelets is contraindicated in a patient with thrombotic thrombocytopenic purpura (TTP) because it may lead to new von Willebrand factor-platelet complexes and increased clotting.

The nurse recalls that the events that lead to heparin-induced thrombocytopenia occur in what order?

Platelet destruction and vascular endothelial injury are the two major responses to an immune-mediated response to heparin. Initially, platelet factor 4 (PF4) binds to heparin. This complex then binds to the platelet surface and more platelet factor 4 (PF4) are released. Because of this a positive feedback loop is created. Antibodies are created against the complex, and they are removed prematurely from circulation, leading to thrombocytopenia and platelet-fibrin thrombi.

A patient with thrombocytopenia is being discharged from the hospital. What should the nurse include in the education? Select all that apply.

Self-care measures to reduce the risk of bleeding include notifying the health care provider of any black, tarry stools, as this is a sign of upper gastrointestinal bleeding. The patient should notify the health care provider of difficulty speaking or sudden weakness in the extremities. This can indicate the patient may be experiencing an intracerebral hemorrhage. Patients with thrombocytopenia should not take aspirin or ibuprofen, as these drugs increase the risk of bleeding. Patients with thrombocytopenia should not use a razor blade to shave; an electric razor is preferred due to bleeding potential. Constipation should be avoided by increasing fluid intake and using stool softeners. Enemas and rectal suppositories should be avoided, as their use may result in bleeding.

A patient that is receiving chemotherapy treatments develops neutropenia. The nurse recognizes that what interventions are appropriate to be included in the patient's plan of care? Select all that apply.

Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4°F or more, but temperature is not monitored every hour.

The patient with leukemia is diagnosed with acute disseminated intravascular coagulation (DIC) and experiences bleeding. The nurse expects what diagnostic finding?

The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. Fibrinogen and platelets are reduced. PT, partial thromboplastin time (PTT), activated partial thromboplastin time (aPTT), and thrombin time are all prolonged. FDP is elevated as the breakdown products from fibrinogen and fibrin are forme

The nurse recalls that which diagnostic finding is a hallmark of chronic myelogenous leukemia (CML)?

The Philadelphia chromosome is present in 90 to 95 percent of patients with chronic myelogenous leukemia (CML) and is referred to as a diagnostic hallmark of chronic myelogenous leukemia. Thrombocytopenia is not specific for CML. It is common in any type of leukemia. Acute lymphocytic leukemia (ALL) is usually associated with the presence of lymphoblasts in the cerebrospinal fluid. ALL and chronic lymphocytic leukemia are associated with hypercellular bone marrow with lymphoblasts.

When preparing to administer a prescribed blood transfusion, the nurse should select which intravenous (IV) solution to prime the blood tubing?

The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It also is 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. Dextrose and lactated Ringer's solutions cannot be used with blood, because they will cause red blood cell (RBC) hemolysis.

The nurse provides discharge teaching to a patient with chronic anemia. What should the nurse include in the education?

The cause of chronic anemia is often inadequate dietary intake of foods high in iron. In most cases of iron-deficiency anemia, the condition may be prevented by consuming a nutritionally balanced diet. Attending a nutrition education session will increase compliance with the recommended diet. Taking supplements of vitamin C, which will increase iron absorption from the GI tract, avoiding large crowds, and discussing the possibility of long-term supplemental iron injections will not have a direct effect on post-discharge management of anemia.

The nurse anticipates that which combinations of chemotherapeutic agents will be prescribed during induction therapy for a patient with acute myelogenous leukemia? Select all that apply.

The common combination of chemotherapeutic agents used during induction therapy for acute myelogenous leukemia includes cytarabine and an antitumor antibiotic. Antitumor antibiotics include idarubicin, daunorubicin, and mitoxantrone. Rituximab is used for treating chronic lymphocytic leukemia. Ofatumumab is used for treating chronic lymphocytic leukemia.

A nurse mentor provides teaching to a group of nursing students about the cardiac manifestations of severe anemia. Which compensatory cardiac changes should the nurse include? Select all that apply.

The compensatory cardiac symptoms of severe anemia are tachycardia, heart failure, and intermittent claudication. The cardiac murmurs that occur in severe anemia are systolic, not diastolic, in nature. In severe anemia, there is an increase in pulse pressure.

The nurse assesses a patient with pernicious anemia and expects to find what classic sign of this condition?

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.

A neutropenic patient is hospitalized with a febrile episode. The nurse identifies that which action is appropriate for inclusion on the plan of care and should be performed first?

The first nursing intervention for a febrile neutropenic patient is to administer a broad spectrum antibiotic by IV route within one hour. Because of the rapid lethal effects of infection, this should be done even before obtaining cultures to determine a specific causative organism. Administration of a broad spectrum antibiotic by the IV route is preferred to oral antibiotic for initial management because it is the faster administration method.

The nurse identifies that the stages of chemotherapy for the treatment of leukemia are administered in what order?

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 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?

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.

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?

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 provides education to a patient with leukemia that is receiving chemotherapy. What is appropriate for the nurse to include in the teaching?

The leukemia patient may be hospitalized or relocated to a treatment center. During this time the nurse should make the patient feel comfortable by saying, "You can feel free to communicate your problems to me, and don't think that you are isolated." The nurse should teach the patient that the side effects of treatment are usually temporary; it is not known if any of them will be permanent. There is no data to support that the patient requires assistance getting out of bed. The nurse should encourage the patient to discuss their quality-of-life issues.

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?

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 peptic ulcer disease reports presence of blood in stools. The laboratory results reveal a hemoglobin level of 10 g/dL and a total iron level of 40 mcg/dL. The nurse expects what clinical manifestations? Select all that apply.

The normal range of total serum iron level is 50 to 175 mcg/dL. 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 10 g/dL and total iron of 40 mcg/dL are indicative of iron deficiency anemia, which may be due to blood loss from peptic ulcer disease. The clinical manifestations of iron deficiency anemia are pallor, cheilitis (inflammation of the lips), and paresthesias. Hepatomegaly may occur in patients with thalassemia due to iron deposition. Jaundice occurs due to prominent hemolysis of red blood cells in patients with thalassemia.

To determine the presence of external bleeding, the nurse should assess which patient clinical parameter?

The nurse assesses parameters such as petechiae and injection sites to determine the signs of external bleeding. The nurse should assess other parameters such as heart rate, mental status, and abdominal girth to determine the signs of internal bleeding.

A patient has a prescription written at 1000 for two units of packed red blood cells. If the transfusion is picked up from the laboratory at 1015, the nurse should plan to hang the unit no later than what time?

The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank, which would be at 1045. 1030, 1100, and 1115 are not consistent with this policy.

The nurse suspects a patient may have von Willebrand disease. Which assessment finding supports the nurse's suspicion?

The nurse would suspect a bleeding disorder such as von Willebrand disease if a patient experiences abnormally prolonged bleeding following a tooth extraction. An elevated platelet count usually results in abnormal clotting. Hypertension is not related to bleeding; blood loss is associated with hypotension. A fractured scapula following positioning in the bed could indicate osteoporosis.

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?

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.

A patient with chronic disseminated intravascular coagulation (DIC) experiences episodes of bleeding. Which interventions are appropriate to be included in the patient's plan of care? Select all that apply.

The patient with chronic disseminated intravascular coagulation (DIC) disorder may experience episodes of bleeding due to microvascular thrombosis and hemorrhage. Gingival oozing is a sign of hemorrhage in DIC. Oozing of blood from the gums should be reported to determine the effectiveness of the therapy. Using a soft toothbrush to clean the teeth reduces damage to mucosal surfaces. Hematuria is also a sign of hemorrhage in a patient with DIC. Therefore instructing the patient to observe stools and urine for the presence of blood will help in the effective management of the patient's condition. Routine blood tests include CBC, blood smears, PT and PTT, D-dimer, and fibrinogen. Hematocrit levels and white blood cell counts should be monitored in a patient with neutropenia.

Before beginning a transfusion of red blood cells (RBCs), which nursing action is the highest priority to avoid an error during the procedure?

The patient's identifying information (name, date of birth, medical record number) on the ID 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 transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringers because it will cause red blood cell (RBC) hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, because this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

A patient is receiving heparin therapy. The nurse anticipates a prescription for warfarin therapy based on what assessment finding?

The platelet count of 150,000/mcL in a patient who is on heparin therapy indicates heparin-induced thrombocytopenia (HIT) and requires warfarin therapy. The platelet count of 180,000/mcL does not indicate the need for warfarin therapy in the patient. Warfarin reverses HIT and prevents microvascular thrombosis in the patient. Plasmapheresis should be performed during severe clotting. Thrombolytic agents should be used to treat a thromboembolic event.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. What primary explanation should the nurse give?

The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

The nurse recalls what information about the Philadelphia chromosome's role in leukemia?

The protein that is encoded by the newly created BCR-ABL gene on the Philadelphia chromosome interferes with normal cell cycle events such as the regulation of cell proliferation. The Philadelphia chromosome is not specific to diagnose CML, because it is also found in ALL and occasionally in AML. The Philadelphia chromosome is present in 20 to 25 percent of patients with ALL. It is present in 90 to 95 percent of patients with CML and is a diagnostic hallmark of CML.

The nurse identifies that which therapies are reserved for patients with disseminated intravascular coagulation (DIC) with a life-threatening hemorrhage? Select all that apply.

Therapies with blood products such as platelets, cryoprecipitates, and fresh frozen plasma are reserved for patients with life-threatening hemorrhage. Heparin is used in the treatment of disseminated intravascular coagulation (DIC) only when the benefits of using it outweigh the risks. Antithrombin III (ATnativ) is used in the treatment of a patient with fulminant DIC.

The nurse concludes that a patient with gingival bleeding and petechiae on the skin is experiencing thrombotic thrombocytopenic purpura (TTP). Which assessment findings support the nurse's conclusion? Select all that apply

Thrombotic thrombocytopenic purpura (TTP) is characterized by hemolytic anemia, which increases reticulocytes because of bleeding. Hemoglobin is decreased in TTP because of bleeding. The laboratory reports of a patient with TTP will show decreased haptoglobin, increased schistocytes, and increased indirect bilirubin.

Which body system should the nurse assess to determine the signs of external bleeding in a patient with disseminated intravascular coagulation (DIC)?

To determine the signs of external bleeding in a patient with disseminated intravascular coagulation (DIC) disorder, the nurse assesses the integumentary system. The nurse assesses the neurologic, cardiovascular, and gastrointestinal systems for internal bleeding.

A patient is in a limited stage of cutaneous T-cell lymphoma. Which treatment administered by the oncology nurse would be most beneficial for this patient?

Topical chemotherapy is beneficial in a patient who is in a limited stage of cutaneous T-cell lymphoma. Phototherapy, α- interferon therapy, and oral bexarotene therapy are used to treat diffuse cancer.