Sherpath: Disorders of the Platelets and Clotting Factors

A patient with a purpuric rash and platelet count of 55,000 has just undergone a bone marrow biopsy. Which diagnostic test results would be expected from the biopsy for a diagnosis of immune thrombocytopenic purpura (ITP)? Increased granulocyte production Decreased erythrocyte production Impaired lymphocyte production The bone marrow results will be normal

The bone marrow results will be normal

The emergency department nurse triages several patients with Von Willebrand disease (vWD). Which patient should the nurse see first? The child with a cough and temperature of 102.4° F. The child with a headache after rolling off the couch who is lethargic. The child who complains of nausea and abdominal pain and is actively vomiting. The child with a platelet count of 125,000 who underwent femur fracture repair 3 days ago.

The child with a headache after rolling off the couch who is lethargic.

The nurse receives a report from the day shift on the assigned children with hemophilia. Which patient should the nurse see first? The child with influenza and a platelet level of 115,000. The child with gastroenteritis and a serum potassium level of 3.1. The child with a right arm fracture and a factor activity level of 48%. The child with hemoglobin of 9 after tonsillectomy.

The child with a right arm fracture and a factor activity level of 48%.

The mother of a child with hemophilia calls the provider's office and states that the child was struck with a baseball during a game. Which question, by the nurse, is most appropriate? "Can you see any obvious bleeding?" "Why was he playing baseball, anyway?" "Take him to the emergency department to be seen." "Where on his body did he get hit with the baseball?"

"Where on his body did he get hit with the baseball?"

The nurse is caring for a child with prolonged bleeding after losing a tooth. The nurse notes bruising around the gum line. Which laboratory values would be concerning to the nurse? Select all that apply. Hemoglobin 11 Fibrinogen level 467 Platelet count 162,000 2% factor VIII activity Prothrombin time (PT) 20 seconds

2% factor VIII activity Prothrombin time (PT) 20 seconds

A patient with frequent epistaxis presents to the clinic. The nurse notes that the enzyme-linked immunosorbent assay (ELISA) reveals a ristocetin cofactor (RCoF) level of 30 IU/dL. Which order can the nurse expect after the patient has been seen by the provider? Obtain hemoglobin level. Assess level of consciousness. Provide intravenous (IV) fluid bolus. Administer DDAVP intravenously.

Administer DDAVP intravenously.

A 12-month-old with a history of otitis media is in the office for her 1-year check-up. She was diagnosed at 9 months of age with immune thrombocytopenic purpura (ITP) and treated with intravenous immunoglobulin (IVIG). Which provider order should the nurse question? Obtain a platelet level. Perform a hearing screening. Assess for psychosocial delays. Administer MMR (measles-mumps-rubella) vaccine.

Administer MMR (measles-mumps-rubella) vaccine.

The nurse is caring for a child with disseminated intravascular coagulation (DIC) after a surgical procedure. The nurse notes continued bleeding from the ears and intravenous (IV) site and a hemoglobin of 6.7. The child has had no urine output for the past 2 hours. After notifying the health care provider, which orders would the nurse anticipate? Select all that apply. Insert Foley catheter. Establish a second IV access site. Administer clotting factor. Administer a normal saline fluid bolus. Transfuse packed red blood cells (PRBCs).

Administer clotting factor. Administer a normal saline fluid bolus. Transfuse packed red blood cells (PRBCs).

The nurse is caring for a 16-year-old admitted for complications of hemophilia. Which psychosocial interventions are important for the nurse to implement? Select all that apply. Allow friends to visit. Allow the patient to express feelings. Administer factor replacement as ordered. Assess the patient's understanding of safety precautions. Place padding over the bed rails, head board, and foot board. Ask the patient if he or she would like to be introduced to other patients of the same age with a similar diagnosis.

Allow friends to visit. Allow the patient to express feelings. Assess the patient's understanding of safety precautions. Ask the patient if he or she would like to be introduced to other patients of the same age with a similar diagnosis.

A female patient with Von Willebrand disease (vWD) presents with an open leg fracture after falling at cheerleading practice. The nurse notes no other fractures, but the bleeding continues after 35 minutes. Which action should the nurse take first? Assess the patient's hemoglobin. Administer an intravenous (IV) normal saline bolus. Apply a pressure dressing to the affected area. Initiate a transfusion of Von Willebrand factor.

Apply a pressure dressing to the affected area.

After the circumcision of a newborn male, the nurse notes prolonged bleeding. Which actions should the nurse take? Select all that apply. Administer an intravenous (IV) fluid bolus. Obtain a partial thromboplastin time (PTT). Administer oral analgesic medications. Apply gentle pressure for 10 to 15 minutes. Notify the provider about the prolonged bleeding time.

Apply gentle pressure for 10 to 15 minutes. Notify the provider about the prolonged bleeding time.

The parents of a 2-year-old report that the child has had episodes of epistaxis three times in the last week. On assessment, the nurse notes bruising across the chest and back. Which actions are important for the nurse to take? Select all that apply. Ask whether there is any gum bleeding when teeth are brushed. Administer a one-time fluid bolus of lactated Ringer's solution. Observe the parent-child interaction for signs of abuse. Determine length of time the bleeding lasts with each nosebleed. While obtaining the health history, ask specifically how the bruises occurred.

Ask whether there is any gum bleeding when teeth are brushed. Observe the parent-child interaction for signs of abuse. Determine length of time the bleeding lasts with each nosebleed. While obtaining the health history, ask specifically how the bruises occurred.

The nurse is caring for a patient with disseminated intravascular coagulation (DIC) after surgery. The nurse has given platelets and blood transfusions to the patient. Which physical assessment finding would be most concerning? Purpuric rash Dilated, fixed pupil Abdominal distention Bruising around the intravenous (IV) site

Dilated, fixed pupil

An emergency department nurse prepares to treat a child with disseminated intravascular coagulation (DIC) experiencing increased clotting. The nurse reviews the health care provider's prescriptions and prepares to administer which medication? Heparin Succimer Vitamin K Protamine sulfate

Heparin

A patient in the intensive care unit (ICU) had a nasogastric tube (NGT) placed for feeding. If the patient develops disseminated intravascular coagulation (DIC), what aspect of the tube needs to be checked? Placement in the abdomen Insertion site into the nares Feeding pump settings Connection to suction canister

Insertion site into the nares

A patient with immune thrombocytopenic purpura (ITP) is admitted to the hospital for medication therapy. The patient begins receiving intravenous (IV) steroids. What should the nurse plan to do to safely administer the medication? Select all that apply. Monitor for bleeding. Administer ibuprofen for discomfort. Monitor the transition from IV to oral steroids. Increase the dose of the medication if improvements are not seen. Abruptly stop the medication once improvements have been noted.

Monitor for bleeding. Monitor the transition from IV to oral steroids.

The nurse is caring for a 5-year-old patient who was struck by a car and has been admitted for observation. On assessment, the nurse notes a firm, distended abdomen; bleeding from the intravenous (IV) site and oozing from a head laceration. Which action should the nurse take first? Provide an oral analgesic. Administer an IV fluid bolus. Administer clotting factors. Notify the health care provider.

Notify the health care provider.

The nurse is caring for a 9-year-old who fell over the handlebars of a bike yesterday. The abdomen is distended, and the child has blood oozing from the nose and ears. Which actions should the nurse take? Select all that apply. Notify the health care provider. Prepare to administer intravenous (IV) antibiotics. Prepare the child for transfer to the intensive care unit (ICU). Prepare to give an IV fluid bolus. Prepare to administer ibuprofen for pain.

Notify the health care provider. Prepare the child for transfer to the intensive care unit (ICU)

The nurse is caring for a child with hemophilia after the child fell from a bike. The child reports abdominal pain and complains of leg pain. After an initial assessment during which vital signs are noted to be within the normal range, the nurse notes bruising over the lower abdomen, abdominal distention, and hematuria. Which priority order from the provider would the nurse anticipate? Obtain complete blood count (CBC). Initiate intravenous (IV) access. Obtain an abdominal computed tomography (CT) scan. Administer pain medication.

Obtain an abdominal computed tomography (CT) scan.

The nurse is caring for a pediatric patient with immune thrombocytopenic purpura (ITP) who is returning to the unit after a tonsillectomy. Which action by the nurse demonstrates appropriate understanding of patient safety? Pad the bed rails. Administer aspirin for pain. Start patient on a regular diet. Give the patient red cherry popsicles for comfort.

Pad the bed rails.

Which presentation is a nurse most likely to see in a patient with chronic immune thrombocytopenic purpura (ITP)? Confusion, tachycardia Petechial rash, bleeding gums Pallor, low oxygen saturation Distended abdomen, joint pain

Petechial rash, bleeding gums

During the medication reconciliation for a patient with Von Willebrand disease (vWD), the nurse notes the child has been taking ibuprofen as needed for headaches. Which action is most important for the nurse to take? Continue to give the ibuprofen as needed. Obtain an order for aspirin, as needed, for headache. Determine the frequency and severity of the patient's headaches. Provide additional education to the caregivers about avoiding medications that affect platelet function.

Provide additional education to the caregivers about avoiding medications that affect platelet function.

The nurse is caring for a child with immune thrombocytopenic purpura (ITP) who has intravenous (IV) fluids running at 25 mL/hr. The insertion site shows no sign of bleeding. The provider orders intramuscular (IM) ceftriaxone to treat a suspected bacterial infection. Which action is most important for the nurse to take? Administer the IM ceftriaxone. Assess for signs of abdominal bleeding. Stop the IV fluids while the medication is administered. Question the order for IM injection and have it changed to IV injection.

Question the order for IM injection and have it changed to IV injection.

The nurse is caring for a patient with Von Willebrand disease. The patient mentions his catch in the last football game. Which action is most important for the nurse to take? Select all that apply. Perform thorough neurological exam. Administer prophylactic DDAVP intravenously as ordered. Refer the child to the hospital social worker for follow-up. Provide the family and child with information to cope with the diagnosis. Discuss the importance of avoiding contact sports with the child and family.

Refer the child to the hospital social worker for follow-up. Provide the family and child with information to cope with the diagnosis. Discuss the importance of avoiding contact sports with the child and family.