Chapter 23: Immune Thrombocytopenia Purpura (ITP) Flashcards
A 7-year-old child is admitted with suspected ITP. The nurse notes petechiae on the legs and mucosal bleeding in the mouth. Lab results show a platelet count of 12,000/mm³ with normal hemoglobin and white blood cell counts. Which intervention would the nurse anticipate?
A. Administering platelet transfusion immediately
B. Scheduling a bone marrow aspiration to confirm diagnosis
C. Starting intravenous immune globulin (IVIG) therapy
D. Observing the child without initiating treatment
C. Starting intravenous immune globulin (IVIG) therapy
Rationale: IVIG is an effective treatment for ITP with platelet counts <10,000/mm³ or active bleeding. Platelet transfusions are typically reserved for severe hemorrhage.
A child with ITP presents with a platelet count of 20,000/mm³ but no active bleeding. What management strategies should the nurse expect? (SATA)
A. Administration of corticosteroids
B. Careful observation without treatment
C. Frequent monitoring of platelet count
D. Administration of IVIG
E. Scheduling a splenectomy
B. Careful observation without treatment
C. Frequent monitoring of platelet count
Rationale: For platelet counts >10,000/mm³ with little or no bleeding, careful observation and regular monitoring are appropriate. Corticosteroids, IVIG, or splenectomy are reserved for more severe or chronic cases.
A child with ITP who has failed to respond to initial corticosteroid therapy continues to experience mucosal bleeding and a platelet count of 8,000/mm³. What intervention is likely next?
A. Repeat platelet transfusion
B. Intravenous anti-D immunoglobulin
C. Observation and reassurance
D. Immediate splenectomy
B. Intravenous anti-D immunoglobulin
Rationale: Intravenous anti-D immunoglobulin is often used in cases where corticosteroids or IVIG have failed. Splenectomy is reserved for chronic, refractory cases.
A 10-year-old patient with ITP has been experiencing thrombocytopenia for 14 months despite treatment with corticosteroids and IVIG. The patient has no active bleeding but reports fatigue and social difficulties due to frequent bruising. What is the next most appropriate intervention?
A. Continue observation and supportive care
B. Administer IV anti-D immunoglobulin
C. Schedule a splenectomy
D. Begin daily platelet transfusions
C. Schedule a splenectomy
Rationale: Splenectomy is an option for chronic ITP with significant impact on quality of life or lack of response to other treatments.
A nurse is preparing discharge instructions for a family of a child recently diagnosed with ITP. Which teaching points should be included? (SATA)
A. Avoid contact sports and activities that may cause injury.
B. Monitor for signs of severe bleeding, such as black tarry stools.
C. Administer aspirin for pain relief if needed.
D. Follow up regularly for platelet monitoring.
E. Encourage a diet high in iron to improve platelet production.
A. Avoid contact sports and activities that may cause injury.
B. Monitor for signs of severe bleeding, such as black tarry stools.
D. Follow up regularly for platelet monitoring.
Rationale: Avoiding injury, monitoring for bleeding, and regular follow-up are critical. Aspirin should be avoided due to its antiplatelet effects, and diet has no direct effect on platelet production in ITP.
What is the primary reason platelet transfusions are not commonly used in the treatment of ITP?
A. Platelet transfusions increase the risk of infection.
B. Platelet transfusions worsen thrombocytopenia by depleting clotting factors.
C. Platelets are unnecessary because the condition resolves spontaneously.
D. Platelets are destroyed quickly in ITP and offer only temporary control of bleeding.
D. Platelets are destroyed quickly in ITP and offer only temporary control of bleeding.
Rationale: In ITP, autoantibodies destroy transfused platelets, making transfusions ineffective for long-term management.
A nurse is caring for a child with ITP receiving IVIG therapy. What is the priority nursing assessment during the infusion?
A. Monitoring blood pressure for signs of hypotension
B. Assessing for symptoms of anaphylaxis
C. Checking platelet counts hourly
D. Evaluating for petechiae and bruising
B. Assessing for symptoms of anaphylaxis
Rationale: IVIG therapy carries a risk of hypersensitivity reactions, including anaphylaxis, which requires immediate intervention.
Which diagnostic finding is most indicative of ITP in a child?
A. Decreased platelet count with normal hemoglobin and white blood cell counts
B. Increased platelet count with decreased hemoglobin levels
C. Bone marrow aspiration showing increased megakaryocytes
D. Decreased platelet count with elevated white blood cell count
A. Decreased platelet count with normal hemoglobin and white blood cell counts
Rationale: ITP typically presents with isolated thrombocytopenia, while other blood parameters remain normal.
What is the most likely cause of ITP in children?
A. A genetic mutation affecting platelet production
B. Autoimmune destruction of platelets following an infectious illness
C. Chronic exposure to environmental toxins
D. Vitamin K deficiency
B. Autoimmune destruction of platelets following an infectious illness
Rationale: ITP is often an autoimmune condition that follows an infectious illness, leading to platelet destruction.
Which symptom would the nurse most likely observe in a child with a platelet count of 8,000/mm³ due to ITP?
A. Fever and tachycardia
B. Jaundice and abdominal pain
C. Petechiae and mucosal bleeding
D. Shortness of breath and cyanosis
C. Petechiae and mucosal bleeding
Rationale: Low platelet counts in ITP are commonly associated with petechiae, ecchymoses, and mucosal bleeding.
Which treatment options are commonly used in the management of ITP? (SATA)
A. Corticosteroids
B. Platelet transfusions for mild bleeding
C. Intravenous immune globulin (IVIG)
D. Splenectomy for chronic ITP
E. Bone marrow transplant
A. Corticosteroids
C. Intravenous immune globulin (IVIG)
D. Splenectomy for chronic ITP
Rationale: Corticosteroids, IVIG, and splenectomy are common treatments. Platelet transfusions are reserved for severe bleeding, and bone marrow transplant is not typically used.
Which symptoms should parents monitor for and report immediately in a child with ITP? (SATA)
A. Severe headache
B. Vomiting and diarrhea
C. Black or tarry stools
D. Decreased appetite
E. Gum or nosebleeds
A. Severe headache
C. Black or tarry stools
E. Gum or nosebleeds
Rationale: Severe headache may indicate intracranial bleeding, and black stools or gum bleeding are signs of active hemorrhage. These require prompt medical attention.
A 9-year-old child with ITP is admitted with mild petechiae but no active bleeding. The parents are anxious and ask about pain management options if the child gets a headache. What is the best response by the nurse?
A. “You can give aspirin as needed to control pain.”
B. “Use acetaminophen for pain, but avoid aspirin or ibuprofen.”
C. “Over-the-counter medications like ibuprofen are fine.”
D. “Avoid all pain medications to prevent further bleeding.”
B. “Use acetaminophen for pain, but avoid aspirin or ibuprofen.”
Rationale: Acetaminophen is preferred for pain management in children with ITP because aspirin and ibuprofen increase the risk of bleeding due to their antiplatelet effects.
The nurse is educating the parents of a child newly diagnosed with ITP about activities to avoid. Which statement by the parents indicates the need for further teaching?
A. “We will avoid sports like soccer and basketball.”
B. “Swimming will be a good activity for our child.”
C. “It’s safe for our child to ride a bike without a helmet.”
D. “We will keep our child away from rough play.”
C. “It’s safe for our child to ride a bike without a helmet.”
Rationale: Activities that pose a risk of head trauma, such as biking without a helmet, should be avoided.
A nurse is caring for a child with ITP who has frequent nosebleeds. What nursing interventions should be implemented to manage bleeding episodes? (SATA)
A. Place the child in a reclined position.
B. Apply firm pressure to the nose for 10 minutes.
C. Apply a cold compress to the bridge of the nose.
D. Administer acetaminophen for pain if the child complains of discomfort.
E. Administer aspirin to prevent clotting.
B. Apply firm pressure to the nose for 10 minutes.
C. Apply a cold compress to the bridge of the nose.
D. Administer acetaminophen for pain if the child complains of discomfort.
Rationale: Applying pressure and a cold compress helps control bleeding, while acetaminophen is appropriate for pain relief. Aspirin and a reclined position are contraindicated.
