Chapter 23: Von Willebrand Disease (VWD) Flashcards
A 13-year-old girl with von Willebrand disease is being evaluated for heavy menstrual bleeding. Which intervention should the nurse anticipate as part of her treatment plan?
A. Administration of IV Factor IX concentrate
B. Oral contraceptives to regulate bleeding
C. Administration of desmopressin (DDAVP)
D. Platelet transfusion for heavy bleeding
C. Administration of desmopressin (DDAVP)
Rationale: Desmopressin is the first-line treatment to promote the release of stored vWF and prevent or manage bleeding episodes. Platelet transfusions and Factor IX concentrate are not indicated for von Willebrand disease.
A child with von Willebrand disease is scheduled for a dental extraction. The nurse should ensure which pre-procedure intervention is completed?
A. Administration of desmopressin (DDAVP) before the procedure
B. Administration of oral anticoagulants to prevent clotting
C. Infusion of fresh frozen plasma 24 hours before the procedure
D. Monitoring the child for at least 24 hours post-procedure
A. Administration of desmopressin (DDAVP) before the procedure
Rationale: Desmopressin (DDAVP) is administered pre-procedure to prevent excessive bleeding. Fresh frozen plasma and oral anticoagulants are not used in von Willebrand disease management.
A nurse is assessing a 10-year-old child with suspected von Willebrand disease. Which clinical findings are consistent with this diagnosis? (SATA)
A. Recurrent nosebleeds
B. Easy bruising
C. Prolonged bleeding from minor cuts
D. Joint swelling and pain
E. Heavy menstrual bleeding
A. Recurrent nosebleeds
B. Easy bruising
C. Prolonged bleeding from minor cuts
E. Heavy menstrual bleeding
Rationale: Recurrent nosebleeds, easy bruising, prolonged bleeding, and menorrhagia are common in von Willebrand disease. Joint swelling and pain are typically associated with hemophilia.
A child with von Willebrand disease is admitted for a minor surgical procedure. What lab findings should the nurse expect?
A. Elevated von Willebrand factor levels
B. Decreased platelet count
C. Decreased clotting factor IX levels
D. Prolonged activated partial thromboplastin time (aPTT)
D. Prolonged activated partial thromboplastin time (aPTT)
Rationale: Prolonged aPTT is a characteristic finding in von Willebrand disease. Platelet counts are typically normal, and vWF levels are decreased.
Which explanation by the nurse best describes von Willebrand disease to the parents of a newly diagnosed child?
A. “It is a rare bleeding disorder caused by low levels of clotting factor IX.”
B. “It is a hereditary condition that affects the ability of the blood to clot properly due to abnormal von Willebrand factor.”
C. “It is an autoimmune condition that destroys the body’s platelets.”
D. “It is caused by a bacterial infection that affects the blood vessels.”
B. “It is a hereditary condition that affects the ability of the blood to clot properly due to abnormal von Willebrand factor.”
Rationale: Von Willebrand disease is a hereditary bleeding disorder characterized by abnormal vWF, which affects clot formation.
The nurse is teaching a family about managing their child’s von Willebrand disease. Which activity should the child avoid?
A. Swimming
B. Basketball
C. Walking
D. Reading
B. Basketball
Rationale: High-impact sports like basketball increase the risk of trauma and bleeding and should be avoided.
The nurse is preparing to educate parents about preventing bleeding episodes in a child with von Willebrand disease. Which points should be included? (SATA)
A. Use a soft-bristle toothbrush for oral care.
B. Avoid administering aspirin or ibuprofen.
C. Allow the child to play contact sports with proper protective equipment.
D. Monitor for signs of bleeding, such as prolonged nosebleeds.
E. Administer desmopressin (DDAVP) as prescribed for procedures.
A. Use a soft-bristle toothbrush for oral care.
B. Avoid administering aspirin or ibuprofen.
D. Monitor for signs of bleeding, such as prolonged nosebleeds.
E. Administer desmopressin (DDAVP) as prescribed for procedures.
Rationale: Soft-bristle toothbrushes prevent gum bleeding, aspirin and ibuprofen increase bleeding risk, and DDAVP is used to prevent bleeding during procedures. Contact sports should be avoided.
A child with von Willebrand disease develops a prolonged nosebleed at school. What is the nurse’s first action?
A. Administer IV von Willebrand factor concentrate.
B. Call the healthcare provider immediately.
C. Encourage the child to lie flat and elevate their legs.
D. Apply pressure to the nose and have the child lean forward.
D. Apply pressure to the nose and have the child lean forward.
Rationale: Applying pressure and positioning the child to lean forward helps control bleeding and prevent blood from entering the airway or stomach.
A nurse is educating the parents of a 5-year-old child with hemophilia about recreational activities. Which of the following activities should the nurse suggest as a safe option?
A. Football
B. Swimming
C. Basketball
D. Soccer
B. Swimming
Rationale: Swimming is a non-contact sport and is considered a safe activity for children with hemophilia. Contact sports like football, basketball, and soccer pose a higher risk of injury and bleeding.
A child with von Willebrand disease is interested in joining a local Boy Scouts troop. Which safety measure should the nurse recommend?
A. Ensure the child wears protective equipment when participating in activities.
B. Have the child avoid all physical activity to prevent injury.
C. Suggest the child only participate in verbal activities, not physical ones.
D. Discourage the child from joining as physical activity could be dangerous.
A. Ensure the child wears protective equipment when participating in activities.
Rationale: Protective equipment should be worn during any physical activities to minimize the risk of bleeding. Physical activities can still be safe if appropriate precautions are taken.
A nurse is assessing a 9-year-old child with hemophilia who is participating in a bike ride. The child suddenly experiences a mild bleeding episode. What is the nurse’s priority intervention?
A. Apply ice to the injured area and elevate it.
B. Administer a platelet transfusion.
C. Encourage the child to continue the activity to build endurance.
D. Restrict the child to bed rest for the rest of the day.
A. Apply ice to the injured area and elevate it.
Rationale: Applying ice and elevating the injured area is the first step in managing a bleeding episode. Platelet transfusion is not typically required for mild bleeding, and bed rest is not necessary unless recommended by the provider.
Which of the following should be included in the nurse’s teaching plan for the parents of a child with hemophilia regarding sports participation?
A. All sports should be avoided indefinitely.
B. Non-contact sports can be safely participated in with protective equipment.
C. Contact sports are encouraged to improve muscle strength.
D. The child should be limited to watching sports rather than participating.
B. Non-contact sports can be safely participated in with protective equipment.
Rationale: Non-contact sports, such as swimming or crafts, are safe for children with hemophilia when appropriate protective equipment is worn. Avoiding all sports is not necessary unless contraindicated by the healthcare provider.
A child with von Willebrand disease is diagnosed after laboratory results show decreased von Willebrand factor levels. The child’s teacher asks about safe activities for the child during gym class. What is the best response by the nurse?
A. “The child can participate in all gym activities without any restrictions.”
B. “The child should avoid any strenuous physical activity.”
C. “The child can participate in low-impact activities with proper safety measures.”
D. “The child should be excused from gym class entirely.”
C. “The child can participate in low-impact activities with proper safety measures.”
Rationale: Low-impact activities, such as swimming or walking, are generally safe for children with von Willebrand disease if proper safety measures are in place. Strenuous activities should be avoided to reduce the risk of injury and bleeding.
Which of the following should be included in the nursing care plan for a child with von Willebrand disease to prevent injury during leisure activities? (SATA)
A. Ensure that the child wears protective equipment appropriate for the activity.
B. Discourage all physical activity to prevent bleeding.
C. Educate coaches and teachers on how to manage bleeding episodes.
D. Encourage the child to engage in contact sports for physical strength.
E. Monitor the child for signs of bleeding during and after physical activity.
A. Ensure that the child wears protective equipment appropriate for the activity.
C. Educate coaches and teachers on how to manage bleeding episodes.
E. Monitor the child for signs of bleeding during and after physical activity.
Rationale: Wearing appropriate protective equipment, educating coaches and teachers, and monitoring for bleeding are important for ensuring the safety of children with von Willebrand disease during physical activities. Contact sports should be avoided.
A nurse is educating the parents of a child recently diagnosed with von Willebrand disease. Which of the following should the nurse include in the teaching plan regarding medication management?
A. “It is safe to administer aspirin for pain relief.”
B. “You should administer over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.”
C. “Acetaminophen should be used for pain management instead of aspirin or NSAIDs.”
D. “You should avoid all medications for pain management.”
C. “Acetaminophen should be used for pain management instead of aspirin or NSAIDs.”
Rationale: Acetaminophen is the recommended pain management for children with von Willebrand disease since it does not inhibit platelet function, unlike aspirin and NSAIDs.
