Chapters 30 and 31 Study guide Questions Flashcards
During physical assessment of a patient with thrombocytopenia, what would the nurse expect to find?
a. Sternal tenderness
b. Petechiae and purpura
c. Jaundiced sclera and skin
d. Tender, enlarged lymph nodes
b. Petechiae are small, flat, red, or reddish-brown pinpoint microhemorrhages that occur on the skin when platelet levels are low. When petechiae are numerous, they
group, causing reddish bruises known as purpura. Sternal tenderness is associated with leukemias. Jaundice occurs when anemias are of a hemolytic origin, resulting in
accumulation of bile pigments from RBCs. Enlarged, tender lymph nodes are associated with infection or cancer.
If a patient with blood type O Rh+ is given AB Rh– blood, what would the nurse expect to happen?
a. The patient’s Rh factor will react with the RBCs of the donor blood.
b. The anti-A and anti-B antibodies in the patient’s blood will hemolyze the donor blood.
c. The anti-A and anti-B antibodies in the donor blood will hemolyze the patient’s blood.
d. No adverse reaction is expected because the patient has no antibodies against the donor blood.
b. A patient with type O Rh+ blood has no A or B antigens on the RBC but does have anti-A and anti-B antibodies in the blood and has an Rh antigen. Type AB Rh− blood has both A and B antigens on the RBC but no Rh antigen and no anti-A or anti-B antibodies. If the type AB Rh− blood is given to the patient with type O Rh+ blood, the antibodies in the patient’s blood will react with the antigens in the donor blood, causing hemolysis of the donor cells. There will be no Rh reaction because the donor blood has no Rh antigen.
The patient’s laboratory results show a marked decrease in RBCs, WBCs, and platelets. What term should the nurse
use when reporting the results to the physician?
a. Hemolysis
b. Leukopenia
c. Pancytopenia
d. Thrombocytosis
c. Pancytopenia is decreased RBCs, WBCs, and
platelets. Hemolysis is RBC destruction. Leukopenia is WBC <4000/μL. Thrombocytosis is increased
platelets and thrombocytopenia is decreased
platelets.
- Which statements accurately describe thrombocytopenia (select all that apply)?
a. Patients with platelet deficiencies can have internal or external hemorrhage.
b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP).
c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen.
d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets.
e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination
of the patient is ecchymosis.
a, c, d. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP)
has decreased platelets and RBCs with enhanced agglutination of the platelets. Platelet deficiencies lead to superficial site bleeding. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common manifestation of thrombocytopenia.
A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy
b. Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary fragility and bleeding time. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy.
Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which
action is most important for the nurse to implement?
a. Taking the temperature every 4 hours to assess for fever
b. Maintaining the patient on strict bed rest to prevent injury
c. Monitoring the patient for headaches, vertigo, or confusion
d. Removing the oral crusting and scabs with a soft brush four times a day
c. The major complication of thrombocytopenia is hemorrhage and it may occur in any area of the body. Cerebral hemorrhage may be fatal and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.
The nurse caring for a patient with heparin-induced thrombocytopenia (HIT) identifies risk for bleeding as the
priority nursing diagnosis. Identify at least five nursing interventions that should be implemented.
a.
b.
c.
d.
e.
Any five of these are appropriate:
Discontinue heparin administration and expect a direct or indirect thrombin inhibitor to be ordered.
Monitor for signs and symptoms of bleeding (check IV sites, wounds, any secretions).
Monitor ordered coagulation studies.
Avoid injections.
Use an electric razor.
Protect the patient from trauma.
Administer ordered blood products.
Instruct the patient and caregiver to avoid aspirin and other anticoagulants.
Instruct the patient to avoid high-contact activities (many sports).
In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find?
a. An absence of factor IX
b. A decreased platelet count
c. A prolonged bleeding time
d. A prolonged partial thromboplastin time (PTT)
d. A prolonged partial thromboplastin time (PTT) occurs when there is a deficiency of clotting factors, such as factor VIII associated with hemophilia A. Factor IX is deficient in hemophilia B and prolonged bleeding time and decreased platelet counts are associated with platelet deficiencies.
A patient with hemophilia comes to the clinic for treatment. What should the nurse anticipate that he or she will need to administer? a. Whole blood b. Thromboplastin c. Factor concentrates d. Fresh frozen plasma
c. Although whole blood and fresh frozen plasma contain the clotting factors that are deficient in hemophilia, specific factor concentrates have been developed that are more pure and safer in preventing infection transmission. Thromboplastin is factor III and is not deficient in patients with hemophilia.
A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing
intervention for the patient?
a. Wrapping the knee with an elastic bandage
b. Placing the patient on bed rest and applying ice to the joint
c. Administering nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain
d. Gently performing range-of-motion (ROM) exercises to the knee to prevent adhesions
b. During an acute bleeding episode in a joint, it is important to rest the involved joint totally and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with range-of-motion (ROM) exercises and physical therapy.
Which bleeding disorder affects both genders, is autosomal dominant, and will have laboratory results showing prolonged bleeding time? a. Hemophilia A b. Hemophilia B c. Thrombocytopenia d. von Willebrand disease
d. This description is characteristic of von Willebrand disease with prolonged bleeding time occurring because of defective platelets, which does not occur with either type of hemophilia. Although inherited thrombocytopenia is believed to be autosomal dominant, the number of platelets is decreased.
Number in sequence the events that occur in disseminated intravascular coagulation (DIC).
a. Activation of fibrinolytic system
b. Uncompensated hemorrhage
c. Widespread fibrin and platelet deposition in capillaries and arterioles
d. Release of fibrin-split products
e. Fibrinogen converted to fibrin
f. Inhibition of normal blood clotting
g. Production of intravascular thrombin
h. Depletion of platelets and coagulation factors
- Production of intravascular thrombin
- Fibrinogen converted to fibrin
- Widespread fibrin and platelet deposition in capillaries and arterioles
- Depletion of platelets and coagulation factors
- Activation of fibrinolytic system
- Release of fibrin-split products
- Inhibition of normal blood clotting
- Uncompensated hemorrhage
A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%.
a. Does the patient have leukopenia?
b. What is the patient’s neutrophil count?
c. Does the patient have neutropenia?
d. Is the patient at risk for developing a bacterial infection? If so, why?
a. Yes, as the WBC count is below 4000/μL.
b. The neutrophil count is 2300 × 40% = 920/μL.
c. Yes, as the neutrophil count is less than 1000/μL.
d. Yes, the patient is at moderate risk of infection with
opportunistic pathogens and nonpathogenic organisms
from normal body flora.
What is the most important method for identifying the presence of infection in a neutropenic patient?
a. Frequent temperature monitoring
b. Routine blood and sputum cultures
c. Assessing for redness and swelling
d. Monitoring white blood cell (WBC) count
a. An elevated temperature is of most significance in
recognizing the presence of an infection in the neutropenic patient because there is no leukocytic response to injury. When the WBC count is depressed, the normal phagocytic mechanisms of infection are impaired and the classic signs of inflammation may not occur. Cultures are indicated if the temperature is elevated but are not used to monitor for infection.
What is a major method of preventing infection in the patient with neutropenia?
a. Prophylactic antibiotics
b. A diet that eliminates fresh fruits and vegetables
c. High-efficiency particulate air (HEPA) filtration rooms
d. Strict hand washing by all persons in contact with the patient
d. Despite its seeming simplicity, hand washing before, during, and after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the patient. IV antibiotics are administered when febrile episodes occur. Some oral antibiotics may
be used prophylactically in some neutropenic patients. High-efficiency particulate air (HEPA) filtration and laminar airflow (LAF) rooms may reduce the number of aerosolized pathogens but they are expensive and LAF use is controversial.