Mod. 1 Disease of Platelets Flashcards
Application/ Identification
A 10-year-old child presents with easy bruising, petechiae on the legs, and nosebleeds. Laboratory results reveal a platelet count of less than 20,000/mL. The child has recently recovered from a viral infection. What type of platelet disorder does this child most likely have?
A. Hemophilia A
B. Immune thrombocytopenic purpura (ITP)
C. Von Willebrand disease
D. Disseminated intravascular coagulation (DIC)
B. Immune thrombocytopenic purpura (ITP)
Rationale: The combination of easy bruising, petechiae, and a platelet count less than 20,000/mL, along with a recent viral infection, suggests acute ITP. ITP is an autoimmune condition where the body destroys platelets, leading to thrombocytopenia. It is more common in children and often follows a viral infection. Hemophilia A, Von Willebrand disease, and DIC have different causes and clinical presentations.
A 65-year-old female with a history of cancer and recent sepsis presents with excessive bleeding from her surgical site, petechiae, and bruising. Blood tests reveal prolonged clotting times and low platelet counts. What condition is this patient most likely experiencing?
A. Thrombotic thrombocytopenic purpura (TTP)
B. Disseminated intravascular coagulation (DIC)
C. Von Willebrand disease
D. Immune thrombocytopenic purpura (ITP)
B. Disseminated intravascular coagulation (DIC)
Rationale: DIC is a life-threatening condition that results in widespread coagulation followed by massive bleeding due to the depletion of clotting factors. This patient’s sepsis and cancer history, along with excessive bleeding and low platelet count, point to DIC. TTP, Von Willebrand disease, and ITP have different etiologies and manifestations.
A 40-year-old male presents with severe abdominal pain, confusion, and signs of organ ischemia. His blood tests show thrombocytopenia and the presence of thrombi in various organs. He has a family history of a genetic disorder affecting von Willebrand factor. What is the most likely diagnosis?
A. Thrombotic thrombocytopenic purpura (TTP)
B. Von Willebrand disease (VWD)
C. Hemophilia A
D. Immune thrombocytopenic purpura (ITP)
A. Thrombotic thrombocytopenic purpura (TTP)
Rationale: The patient’s presentation of thrombocytopenia, organ ischemia, confusion, and abdominal pain, combined with a family history of a genetic disorder affecting von Willebrand factor, suggests TTP. TTP involves a deficiency of the enzyme that cleaves von Willebrand factor, leading to hypercoagulation, thrombosis, and subsequent depletion of platelets. VWD, Hemophilia A, and ITP have different pathophysiologies and manifestations.
A patient is admitted to the hospital after a traumatic injury. Blood tests show a low platelet count and the presence of bruising and petechiae. The patient is also experiencing massive bleeding from the injury site. What is the most likely diagnosis for this patient?
A. Von Willebrand disease
B. Hemophilia A
C. Thrombotic thrombocytopenic purpura (TTP)
D. Immune thrombocytopenic purpura (ITP)
D. Immune thrombocytopenic purpura (ITP)
Rationale: ITP is characterized by a low platelet count and increased risk of bleeding, such as bruising, petechiae, and massive bleeding from an injury site. The disorder is caused by autoimmune destruction of platelets. Von Willebrand disease, Hemophilia A, and TTP present with different symptoms and underlying causes.
A 35-year-old female with a history of excessive bleeding after childbirth and recent surgery presents with bruising and signs of bleeding from the gums. Genetic testing reveals a deficiency in von Willebrand factor. What type of bleeding disorder is this patient most likely suffering from?
A. Von Willebrand disease (VWD)
B. Hemophilia A
C. Immune thrombocytopenic purpura (ITP)
D. Disseminated intravascular coagulation (DIC)
A. Von Willebrand disease (VWD)
Rationale: Von Willebrand disease is the most common hereditary bleeding disorder, characterized by a deficiency of von Willebrand factor, which impairs platelet adhesion and aggregation. This patient’s excessive bleeding, including after childbirth and surgery, is a common presentation of VWD. Hemophilia A, ITP, and DIC have different pathophysiologies and clinical presentations.
A 70-year-old male with a history of cancer and recent chemotherapy treatment presents with low platelet levels, signs of organ failure, and spontaneous bleeding from the mucous membranes. What condition should be suspected in this patient?
A. Thrombotic thrombocytopenic purpura (TTP)
B. Disseminated intravascular coagulation (DIC)
C. Immune thrombocytopenic purpura (ITP)
D. Von Willebrand disease (VWD)
B. Disseminated intravascular coagulation (DIC)
Rationale: DIC can be triggered by cancer, chemotherapy, or other systemic conditions. It is characterized by widespread clotting followed by bleeding, as clotting factors are depleted. The patient’s signs of organ failure, bleeding, and low platelet levels are consistent with DIC. TTP, ITP, and VWD have different underlying mechanisms and symptoms.
Which of the following is the most common hereditary bleeding disorder?
A) Von Willebrand disease
B) DIC
C) Immune thrombocytopenic purpura (ITP)
D) Thrombotic thrombocytopenic purpura (TTP)
A) Von Willebrand disease
Rationale: Von Willebrand disease is the most common hereditary bleeding disorder, caused by a deficiency of von Willebrand factor, leading to impaired platelet adhesion. DIC, ITP, and TTP have different causes and clinical presentations.
A 25-year-old male with a known history of Hemophilia A presents to the emergency department with significant bleeding after a minor cut while shaving. His platelet count is within normal limits. What is the priority intervention for this patient?
A. Administer a platelet transfusion
B. Administer recombinant clotting factor VIII
C. Apply pressure to the wound
D. Start an IV of normal saline
B. Administer recombinant clotting factor VIII
Rationale: Hemophilia A is characterized by a deficiency of clotting factor VIII, not platelets. The priority intervention is to administer recombinant clotting factor VIII to correct the clotting deficiency. Platelet transfusions are not necessary since platelet levels are normal, and simply applying pressure will not resolve the underlying clotting factor deficiency.
A 40-year-old female with a diagnosis of Von Willebrand disease is scheduled for a dental extraction. Her physician prescribes desmopressin (DDAVP) prior to the procedure. What is the most important action for the nurse to take before administration of desmopressin?
A. Check the patient’s platelet count
B. Assess the patient’s renal function
C. Administer a platelet transfusion
D. Obtain a complete blood count
A 40-year-old female with a diagnosis of Von Willebrand disease is scheduled for a dental extraction. Her physician prescribes desmopressin (DDAVP) prior to the procedure. What is the most important action for the nurse to take before administration of desmopressin?
A. Check the patient’s platelet count
B. Assess the patient’s renal function
C. Administer a platelet transfusion
D. Obtain a complete blood count
A 55-year-old male with a history of cancer presents with signs of disseminated intravascular coagulation (DIC), including spontaneous bleeding, petechiae, and bruising. His lab results show low platelets, elevated D-dimer, and prolonged clotting times. What is the most appropriate initial intervention?
A. Administer clotting factor transfusions
B. Initiate anticoagulation therapy
C. Identify and treat the underlying cause
D. Administer a platelet transfusion
C. Identify and treat the underlying cause
Rationale: DIC is a life-threatening condition characterized by widespread clotting followed by massive bleeding. The most important intervention is to identify and treat the underlying cause (e.g., infection, cancer, sepsis) to control DIC. Anticoagulation therapy and clotting factor transfusions are not recommended until the underlying cause is addressed. Platelet transfusions may be used, but they are secondary to treating the cause.
A 30-year-old female with a history of Thrombotic Thrombocytopenic Purpura (TTP) is admitted to the hospital with symptoms of confusion, anemia, and thrombocytopenia. The healthcare provider orders plasmapheresis. What is the primary purpose of plasmapheresis in this patient’s treatment plan?
A. To replace the deficient clotting factors
B. To remove circulating antibodies or clotting inhibitors
C. To increase platelet production
D. To administer fresh frozen plasma for clotting factors
B. To remove circulating antibodies or clotting inhibitors
Rationale: Plasmapheresis is used in TTP to remove the circulating antibodies or inhibitors that are causing the dysfunction of von Willebrand factor cleavage. This treatment helps reduce clot formation and prevent further platelet consumption. Clotting factors are not replaced by plasmapheresis, and platelet production is not directly stimulated by the procedure.
A patient with Immune Thrombocytopenic Purpura (ITP) is receiving glucocorticoid therapy to increase platelet production. The nurse notices the patient’s blood pressure is elevated and the patient has developed weight gain. What should the nurse do next?
A. Continue monitoring the patient, as these are expected side effects
B. Administer a diuretic to counteract fluid retention
C. Notify the healthcare provider of the elevated blood pressure
D. Discontinue glucocorticoids and prepare for alternative treatments
C. Notify the healthcare provider of the elevated blood pressure
Rationale: Glucocorticoids, a common treatment for ITP, can cause fluid retention, weight gain, and elevated blood pressure. The nurse should notify the healthcare provider, as these symptoms may require adjustment of the medication or additional monitoring. Discontinuing glucocorticoids is not appropriate without consulting the provider.
A 25-year-old patient with a history of Thrombotic Thrombocytopenic Purpura (TTP) has a platelet count of 18,000/mm3 and is experiencing symptoms of organ ischemia. Which of the following should be included in the patient’s plan of care?
A. Administering fresh frozen plasma (FFP)
B. Performing plasmapheresis
C. Giving vitamin K to promote clotting factor synthesis
D. Initiating anticoagulation therapy to prevent thrombus formation
B. Performing plasmapheresis
Rationale: Plasmapheresis is the primary treatment for TTP, as it removes the antibodies or inhibitors that are interfering with von Willebrand factor cleavage and contributing to thrombosis and thrombocytopenia. FFP is not recommended, and vitamin K and anticoagulation therapy are not appropriate in this situation.
A nurse is caring for a patient with hemophilia who is scheduled for elective surgery. The nurse should anticipate the administration of which of the following treatments before the surgery?
A. Platelet transfusion
B. Clotting factor replacement
C. Cryoprecipitate infusions
D. Immunoglobulin therapy
B. Clotting factor replacement
Rationale: Patients with hemophilia have deficiencies in clotting factors, so clotting factor replacement is the essential treatment before any surgery to prevent bleeding complications. Platelet transfusions, cryoprecipitate, and immunoglobulin therapy are not indicated for this condition.
