Unit4:CH 22 (Porth's 5th ED) Disorders of Hemostasis

Question 1

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a
patient. Which of the following statements best reflects an aspect of the platelets that
would constitute part of the CBC?
A) Platelets originate with granulocyte colony–forming units (CFU).
B) The half-life of a platelet is typically around 8 to 12 days.
C) The -granules of platelets contribute primarily to vasoconstriction.
D) New platelets are released from the bone marrow into circulation.

Answer 1

Ans: B
Feedback:
Platelets’ half-life is typically around 8 to 12 days. They originate from megakaryocytes,
and -granules facilitate vasoconstriction. New platelets are released from the spleen
into circulation.

Question 2

A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral
vascular disease (PVD) has been advised by his family physician to begin taking 81 mg
aspirin once daily. Which of the following statements best captures an aspect of the
underlying rationale for the physician’s suggestion?
A) Platelet aggregation can be precluded through inhibition of prostaglandin
production by aspirin.
B) Aspirin helps to inhibit ADP action and minimizes platelet plug formation.
C) Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis.
D) Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet
plug formation.

Answer 2

Ans: A
Feedback:
Aspirin prevents platelet plug formation by inhibiting synthesis of prostaglandins that
mediate clot formation. Aspirin does not influence ADP, TXA2 synthesis, or fibrinogen
conversion.

Question 3

A hospital client is receiving intravenous infusion of heparin for treatment of a
pulmonary embolus. Which of the following phenomena is most likely to occur,
resulting in the drug’s therapeutic effect?
A) Inhibition of vitamin K synthesis in the liver
B) Suppression of fibrin formation
C) Deactivation of the intrinsic clotting pathway
D) Inhibition of ADP-induced platelet aggregation

Answer 3

Ans: B
Feedback:
Ultimately, heparin inhibits the clotting factors that mediate the formation of fibrin. It
does not inhibit vitamin K synthesis, nor does it deactivate the intrinsic clotting pathway
in particular. Heparin does not act on platelet plug formation.

Question 4

When discussing the sequence of clot dissolution, the science instructor will talk about
which item that begins the process?
A) Plasminogen
B) Dabigatran
C) Platelets
D) A2-plasmin inhibitor

Answer 4

Ans: A
Feedback:
As with clot formation, clot dissolution requires a sequence of steps controlled by
activators and inhibitors. Plasminogen, the proenzyme for the fibrinolytic process,
normally is present in the blood in its inactive form. It is converted to its active form,
plasmin, by plasminogen activators formed in the vascular endothelium, liver, and
kidneys. Dabigatran is an anticoagulant. Platelets actually help cells stick together or
adhere.

Question 5

In which of the following patients, would diagnostic investigations least likely reveal
increased thrombopoietin production?
A) An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive
B) A 55-year-old man with dehydration secondary to Crohn disease
C) A 66-year-old woman with a diagnosis of lung cancer with bone metastases
D) A 21-year-old woman awaiting bone marrow transplant for myelogenous
leukemia

Answer 5

Ans: D
Feedback:
Diseases such as myelogenous leukemia and other cases of primary thrombocytosis
result in abnormalities in the thrombopoietin receptor and platelet binding. Cases of
secondary thrombocytosis have an etiology rooted in increased thrombopoietin
production. The common underlying causes of secondary thrombocytosis include tissue
damage due to surgery, infection, cancer, and chronic inflammatory conditions such as
rheumatoid arthritis and Crohn disease.

Question 6

A 44-year-old Caucasian woman is being treated in an airport infirmary after she
developed a painful, swollen leg during a transatlantic flight in economy class. The
woman is suspected of having deep vein thrombosis (DVT) and is questioning the
paramedics about why this might be the case, given that she has twice previously had
similar experiences. Which of the following teaching points by the airport medical staff
would be most appropriate?
A) “A lot of Caucasian people have a genetic mutation that causes platelets to stick to
their blood vessel walls.”
B) “There is a genetic disorder that causes many Caucasians to form more clots in
their blood vessels.”
C) “A lot of Caucasians have an inherited inability to dissolve clots that form in their
bodies.”
D) “Your doctor might be able to tell you if you’ve inherited a predisposition to
bleeding in your veins.”

Answer 6

Ans: C
Feedback:
All of the listed responses refer to the Leiden mutation, which is best characterized as an
inhibition of normal clot dissolution due to factor V defects. It does not involve platelet
aggregation or adhesion or excess bleeding. It is better characterized as decreased clot
dissolution rather than increased clot formation.

Question 7

A medical student is familiarizing herself with recent overnight admissions to an acute
medical unit of a university hospital. Which of the following patients would the student
recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her
medical history?
A) A 66-year-old obese male with left-sided hemiplegia secondary to a
cerebrovascular accident
B) A 90-year-old female resident of a long-term care facility who has been
experiencing transient ischemic attacks
C) A 30-year-old female with a diagnosis of left leg deep vein thrombosis and a
pulmonary embolism
D) A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis
secondary to intravenous drug use

Answer 7

Ans: D
Feedback:
Stroke, transient ischemic attacks, deep vein thrombosis, and pulmonary emboli are all
common manifestations of the hypercoagulability associated with antiphospholipid
syndrome. Cellulitis, endocarditis, and other infectious processes are less likely to be
correlated with antiphospholipid syndrome

Question 8

A 36-year-old woman with a diagnosis of antiphospholipid syndrome is receiving a
scheduled checkup from her nurse practitioner. Which of the following teaching points
would the nurse most likely prioritize?
A) “It’s important for you to do regular physical activity and maintain a healthy body
weight.”
B) “Good nutrition and blood sugar control are important in your case.”
C) “You’ll need to avoid taking nonsteroidal anti-inflammatory drugs when you have
menstrual cramps.”
D) “You need to ensure your birth control pills don’t contain estrogen.”

Answer 8

Ans: D
Feedback:
Estrogen-containing birth control pills can predispose individuals with antiphospholipid
syndrome to a thrombotic event. Exercise, nutrition, and blood sugar control are not
particularly associated with management of antiphospholipid syndrome, and
nonsteroidal anti-inflammatory drugs have no noted relevance to the disease

Question 9

A patient asks the health care provider why his lower legs look purple. The health care
provider will base her response on which pathophysiological principle?
A) Too much trauma breaks capillaries, and they bleed into the tissue.
B) The bruising around the ankles is due to the fact that it is a dependent area where
the capillary pressure is higher.
C) There is a problem with his plasminogen levels.
D) Morbid obesity causes veins to enlarge and bleed into tissues due to stress the abdomen is placing on the vascular system.

Answer 9

Ans: B
Feedback:
Cutaneous bleeding is seen as pinpoint hemorrhages and purple areas of bruising in
dependent areas where the capillary pressure is higher. There is no indication that the
patient has experienced trauma to the area or is morbidly obese. Plasminogen helps with
clot dissolution.

Question 10

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the
suggestion of removing the boy’s spleen. Which of the following teaching points would
be most accurate?
A) “We believe that your son’s spleen is causing the destruction of many of his blood
platelets, putting him at a bleeding risk.”
B) “Your son’s spleen is inappropriately filtering out the platelets from his blood and
keeping them from normal circulation.”
C) “Your son’s spleen is holding on to too many of his platelets, so they’re not
available for clotting.”
D) “We think that his spleen is inhibiting the production of platelets by his bone
marrow.”

Answer 10

Ans: C
Feedback:
A cause of thrombocytopenia is excessive sequestering of platelets by the spleen,
necessitating splenectomy. The spleen would not be involved in destroying platelets,
filtering them out from existing circulation, or inhibiting their production.

Question 11

While being on subcutaneous heparin injections for deep vein thrombosis during her
latter pregnancy, a patient begins to experience major side effects. Her OB-GYN
physician has called in a specialist who thinks that the patient is experiencing
heparin-induced thrombocytopenia. The nurse should anticipate which of the following
orders?
A) Decrease the dose of 5000 units b.i.d to 3000 units b.i.d
B) Immediately discontinue the heparin therapy
C) Switch to Coumadin 2.5 mg once/day
D) Infuse FFP stat

Answer 11

Ans: B
Feedback:
The treatment of HIT requires the immediate discontinuation of heparin therapy and the
use of alternative anticoagulants to prevent thrombosis recurrence. Decreasing the dose
will not stop HIT. Coumadin is contraindicated in pregnancy. FFP is not called for in
this situation.

Question 12

Following a course of measles, a 5-year-old girl developed scattered bruising over
numerous body surfaces and was diagnosed with immune thrombocytopenic purpura
(ITP). As part of her diagnostic workup, blood work was performed. Which of the
following results is most likely to be considered unexpected by the health care team?
A) Increased thrombopoietin levels
B) Decreased platelet count
C) Normal vitamin K levels
D) Normal leukocyte levels

Answer 12

Ans: A
Feedback:
In ITP, thrombopoietin levels are not elevated. Platelet levels would be expected to be
low, and vitamin K and leukocyte levels would be unlikely abnormal.

Question 13

Two nursing students are attempting to differentiate between the presentations of
immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura
(TTP). Which of the students’ following statements best captures an aspect of the two
health problems?
A) “Both diseases can result from inadequate production of thrombopoietin by
megakaryocytes.”
B) “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme
deficiency.”
C) “Both of them involve low platelet counts, but in TTP, there can be more, not less,
hemostasis.
D) “TTP can be treated with plasmapheresis, but ITP is best addressed with
transfusion of fresh frozen plasma.”

Answer 13

Ans: C
Feedback:
TTP is marked by sudden and severe thrombotic involvement. Neither disease has an
etiology of low thrombopoietin production, and TTP, not ITP, is rooted in an enzyme
deficiency. ITP is normally treated with corticosteroids and/or immunoglobulins.

Question 14

Misinterpreting her physician’s instructions, a 69-year-old woman with a history of
peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has
this most likely affected her hemostatic status?
A) Irreversible acetylation of platelet cyclooxygenase activity has occurred.
B) The patient’s prostaglandin (TXA2) levels are abnormally high.
C) She is at risk of developing secondary immune thrombocytopenic purpura (ITP).
D) The binding of an antibody to platelet factor IV produces immune complexes.

Answer 14

Ans: A
Feedback:
Aspirin can cause inhibition of platelet aggregation that lasts for the life of the platelet.
High TXA2 levels would be associated with increased coagulability. ITP would not
result from aspirin intake, and binding of an antibody to platelet factor IV is associated
with heparin-induced thrombocytopenia.

Question 15

Which of the following teaching points would be most appropriate with a client who has
a recent diagnosis of von Willebrand disease?
A) “It’s important that you avoid trauma.”
B) “Your disease affects your platelet function rather than clot formation.”
C) “Make sure that you avoid taking aspirin.”
D) “Clotting factor VIII can help your body compensate for the difficulty in
clotting.”

Answer 15

Ans: C
Feedback:
No treatment other than the avoidance of aspirin is normally needed in the case of von
Willebrand disease. Avoiding trauma and factor VIII therapy apply to hemophilia. Von
Willebrand disease involves both the platelet and coagulation systems.

Question 16

The school nurse knows several children with hemophilia A. After recess, one student
with hemophilia comes to the school nurse complaining of pain in his knee from falling
on the playground. The nurse notes there is swelling in the knee and pain on palpation.
The nurse should
A) administer some NSAIDs to relieve the pain.
B) wrap the knee in an ace bandage for compression.
C) apply some warm compresses to the knee.
D) notify parents to pick up the child and possibly administer factor VIII.

Answer 16

Ans: D
Feedback:
Prevention of trauma is important. ASA and other NSAIDs that affect platelet function
should be avoided. Factor VIII replacement therapy administered at home has reduced
the typical musculoskeletal damage. Wrapping with a bandage will not prevent damage.
Warm compression will extend the bleed.

Question 17

A 44-year-old female patient presents to the emergency department with abnormal
bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the
following diagnoses would the medical team be most justified in suspecting as a cause
of the patient’s bleeding?
A) Excess calcium
B) Vitamin K deficiency
C) Hemophilia B
D) Idiopathic immune thrombocytopenic purpura (ITP)

Answer 17

Ans: B
Feedback:
Factors VII, IX, and X and prothrombin require the presence of vitamin K for normal
activity. Vitamin K deficiency may result from impaired fat absorption caused by liver
or gallbladder disease. Calcium, factors X and V, and platelet phospholipids combine to
form prothrombin activator, which then converts prothrombin to thrombin. Excess
calcium could result in increased formation of blood clots. Hemophilia B is a hereditary
disorder. Half of the cases of ITP occur as an acute disorder in children; ITP in adults is
a chronic disorder with insidious onset.

Question 18

Which of the following patients would be at risk for developing nonthrombocytopenic
purpura? Select all that apply.
A) A child adopted from India and displaying malaise, lethargy, and petechiae all
over the body
B) A 73-year-old patient had a concussion that resulted from a fall
C) A 55-year-old patient diagnosed with Cushing disease displaying bruises, weight
gain with a buffalo hump, and moon face
D) A 15-year-old insulin-dependent diabetic with hypoglycemia displaying
irritability with headaches and tachycardia
E) A pregnant mother experiencing headaches and proteinuria

Answer 18

Ans: A, C
Feedback:
Vascular disorders that cause bleeding include vitamin C deficiency (answer A),
Cushing disease (answer C), senile purpura, and aging process. Answers B and D do not
result in weak vessel walls initially. Pregnant mother experiencing headaches and
proteinuria is associated with preeclampsia.

Question 19

A 30-year-old woman who has given birth 12 hours prior is displaying signs and
symptoms of disseminated intravascular coagulation (DIC). The client’s husband is
confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s
following statements best characterizes DIC?
A) “So much clotting takes place that there are no available clotting components left,
and bleeding ensues.”
B) “Massive clotting causes irritation, friction, and bleeding in the small blood
vessels.”
C) “Excessive activation of clotting causes an overload of vital organs, resulting in
bleeding.”
D) “The same hormones and bacteria that cause clotting also cause bleeding.”

Answer 19

Ans: A
Feedback:
DIC hemorrhage results from an insufficiency of clotting proteins after large-scale
coagulation. It is not a result of physical irritation, organ overload, or bacteria and
hormones.

Question 20

A newly diagnosed leukemia patient begins hemorrhaging from every orifice. The
physician is concerned that the patient has developed disseminated intravascular
coagulation (DIC). The nurse should anticipate which of the following orders to be
prescribed for this patient? Select all that apply.
A) Transfuse 2 units of platelets.
B) Transfuse fresh frozen plasma.
C) Give aspirin twice per day.
D) Administer IV Toradol stat.
E) Place in reverse isolation.

Answer 20

Ans: A, B
Feedback:
The treatment of DIC is directed toward managing the primary disease, replacing
clotting components, and preventing further activation of clotting mechanisms.
Transfusions of FFP, platelets, or fibrinogen-containing cryoprecipitate may correct the
clotting factor deficiency. ASA would make the bleeding worse. Toradol is an NSAID
and should be avoided in patients with a bleeding problem. Reverse isolation is
implemented for patients with pancytopenia.

Question 21

Coagulation activated by the extrinsic pathway is initiated when:

a. there is release of thromboplastin from the injured vessel wall.
b. blood is exposed to tissue extracts.
c. factor X is activated.
d. an increase in blood volume occurs in the vascular system.

Answer 21

Correct Response: there is release of thromboplastin from the injured vessel wall.

Rationale:
The extrinsic pathway begins with trauma to the blood vessel or surrounding tissues and the release of an adhesive lipoprotein called tissue factor (also known as thromboplastin or factor III) from the subendothelial cells. Activation of factor X is the terminal step of both the intrinsic and extrinsic pathway of coagulation.

Question 22

The father of a 2-year-old boy recently diagnosed with hemophilia A asks the nurse how to prevent complications for his son. The best response would be:
A. “Small bleeding in the joints is to be expected and can be treated at home.”
B. “Hemophilia A will no longer be a concern once treated with a blood transfusion.”
C. “Avoid administering aspirin and nonsteroidal anti-inflammatory drugs.”
D. “Do not allow the child to play outside or with other children.”

Answer 22

Correct Response:”Avoid administering aspirin and nonsteroidal anti-inflammatory drugs.”

Rationale:
The prevention of trauma is important in persons with hemophilia, and aspirin and nonsteroidal anti-inflammatory drugs should be avoided. Children with hemophilia should not be prevented from interaction with other children. Hemophilia will not be resolved with a blood transfusion. All bleeds require medical attention.

Question 23

A week after starting atorvastatin for high cholestrol, the client returns reporting bleeding from the mouth (mucous membranes) and nose. What priority intervention should the health care provider perform?
A. Request prescription for a good blood thinner to interrupt the coagulation.
B. Discontinue the atorvastatin immediately.
C. Send the client to see an ears, nose, throat (ENT) specialist.
D. Apply an ice bag to the mouth and nose.

Answer 23

Correct Response:Discontinue the atorvastatin immediately.

Rationale:
In clients with drug-associated thrombocytopenia, there is a rapid fall in the platelet count within 2 to 3 days of resuming a drug or 7 or more days after starting a drug for the first time. The platelet count rises rapidly after the drug is discontinued. Ice can cause vasoconstriction but is hard to apply to the mouth and nose. This client does not have disseminated intravascular coagulation and therefore blood thinners are contraindicated. Stopping the medication should be the best choice. Sending the client to an ENT specialist is not needed at this time.

Question 24

The nurse is reviewing hospital discharge instructions with a client who has been diagnosed with secondary thrombocytosis and who also suffers from chronic ulcerative colitis, making anticoagulation inadvisable. The nurse stresses that the client should avoid: Select all that apply.
A. Immobilization
B. Folate supplements
C. Oral contraceptives
D. Low-fat diet
E. Smoking

Answer 24

Correct Response: Immobilization,
Oral contraceptives,
Smoking

Rationale:
The goal with these clients would be to decrease thrombotic effects from other causes, such as immobolization, smoking, oral contraceptives, steroid therapy, vitamin B, and folate deficiencies, and to decrease the need for anticoagulation therapy.

Question 25

The nurse reviews the lab results of a client who has a thrombocyte count of 60 ×103/μL (60 ×109/L). The client is at risk for:
A. Bleeding
B. Disseminated intravascular coagulation
C. Hypercoagulation
D. Deep vein thrombosis

Answer 25

Correct Response: Bleeding

Rationale:
The normal serum concentration of platelets, also called thrombocytes, is about 150 to 400 ×103/μL (150 to 400 ×109/L) of blood. A low platelet count may lead to abnormal bleeding. An elevated platelet count can predispose a client to a thrombosis and hypercoagulation. Disseminated intravascular coagulation develops as consequence of severe injury and trauma that results in bleeding.

Question 26

A female client has been diagnosed with antiphospholipid syndrome. The nurse would anticipate the client has a health history that may include which disorders? Select all that apply.
A. Uteroplacental insufficiency
B. Hypertension during pregnancy
C. Pregnancy loss before the 10th week
D. Multiple births
E. Large-birth-weight babies
F. Recurrent fetal loss

Answer 26

Correct Response: Uteroplacental insufficiency,
Hypertension during pregnancy,
Pregnancy loss before the 10th week,
Recurrent fetal loss

Rationale:
Women with the disorder commonly have a history of recurrent pregnancy losses after the 10th week of gestation because of ischemia and thrombosis of the placental vessels. These women also have increased risk of giving birth to a premature infant owing to pregnancy-associated hypertension and uteroplacental insufficiency

Question 27

A client diagnosed with autosomal dominant von Willebrand factor disease (vWF) is experiencing mild to moderate bleeding. The health care provider would classify the diagnosis as:
A. Type 1
B. Type 4
C. Type 3
D. Type 2

Answer 27

Correct Response: Type 2

Rationale:
Type 2 vWF is an autosomal dominant disorder that is characterized by defects in vWF and results in mild to moderate bleeding. Types 1 and 3 are associated with reduced levels of vWF. There is no type 4.

Question 28

The parents are ready to take home their child with newly diagnosed hemophilia A. Which teaching aspects should the nurse discuss with them prior to discharge? Select all that apply.
A. Give ibuprofen (an NSAID) if the child runs a fever.
B. The signs of an MI related to bleeding in the heart vessels
C. Keep the child away from contact sports like football and wrestling.
D. Administration of factor VIII at home when bleeding occurs
D. Aspirin should only be given for severe pain in the joints.

Answer 28

Correct Response: Keep the child away from contact sports like football and wrestling.,
Administration of factor VIII at home when bleeding occurs

Rationale:
The prevention of trauma is important in persons with hemophilia. Aspirin and other NSAIDs that affect platelet function should be avoided. Factor VIII replacement therapy (either recombinant or heat-treated concentrates from human plasma) administered at home has reduced the typical musculoskeletal damage. It is initiated when bleeding occurs or as prophylaxis with repeated bleeding episodes. Characteristically, bleeding occurs in soft tissues, the gastrointestinal tract, and the hip, knee, elbow, and ankle joints. Bleeding of the heart vessels is not usually associated with hemophilia A.

Question 29

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?
A. Increases prothrombin
B. Increases procoagulation factors
C. Increases vitamin K–dependent factors in the liver
D. Alters vitamin K, reducing its ability to participate in the coagulation of the blood

Answer 29

Correct Response:Alters vitamin K, reducing its ability to participate in the coagulation of the blood

Rationale:
The anticoagulant drugs warfarin and heparin are used to prevent thromboembolic disorders, such as deep vein thrombosis and pulmonary embolism. Warfarin acts by decreasing prothrombin and other procoagulation factors. It alters vitamin K in a manner that reduces its ability to participate in synthesis of the vitamin K–dependent coagulation factors in the liver.

Question 30

A neonatal nurse is caring for a newborn that has been prescribed an injection of vitamin K to prevent possible bleeding. Lack of which physiologic finding in a newborn makes it necessary for the neonate to be given vitamin K?
A. Liver enzymes
B. Coagulation factors
C. Plasma fibrinogen
D. Intestinal bacteria

Answer 30

Correct Response: Intestinal bacteria

Rationale:
The main source of vitamin K is from intestinal bacteria synthesis; infants are born with a lack of intestinal flora and are therefore at risk for vitamin K deficiency.

Question 31

A client refuses to take the 81 mg of aspirin ordered by the physician, stating, “I do not have any pain.” The best response by the nurse would be:
A. “The 81 mg of aspirin daily will help protect you from a stroke or a heart attack.”
B. “Low-dose aspirin will help prevent you from having increased bleeding after surgery.”
C. “This dose of aspirin will break apart the blood clot that you have in your leg.”
D. “The doctor wants you to take the medication to prevent you from experiencing pain.”

Answer 31

Correct Response: “The 81 mg of aspirin daily will help protect you from a stroke or a heart attack.”

Rationale:
A low dose of aspirin (81 mg) can be used to prevent platelet aggregation and clot formation in persons who are at risk for myocardial infarction, stroke, or peripheral artery disease. This dose of aspirin will not be therapeutic for preventing pain in most clients and will not prevent increased bleeding. Aspirin will not dissolve a blood clot.

Question 32

A client has been diagnosed with inherited hypercoagulability. Select the most likely cause.
A. Myocardial infarction
B. Hyperestrogenic state
C. Prolonged immobility
D. Factor V gene mutation

Answer 32

Correct Response: Factor V gene mutation

Rationale:
Of the inherited causes of hypercoagulability, mutations in the factor V gene and prothrombin gene are the most common. Among the acquired or secondary factors that lead to increased coagulation and thrombosis are venous stasis due to prolonged bed rest and immobility, myocardial infarction, cancer, hyperestrogenic states, and use of oral contraceptives.

Question 33

Which medication is known to interfere with the body’s ability to control bleeding? Select all that apply.
A. Heparin
B. Potassium chloride
C. Hormone replacement therapies
D. Warfarin
E. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer 33

Correct Response: Heparin,
Warfarin,
Nonsteroidal anti-inflammatory drugs (NSAIDs)

Rationale:
Heparin interferes with platelet production; heparin and warfarin interfere with coagulation factors. The use of nonsteroidal anti-inflammatory drugs is the most common cause of impaired platelet function. Hormone replacement therapies and potassium chloride administration have not been connected with impaired hemostasis.

Question 34

A client with thrombotic thrombocytopenic purpura (TTP) is signing consent for plasmapheresis. The client asks, “What is this procedure and why do I need it?” Which response by the health care provider is most accurate?
A. “Instead of giving you packed red blood cells, the health care provider will infuse white blood cells into your veins.”
B. “It is very similar to donating a unit of blood at the Red Cross.”
C. “The laboratory will remove plasma from the withdrawn blood and replace it with fresh-frozen plasma.”
D. “The health care provider will perfom a bone marrow aspiration to withdraw plasma to analyze.”

Answer 34

Correct Response: “The laboratory will remove plasma from the withdrawn blood and replace it with fresh-frozen plasma.”

Rationale:
TTP is a combination of thrombocytopenia (low platelet count), hemolytic anemia (low red blood cells [RBCs]), renal failure, and fever. Emergency treatment of TTP includes phasmapheresis, a procedure that involves removal of plasma from withdrawn blood and replacement of fresh-frozen plasma. Plasma infusion will provide the deficient enzyme. No bone marrow aspiration is performed with this procedure. However, it is very different from giving blood which is just the donation of RBCs. White blood cells (WBCs) will not be infused with this procedure. WBC transfusions are given rarely. Research does not show that giving WBC transfusions lowers the risk of death or infection in people with low WBC counts or WBCs that are impaired. Instead of transfusing WBCs, health care providers now commonly use drugs called colony-stimulating factors or growth factors to help the body make its own.

Question 35

How does low-dose aspirin therapy impact clot formation?
A. Aspirin acts as a clot buster by damaging fibrin strands.
B. Aspirin has a negative effect on the platelet’s adhesion abilities.
C. Aspirin increases capillary permeability.
D. Aspirin is a platelet aggregation inhibitor.

Answer 35

Correct Response: Aspirin is a platelet aggregation inhibitor.

Rationale:
Low-dose aspirin therapy inhibits prostaglandin synthesis, thus interfering with platelet aggregation. The other options do not accurately describe the effect that aspirin has on the formation of clots.

Question 36

A client has an impaired platelet function that may have developed from inheritance, drugs, disease, or extracorporeal circulation. The health care provider would document this as:
A. Thrombocytopathia
B. Fibrinolysis
C. Disseminated intravascular coagulation
D. Plasmapheresis

Answer 36

Correct Response: Thrombocytopathia

Rationale:
Thrombocytopathia results from inherited disorders of adhesion and/or acquired defects such as drugs, disease process, or extracorporeal circulation. Plasmapheresis is the process of removal of plasma from withdrawn blood and replacement with fresh frozen plasma. Fibrinolysis is the process in which a blood clot is dissolved

Question 37

The coagulation cascade is the third component of the hemostatic process. The other two are:
A. Agglutination
B. Platelet aggregation
C. Vessel spasm
D. Hematopoiesis

Answer 37

Correct Response: Platelet aggregation,
Vessel spasm

Rationale:
Spasm of the blood vessel and platelet aggregation are the first and second steps of hemostasis. Agglutination is the sticking of blood cells together due to antibodies. Hematopoiesis is the formation of blood cells.

Question 38

The nurse is studying hemostasis. She knows that which statements are true? Select all that apply.
A. Hemostasis refers to the body’s ability to control bleeding.
B. Hemostasis occurs in established stages.
C. Blood clot formation is a malfunction of hemostasis
D. Hemostasis results in the formation of a platelet plug.
E. Vessel constriction or spasm is a factor in effective hemostasis.

Answer 38

Correct Response: Hemostasis refers to the body’s ability to control bleeding.,
Hemostasis occurs in established stages.,
Hemostasis results in the formation of a platelet plug.,
Vessel constriction or spasm is a factor in effective hemostasis.

Rationale:
Hemostasis, which refers to the stoppage of blood flow, is divided into stages which include vessel vasoconstriction and formation of the platelet plug. The development of a blood clot is a part of the coagulation process.

Question 39

The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be:
A. “Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting.”
B. “It is hospital policy to administer the injection to newborns.”
C. “Infants have a higher body fat content, which prohibits the absorption of vitamin K.”
D. “The infant was exposed to high levels of heparin upon birth.”

Answer 39

Correct Response: “Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting.”

Rationale:
Vitamin K is needed by newborns to begin the synthesis of blood clotting prior to their establishing the normal intestinal flora. While it may be hospital policy to administer vitamin K, this does not explain to the concerned mother why her newborn is getting an injection.

Question 40

A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of:
A. weakening of the organ walls as a result of inflammation.
B. increased amounts of vitamin K being produced in the liver.
C. a vitamin C deficiency in the diet.
D. the reduction of clotting factors synthesized in the liver.

Answer 40

Correct Response: the reduction of clotting factors synthesized in the liver.

Rationale:
In liver disease, synthesis of clotting factors is reduced and bleeding may result. Vitamin K would not be produced in large amounts of active form in a diseased liver. Vitamin C deficiency in the diet would not contribute to increased bleeding.