NURS 3320 Chapter 26- Disorders of Hemostasis: Questions and Answers (GRADED A) | 100% VERIFIED.

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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. 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. 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. 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. 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 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. 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) 2-plasmin inhibitor 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. 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 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. 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.” 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. 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 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. 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.” 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. 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. 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. 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.” 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. 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 heparin from 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 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. 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 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. 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.” 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. 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. 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. 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.” 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. 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. 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. 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) 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. 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 admitted with 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 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. 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.” 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. 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. 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. [Show More]

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