Deck 38: Hematologic Disorders and Oncologic Emergencies

Question 1

The high-risk period for developing HIT is

A) 5 to 10 hours after initiation of heparin.
B) 5 to 14 hours after initiation of heparin.
C) 5 to 14 days after initiation of heparin.
D) 30 to 60 days after initiation of heparin.

Answer 1

5 to 14 days after initiation of heparin.

Question 2

Which of the following previous medical conditions would indicate a patient at risk for developing HIT?

A) Sepsis
B) Deep vein thrombosis
C) Cardiac arrest
D) Pneumonia

Answer 2

Deep vein thrombosis

Question 3

Hydroxyurea is increased by what dosage until the maximum of 35 mg/kg is reached?

A) 5 mg/kg every 4 weeks
B) 10 mg/kg every 8 weeks
C) 5 mg/kg every 12 weeks
D) 15 mg/kg every 15 weeks

Answer 3

5 mg/kg every 12 weeks

Question 4

Hospital-acquired anemia is an increasing problem in critically ill patients.Which of the following nursing interventions can be most beneficial in preventing this problem?

A) Administering fluids and inotropic agents to optimize blood pressure
B) Using blood salvage devices
C) Obtaining smaller blood samples through the use of pediatric blood tubes and point-of-care testing
D) Decreasing afterload through the use of vasodilators

Question 5

Which of the following would be appropriate for treating hypocalcemia?

A) Calcium gluconate
B) Insulin
C) Sodium bicarbonate
D) Dialysis

Question 6

Which of the following does not play a role in thrombin inhibition?

A) Thromboxane A?
B) Antithrombin III
C) Protein S
D) Protein C

Question 7

Which of the following interventions would be appropriate for ITP?

A) Instituting a heparin infusion of 1000 U/hr
B) Instructing the patient to blow his or her nose carefully
C) Removing heparin from hemodynamic pressure monitoring systems
D) Administering isotonic saline intravenously

Question 8

Type 2 heparin-induced thrombocytopenia is characterized by

A) formation of thrombi, causing vessel occlusion.
B) spontaneous epistaxis.
C) elevated prothrombin times.
D) massive peripheral ecchymoses.

Question 9

The intrinsic coagulation pathway is activated when

A) local blood vessels constrict at the injury site.
B) damaged endothelium comes into contact with circulating blood.
C) tissue factor is released by injured cells.
D) fibrinogen is converted to fibrin.

Question 10

A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites,and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work,his platelets are normal,and his international normalized ratio is elevated.The primary treatment goal for this patient is to

A) maintain adequate organ perfusion.
B) suppress antibody response that is destroying platelets.
C) treat life-threatening metabolic disturbances.
D) begin hypothermic therapy to prevent cerebral hemorrhage.

Question 11

Sickle cell anemia is not prevalent in persons of which descent?

A) West African
B) Sole European
C) Middle Eastern
D) Asian or Pacific Islander

Question 12

Pulmonary embolism,a serious complication of HIT,is manifested by which of the following clinical signs?

A) Blanching of fingers and toes and loss of peripheral pulses
B) Chest pain, pallor, and confusion
C) Headache, impaired speech, and loss of motor function
D) Dyspnea, pleuritic pain, and rales

Question 13

The primary mechanism in the development of tumor lysis syndrome is

A) destruction of platelets by lymphocytic antibodies.
B) destruction of malignant cells through radiation or chemotherapy.
C) formation of heparin antibodies.
D) damage to the endothelium.

Question 14

Which of the following pathophysiologic events contributes to renal failure associated with tumor lysis syndrome?

A) Hypocalcemia
B) Elevated white blood cell count
C) Metabolic acidosis
D) Crystallization of uric acid in the renal tubules

Question 15

Medication used to increase the level of fetal hemoglobin in the RBCs and reduce the concentration of sickle hemoglobin is known as

A) transfusion therapy.
B) hydroxyurea.
C) Kayexalate.
D) oxygen.

Question 16

The most common cause of disseminated intravascular coagulation (DIC)is

A) sepsis caused by gram-positive organisms.
B) sepsis caused by gram-negative organisms.
C) sickle cell anemia.
D) burns.

Question 17

Which of the following platelet counts would be most indicative of a diagnosis of ITP?

A) 28,000/mm3
B) 35,000/mm3
C) 72,000/mm3
D) 110,000/mm3

Question 18

The primary mechanism in the development of idiopathic thrombocytopenic purpura (ITP)is

A) destruction of platelets by lymphocytic antibodies.
B) destruction of malignant cells through radiation or chemotherapy.
C) formation of heparin antibodies.
D) damage to the endothelium.

Question 19

A patient is admitted into the critical care unit with symptoms of a low-grade fever,joint pain,tachycardia,hepatomegaly,photophobia,and an inability to follow commands.The patient is becoming more agitated and complaining of pain.The nurse suspects that the patient has

A) ITP.
B) heparin-induced thrombocytopenia.
C) sickle cell anemia.
D) DIC.

Question 20

A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites,and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work,his platelets are normal,and his international normalized ratio is elevated.What other laboratory value would be most valuable in definitively diagnosing the patient's condition?

A) Fibrin split products
B) D-Dimer level
C) Bleeding time
D) White blood cell count

Question 21

Medical intervention to prevent metabolic imbalances associated with tumor lysis syndrome includes

A) give Kayexalate for hypokalemia.
B) keep urine pH below 7.0.
C) fluid restriction.
D) dietary restriction of potassium and phosphorus foods.

Question 22

Clinical manifestations of ITP include which of the following?

A) Gingival bleeding
B) Retinal hemorrhage
C) Fluid retention
D) Muscle cramps
E) Petechial hemorrhages on legs

Question 23

Place these pathophysiologic mechanisms of DIC in the order in which they occur.
1)Activation of the fibrinolytic system
2)Breakdown of thrombi; spontaneous hemorrhage
3)Consumption of coagulation factors; failure of regulatory mechanisms
4)Endothelial damage; release of tissue factor
5)Thrombin formation; clots form along epithelial walls

A) 4, 5, 3, 1, 2
B) 4, 1, 3, 2, 5
C) 5, 1, 2, 4, 3
D) 2, 3, 1, 5, 4

Question 24

Common findings in tumor lysis syndrome (TLS)include

A) increased calcium.
B) decreased potassium.
C) dysrhythmias.
D) elevated blood urea nitrogen (BUN) and creatine.
E) edema.

Question 25

Which of the following nursing interventions would be used if a patient was put under bleeding precautions?

A) Avoid injections as appropriate.
B) Encourage the patient to eat foods high in calcium and vitamin C
C) Use a soft toothbrush or toothettes for oral care.
D) Provide a therapeutic mattress and pad side rails.
E) Use an electric razor for shaving.