Deck 25: Structure and Function of the Cardiovascular System

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 $\alpha$ -granules of platelets contribute primarily to vasoconstriction.
D) New platelets are released from the bone marrow into circulation.

Answer 1

The half-life of a platelet is typically around 8 to 12 days.

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 TXA}2 ^synthesis.
D) Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

Answer 2

Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

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

Suppression of fibrin 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) $\alpha$ ₂-plasmin inhibitor

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

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."

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

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."

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.

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."

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 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

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

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."

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 (TXA}2^{) 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.

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."

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.

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)

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 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

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."

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.