Deck 37: Hematologic and Oncologic Emergencies

Question 1

Hospital-acquired anemia is an increasing problem in critically ill patients.Which 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

Answer 1

Obtaining smaller blood samples through the use of pediatric blood tubes and point-of-care testing

Question 2

A patient was admitted with gram-negative sepsis a few days ago.Today the nurse notes continual oozing from intravenous sites and ecchymosis beneath the blood pressure cuff.The patient's platelet count is normal,and international normalized ratio (INR)is elevated.The nurse places highest priority on which treatment goal?

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.

Answer 2

Maintain adequate organ perfusion.

Question 3

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

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

Answer 3

Destruction of platelets by lymphocytic antibodies

Question 4

The nurse is caring for a critically ill patient who is receiving heparin and understands that the patient is at risk for developing heparin-induced thrombocytopenia (HIT).Which previous medical conditions places this patient at risk for developing HIT?

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

Question 5

The nurse is caring for a patient with idiopathic thrombocytopenic purpura (ITP).Which platelet count would the nurse expect to note to confirm this diagnosis?

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

Question 6

Sickle cell anemia is the most prevalent in persons of which descent?

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

Question 7

What is the most common cause of disseminated intravascular coagulation (DIC)?

A) Sepsis caused by gram-positive organisms
B) Sepsis caused by gram-negative organisms
C) Sickle cell anemia
D) Burns

Question 8

The nurse is caring for a patient with type 2 heparin-induced thrombocytopenia (HIT).The nurse understands that this disorder has which characteristic?

A) Formation of thrombi
B) Spontaneous epistaxis
C) Elevated prothrombin times
D) Massive peripheral ecchymoses

Question 9

The nurse is developing a patient education plan for a patient with sickle cell anemia.Hydroxyurea is the medication used in the treatment of the disorder.The nurse would inform the patient that the hydroxyurea may be 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

Question 10

A patient was admitted with gram-negative sepsis a few days ago.Today the nurse notes continual oozing from intravenous sites and ecchymosis beneath the blood pressure cuff.The patient's platelet count is normal,and international normalized ratio (INR)is elevated.What other laboratory value would be 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 11

The nurse is caring for a patient with idiopathic thrombocytopenic purpura (ITP).The nursing management plan for this patient would include which intervention?

A) Instituting a heparin infusion of 1000 U/h
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 12

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

A) Thromboxane A₂
B) Antithrombin III
C) Protein S
D) Protein C

Question 13

Which pathophysiologic event 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 14

A patient has been admitted with sickle cell anemia and is requiring a blood transfusion.The nurse understands that transfusions should be used with caution in this patient because of what complication?

A) Fluid overload
B) Iron overload
C) Vasoocclusive crisis
D) Stroke

Question 15

A patient is admitted 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 which disorder?

A) Idiopathic thrombocytopenic purpura
B) Heparin-induced thrombocytopenia
C) Sickle cell anemia
D) Disseminated intravascular coagulation

Question 16

The nurse is caring for a critically ill patient who is receiving heparin and understands that the patient is at risk for developing heparin-induced thrombocytopenia (HIT).Which intervention would be included into the patient's plan of care to monitor for this potential complication?

A) Monitor D-dimer levels every 5 to 10 hours from day 2 to day 5.
B) Monitor prothrombin time (PT) every 5 to 14 hours from day 2 to day 12.
C) Monitor platelet count every 2 or 3 days from day 4 to day 14.
D) Monitor international normalized ratio (INR) every 5 days from day 10 to day 30.

Question 17

The nurse is caring for a patient with type 2 heparin-induced thrombocytopenia (HIT).The nurse knows that pulmonary embolism is a serious complication of HIT.Which findings would alert the nurse to the presence of this complication?

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 18

A patient with a history of alcoholism is admitted with esophageal bleeding.Which finding would be an indication for the administration of blood in this patient?

A) Hemoglobin less than 7 g/dL
B) Hematocrit less than 30%
C) Altered level of conscious
D) D-dimer greater than 250 ng/mL

Question 19

How is the intrinsic coagulation pathway activated?

A) Local blood vessels constrict at the injury site.
B) Damaged subendothelium comes into contact with circulating blood.
C) Tissue factor is released by injured vascular cells.
D) Serotonin and histamine are released.

Question 20

What is the primary mechanism in the development of tumor lysis syndrome?

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 21

The nurse is caring for a patient with heparin-induced thrombocytopenia (HIT).The nurse knows the patient is at high risk for bleeding and injury.Which interventions would be included in the plan of care?

A) Avoid intramuscular injections.
B) Use a large-gauge intravenous cannula for venipunctures.
C) Use a soft-bristled toothbrush when providing mouth care.
D) Use a draw sheet when repositioning the patient in bed.
E) Shave the patient with an electric shaver only.

Question 22

Place these pathophysiologic mechanisms of disseminated intravascular coagulation (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 23

A patient has been admitted with tumor lysis syndrome (TLS).Which intervention would be incorporated into the plan of care to prevent the metabolic imbalances associated with this disorder?

A) Give sodium polystyrene sulfonate for hypokalemia.
B) Keep urine pH below 7.0.
C) Restrict all oral fluids.
D) Restrict foods containing potassium.

Question 24

A patient has been admitted with tumor lysis syndrome (TLS).Which laboratory findings would the nurse expect to note to support this diagnosis?

A) Increased calcium
B) Decreased potassium
C) Dysrhythmias
D) Elevated blood urea nitrogen (BUN)
E) Elevated creatine

Question 25

A patient has been admitted with immune thrombocytopenia purpura (ITP).Which sign and symptoms would the nurse expect to note to support this diagnosis?

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