Common Hematological Disorders: Ch 49 In Critical Care Nursing: A Holistic Approach

Front 1

Iron deficiency anemia may be caused by:
A. inadequate intake of iron in the diet.
B. malabsorption of oral iron.
C. chronic blood loss.
D. all of the above.

Back 1

D. All of the above

Iron deficiency anemia may be caused by inadequate intake of iron in the diet, malabsorption of oral iron, or chronic blood loss.

Front 2

The most effective treatment for chronic myelogenous leukemia (CML) is:
A. alpha interferon.
B. bone maroow transplantation.
C. STI571.
D. glucocorticoids.

Back 2

C. STI571

STI571 is a new and extremely successful treatment of chronic myelogenous leukemia (CML) with very few side effects.

Front 3

An acute episode of bleeding in a pt with hemophilia A would be managed with administration of:
A. von Willebrand's factor.
B. factor VIII.
C. factor IX.
D. platelet transfusion.

Back 3

B. factor VIII

An acute episode of bleeding in a pt with hemophilia A would be managed by administering factor VIII, which is deficient in these pts.

Front 4

Normal inhibitors of coagulation include all but which of the following?
A. Adequate cardiac output, which dilates activated factors
B. Antithrombin III, which inactivates thrombin
C. Tissue thromboplastin, which interferes with fibrin formation
D. Plasminogen converting to plasmin

Back 4

C. Tissue thromboplastin, which interferes with fibrin formation.

Normal inhibitors of coagulation include adequate cardiac output, the presence of antithrombin III, and plasminogen converting to plasmin. Tissue thromboplastin in the circulation causes activation of the extrinsic pathway through activation of factor VII.

Front 5

An early indication of a disseminated intravascular coagulation (DIC) process is bleeding associated with:
A. a decreased platelet count.
B. a decreased prothrombin time (PT).
C. decreased levels of fibrin degradation products (FDPs).
D. increased fibrinogen

Back 5

A. a decreased platelet count.

An early indication of a disseminated intravascular coagulation (DIC) process is a decreased platelet count. Platelets are consumed in the initial hypercoagulable state to form platelet plugs and to initiate clotting via the intrinsic pathway through the release of platelet factor 3.

Front 6

Pts with disseminated intravascular coagulation (DIC), a hypercoagulable syndrome, bleed because of all the following except:
A. depleted clotting factors.
B. increased levels of fibrin degradation products (FDPs)
C. diffuse microthrombosis
D. decreased plasminogen levels

Back 6

D. decreased plasminogen levels

Pts with disseminated intravascular intravascular coagulation (DIC) bleed because of depleted clotting factors, increased levels of fibrin degradation products (FDPs), and diffuse microthrombosis. Decreased plaminogen levels resutl in decreased levels of plasmin. Plasmin is the lymic enzyme that acts to break down fibrin. Hence, decreased plasmin levels result in decreased clot break down lessening the chance of bleeding and consumption of clotting factors.

Front 7

A critically ill patient develops hemolytic anemia after administration of penicillin. The treatment is:
A. discontinuation of the drug.
B. heparin.
C. possible red blood cell transfusion. D. a and c are correct.

Back 7

D. a and c are correct.

Treatment of drug-induced hemolytic anemia is discontinuation of the drug and RBC transfusion, if necessary.

Front 8

A critically ill patient has renal artery stenosis, causing an alteration in the erythropoietin production. The disorder most likely for the patient to experience is:
A. acquired hemolytic anemia. B. megaloblastic anemia.
C. polycythemia.
D. neutropenia

Back 8

C. polycythemia.

Secondary polycythemia is an increased red blood cell mass caused by increased red blood cell production.

Front 9

Activated protein C (Xigris) is administered to a septic patient who is at risk for development of DIC. This medication is given to:
A. slow the clotting cascade.
B. decrease the rate of clot formation.
C. reclaim the balance between clotting and fibrinolysis.
D. All of the above are correct.

Back 9

D. All of the above are correct.

Activated protein C (Xigris) is administered to slow the clotting cascade, decrease the rate of clot formation, and reclaim the balance between clotting and fibrinolysis.

Front 10

pharmacotherapeutic agent used in the treatment of thrombotic thrombocytopenic purpura is
A. heparin.
B. plasma transfusion.
C. warfarin.
D. protamine sulfate.

Back 10

B. plasma transfusion.

Primary treatment of TTP is simple plasma transfusion to replace whatever factors are missing in the patient's plasma.

Front 11

For iron deficiency anemia, the initial management would include correcting the underlying bleeding and:
A. administering iron supplements orally.
B. transfusing with packed cells.
C. instructing the patient to eat organ meats.
D. promoting collateral circulation by exercising.

Back 11

A. administering iron supplements orally.

Initial management includes correcting underlying bleeding, if possible, and replacing iron using oral supplements.

Front 12

Heparin usage in the management of DIC runs the risk of:
A. increasing bleeding.
B. causing thrombus formation.
C. pulmonary emboli.
D. All of the above are correct

Back 12

A. increasing bleeding.

Previously, heparin therapy was initiated to minimize further clotting. However, the risk of increased bleeding is always a major concern.

Front 13

In immune thrombocytopenia purpura, there is:
A. platelet destruction.
B. leukopenia.
C. hemolytic anemia.
D. bone marrow suppression.

Back 13

A. platelet destruction.

ITP is an immune-mediated disorder of platelet destruction.

Front 14

Platelet count in disseminated intravascular coagulation (DIC) is




A. increased.
B. decreased.
C. normal.
D. unpredictable.

Back 14

B. decreased.

Platelet count in DIC is decreased.

Front 15

Sudden onset of an acute headache in a patient who has DIC may be a sign of:
A. hypoxemia.
B. intracerebral bleeding.
C. head trauma.
D. electrolyte imbalance.

Back 15

B. intracerebral bleeding.

Sudden and acute headache is more likely to be hemorrhagic.

Front 16

The mainstay of therapy in DIC is




A. blood replacement.
B. clotting factor replacement.
C. elimination of the cause. D. heparin therapy.

Back 16

C. elimination of the cause.

The backbone of therapy for DIC is elimination of the causative agent.

Front 17

The triggering event in disseminated intravascular coagulation (DIC) causes:
A. systemic coagulation activity.
B. uncontrolled bleeding.
C. excessive platelet production.
D. activation of the fibrinolytic system.

Back 17

A. systemic coagulation activity.

Regardless of the precipitating event in DIC, the triggering stimulus initiates systemic coagulation activity, resulting in diffuse intravascular fibrin formation and deposition of fibrin in the microcirculation.

Front 18

When assessing lab tests for a patient diagnosed with polycythemia, the nurse will find:
A. increased platelets and low hemoglobin.
B. leukopenia and decreased platelets.
C. high hematocrit and increased red blood cell (RBC) mass.
D. decreased red blood cells (RBCs) and increased white blood cells (WBCs).

Back 18

C. high hematocrit and increased red blood cell (RBC) mass.

Polycythemia is a disorder of increased red blood cell production, as indicated by a high hematocrit and increased red blood cell (RBC) mass.