Chapter 63
1. Which of the following statements best describes thrombopoiesis?
1. Platelet development from the hematopoietic stem cell to fully mature platelets
2. Blood cell development, beginning in the bone marrow and extending through cell
maturation in the peripheral bloodstream
3. Response to extrinsic factors that initiates the clotting cascade
4. The process that mitigates blood loss due to injury to any blood vessel
Answer: Platelet development from the hematopoietic stem cell to fully mature platelets
Rationale:
Hematopoiesis refers to blood cell development. Thrombopoiesis is not an extrinsic factor
that initiates blood clotting; it does refer to platelet development as only one component of
blood cell development. The process that mitigates blood loss due to injury to any blood
vessel is called hemostasis.
2. Which of the following disorders is reflective of primary hemostasis?
1. Thrombocytopenia
2. Hemophilia
3. Aplastic anemia
4. Iron deficiency anemia
Answer: Thrombocytopenia
Rationale:
Thrombocytopenia is defined as a decrease in the number of circulating platelets from the
normal value of 150,000/µL. Hemophilia is a disorder of secondary hemostasis; it is a
chronic condition that arises from the inheritance of mutated genes that control some of the
clotting factors, VIII or IX. Aplastic anemia is a disorder characterized by severe
pancytopenia (low or absent red blood cells, white blood cells, and platelets) in both the
periphery and bone marrow. Iron deficiency anemia is a common underlying cause of anemia
representative of insufficient or depleted iron supplies.
3. In instructing clients with disorders related to platelet and clotting factors, the nurse should
advise them to:
Select all that apply.
1. Refrain from flossing during the acute phase.
2. Use lightweight blankets.
3. Avoid Valsalva’s maneuver.
4. Monitor skin condition.
5. Brush teeth only once per day.
Answer: 1. Refrain from flossing during acute phase.
2. Use lightweight blankets.
3. Avoid Valsalva’s maneuver.
4. Monitor skin condition.
Rationale:
Refrain from flossing during acute phase. Flossing may stimulate bleeding.
Use lightweight blankets. Heat causes vasodilation.
Avoid Valsalva’s maneuver. Increased intrathoracic pressure may cause bleeding.
Monitor skin condition. Petechiae and ecchymoses are signs of bleeding.
Brush teeth only once per day. The number of times teeth are brushed is irrelevant and does
not precipitate bleeding.
4. A client is admitted with the diagnosis of generalized anemia. This disorder is caused by:
Select all that apply.
1. A disruption in erythrocyte volume.
2. Decreased oxygen availability to the tissues.
3. Defective oxygenation in the lungs.
4. An airway obstruction.
5. Abnormal pulmonary function.
Answer: 1. A disruption in erythrocyte volume.
2. Decreased oxygen availability to the tissues.
Rationale:
A disruption in erythrocyte volume. Decreased erythrocyte volume results in anemic hypoxia
or decreased oxygen availability to the tissues specifically due to decreased concentration of
functional hemoglobin or a reduced number of red blood cells.
Decreased oxygen availability to the tissues. Decreased erythrocyte volume results in anemic
hypoxia or decreased oxygen availability to the tissues specifically due to decreased
concentration of functional hemoglobin or a reduced number of red blood cells.
Defective oxygenation in the lungs. Defective oxygenation in the lungs causes hypoxic
hypoxia, in which oxygen deprivation occurs from defective oxygenation in the lungs.
An airway obstruction. An airway obstruction results in defective oxygenation in the lungs.
Abnormal pulmonary function. Abnormal pulmonary function results in defective
oxygenation in the lungs.
5. Client symptoms associated with thrombocytopenia are centered around:
Select all that apply.
1. A tendency to bleed after any invasive procedure.
2. Mucosal bleeding.
3. Blood-tinged sputum after coughing.
4. Discoloration of the skin.
5. An increased platelet count.
Answer: 1. A tendency to bleed after any invasive procedure.
2. Mucosal bleeding.
3. Blood-tinged sputum after coughing.
4. Discoloration of the skin.
Rationale:
A tendency to bleed after any invasive procedure. Thrombocytopenia is defined as a decrease
in the number of circulating platelets caused by impaired or suppressed production of
platelets or accelerated destruction of platelets. This results in a clotting failure and the
tendency to bleed.
Mucosal bleeding. Thrombocytopenia is defined as a decrease in the number of circulating
platelets caused by impaired or suppressed production of platelets or accelerated destruction
of platelets. This results in a clotting failure and the tendency to bleed when tissue is
aggravated.
Blood-tinged sputum after coughing. Coughing causes stress on tissues that may stimulate
bleeding due to the decrease in circulating platelets.
Discoloration of the skin. Skin discoloration is caused by bleeding into the tissues, an effect
of bleeding and decreased platelets.
An increased platelet count. Thrombocytopenia results from a decrease in the number of
circulating platelets.
6. Immune thrombocytopenia purpura (ITP) is an immune disease marked by a decrease in
the number of platelets due to:
1. Destruction by antibodies produced against a client’s own platelets.
2. An overproduction of reticulocytes.
3. An overproduction of neutrophils.
4. A reaction to heparin therapy.
Answer: Destruction by antibodies produced against an individual’s own platelets.
Rationale:
Immune thrombocytopenic purpura (ITP) is an autoimmune disease marked by a decrease in
the number of platelets due to destruction by antibodies produced against a client’s own
platelets. It is categorized as secondary and primary. Secondary ITP refers to the appropriate
development of antibodies against invading pathogens or drugs, which then inappropriately
cross-react against platelets, causing their destruction. In primary ITP, antibodies against
platelets also surface, but occur in the absence of viral, bacterial, or drug exposure. An
overproduction of immature red blood cells, reticulocytes. does not affect the number of
platelets. An overproduction of white blood cells, such as neutrophils, does not diminish the
number of platelets. A reaction to heparin therapy is referred to as heparin-induced
thrombocytopenia and results from being treated with unfractionated heparin and frequent
exposure to diluted heparin flushes for IV therapy management.
7. In developing a teaching plan for a client who is at home and has thrombocytopenia, the
nurse should consider:
Select all that apply.
1. Developing a plan for physical exercise.
2. Discussing the home environment with patient and family to ensure safety.
3. Assisting the client/family to develop an awareness of bleeding precautions.
4. Collaborating with the pharmacist to identify drugs that might exacerbate the destruction of
platelets.
5. Discussing the need to reduce alcohol and increase thiazide medications.
Answer: 1. Developing a plan for physical exercise.
2. Discussing the home environment with patient and family to ensure safety.
3. Assisting the client/family to develop an awareness of bleeding precautions.
4. Collaborating with the pharmacist to identify drugs that might exacerbate the destruction of
platelets.
Rationale:
Developing a plan for physical exercise. The client should engage in physical exercise that
will maintain cardio-muscular strength, but not expose the client to injury.
Discussing the home environment with patient and family to ensure safety. The home
environment should be free from safety hazards that may cause falls or other types of
physical injury.
Assisting the client/family to develop an awareness of bleeding precautions. The client should
be aware of bleeding precautions such as using a soft toothbrush or tooth sponges for mouth
care, avoiding rectal thermometers and enemas, and preventing constipation and straining
with stools.
Collaborating with the pharmacist to identify drugs that might exacerbate the destruction of
platelets. Medications in the form of prescriptions and over-the-counter drugs may contribute
to bleeding problems.
Discussing the need to reduce alcohol and increase thiazide medications. Alcohol has a
marrow-depressing effect leading to transient thrombocytopenia; its use should be reduced.
Thiazide medications can produce mild thrombocytopenia; their use should be reduced.
8. A client diagnosed with hemolytic anemia typically presents with the following symptoms:
Select all that apply.
1. Tachycardia.
2. Jaundice.
3. Hepatomegaly.
4. Decreased urine output.
5. Increased urine output.
Answer: 1. Tachycardia.
2. Jaundice.
3. Hepatomegaly.
4. Decreased urine output.
Rationale:
Tachycardia. Tachycardia is a result of decreased oxygenation in anemia.
Jaundice. Jaundice results from an increase in indirect billirubin in hemolysis.
Hepatomegaly. Hepatomegaly, particularly in combination with poor liver function, is an
indicator of persistent hemolysis.
Decreased urine output. Decreased urine output is an indication of renal failure.
Increased urine output. Increased urine output would be atypical; decreased urine output is an
indication of renal failure.
9. A positive response to iron therapy is evidenced by an increase in:
1. Reticulocytes.
2. Basophils.
3. Eosinophils.
4. Platelets.
Answer: Reticulocytes.
Rationale:
Reticulocytes are red blood cells that respond positively to iron therapy, resulting in increased
reticulocytes. Basophils and eosinophils are types of white blood cells whose growth is not
influenced by iron therapy. Platelets cells are necessary for clotting but are not responsive to
iron therapy.
10. The laboratory test results for a client with hemophilia will include which of the
following?
1. Prolonged partial thromboplastin time (PTT)
2. INR (international normalized ratio) in the normal range
3. Normal prothrombin time (PT)
4. Normal bleeding time
Answer: Prolonged partial thromboplastin time (PTT)
Rationale:
A PTT and INR are indicated for any patient suspected of having hemophilia. An increased or
prolonged PTT is indicative of clotting factor deficiency or hemophilia. The INR time also
would be increased beyond the normal range in accordance with the prolonged prothrombin
time results. A normal PT and bleeding time are not indicative of a clotting factor disorder.
11. A client admitted with iron deficiency anemia has clinical symptoms related to which
abnormal laboratory value?
1. Low levels of iron-bound transferrin
2. High levels of iron-bound transferrin
3. High levels of ferritin
4. High hemoglobin level
Answer: Low levels of iron-bound transferrin
Rationale:
Iron is required for the heme portion of the hemoglobin protein; it is coupled with the irontransporting protein transferrin. Thus erythrocyte production is slowed when iron-dependent
hemoglobin supplies are depleted or insufficient in contrast to high levels of ferritin, which
may indicate other types of anemias—hemolytic, pernicious, and folic acid deficiency, liver
damage, or thalassemia. Ferritin is an iron-storage protein that is produced in the liver,
spleen, and bone marrow. High ferritin levels are related to the amount of iron stored in the
body tissues, and would indicate disorders related to chronic diseases such as leukemia,
lymphoma, iron overload, and tissue damage. A high hemoglobin level indicates
hemoconcentration resulting from dehydration, which does not typically occur in iron
deficiency anemia.
12. Megaloblastic anemia results from impaired DNA synthesis of the erythrocyte RBC
precursors, resulting in:
1. Large immature red blood cells, called megaloblasts.
2. Small, pale red blood cells.
3. Juvenile red blood cells, called reticulocytes.
4. Elongated, hard, sticky, cells.
Answer: Large immature red blood cells, termed megaloblasts.
Rationale:
Impaired DNA synthesis of the erythrocyte RBC precursors produce cells called
megaloblasts. Due to their immaturity and large size, these cells are often sequestered in the
bone marrow rather than released into the periphery. If released into the peripheral
bloodstream, megaloblasts are subject to an increased rate of hemolysis due to structural
defects in their membranes. Bone marrow sequestration and increased hemolysis result in a
decreased total RBC count or anemia. Small, pale red blood cells are reflective of iron
deficiency anemia. Reticulocytes are juvenile erythrocytes present in peripheral blood.
Reticulocytes increase in most types of sustained anemia, as erythropoiesis accelerates as a
compensatory mechanism. Their presence is not indicative of megaloblastic anemia.
Elongated, hard, sticky, cells are found in sickle cell anemia.
13. What is the goal of nursing management when caring for a hospitalized client with
hemophilia?
Select all that apply.
1. Disease management
2. Environmental control
3. Client/family education
4. Administration of replacement factors
5. Cure
Answer: 1. Disease management
2. Environmental control
3. Client/family education
4. Administration of replacement factors
Rationale:
Disease management. Disease management focuses on reduction of environmental factors
that increase risk and on management of the administration of the replacement factors.
Environmental control. Disease management focuses on reduction of environmental factors
that increase risk and on management of the administration of the replacement factors.
Client/family education. Client/family education is critical to ensuring that they understand
the disease process and comply with the goals of the disease management plan.
Administration of replacement factors. Disease management focuses on reduction of
environmental factors that increase risk and on management of the administration of the
replacement factors.
Cure. Hemophilia is a chronic condition caused by the inheritance of mutated clotting genes
controlling Factor VIII or Factor IX, for which there is no cure. The goal of treatment
revolves around factor replacement therapy.
14. A nurse is assigned to care for a female client diagnosed with aplastic anemia. What are
the expected outcomes of the nurse’s interventions?
Select all that apply.
1. Free of injury from falls
2. Able to perform own ADLs
3. Alert and oriented
4. Hematocrit of 32
5. Dyspnea upon exertion
Answer: 1. Free of injury from falls
2. Able to perform own ADLs
3. Alert and oriented
Rationale:
Free of injury from falls. The patient with aplastic anemia benefits from nursing interventions
designed for anemia, thrombocytopenia, and infection prevention. Free from falls indicates
that the client has enough muscle strength to ambulate safely, without falls.
Able to perform own ADLs. The patient with aplastic anemia benefits from nursing
interventions designed for anemia, thrombocytopenia, and infection prevention. This
indicates that the patient has enough energy based on oxygenation to perform her own ADLs.
Alert and oriented. Being alert and oriented indicates that the patient is getting enough
oxygen to the brain. In the cases of some anemia clients, this would not be satisfactory.
Hematocrit of 32. This is a low value for female hematocrit and is therefore incorrect.
Dyspnea upon exertion. The patient with aplastic anemia benefits form nursing interventions
designed for anemia, thrombocytopenia, and infection prevention. This indicates that the
patient becomes hypoxic with exertion, which is not a desired outcome.
15. In preparing to care for a client with clotting disorders, the nurse reviews the types
(categories) of medications the client is likely to receive, including:
1. Immune-suppressive medications.
2. Erythropoietic agents.
3. Parenteral iron supplementation.
4. Vitamin supplementation.
Answer: Immune-suppressive medications.
Rationale:
Immune-suppressive medications, such as steroids and intravenous immunoglobulin, are used
to suppress the immune response, including the autoimmune response. Suppression of the
immune system results in platelet survival. Erythropoietic agents are used to treat anemias by
stimulating, differentiating, and proliferating the hematopoietic cascade. Parenteral iron
supplements and vitamin supplements also are used to treat anemias. Parenteral iron
supplementation stimulates the release of iron from plasma. Vitamin supplementation is used
to correct deficiencies in key elements, such as vitamin B12 and serum folate, required for
hemoglobin synthesis.
16. The nurse is caring for a client who is on coumadin due to a history of deep vein
thrombosis. The teaching plan for the client must include instructions to avoid which of the
following food choices?
1. Dark-green leafy vegetables
2. Fish
3. Fruit
4. Red meat
Answer: Dark-green leafy vegetables
Rationale:
Dark-green leafy vegetables contain vitamin K, thus they would counteract the effects of
coumadin. Fish, fruit, and red meat do not contain vitamin K, and would be safe to include in
the diet.
17. The nurse is admitting a client to the emergency department who is bleeding from a
gunshot wound to the right thigh. The nurse is unable to stop the bleeding. What diagnostic
tests must be performed on this client?
Select all that apply.
1. Platelet count
2. INR (international normalized ratio)
3. PTT (partial thromboplastin time)
4. WBC (white blood count)
5. BUN (blood urea nitrogen)
Answer: 1. Platelet count
2. INR (international normalized ratio)
3. PTT (partial thromboplastin time)
Rationale:
Platelet count. The platelet count measures the circulating platelets in the blood; platelets
facilitate the clotting process. INR (international normalized ratio). The international
normalized ratio monitors anticoagulant therapy, and it is generally used to monitor coumadin
therapy. PTT (partial thromboplastin time). Partial thromboplastin time is a screening test
used to detect deficiencies in all clotting factors except VII and XIII and to detect platelet
variations. WBC (white blood count). The white blood count (WBC) is part of a complete
blood count and is used to determine the presence of an infection. BUN (blood urea
nitrogen). The blood urea nitrogen (BUN) measures the urea excreted by the kidneys and is
used to detect a renal disorder or dehydration associated with increased BUN levels.
18. The nurse is caring for a postoperative hip fracture client who is complaining of chest
pain and shortness of breath. What laboratory tests must be ordered for this client?
Select all that apply.
1. Platelet count
2. PTT
3. INR
4. WBC
5. BUN
Answer: 1. Platelet count
2. PTT
Rationale:
Platelet count. The client is at high risk for a clotting disorder to develop. The platelet count
measures the circulating platelets in the blood; platelets facilitate the clotting process. PTT.
Partial thromboplastin time is a screening test used to detect deficiencies in all clotting factors
except VII and XIII and to detect platelet variations, thus it would be appropriate to order.
INR. The international normalized ratio monitors anticoagulant therapy, and it is generally
used to monitor coumadin therapy. This client has not been diagnosed for the chest pain and
has not been placed on anticoagulant therapy. WBC. The white blood count (WBC) is part of
a complete blood count and is used to determine the presence of an infection, and would not
be ordered. BUN. The blood urea nitrogen (BUN) measures the urea excreted by the kidneys
and is used to detect a renal disorder or dehydration associated with increased BUN levels,
and would be ordered to determine the cause of chest pain and shortness of breath.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
