C HAPTER 37: H EMATOLOGIC AND
O NCOLOGIC E MERGENCIES
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient with t ype 2 heparin -induced
thrombocytopenia (HIT). The nurse knows that pulmonary embolism is a
serious complicat ion 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
ANS: D
The presence of blanching and the loss of peripheral pulses, sensation,
or motor function in a limb indicate peripheral vascular thrombi.
Neurologic signs and symptoms such as confusion, headache, and
impaired speech can signal the o nset of cerebral artery occlusion and
stroke. Acute m yocardial infarction may be heralded by dyspnea, chest
pain, pallor, and alterations in blood pressure. Thrombi in the
pulmonary vasculature may be evidenced by pleuritic pain, rales, and
dyspnea.
, DIF: Cognitive Level: Appl ying REF: p. 911 | p. 912 | Table
37-5 OBJ: Nursing Process Step: Diagnosis TOP:
Hematologic Disorders and Oncologic Emergencies MSC:
NCLEX: Physiologic Integrit y
2. The nurse is caring for a criticall y 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.
ANS: C
Current guidelines suggest that for high -risk patients, platelet count
monitoring should be performed every 2 or 3 days from day 4 to day
14. When a decrease in the platelet count is detected, heparin therapy
should be discontinued immediatel y, and the patien t should be tested
for the presence of heparin antibodies.
DIF: Cognitive Level: Appl ying REF: p. 912 OBJ:
Nursing Process Step: Intervention TOP: Hematologic
Disorders and Oncologic Emergencies MSC: NC LEX:
Physiologic Integrit y
, 3. The nurse is caring for a criticall y 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
ANS: B
Ascertaining a medical history that includes previous heparin therapy,
deep vein thrombosis, or cardiovascular surgery that included the use
of cardiopulmonary bypass can alert the nurse to potential problems.
DIF: Cognitive Level: Appl ying REF: p. 912 OBJ:
Nursing Process Step: Assessment TOP: Hematologic
Disorders and Oncologic Emergencies MSC: NC LEX:
Physiologic Integrit y
4. What is the primary mechanism in the development of tumor lysis
s yndrome?
a. Destruction of platelets by l ymphocytic antibodies
b. Destruction of malignant cells through radiation or chemotherapy
c. Formation of heparin antibodies
d. Damage to the endothelium
ANS: B
O NCOLOGIC E MERGENCIES
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient with t ype 2 heparin -induced
thrombocytopenia (HIT). The nurse knows that pulmonary embolism is a
serious complicat ion 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
ANS: D
The presence of blanching and the loss of peripheral pulses, sensation,
or motor function in a limb indicate peripheral vascular thrombi.
Neurologic signs and symptoms such as confusion, headache, and
impaired speech can signal the o nset of cerebral artery occlusion and
stroke. Acute m yocardial infarction may be heralded by dyspnea, chest
pain, pallor, and alterations in blood pressure. Thrombi in the
pulmonary vasculature may be evidenced by pleuritic pain, rales, and
dyspnea.
, DIF: Cognitive Level: Appl ying REF: p. 911 | p. 912 | Table
37-5 OBJ: Nursing Process Step: Diagnosis TOP:
Hematologic Disorders and Oncologic Emergencies MSC:
NCLEX: Physiologic Integrit y
2. The nurse is caring for a criticall y 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.
ANS: C
Current guidelines suggest that for high -risk patients, platelet count
monitoring should be performed every 2 or 3 days from day 4 to day
14. When a decrease in the platelet count is detected, heparin therapy
should be discontinued immediatel y, and the patien t should be tested
for the presence of heparin antibodies.
DIF: Cognitive Level: Appl ying REF: p. 912 OBJ:
Nursing Process Step: Intervention TOP: Hematologic
Disorders and Oncologic Emergencies MSC: NC LEX:
Physiologic Integrit y
, 3. The nurse is caring for a criticall y 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
ANS: B
Ascertaining a medical history that includes previous heparin therapy,
deep vein thrombosis, or cardiovascular surgery that included the use
of cardiopulmonary bypass can alert the nurse to potential problems.
DIF: Cognitive Level: Appl ying REF: p. 912 OBJ:
Nursing Process Step: Assessment TOP: Hematologic
Disorders and Oncologic Emergencies MSC: NC LEX:
Physiologic Integrit y
4. What is the primary mechanism in the development of tumor lysis
s yndrome?
a. Destruction of platelets by l ymphocytic antibodies
b. Destruction of malignant cells through radiation or chemotherapy
c. Formation of heparin antibodies
d. Damage to the endothelium
ANS: B
