TEST BANK
NUR 775 Unit 3
Chapter 238: Blood Coagulation Disorders
1. A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks about a
family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding
episodes, but states that a maternal uncle and his maternal grandfather both had post-surgical complications
related to bleeding. Based on this history, which diagnosis is possible?
a. a. Hemophilia
b. b. Thrombocytopenia
c. c. Thrombophilia
d. d. Von Willebrand disease
ANS: A
Hemophilia is an X-linked recessive disorder affecting only males and carried by females. A family history of
maternal males with bleeding disorders should clue the provider that this disorder is likely. Thrombocytopenia is
usually an acquired disorder. Thrombophilia causes clots and thrombi, not bleeding. Von Willebrand disease is an
autosomal genetic disorder affecting both males and females.
2. A patient is noted to have prolonged bleeding after an intravenous needle is removed. A subsequent
laboratory test reveals a prolonged activated partial thromboplastin (aPTT) time with a normal
prothrombin time (PT). Based on this result, the provider may suspect alteration in function of which
factor?
a. a. Factor V
b. b. Factor VII
c. c. Factor VIII
d. d. Factor X
ANS: C
Factor VIII is part of the intrinsic system, which aPTT measures. The other factors are part of the extrinsic system,
which is measured by PT.REF: Pathophysiology
1. 3. A patient has type 1 Von Willebrand disease (vWD). What treatment is generally effective to prevent and
treat bleeding episodes in this patient?
a. a. Coagulation factor
b. b. Desmopressin
c. c. Heparin
d. d. Vitamin K
ANS: B
Desmopressin may be useful in patients with type 1 vWD. Coagulation factor is used in most patients with
hemophilia. Heparin is an anticoagulant. Vitamin K is used to counter warfarin overdose.REF: Von Willebrand
Disease
1
, NUR 775 Unit 3
Chapter 239: Leukemias
3. 1. A patient is suspected of having leukemia and the provider orders biochemical studies and a bone
marrow aspirate and biopsy. The results include WBCs greater than 200,000 cells/mm3 normal RBCs,
hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase. Which test will the
provider order to confirm a diagnosis in this patient?
a. Chest radiograph
b. Coagulation studies
c. Philadelphia chromosome test
d. Serum protein electrophoresis
ANS: C
The findings from the CBC and bone marrow biopsy, along with a positive Philadelphia chromosome test, confirm
the diagnosis of chronic myelogenous leukemia. A chest radiograph and serum protein electrophoresis may be
performed to evaluate for associated symptoms. Coagulation studies are usually performed as part of the
diagnostic workup for ALL.REF: Clinical Presentation/Chronic Leukemias/Diagnostics and Differential Diagnosis
1. 2. A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes
petechiae and diffuse lymphadenopathy. A complete blood count reveals a WBC of 30,000 cells/mm3 and
near normal RBC and platelet counts. What will the provider do next to manage this patient?
e. a. Order coagulation studies to evaluate for coagulopathies
f. b. Perform biochemical studies to look for hyperuricemia
g. c. Refer to a specialist for a bone marrow aspirate and biopsy
h. d. Repeat the complete blood count in two weeks
ANS: C
Patients with ALL may have normal blood counts even when the marrow has been replaced with leukemic cells,
so a bone marrow aspirate and biopsy is required for the definitive diagnosis. Coagulation and biochemical
studies may be performed after the diagnosis is known to evaluate for complications. Waiting and repeating the
CBC in 2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.REF: Clinical
Presentation/Acute Leukemias/Diagnostics and Differential Diagnosis
2. 3. A patient with acute myelogenous leukemia (AML) who has a high white blood cell count and diffuse
lymphadenopathy is hospitalized during the induction phase of chemotherapy. What monitoring and
interventions are critical to assess for complications during this phase of care for this patient?
Select all that apply.
e. a. Administration of sodium bicarbonate and allopurinol
f. b. Assessment for bruising and petechiae
g. c. Close monitoring of absolute neutrophil counts
h. d. Daily renal function and chemistry values
i. e. Meticulous assessment of hydration status
ANS: A, D, E
2
, NUR 775 Unit 3
This patient has a high WBC load and diffuse lymphadenopathy, so is at increased risk for acute tumor lysis
syndrome (ATLS). Close monitoring of renal function, serum renal chemistry values, and hydration status is
essential. Adding sodium bicarbonate and allopurinol help to minimize risk. Thrombocytopenia causing bruising
and petechiae, along with neutropenia, are common complications of chemotherapy but these symptoms
generally occur 7 to 10 days after initiation of therapy.REF: Tumor Lysis Syndrome
Chapter 102: Acute Bronchitis
4. 1. An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a
runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is
recommended for this patient?
e. a. Azithromycin daily for 5 days
f. b. Isolation if paroxysmal cough develops
g. c. Pertussis vaccine booster
h. d. Symptomatic care only
ANS: A
Adults previously immunized against pertussis may still get the disease without the classic whooping cough sign
seen in children and are contagious from the beginning of the catarrhal stage of runny nose and common cold
symptoms. Azithromycin or other macrolide antibiotics are useful for reducing symptoms and for decreasing
shedding of bacteria to limit spread of the disease. Patients should be isolated for 5 days from the start of
treatment. Pertussis vaccine booster will not alter the course of the disease once exposed. Symptomatic care
only will not reduce symptoms or decrease disease spread.
2. 2. A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the
cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?
i. a. Antibiotic therapy
j. b. Antitussive medication
k. c. Bronchodilator treatment
l. d. Mucokinetic agents
ANS: B
Antitussive medications are occasionally useful for short-term relief of coughing. Antibiotic therapy is generally
not needed and should be avoided unless a bacterial cause is likely. Bronchodilator medications show no
demonstrated reduction in symptoms and are not recommended. Mucokinetic agents have no evidence to
support their use. REF: Communication and Language Development
3. 3. A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help
reduce the duration of symptoms in this patient?
j. a. Azithromycin
k. b. Clindamycin
l. c. Oseltamivir
m. d. Trimethoprim-sulfamethoxazole
3
NUR 775 Unit 3
Chapter 238: Blood Coagulation Disorders
1. A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks about a
family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding
episodes, but states that a maternal uncle and his maternal grandfather both had post-surgical complications
related to bleeding. Based on this history, which diagnosis is possible?
a. a. Hemophilia
b. b. Thrombocytopenia
c. c. Thrombophilia
d. d. Von Willebrand disease
ANS: A
Hemophilia is an X-linked recessive disorder affecting only males and carried by females. A family history of
maternal males with bleeding disorders should clue the provider that this disorder is likely. Thrombocytopenia is
usually an acquired disorder. Thrombophilia causes clots and thrombi, not bleeding. Von Willebrand disease is an
autosomal genetic disorder affecting both males and females.
2. A patient is noted to have prolonged bleeding after an intravenous needle is removed. A subsequent
laboratory test reveals a prolonged activated partial thromboplastin (aPTT) time with a normal
prothrombin time (PT). Based on this result, the provider may suspect alteration in function of which
factor?
a. a. Factor V
b. b. Factor VII
c. c. Factor VIII
d. d. Factor X
ANS: C
Factor VIII is part of the intrinsic system, which aPTT measures. The other factors are part of the extrinsic system,
which is measured by PT.REF: Pathophysiology
1. 3. A patient has type 1 Von Willebrand disease (vWD). What treatment is generally effective to prevent and
treat bleeding episodes in this patient?
a. a. Coagulation factor
b. b. Desmopressin
c. c. Heparin
d. d. Vitamin K
ANS: B
Desmopressin may be useful in patients with type 1 vWD. Coagulation factor is used in most patients with
hemophilia. Heparin is an anticoagulant. Vitamin K is used to counter warfarin overdose.REF: Von Willebrand
Disease
1
, NUR 775 Unit 3
Chapter 239: Leukemias
3. 1. A patient is suspected of having leukemia and the provider orders biochemical studies and a bone
marrow aspirate and biopsy. The results include WBCs greater than 200,000 cells/mm3 normal RBCs,
hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase. Which test will the
provider order to confirm a diagnosis in this patient?
a. Chest radiograph
b. Coagulation studies
c. Philadelphia chromosome test
d. Serum protein electrophoresis
ANS: C
The findings from the CBC and bone marrow biopsy, along with a positive Philadelphia chromosome test, confirm
the diagnosis of chronic myelogenous leukemia. A chest radiograph and serum protein electrophoresis may be
performed to evaluate for associated symptoms. Coagulation studies are usually performed as part of the
diagnostic workup for ALL.REF: Clinical Presentation/Chronic Leukemias/Diagnostics and Differential Diagnosis
1. 2. A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes
petechiae and diffuse lymphadenopathy. A complete blood count reveals a WBC of 30,000 cells/mm3 and
near normal RBC and platelet counts. What will the provider do next to manage this patient?
e. a. Order coagulation studies to evaluate for coagulopathies
f. b. Perform biochemical studies to look for hyperuricemia
g. c. Refer to a specialist for a bone marrow aspirate and biopsy
h. d. Repeat the complete blood count in two weeks
ANS: C
Patients with ALL may have normal blood counts even when the marrow has been replaced with leukemic cells,
so a bone marrow aspirate and biopsy is required for the definitive diagnosis. Coagulation and biochemical
studies may be performed after the diagnosis is known to evaluate for complications. Waiting and repeating the
CBC in 2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.REF: Clinical
Presentation/Acute Leukemias/Diagnostics and Differential Diagnosis
2. 3. A patient with acute myelogenous leukemia (AML) who has a high white blood cell count and diffuse
lymphadenopathy is hospitalized during the induction phase of chemotherapy. What monitoring and
interventions are critical to assess for complications during this phase of care for this patient?
Select all that apply.
e. a. Administration of sodium bicarbonate and allopurinol
f. b. Assessment for bruising and petechiae
g. c. Close monitoring of absolute neutrophil counts
h. d. Daily renal function and chemistry values
i. e. Meticulous assessment of hydration status
ANS: A, D, E
2
, NUR 775 Unit 3
This patient has a high WBC load and diffuse lymphadenopathy, so is at increased risk for acute tumor lysis
syndrome (ATLS). Close monitoring of renal function, serum renal chemistry values, and hydration status is
essential. Adding sodium bicarbonate and allopurinol help to minimize risk. Thrombocytopenia causing bruising
and petechiae, along with neutropenia, are common complications of chemotherapy but these symptoms
generally occur 7 to 10 days after initiation of therapy.REF: Tumor Lysis Syndrome
Chapter 102: Acute Bronchitis
4. 1. An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a
runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is
recommended for this patient?
e. a. Azithromycin daily for 5 days
f. b. Isolation if paroxysmal cough develops
g. c. Pertussis vaccine booster
h. d. Symptomatic care only
ANS: A
Adults previously immunized against pertussis may still get the disease without the classic whooping cough sign
seen in children and are contagious from the beginning of the catarrhal stage of runny nose and common cold
symptoms. Azithromycin or other macrolide antibiotics are useful for reducing symptoms and for decreasing
shedding of bacteria to limit spread of the disease. Patients should be isolated for 5 days from the start of
treatment. Pertussis vaccine booster will not alter the course of the disease once exposed. Symptomatic care
only will not reduce symptoms or decrease disease spread.
2. 2. A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the
cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?
i. a. Antibiotic therapy
j. b. Antitussive medication
k. c. Bronchodilator treatment
l. d. Mucokinetic agents
ANS: B
Antitussive medications are occasionally useful for short-term relief of coughing. Antibiotic therapy is generally
not needed and should be avoided unless a bacterial cause is likely. Bronchodilator medications show no
demonstrated reduction in symptoms and are not recommended. Mucokinetic agents have no evidence to
support their use. REF: Communication and Language Development
3. 3. A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help
reduce the duration of symptoms in this patient?
j. a. Azithromycin
k. b. Clindamycin
l. c. Oseltamivir
m. d. Trimethoprim-sulfamethoxazole
3
