NRNP 6566 Week 5 Knowledge Check
QUESTION 1
1. A 54-year women is 3 days post abdominal surgery for removal of a cancerous mass
in her abdomen. She develops acute shortness of breath associated with tachycardia
and hypotension. CT Scan of the chest is positive for multiple small pulmonary
embolism. What medication and dosing would you order initially to treat the
pulmonary embolism?
This patient should be given fondaparinuc (Arixtra) subcutaneously. Dosing is weight-
based:
1. 5 mg SQ once daily (for weight less than 50 kg
2. 7.5 mg SQ once daily (for weight ranges from 50-100 kg)
3. 10 mg SQ once daily (for weight exceeding 100 kg).
QUESTION 2
1. A 64-year man is recovering from a transurethral resection of the prostate for
treatment of benign prostate hyperplasia. The patient is receiving intravenous
antibiotics for the urinary tract infection. The post-operative course has been smooth
and the APRN is removing the 3-way Foley catheter when there is a sudden release of
bright red blood with many blood clots in the Foley bag. The patient becomes
hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms
and legs. The patient was immediately transferred to the surgical intensive care unit
(SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral
blood smear, partial thromboplastin time, Prothrombin time/international
normalization ratio (INR), and fibrinogen labs were drawn. Results were:
CBC with markedly decreased platelet count, peripheral blood smear showed
decreased number of platelets and presence of large platelets and fragmented red
cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin
time. The d-dimer was markedly elevated, and fibrinogen level was low.
Based on the clinical presentation and laboratory data provided, what is your working
diagnosis?
The working diagnosis for this patient is disseminated intravascular coagulation
(DIC). It is an acquired coagulation disorder that is most commonly caused by infections
(gram negative sepsis), malignant neoplasm, obstetric complication, liver disease, trauma,
and burns. This patient is positive for urinary tract infection. Thrombocytopenia (decreased
platelets), prolonged PT and aPTT, low fibrinogen levels, positive D-dimer, and schistocytes
are all indicative of an acute uncompensated DIC (active hemorrhagic event).
QUESTION 3
1. A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained an
acute subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury
and resulting paralysis. He has a warm swollen right lower leg. Duplex ultrasound of
the right lower leg is positive. What is the best treatment for this patient?
QUESTION 1
1. A 54-year women is 3 days post abdominal surgery for removal of a cancerous mass
in her abdomen. She develops acute shortness of breath associated with tachycardia
and hypotension. CT Scan of the chest is positive for multiple small pulmonary
embolism. What medication and dosing would you order initially to treat the
pulmonary embolism?
This patient should be given fondaparinuc (Arixtra) subcutaneously. Dosing is weight-
based:
1. 5 mg SQ once daily (for weight less than 50 kg
2. 7.5 mg SQ once daily (for weight ranges from 50-100 kg)
3. 10 mg SQ once daily (for weight exceeding 100 kg).
QUESTION 2
1. A 64-year man is recovering from a transurethral resection of the prostate for
treatment of benign prostate hyperplasia. The patient is receiving intravenous
antibiotics for the urinary tract infection. The post-operative course has been smooth
and the APRN is removing the 3-way Foley catheter when there is a sudden release of
bright red blood with many blood clots in the Foley bag. The patient becomes
hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms
and legs. The patient was immediately transferred to the surgical intensive care unit
(SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral
blood smear, partial thromboplastin time, Prothrombin time/international
normalization ratio (INR), and fibrinogen labs were drawn. Results were:
CBC with markedly decreased platelet count, peripheral blood smear showed
decreased number of platelets and presence of large platelets and fragmented red
cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin
time. The d-dimer was markedly elevated, and fibrinogen level was low.
Based on the clinical presentation and laboratory data provided, what is your working
diagnosis?
The working diagnosis for this patient is disseminated intravascular coagulation
(DIC). It is an acquired coagulation disorder that is most commonly caused by infections
(gram negative sepsis), malignant neoplasm, obstetric complication, liver disease, trauma,
and burns. This patient is positive for urinary tract infection. Thrombocytopenia (decreased
platelets), prolonged PT and aPTT, low fibrinogen levels, positive D-dimer, and schistocytes
are all indicative of an acute uncompensated DIC (active hemorrhagic event).
QUESTION 3
1. A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained an
acute subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury
and resulting paralysis. He has a warm swollen right lower leg. Duplex ultrasound of
the right lower leg is positive. What is the best treatment for this patient?
