N201 MEDSURG 2: THROMBOCYTOPENIA EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS GRADED A++
A patient with leukemia is admitted for severe hypovelemia after prolonged
diarrhea. THe platelet count is 43,000/uL. What is the best action for the nurse to
take?
a) Insert two 18 gauge IV catheters
b) Administer prescriber enoxaparin
c) Monitor the pt's temperature every 2 hrs
d) Check stools for presence of frank or occult blood.
D) Check stools for presence of frank or occult blood.
Rationale:
A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from
trauma or injury does not usually occur until the platelet counts are below 50,000/µL.
Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated
for patients with thrombocytopenia. Injections (including IVs) should be avoided;
however, when needed for critical fluids and medications, IV access should be provided
through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant
administered subcutaneously, is contraindicated in patients with thrombocytopenia.
Monitoring temperature would be indicated in a patient with leukopenia.
,What is the mainstay treatment for Immune Thrombocytopenia (ITP)?
Administration of oral or IV corticosteroids
Rationale:
Common treatment modalities for ITP include corticosteroid therapy to suppress the
phagocytic response of splenic macrophages. Blood transfusions, administration of
clotting factors, and reverse isolation are not interventions that are indicated in the care
of patients with ITP. Standard precautions are used with all patients.
A pt present with throbocytopenia secondary to heparin adminitration. THe nurse
should assess the pt for w/c potential complications
Venous thrombosis is the major clinical complication of heparin-induced
thrombocytopenia and can lead to further life-threatening complications.Correct--Altered
cognitive statusNeurologic abnormalities, resulting in altered cognitive status, can occur
as part of thrombotic stroke. This is a complication of heparin-induced
thrombocytopenia.
A patient presents with symptoms of thrombocytopenia and a platelet count of
50,000/µL. To differentiate thrombocytopenia from a myeloproliferative disorder,
which diagnostic study would the nurse anticipate being prescribed for this
patient?
-Bone marrow biopsyA bone marrow biopsy may be necessary to rule out leukemia,
aplastic anemia, and other myeloproliferative disorders and can be used to differentiate
thrombocytopenia from other myeloproliferative disorders.
44-year-old patient presents to the emergency department with a fever, blood
clots, and history of an abnormal enzyme deficiency. The patient has not taken
, any medications in the past month. Why is this patient also likely to experience
pain with the condition?
This patient is presenting with signs of thrombotic thrombocytopenic purpura (TTP).This
patient is presenting with signs of TTP that include fever (without an identifiable cause)
and history of an enzyme deficiency (ADAMTS13) needed to break down von
Willebrand factor. TTP patients need to be monitored for microthrombi that can cause
ischemia and pain.
A patient presents to the clinic with possible immune thrombocytopenic purpura
(ITP) due to a rash on the upper legs and arm and is also recovering from a bad
case of strep throat. The patient has no significant medical history. The nurse
should anticipate which medication will be administered to this patient?
PrednisoneThis patient is presenting with signs of ITP. Many cases will resolve on their
own, but if needed, the best medication for this patient would be a low-dose steroid.
A patient is diagnosed with thrombotic thrombocytopenic purpura (TTP) and asks
the nurse what to expect regarding treatment. Identify the treatments the nurse
should review in the order that they would be administered.
he first step in treating thrombotic thrombocytopenic purpura is to treat the underlying
causes such as infection. Infection would be treated with antibiotics.If treating the cause
did not address the problem, plasmapheresis or plasma exchange would be
performed.Rituximab may be used for patients refractory to plasma exchange.Finally,
splenectomy may be considered in patients who are refractory to plasma exchange or
immunosuppression.
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS GRADED A++
A patient with leukemia is admitted for severe hypovelemia after prolonged
diarrhea. THe platelet count is 43,000/uL. What is the best action for the nurse to
take?
a) Insert two 18 gauge IV catheters
b) Administer prescriber enoxaparin
c) Monitor the pt's temperature every 2 hrs
d) Check stools for presence of frank or occult blood.
D) Check stools for presence of frank or occult blood.
Rationale:
A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from
trauma or injury does not usually occur until the platelet counts are below 50,000/µL.
Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated
for patients with thrombocytopenia. Injections (including IVs) should be avoided;
however, when needed for critical fluids and medications, IV access should be provided
through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant
administered subcutaneously, is contraindicated in patients with thrombocytopenia.
Monitoring temperature would be indicated in a patient with leukopenia.
,What is the mainstay treatment for Immune Thrombocytopenia (ITP)?
Administration of oral or IV corticosteroids
Rationale:
Common treatment modalities for ITP include corticosteroid therapy to suppress the
phagocytic response of splenic macrophages. Blood transfusions, administration of
clotting factors, and reverse isolation are not interventions that are indicated in the care
of patients with ITP. Standard precautions are used with all patients.
A pt present with throbocytopenia secondary to heparin adminitration. THe nurse
should assess the pt for w/c potential complications
Venous thrombosis is the major clinical complication of heparin-induced
thrombocytopenia and can lead to further life-threatening complications.Correct--Altered
cognitive statusNeurologic abnormalities, resulting in altered cognitive status, can occur
as part of thrombotic stroke. This is a complication of heparin-induced
thrombocytopenia.
A patient presents with symptoms of thrombocytopenia and a platelet count of
50,000/µL. To differentiate thrombocytopenia from a myeloproliferative disorder,
which diagnostic study would the nurse anticipate being prescribed for this
patient?
-Bone marrow biopsyA bone marrow biopsy may be necessary to rule out leukemia,
aplastic anemia, and other myeloproliferative disorders and can be used to differentiate
thrombocytopenia from other myeloproliferative disorders.
44-year-old patient presents to the emergency department with a fever, blood
clots, and history of an abnormal enzyme deficiency. The patient has not taken
, any medications in the past month. Why is this patient also likely to experience
pain with the condition?
This patient is presenting with signs of thrombotic thrombocytopenic purpura (TTP).This
patient is presenting with signs of TTP that include fever (without an identifiable cause)
and history of an enzyme deficiency (ADAMTS13) needed to break down von
Willebrand factor. TTP patients need to be monitored for microthrombi that can cause
ischemia and pain.
A patient presents to the clinic with possible immune thrombocytopenic purpura
(ITP) due to a rash on the upper legs and arm and is also recovering from a bad
case of strep throat. The patient has no significant medical history. The nurse
should anticipate which medication will be administered to this patient?
PrednisoneThis patient is presenting with signs of ITP. Many cases will resolve on their
own, but if needed, the best medication for this patient would be a low-dose steroid.
A patient is diagnosed with thrombotic thrombocytopenic purpura (TTP) and asks
the nurse what to expect regarding treatment. Identify the treatments the nurse
should review in the order that they would be administered.
he first step in treating thrombotic thrombocytopenic purpura is to treat the underlying
causes such as infection. Infection would be treated with antibiotics.If treating the cause
did not address the problem, plasmapheresis or plasma exchange would be
performed.Rituximab may be used for patients refractory to plasma exchange.Finally,
splenectomy may be considered in patients who are refractory to plasma exchange or
immunosuppression.
