FINAL EXAM NR574 WEEK 2 CONTENT BLEEDING DISORDERS, HEMATOLOGICAL MA LIGNANCIES,& NEOPLASMS QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

FINAL EXAM NR574 WEEK 2 CONTENT BLEEDING DISORDERS, HEMATOLOGICAL MA LIGNANCIES,& NEOPLASMS QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. Heparin-induced thrombocytopenia (HIT) Correct Answer Development of IgG antibodies against heparin- bound platelet factor 4 (PF4). Antibody-heparin-PF4 complex activates platelets leading to thrombosis and thrombocytopenia. 2. Features of HIT Correct Answer Thrombocytopenia Timing Type of heparin type of patient thrombosis 3. HIT Thrombocytopenia (plt count) Correct Answer platelet count of 100,000 or decrease in platelet count by 50% from pre treatment value 4. What is the time frame that a patient will start showing signs of HIT Correct Answer within 5-14 days after starting heparin can occur sooner if pt has received heparin within the last 3 months 5. what type of heparin is HIT more commonly associated with Correct Answer unfractionated heparin 6. diagnosis of HIT Correct Answer 50% drop in platelet count from baseline Includes antibody immunoassay (ELISA) and functional platelet activation assays (serotonin release assay [SRA] & heparin induced platelet activation assay [HIPA]) 7. Management of HIT Correct Answer stop heparin give alternative anticoagulant do not give platelet transfusions do not give warfarin until plt count returns to baseline level -if warfarin was given, give vit k to restore INR to normal evaluate for thrombus-particularly DVT 8. When heparin is stopped after dx of HIT, what anticoagulant should be used Correct Answer argatroban (Acova)-used specifically to tx HIT bivalirudin (angiomax) fondaparinux (arixtra) rivaroxaban (xarelto) 9. what anticoagulant should not be given to a patient with HIT Correct Answer Warfarin 10. IF warfarin was given to a patient with HIT, what should you do Correct Answer stop the medication, give vitamin K and wait until INR returns to baseline number. 11. The adult gerontology acute care nurse practitioner (AGACNP) is completing a preoperative assessment on Ava, a 28-year-old female client who is recovering from a non emergent cholecystectomy. The following abnormal findings are noted: white blood cells (WBC) 7.4 x 109/L; hemoglobin (Hgb) 14.4 gm/dL; hematocrit (Hct) 39. 8%; Platelets 40 x 109/L. The remaining CBC parameters and a comprehensive metabolic panel are normal. Ava denies recent illnesses, bleeding, or history of bleeding disorders or medication use except for omeprazole which she has been taking for more than 6 months. Which of the following is the most likely diagnosis in the differential Correct Answer Immune thrombocytopenia (Correct answer) Rationale: Ava has no symptoms; the only abnormal CBC parameter is thrombocytopenia, which is the most common finding in ITP. A malignancy presents with other CBC abnormalities besides isolated thrombocytopenia. The client has no history of heparin exposure and n identified triggers for DIC. 12. Sunil was involved in a motor vehicle crash (MVC) two days ago. He had an immediate exploratory laparotomy and repair of a grade 2 liver laceration. He was directly admitted to the intensive care unit (ICU), post-operatively. While assessing Sunil, the AGACNP notices oozing of blood from his central and arterial line sites, along with bleeding from the surgical site. What is the most appropriate next action Correct Answer Order a CBC, aPTT, PT/INR, fibrinogen, and D-dimer (Correct answer) Rationale: Sunil has new-onset bleeding from two catheter sites and the surgical incision. These findings along with the history of recent trauma, place him at increased risk for DIC. While other causes of bleeding need to be considered such as ITP and HIT, obtaining baseline labs including CBC and bleeding times is the first step in determining the underlying etiology so that appropriate treatment may be administered. 13. Leonard is admitted with pneumonia. When evaluating his morning labs, the AGACNP noticed that his platelets have decreased from 170 x 109/L to 60 x 109/L. Leonard has been receiving enoxaparin for deep vein thrombosis (DVT) prophylaxis and the 4Ts score strongly suggests HIT. Which of the following should be performed first Correct Answer Discontinue all sources of heparin (Correct answer) Rationale: Immediate treatment for HIT mirrors the treatment for DIC, and begins with the fundamental principles of ACLS (airway, breathing, and circulation). In clients with a high probability 4Ts score like Leonard, all forms of heparin (even those used to flush IV catheters), should be immediately discontinued. Immunoassay should follow and if positive should prompt the AGACNP to order a functional assay. Clients with HIT who are at high risk for thrombotic events should also be administered non-heparin-based anticoagulation therapy. Platelet transfusion should be avoided in clients with HIT, due to its thrombogenic effects. 14. Disseminated Intravascular Coagulation (DIC): Complex, acquired disorder in which clotting and hemorrhage simultaneously occur intravascular activation of coagulation with loss of localization arising from different causes that can originate from and cause damage to the microvasculature, which if sufficiently severe, can produce organ dysfunction. 15. Risk factors of DIC Correct Answer Sepsis, Cardiac arrest, Trauma, Obstetric complications (amniotic fluid embolism, eclampsia, retained placenta), Cancer, Hypersensitivity reactions (blood transfusion reaction, anaphylaxis) 16. Clinical presentation of DIC Correct Answer In the hospital setting, tell-tale signs of DIC are common manifestations of vascular thrombosis and bleeding: -Microvascular thrombosis (common occult cause of organ failure in DIC) -Macrovascular thrombosis (DVT, PE) -Bleeding (petechiae, purpura, or distal extremity necrosis, sudden bleeding from wounds, surgical sites, or intravenous lines, shock, internal hemorrhage (gastrointestinal (GI), intracranial, etc.) 17. what are Lymphomas Correct Answer are solid tumors of the immune system, or lymphoid tissue, such as the lymph nodes, spleen, thymus, etc. 18. What are the two categories of lymphomas Correct Answer Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). 19. Hodgkin's lymphoma