FINAL EXAM NR574 Week 2 content Bleeding Disorders, Hematological
M lignancies,& Neoplasms UPDATED ACTUAL Questions and
CORRECT Answers
1. Heparin-induced thrombocytopenia (HIT) Development of IgG antibodies
against heparin- bound platelet fac-
tor 4 (PF4). Antibody-heparin-PF4
complex activates platelets leading
to thrombosis and thrombocytope-
nia.
2. Features of HIT Thrombocytopenia
Timing
Type of heparin
type of patient
thrombosis
3. HIT Thrombocytopenia (plt count) platelet count of <100,000 or de-
crease in platelet count by >50%
from pre treatment value
4. What is the time frame that a patient will start within 5-14 days after starting he-
showing signs of HIT? parin
can occur sooner if pt has received
heparin within the last 3 months
5. what type of heparin is HIT more commonly unfractionated heparin
associated with?
6. diagnosis of HIT >50% drop in platelet count from
baseline
Includes antibody immunoassay
(ELISA) and functional platelet acti-
vation assays (serotonin release as-
, say [SRA] & heparin-induced platelet
activation assay [HIPA])
7. Management of HIT 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 argatroban (Acova)-used specifically
anticoagulant should be used? to tx HIT
bivalirudin (angiomax)
fondaparinux (arixtra)
rivaroxaban (xarelto)
9. what anticoagulant should not be given to a Warfarin
patient with HIT?
10. IF warfarin was given to a patient with HIT, what stop the medication, give vitamin K
should you do? and wait until INR returns to baseline
number.
11. The adult gerontology acute care nurse practi- Immune thrombocytopenia (Correct
tioner (AGACNP) is completing a preoperative answer)
assessment on Ava, a 28-year-old female client
who is recovering from a non-emergent chole- Rationale: Ava has no symptoms;
cystectomy. The following abnormal findings the only abnormal CBC parameter is
are noted: white blood cells (WBC) 7.4 x 109/L; thrombocytopenia, which is the most
, hemoglobin (Hgb) 14.4 gm/dL; hematocrit (Hct) common finding in ITP. A malignan-
39. 8%; Platelets 40 x 109/L. The remaining cy presents with other CBC abnor-
CBC parameters and a comprehensive metabol- malities besides isolated thrombo-
ic panel are normal. Ava denies recent illness- cytopenia. The client has no history
es, bleeding, or history of bleeding disorders of heparin exposure and n identified
or medication use except for omeprazole which triggers for DIC.
she has been taking for more than 6 months.
Which of the following is the most likely diagno-
sis in the differential?
12. Sunil was involved in a motor vehicle crash Order a CBC, aPTT, PT/INR, fibrino-
(MVC) two days ago. He had an immediate ex- gen, and D-dimer (Correct answer)
ploratory laparotomy and repair of a grade 2
liver laceration. He was directly admitted to the Rationale: Sunil has new-onset
intensive care unit (ICU), post-operatively. While bleeding from two catheter sites and
assessing Sunil, the AGACNP notices oozing of the surgical incision. These findings
blood from his central and arterial line sites, along with the history of recent trau-
along with bleeding from the surgical site. What ma, place him at increased risk for
is the most appropriate next action? DIC. While other causes of bleeding
need to be considered such as ITP
and HIT, obtaining baseline labs in-
cluding CBC and bleeding times is
the first step in determining the un-
derlying etiology so that appropriate
treatment may be administered.
13. Leonard is admitted with pneumonia. When Discontinue all sources of heparin
evaluating his morning labs, the AGACNP no- (Correct answer)
ticed that his platelets have decreased from 170
x 109/L to 60 x 109/L. Leonard has been re- Rationale: Immediate treatment for
ceiving enoxaparin for deep vein thrombosis HIT mirrors the treatment for DIC,
and begins with the fundamental
M lignancies,& Neoplasms UPDATED ACTUAL Questions and
CORRECT Answers
1. Heparin-induced thrombocytopenia (HIT) Development of IgG antibodies
against heparin- bound platelet fac-
tor 4 (PF4). Antibody-heparin-PF4
complex activates platelets leading
to thrombosis and thrombocytope-
nia.
2. Features of HIT Thrombocytopenia
Timing
Type of heparin
type of patient
thrombosis
3. HIT Thrombocytopenia (plt count) platelet count of <100,000 or de-
crease in platelet count by >50%
from pre treatment value
4. What is the time frame that a patient will start within 5-14 days after starting he-
showing signs of HIT? parin
can occur sooner if pt has received
heparin within the last 3 months
5. what type of heparin is HIT more commonly unfractionated heparin
associated with?
6. diagnosis of HIT >50% drop in platelet count from
baseline
Includes antibody immunoassay
(ELISA) and functional platelet acti-
vation assays (serotonin release as-
, say [SRA] & heparin-induced platelet
activation assay [HIPA])
7. Management of HIT 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 argatroban (Acova)-used specifically
anticoagulant should be used? to tx HIT
bivalirudin (angiomax)
fondaparinux (arixtra)
rivaroxaban (xarelto)
9. what anticoagulant should not be given to a Warfarin
patient with HIT?
10. IF warfarin was given to a patient with HIT, what stop the medication, give vitamin K
should you do? and wait until INR returns to baseline
number.
11. The adult gerontology acute care nurse practi- Immune thrombocytopenia (Correct
tioner (AGACNP) is completing a preoperative answer)
assessment on Ava, a 28-year-old female client
who is recovering from a non-emergent chole- Rationale: Ava has no symptoms;
cystectomy. The following abnormal findings the only abnormal CBC parameter is
are noted: white blood cells (WBC) 7.4 x 109/L; thrombocytopenia, which is the most
, hemoglobin (Hgb) 14.4 gm/dL; hematocrit (Hct) common finding in ITP. A malignan-
39. 8%; Platelets 40 x 109/L. The remaining cy presents with other CBC abnor-
CBC parameters and a comprehensive metabol- malities besides isolated thrombo-
ic panel are normal. Ava denies recent illness- cytopenia. The client has no history
es, bleeding, or history of bleeding disorders of heparin exposure and n identified
or medication use except for omeprazole which triggers for DIC.
she has been taking for more than 6 months.
Which of the following is the most likely diagno-
sis in the differential?
12. Sunil was involved in a motor vehicle crash Order a CBC, aPTT, PT/INR, fibrino-
(MVC) two days ago. He had an immediate ex- gen, and D-dimer (Correct answer)
ploratory laparotomy and repair of a grade 2
liver laceration. He was directly admitted to the Rationale: Sunil has new-onset
intensive care unit (ICU), post-operatively. While bleeding from two catheter sites and
assessing Sunil, the AGACNP notices oozing of the surgical incision. These findings
blood from his central and arterial line sites, along with the history of recent trau-
along with bleeding from the surgical site. What ma, place him at increased risk for
is the most appropriate next action? DIC. While other causes of bleeding
need to be considered such as ITP
and HIT, obtaining baseline labs in-
cluding CBC and bleeding times is
the first step in determining the un-
derlying etiology so that appropriate
treatment may be administered.
13. Leonard is admitted with pneumonia. When Discontinue all sources of heparin
evaluating his morning labs, the AGACNP no- (Correct answer)
ticed that his platelets have decreased from 170
x 109/L to 60 x 109/L. Leonard has been re- Rationale: Immediate treatment for
ceiving enoxaparin for deep vein thrombosis HIT mirrors the treatment for DIC,
and begins with the fundamental
