C HAPTER 27: H EMATOLOGIC D ISORDERS AND
O NCOLOGIC E MERGENCIES
Urden: Priorities in Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient with t ype 2 heparin -induced
thrombocytopenia (HIT). The nurse knows that pulmonary embolism is a
serious complication of HIT. Which find ings would alert the nurse to the
presence of this complication?
a. Blanching of fingers and toes and loss of peripheral pulses
b. Chest pain, pallor, and confusion
c. Headache, impaired speech, and loss of motor function
d. Dyspnea, pleuritic pain, and rales
ANS: D
The presence of blanching and the loss of peripheral pulses, sensation,
or motor function in a limb indicate peripheral vascular thrombi.
Neurologic signs and symptoms such as confusion, headache, and
impaired speech can signal the onset of cerebral a rtery occlusion and
stroke. Acute m yocardial infarction may be heralded by dyspnea, chest
pain, pallor, and alterations in blood pressure. Thrombi in the
pulmonary vasculature may be evidenced by pleuritic pain, rales, and
dyspnea.
PTS: 1 DIF: Cognitive Level: Appl ying OBJ: Nursing
Process Step: Diagnosis TOP: Hematologic Disorders and
, Oncologic Emergencies MSC: NC LEX: Physiological
Integrit y: Physiological Adaptation
2. The nurse is caring for a criticall y ill patient who is receiving heparin
and understands that the patient is at risk for developing heparin -
induced thrombocytopenia (HIT). Which intervention would be included
into the patient’s plan of care to monitor for this potential complication?
a. Monitor D-dimer levels every 5 to 10 hours from day 2 to day 5.
b. Monitor prothrombin time (PT) every 5 to 14 hours from day 2 to
day 12.
c. Monitor platelet count every 2 or 3 days from day 4 to day 14.
d. Monitor international normalized ratio (INR) every 5 days from
day 10 to day 30.
ANS: C
Current guidelines suggest that for high -risk patients, platelet count
monitoring should be performed every 2 or 3 days from day 4 to day
14. When a decrease in the platelet count is detected, heparin therapy
should be discontinued immediatel y, and the patient should be tested
for the presence of heparin antibodies.
PTS: 1 DIF: Cognitive Level: Appl ying OBJ: Nursing
Process Step: Implementation TOP: Hematologic
Disorders and Oncologic Emergencies MSC: NC LEX:
Physiological Integrity: Reduction of Risk Potentia l
3. The nurse is caring for a criticall y ill patient who is receiving heparin
and understands that the patient is at risk for developing heparin -
, induced thrombocytopenia (HIT). Which previous medical conditions
places this patient at risk for developing HI T?
a. Sepsis
b. Deep vein thrombosis
c. Cardiac arrest
d. Pneumonia
ANS: B
Ascertaining a medical history that includes previous heparin therapy,
deep vein thrombosis, or cardiovascular surgery that included the use
of cardiopulmonary bypass can alert the nur se to potential problems.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Assessment TOP: Hematologic Disorders and
Oncologic Emergencies MSC: NC LEX: Physiological
Integrit y: Physiological Adaptation
4. A patient has been admitte d with tumor lysis syndrome. The nurse
understands that this is due which pathophysiologic mechanism?
a. Destruction of platelets by l ymphocytic antibodies
b. Destruction of malignant cells through radiation or chemotherapy
c. Formation of heparin antibodies
d. Damage to the endothelium
ANS: B
The primary mechanism involved in the development of tumor l ysis
s yndrome is the destruction of massive numbers of malignant cells,
either by chemotherapy or radiation. This mass destruction results in
O NCOLOGIC E MERGENCIES
Urden: Priorities in Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient with t ype 2 heparin -induced
thrombocytopenia (HIT). The nurse knows that pulmonary embolism is a
serious complication of HIT. Which find ings would alert the nurse to the
presence of this complication?
a. Blanching of fingers and toes and loss of peripheral pulses
b. Chest pain, pallor, and confusion
c. Headache, impaired speech, and loss of motor function
d. Dyspnea, pleuritic pain, and rales
ANS: D
The presence of blanching and the loss of peripheral pulses, sensation,
or motor function in a limb indicate peripheral vascular thrombi.
Neurologic signs and symptoms such as confusion, headache, and
impaired speech can signal the onset of cerebral a rtery occlusion and
stroke. Acute m yocardial infarction may be heralded by dyspnea, chest
pain, pallor, and alterations in blood pressure. Thrombi in the
pulmonary vasculature may be evidenced by pleuritic pain, rales, and
dyspnea.
PTS: 1 DIF: Cognitive Level: Appl ying OBJ: Nursing
Process Step: Diagnosis TOP: Hematologic Disorders and
, Oncologic Emergencies MSC: NC LEX: Physiological
Integrit y: Physiological Adaptation
2. The nurse is caring for a criticall y ill patient who is receiving heparin
and understands that the patient is at risk for developing heparin -
induced thrombocytopenia (HIT). Which intervention would be included
into the patient’s plan of care to monitor for this potential complication?
a. Monitor D-dimer levels every 5 to 10 hours from day 2 to day 5.
b. Monitor prothrombin time (PT) every 5 to 14 hours from day 2 to
day 12.
c. Monitor platelet count every 2 or 3 days from day 4 to day 14.
d. Monitor international normalized ratio (INR) every 5 days from
day 10 to day 30.
ANS: C
Current guidelines suggest that for high -risk patients, platelet count
monitoring should be performed every 2 or 3 days from day 4 to day
14. When a decrease in the platelet count is detected, heparin therapy
should be discontinued immediatel y, and the patient should be tested
for the presence of heparin antibodies.
PTS: 1 DIF: Cognitive Level: Appl ying OBJ: Nursing
Process Step: Implementation TOP: Hematologic
Disorders and Oncologic Emergencies MSC: NC LEX:
Physiological Integrity: Reduction of Risk Potentia l
3. The nurse is caring for a criticall y ill patient who is receiving heparin
and understands that the patient is at risk for developing heparin -
, induced thrombocytopenia (HIT). Which previous medical conditions
places this patient at risk for developing HI T?
a. Sepsis
b. Deep vein thrombosis
c. Cardiac arrest
d. Pneumonia
ANS: B
Ascertaining a medical history that includes previous heparin therapy,
deep vein thrombosis, or cardiovascular surgery that included the use
of cardiopulmonary bypass can alert the nur se to potential problems.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Assessment TOP: Hematologic Disorders and
Oncologic Emergencies MSC: NC LEX: Physiological
Integrit y: Physiological Adaptation
4. A patient has been admitte d with tumor lysis syndrome. The nurse
understands that this is due which pathophysiologic mechanism?
a. Destruction of platelets by l ymphocytic antibodies
b. Destruction of malignant cells through radiation or chemotherapy
c. Formation of heparin antibodies
d. Damage to the endothelium
ANS: B
The primary mechanism involved in the development of tumor l ysis
s yndrome is the destruction of massive numbers of malignant cells,
either by chemotherapy or radiation. This mass destruction results in
