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A nurse is planning the care of a patient who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions?
- A. Gabapentin (Neurontin) is effective because of the neuropathic nature of the patient's pain.
- B. Opioids partially inhibit the patient's synthesis of clotting factors.
- C. Opioids may cause vasodilation and exacerbate bleeding.
- D. NSAIDs are contraindicated due to the risk for bleeding.
Correct Answer: D
Rationale: NSAIDs may be contraindicated in patients with hemophilia due to the associated risk of bleeding. Opioids do not have a similar effect and they do not inhibit platelet synthesis. The pain associated with hemophilia is not neuropathic.
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A patients blood work reveals a platelet level of 17,000/mm3. When inspecting the patients integumentary system, what finding would be most consistent with this platelet level?
- A. Dermatitis
- B. Petechiae
- C. Urticaria
- D. Alopecia
Correct Answer: B
Rationale: When the platelet count drops to less than 20,000/mm?³, petechiae can appear. Low platelet levels do not normally result in dermatitis, urticaria (hives), or alopecia (hair loss).
A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient?
- A. Packed red blood cells (PRBCs)
- B. Vitamin K
- C. Oral anticoagulants
- D. Heparin infusion
Correct Answer: A
Rationale: Patients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh frozen plasma, PRBCs, and platelets is usually required. Vitamin K may be ordered once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the patient's bleeding.
A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the patient's previous medication regimen may have contributed to the development of this disorder?
- A. Calcium carbonate
- B. Vitamin B12
- C. Aspirin
- D. Vitamin D
Correct Answer: C
Rationale: Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Calcium, vitamin D, and vitamin B12 do not have the potential to induce a platelet defect.
A patient with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure?
- A. The patient should not undergo the normal bowel cleansing protocol prior to the procedure.
- B. The patient should receive a unit of fresh-frozen plasma 48 hours before the procedure.
- C. The patient should be admitted to the surgical unit on the day before the procedure.
- D. The patient should be given necessary clotting factors before the procedure.
Correct Answer: D
Rationale: A goal of treating vWD is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding. Bowel cleansing is not contraindicated and FFP does not reduce the patient's risk of bleeding. There may or may not be a need for preprocedure hospital admission.
A nurse is providing discharge education to a patient who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this patient?
- A. Avoiding buses, subways, and other crowded, public sites
- B. Avoiding activities that carry a risk for injury
- C. Keeping immunizations current
- D. Avoiding foods high in vitamin K
Correct Answer: B
Rationale: Patients with bleeding disorders need to understand the importance of avoiding activities that increase the risk of bleeding, such as contact sports. Immunizations involve injections and may be contraindicated for some patients. Patients with bleeding disorders do not need to normally avoid crowds. Foods high in vitamin K may be beneficial, not detrimental.