PCCN PCCN Hematology and Immunology 2 — Questions and Answers
Question 1: A patient on heparin infusion has a PTT of 210 seconds (goal 60–100 seconds). What is the priority nursing action?
- Increase the heparin rate
- Hold the infusion and notify the provider (Correct answer)
- Administer vitamin K
- Obtain a platelet count only
Correct answer: Hold the infusion and notify the provider
A supratherapeutic PTT significantly above goal indicates over-anticoagulation; the infusion should be stopped and the provider notified immediately.
Question 2: Which clinical finding is most indicative of heparin-induced thrombocytopenia (HIT)?
- Platelet count drop of >50% after 5–14 days of heparin (Correct answer)
- Immediate platelet drop after first heparin dose
- Platelet count of 400,000/mm³
- Bleeding from IV sites within 24 hours
Correct answer: Platelet count drop of >50% after 5–14 days of heparin
HIT classically presents with a >50% decline in platelets occurring 5–14 days after heparin exposure due to antibody formation.
Question 3: A patient with immune thrombocytopenic purpura (ITP) has a platelet count of 10,000/mm³. Which finding would require the most urgent intervention?
- Petechiae on the lower extremities
- Sudden severe headache and altered mental status (Correct answer)
- Mild bruising on the arms
- Prolonged bleeding after venipuncture
Correct answer: Sudden severe headache and altered mental status
Sudden severe headache and altered mental status suggest intracranial hemorrhage, the most dangerous complication of severe thrombocytopenia.
Question 4: When preparing to transfuse irradiated blood products, the nurse understands this measure prevents which complication?
- Febrile non-hemolytic reaction
- Transfusion-associated graft-versus-host disease (Correct answer)
- Allergic urticarial reaction
- Hyperkalemia
Correct answer: Transfusion-associated graft-versus-host disease
Irradiation inactivates donor T lymphocytes, preventing transfusion-associated graft-versus-host disease in immunocompromised patients.
Question 5: A patient with polycythemia vera is most at risk for which complication in the progressive care unit?
- Spontaneous hemorrhage
- Thromboembolic events (Correct answer)
- Severe anemia
- Opportunistic infections
Correct answer: Thromboembolic events
Polycythemia vera causes increased blood viscosity due to excess RBCs, significantly elevating risk for thrombosis and embolic events.
Question 6: Which action is most important when administering leukocyte-reduced blood products?
- Warm the blood to 40°C before infusion
- Use a standard blood filter (170–260 microns)
- Administer slowly over 6 hours
- Ensure the product is used to prevent CMV transmission (Correct answer)
Correct answer: Ensure the product is used to prevent CMV transmission
Leukocyte reduction reduces the risk of CMV transmission and febrile non-hemolytic reactions in at-risk patients.
PCCN PCCN Hematology and Immunology 2
A patient on heparin infusion has a PTT of 210 seconds (goal 60–100 seconds).
What is the priority nursing action?