PCCN PCCN Hematology and Immunology 2

Question 1

A patient on heparin infusion has a PTT of 210 seconds (goal 60–100 seconds). What is the priority nursing action?

Accepted Answer

Hold the infusion and notify the provider

Answer

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)?

Accepted Answer

Platelet count drop of >50% after 5–14 days of heparin

Answer

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?

Accepted Answer

Sudden severe headache and altered mental status

Answer

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?

Accepted Answer

Transfusion-associated graft-versus-host disease

Answer

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?

Accepted Answer

Thromboembolic events

Answer

Polycythemia vera causes increased blood viscosity due to excess RBCs, significantly elevating risk for thrombosis and embolic events.

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