Two years after chemotherapy and radiation therapy for lung ...

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Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old patient notices that he seems to be extremely tired all the time.
 
  The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia? Select all that apply.
  A)
  Complaints of weakness and fatigue
  B)
  Small spots of skin hemorrhages over the entire body
  C)
  Excess bleeding from gums and nose
  D)
  Spoon-shaped deformity of the fingernails
  E)
  Hemolysis from renal dialysis treatments.

Question 2

Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?
 
  A)
  Irreversible acetylation of platelet cyclooxygenase activity has occurred.
  B)
  The patient's prostaglandin (TXA2) levels are abnormally high.
  C)
  She is at risk of developing secondary immune thrombocytopenic purpura (ITP).
  D)
  The binding of an antibody to platelet factor IV produces immune complexes.

[amit]

Answer to Question 1

Ans:
A, B, C

Feedback:

The onset of aplastic anemia may be insidious or sudden. The initial presenting symptoms include weakness, fatigue, and pallor caused by the anemia. Petechiae and ecchymoses often occur on the skin, and bleeding from the nose, gums, vagina, or GI tract may occur due to decreased platelet levels. Spoon-shaped deformity of the fingernails is seen in iron deficiency anemia. Hemolysis and blood loss from renal dialysis treatments contribute to anemia associated with a deficiency of erythropoietin (which is normally produced in the kidneys).

Answer to Question 2

Ans:
A

Feedback:

Aspirin can cause inhibition of platelet aggregation that lasts for the life of the platelet. High TXA2 levels would be associated with increased coagulability. ITP would not result from aspirin intake, and binding of an antibody to platelet factor IV is associated with heparin-induced thrombocytopenia.