Challenge Your Exam Readiness With Our Free AOCNP Practice Questions

Hyperviscosity syndrome from excess circulating IgM causes impaired microcirculatory flow leading to visual changes, neurologic symptoms, and bleeding. The emergency treatment is therapeutic plasma exchange (plasmapheresis), which rapidly reduces IgM levels and viscosity, relieving symptoms within hours. This is a temporizing measure; definitive control requires disease-directed therapy (e.g., BTK inhibitors, rituximab-based regimens), recognizing that rituximab can transiently increase IgM (flare) and sometimes necessitates pre-emptive plasmapheresis. Steroids alone (Option A) will not promptly lower viscosity. Starting targeted therapy (Option C) without immediate viscosity reduction risks clinical deterioration. Observation/fluids (Option D) are inadequate. APRNs should coordinate emergent apheresis access, hemodynamic/neurologic monitoring, and bleeding management, while planning subsequent systemic therapy in collaboration with hematology. Patient education should address symptom recognition and the potential for recurrence, and documentation should note a history of hyperviscosity to trigger early intervention in future flares.