Nokea
A client has heparin-induced thrombocytopenia (HIT). The student nurse asks how this is treated. About what drugs does the nurse instructor teach? (Select all that apply.)
- A. Argatroban (Argatroban)
- B. Bivalirudin (Angiomax)
- C. Clopidogrel (Plavix)
- D. Lepirudin (Refludan)
- E. Methylprednisolone (Solu-Medrol)
Correct Answer: A,B,D
Rationale: Argatroban, bivalirudin, and lepirudin are direct thrombin inhibitors used to treat HIT. Clopidogrel is an antiplatelet agent, and methylprednisolone is a steroid, neither used for HIT.
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The nurse instructor is best?
- A. Because of immunosuppression, the donor cells take over.
- B. In like a transfusion reaction because no perfect matches exist.
- C. The client's cells are fighting donor cells for dominance.
- D. The donor's cells are actually attacking the client's cells.
Correct Answer: D
Rationale: Graft versus host disease is an autoimmune-type process in which the donor cells recognize the client's cells as foreign and begin attacking them. The other answers are not accurate.
A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the client?
- A. Apply ice packs to the client's legs.
- B. Elevate the client's legs on pillows.
- C. Keep the lower extremities warm.
- D. Place elastic bandage wraps on the client's legs.
Correct Answer: C
Rationale: During a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and ischemia, leading to pain. Keeping the legs warm helps improve comfort due to decreased blood flow causing coolness. Elevation or elastic bandages may further reduce perfusion, and ice packs are not indicated.
A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client?
- A. Zoledronic acid (Zometa)
- B. Denosumab (Xgeva)
- C. Bortezomib (Velcade)
- D. Lenalidomide (Revlimid)
Correct Answer: A
Rationale: Zoledronic acid is a bisphosphonate commonly used to treat bone loss in multiple myeloma by inhibiting osteoclast activity, thus improving bone density. Denosumab is another option for bone health but is less commonly used in this context. Bortezomib and lenalidomide are used for treating multiple myeloma but primarily target the cancer cells, not specifically bone density.
A nurse is preparing to administer a blood transfusion. What action is most important?
- A. Correctly identifying client using two identifiers
- B. Obtaining informed consent
- C. Placing the blood product with Ringer's lactate
- D. Staying with the client for the entire transfusion
Correct Answer: B
Rationale: Obtaining informed consent is critical as it ensures the client understands the procedure and risks, which is a priority before initiating a transfusion. Correctly identifying the client is also crucial but follows consent in priority if the facility requires it. Ringer's lactate is not used for blood transfusions, and staying for the entire transfusion is not necessary.
A nurse caring for a client with sickle cell disease (SCD) reviews the clients laboratory work. Which finding should the nurse reports to the provider?
- A. Creatinine: 2.9 mg/dL
- B. Hemlacture: 30.9%
- C. Sodium: 147 mEq/L
- D. White blood cell count: 12,000/mm3
Correct Answer: A
Rationale: An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30.9% is an expected finding, as is a slightly elevated white blood cell count. A sodium level of 147 mEq/L, although slightly high, is not concerning.