Nokea
A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take?
- A. Administer the powdered form orally.
- B. Premedicate with aspirin.
- C. Administer it via rapid IV bolus.
- D. Have emergency equipment ready.
Correct Answer: D
Rationale: The correct answer is D because having emergency equipment ready is crucial due to the risk of allergic reactions or complications associated with factor VIII therapy. This includes supplies for managing anaphylaxis or other adverse reactions, such as epinephrine, antihistamines, and airway support. Administering the powdered form orally (A) is incorrect as factor VIII is given intravenously. Premedicating with aspirin (B) is contraindicated as aspirin can increase the risk of bleeding. Administering it via rapid IV bolus (C) is dangerous as it can lead to adverse effects like hypotension or clotting. Having emergency equipment ready ensures prompt and effective management of any potential complications.
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Peripheral bl. Picture is most useful in:
- A. NHL
- B. multiple myeloma
- C. myelodysplastic syndrome
- D. CML
Correct Answer: D
Rationale: The correct answer is D: CML. Peripheral blood picture is most useful in CML because it typically shows increased white blood cell count with left shift, basophilia, and presence of the Philadelphia chromosome. In contrast, A (NHL) primarily involves lymph nodes, B (multiple myeloma) shows monoclonal protein in serum/bone marrow, and C (myelodysplastic syndrome) presents with cytopenias and dysplastic changes in blood cells. Therefore, based on the specific findings seen in CML on peripheral blood, it is the most appropriate choice.
Which of the following is a key feature of Factor XIII?
- A. Its half-life is about 10 days.
- B. It is an important activator of thrombin.
- C. Its levels are normal in newborns.
- D. It is part of the contact activation system.
Correct Answer: A
Rationale: The correct answer is A: Its half-life is about 10 days. Factor XIII has a long half-life due to its stable tetrameric structure, allowing it to circulate in the blood for about 10-14 days. This extended half-life is crucial for its role in stabilizing fibrin clots.
Explanation for why other choices are incorrect:
B: Factor XIII is not an activator of thrombin; rather, it crosslinks fibrin strands to strengthen clots.
C: Factor XIII levels are low in newborns and gradually increase during the first few months of life.
D: Factor XIII is not part of the contact activation system, which involves factors XII, XI, and prekallikrein.
Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following?
- A. Daily treatment with targeted treatment medications
- B. Radiation therapy on a daily basis
- C. Hematopoietic stem cell transplantation
- D. An aggressive course of chemotherapy
Correct Answer: D
Rationale: The correct answer is D: An aggressive course of chemotherapy. For AML, induction therapy typically involves aggressive chemotherapy to achieve remission. This approach aims to rapidly reduce the number of leukemia cells in the body. Targeted treatment medications are not the standard first-line therapy for AML. Radiation therapy is not commonly used as a primary treatment for AML. Hematopoietic stem cell transplantation is usually considered after achieving remission with chemotherapy as a consolidation therapy. Therefore, preparing the patient for an aggressive course of chemotherapy aligns with the standard treatment approach for AML.
Henoch Schonlein purpura is not associated with:
- A. thrombocytopenia
- B. palpable purpura
- C. intussusception
- D. acute diffuse glomerulonephritis
Correct Answer: A
Rationale: Henoch-Schonlein purpura (HSP) is a vasculitis that primarily affects small blood vessels. Thrombocytopenia, which is a low platelet count, is not typically associated with HSP. Palpable purpura, intestinal intussusception, and acute diffuse glomerulonephritis are commonly seen in HSP due to immune-mediated inflammation of blood vessels, gastrointestinal involvement, and renal complications. Thrombocytopenia, on the other hand, is not a characteristic feature of HSP, making choice A the correct answer.
A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention?
- A. Arrange for total parenteral nutrition (TPN).
- B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube.
- C. Provide the patient with several small, soft-textured meals each day.
- D. Assign responsibility for the patient's nutrition to the patient's friends and family.
Correct Answer: C
Rationale: The correct answer is C: Provide the patient with several small, soft-textured meals each day. This intervention is appropriate for the patient showing early signs of malnutrition as it aims to increase the patient's nutrient intake in a manageable way. Small, soft-textured meals are easier for the patient to consume and digest, promoting better absorption of nutrients. This approach also aligns with the principle of promoting oral intake whenever possible before resorting to more invasive measures like TPN or PEG tube placement.
Incorrect choices:
A: Total parenteral nutrition (TPN) is typically reserved for patients who cannot tolerate oral feeding at all or have significant malabsorption issues.
B: Percutaneous endoscopic gastrostomy (PEG) tube placement is usually considered if the patient cannot meet their nutritional needs orally in the long term.
D: Assigning responsibility for the patient's nutrition to friends and family is not a sustainable or appropriate solution for addressing malnutrition in a hospitalized patient.