Nokea
A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?
- A. Activating thromboxane A2
- B. Blocking adenosine diphosphate receptor agonists
- C. Suppressing specific clotting factors
- D. Inhibiting cyclooxygenase action in platelets
Correct Answer: D
Rationale: The correct answer is D: Inhibiting cyclooxygenase action in platelets. Aspirin works by irreversibly inhibiting cyclooxygenase, specifically COX-1, in platelets. By inhibiting COX-1, aspirin prevents the formation of thromboxane A2, which is a potent platelet aggregator. This action reduces platelet aggregation and ultimately decreases the risk of clot formation leading to a cardiovascular event.
Choice A is incorrect because aspirin does not activate thromboxane A2, but rather inhibits its formation. Choice B is incorrect as aspirin does not block adenosine diphosphate receptors. Choice C is incorrect as aspirin does not suppress specific clotting factors, but rather inhibits platelet function through the mechanism described above.
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The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?
- A. Aspirin
- B. Heparin
- C. Warfarin
- D. Erythropoietin
Correct Answer: B
Rationale: The correct answer is B: Heparin. An aPTT level of 28 seconds indicates a shorter clotting time than normal, suggesting that the patient may be at risk for bleeding due to excessive anticoagulation with heparin. The nurse should notify the healthcare provider to adjust the heparin dosage to prevent bleeding complications.
A: Aspirin is an antiplatelet medication and does not affect aPTT levels.
C: Warfarin is a vitamin K antagonist and primarily affects the PT/INR levels, not aPTT.
D: Erythropoietin is a hormone that stimulates red blood cell production and does not affect clotting parameters such as aPTT.
Oral iron supplements are given for iron deficiency anemia. Which of the statement is true regarding the absorption of oral iron supplements?
- A. Absorption occurs in the large intestine
- B. Intrinsic factor is necessary for the iron absorption
- C. Ascorbic acids reduces iron absorption
- D. Absorption is increased in hereditary hemochromatosis
Correct Answer: A
Rationale: Rationale:
A: Correct - Iron absorption primarily occurs in the duodenum and upper small intestine, not the large intestine.
B: Incorrect - Intrinsic factor is necessary for Vitamin B12 absorption, not iron.
C: Incorrect - Ascorbic acid (Vitamin C) actually enhances iron absorption.
D: Incorrect - Absorption is decreased in hereditary hemochromatosis, a condition of iron overload.
A female infant is diagnosed with hemophagocytic lymphohistiocytosis (HLH) not associated with an Epstein-Barr virus (EBV) infection. In taking the family history, you learn that another female infant died of HLH 2 years ago. Also, a newborn female child died of an unknown disease 4 years prior and was said have been bleeding profusely, jaundiced, and had a distended abdomen. When counseling the family about the genetics of HLH, how will you explain it?
- A. It is an X-linked syndrome
- B. It is an autosomal recessive syndrome
- C. It is a dominant inheritance syndrome
- D. It is an autosomal recessive syndrome with incomplete penetrance
Correct Answer: B
Rationale: The correct answer is B: It is an autosomal recessive syndrome. HLH is typically inherited in an autosomal recessive pattern, meaning both parents must pass on a copy of the mutated gene for the child to develop the condition. In this case, the family history suggests a pattern of multiple affected female infants, which is more indicative of an autosomal recessive inheritance. Choice A (X-linked syndrome) is incorrect because the pattern of inheritance in this family does not align with X-linked inheritance. Choice C (dominant inheritance syndrome) is incorrect because a dominant inheritance pattern would not typically result in multiple affected offspring. Choice D (autosomal recessive syndrome with incomplete penetrance) is incorrect because incomplete penetrance would not explain the consistent occurrence of HLH in this family.
A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?
- A. Spherocytes on peripheral blood smear
- B. Gram-negative Bacillus on gram stain of remaining RBC unit
- C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
- D. DAT positive for C3
Correct Answer: D
Rationale: The correct answer is D because in this scenario, the patient is experiencing symptoms of a transfusion reaction, likely a hemolytic transfusion reaction due to ABO incompatibility. The presence of a positive Direct Antiglobulin Test (DAT) for C3 indicates complement activation, supporting the diagnosis.
Choice A (Spherocytes on peripheral blood smear) is incorrect as spherocytes are seen in autoimmune hemolytic anemia, not typically in transfusion reactions.
Choice B (Gram-negative Bacillus on gram stain of remaining RBC unit) is unlikely as the symptoms are more indicative of a hemolytic reaction rather than an infection.
Choice C (Chest x-ray with bilateral pulmonary infiltrates) is suggestive of transfusion-related acute lung injury (TRALI), but the symptoms described in the question (fever, chills, rigors) are more indicative of a hemolytic reaction rather than TRALI.
Which of the following is the most suitable anti malarial drug for pregnant women?
- A. Atovaquone and proguanil
- B. Quinine and doxycycline
- C. Quinine and clindamycin
- D. Primaquine
Correct Answer: C
Rationale: The correct answer is C: Quinine and clindamycin. Quinine is considered safe for use in pregnancy to treat malaria, as it has been used for many years without significant adverse effects. Clindamycin is also safe for use in pregnancy and can be used in combination with quinine to treat malaria. Atovaquone and proguanil (choice A) are not recommended for use in pregnancy due to limited safety data. Quinine and doxycycline (choice B) is not suitable for pregnant women as doxycycline is contraindicated during pregnancy. Primaquine (choice D) is not recommended for use during pregnancy as it can cause harm to the fetus.