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 inhibits cyclooxygenase, specifically COX-1, in platelets, leading to the inhibition of thromboxane A2 production. Thromboxane A2 is a potent platelet aggregator. By inhibiting its production, aspirin reduces platelet aggregation, thus reducing the risk of cardiovascular events.
A: Activating thromboxane A2 - This is incorrect because aspirin actually inhibits the production of thromboxane A2.
B: Blocking adenosine diphosphate receptor agonists - This is incorrect because aspirin primarily works through the inhibition of cyclooxygenase, not adenosine diphosphate receptors.
C: Suppressing specific clotting factors - This is incorrect because aspirin's primary mechanism of action is through platelet inhibition, not through suppressing clotting factors.
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A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?
- A. Clarify the prescription with the provider.
- B. Administer the drug with an analgesic.
- C. Administer the required dose orally.
- D. Assess factor IX levels.
Correct Answer: A
Rationale: The correct answer is A: Clarify the prescription with the provider. Desmopressin is a medication that can cause hyponatremia, especially in patients with low sodium levels like this client. Before administering desmopressin, the nurse should consult with the provider to ensure it is safe to administer the medication given the client's sodium level. Administering the drug without clarifying may worsen the hyponatremia.
Choice B is incorrect because administering the drug with an analgesic is not necessary or relevant in this situation. Choice C is incorrect because desmopressin is typically administered via injection, not orally. Choice D is incorrect because assessing factor IX levels is not directly related to the administration of desmopressin in this scenario.
In microcytic hypochromic anaemia
- A. Red cells are larger with normal staining
- B. Red blood cell count is increased
- C. Haemtocrit and mean corpuscular haemoglobin are normal
- D. Red cells are smaller with a pale large central pallor
Correct Answer: D
Rationale: In microcytic hypochromic anemia, the correct answer is D because red cells are smaller (microcytic) and have a pale large central pallor (hypochromic). This is due to decreased hemoglobin content and iron deficiency. Choice A is incorrect as red cells are smaller, not larger. Choice B is incorrect as the red blood cell count is typically decreased in this type of anemia. Choice C is incorrect as both hematocrit and mean corpuscular hemoglobin are decreased in microcytic hypochromic anemia, not normal. Therefore, the correct answer is D based on the characteristic features of microcytic hypochromic anemia.
Which is not associated with hypersplenism:
- A. splenomegaly
- B. pancytopenia
- C. hyper cellular bone marrow
- D. reversibility by splenectomy
Correct Answer: C
Rationale: Rationale:
C: Hypercellular bone marrow is not associated with hypersplenism. Hypersplenism is characterized by splenomegaly, pancytopenia, and reversible by splenectomy. Hypercellular bone marrow is a feature of bone marrow hyperplasia, not hypersplenism.
A patient receiving blood complains of dyspnea. The nurse auscultates the patient's lungs and finds crackles that were not present before the start of the transfusion. Which type of reaction should the nurse suspect?
- A. Urticarial
- B. Hemolytic
- C. Anaphylactic
- D. Circulatory overload
Correct Answer: D
Rationale: The correct answer is D: Circulatory overload. This type of reaction occurs when the patient receives blood too quickly, leading to fluid overload in the circulatory system. The dyspnea and crackles are indicative of pulmonary edema, a common symptom of circulatory overload. Urticarial reaction (choice A) presents with hives, not dyspnea. Hemolytic reaction (choice B) involves the destruction of red blood cells, not fluid overload. Anaphylactic reaction (choice C) is a severe allergic reaction that includes symptoms like hives, swelling, and hypotension, but not typically pulmonary edema.
A 3-year-old boy is referred to you for evaluation of right leukocoria. Funduscopic examination under anesthesia reveals a large amelanotic mass occupying more than two-thirds of the vitreous space in his right eye, with massive retinal detachment, consistent with group E retinoblastoma. The left eye is normal. An MRI confirms the funduscopic findings and shows no extraocular disease. What is the most appropriate next step in the management of this child's disease?
- A. Enucleation
- B. Systemic chemotherapy
- C. Brachytherapy
- D. Needle biopsy
Correct Answer: A
Rationale: The most appropriate next step in the management of the child's retinoblastoma is enucleation (choice A). Enucleation, the surgical removal of the affected eye, is indicated when there is a large intraocular tumor with extensive retinal detachment, as in this case. Enucleation can provide local control of the disease and prevent systemic spread. It is considered the standard treatment for advanced retinoblastoma to prevent metastasis.
Systemic chemotherapy (choice B) is not the first-line treatment for advanced retinoblastoma with massive intraocular involvement. Brachytherapy (choice C) involves the placement of a radioactive source near the tumor, which may not be effective in this case of extensive intraocular disease. Needle biopsy (choice D) is not recommended as the primary management strategy due to the risk of seeding tumor cells outside the eye. Therefore, enucleation is the most appropriate next step in this scenario.