Nokea
A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?
- A. Bronchodilation
- B. Headache
- C. Edema
- D. Hypertension
Correct Answer: B
Rationale: The correct answer is B: Headache. Alteplase is a thrombolytic medication that can cause cerebral bleeding, leading to headaches. Monitoring for headaches is crucial as it can indicate a serious adverse effect. Bronchodilation (A) is not associated with alteplase therapy. Edema (C) is not a common adverse effect of alteplase. Hypertension (D) is a potential adverse effect, but it is not as specific or common as headaches in this context.
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You receive a phone call that a 3-year-old patient on long-term warfarin therapy for congenital heart disease has an international normalized ratio (INR) of 5.8. On further history, you learn the patient and several family members have had recent gastrointestinal illnesses, but the patient is recovering. His mother reports he is not experiencing bleeding symptoms. Which of the following interventions would be most reasonable in this clinical scenario?
- A. Hold 1 to 2 doses of warfarin and recheck INR
- B. Administer oral vitamin K therapy
- C. Administer fresh frozen plasma (FFP)
- D. Administer recombinant factor VIIa
Correct Answer: A
Rationale: The correct answer is A: Hold 1 to 2 doses of warfarin and recheck INR. In this scenario, the patient's elevated INR of 5.8 indicates an increased risk of bleeding due to excessive anticoagulation. Since the patient is not experiencing bleeding symptoms and is recovering from gastrointestinal illness, temporarily holding 1 to 2 doses of warfarin is the most reasonable intervention to prevent bleeding complications while allowing the INR to normalize. Rechecking the INR after holding the doses will help assess the patient's response to the intervention. Choices B, C, and D are incorrect because administering oral vitamin K therapy, FFP, or recombinant factor VIIa are more aggressive interventions that are not warranted in this case where the patient is asymptomatic and recovering from a transient illness.
A female patient's hematocrit level is 50% and oxygen saturation is 98% on room air. What should the nurse suspect as being the cause for this patient's hematocrit level?
- A. Dehydration
- B. Chronic renal failure
- C. Bone marrow suppression
- D. Bleeding esophageal varices
Correct Answer: A
Rationale: The correct answer is A: Dehydration. When a patient is dehydrated, their blood volume decreases, leading to a relative increase in the concentration of red blood cells and hematocrit level. In this case, the patient's high hematocrit level of 50% indicates hemoconcentration due to dehydration. Oxygen saturation being normal suggests that the body is compensating for the decreased blood volume by maintaining adequate oxygen delivery.
Summary of incorrect choices:
B: Chronic renal failure would likely result in anemia due to decreased erythropoietin production.
C: Bone marrow suppression would lead to a decrease in red blood cell production, causing anemia.
D: Bleeding esophageal varices would result in acute blood loss and a decreased hematocrit level.
Which of the following anemia is associated with splenomegaly:
- A. chronic renal failure
- B. aplastic anemia
- C. hereditary spherocytosis
- D. sickle cell anaemia
Correct Answer: C
Rationale: The correct answer is C, hereditary spherocytosis. This condition is characterized by a defect in red blood cell membrane proteins, leading to their premature destruction in the spleen, causing splenomegaly. In contrast, chronic renal failure (A) does not typically present with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure, not splenomegaly. Sickle cell anemia (D) is associated with splenomegaly in early childhood due to sequestration of damaged red blood cells, but splenomegaly usually resolves in later life.
Which of the following statements about myeloablative, myeloablative but reduced toxicity, reduced intensity, and non-myeloablative approaches is not correct?
- A. Myeloablative approaches are needed for high-risk malignancies to maximize depth of remission and decrease the likelihood of relapse.
- B. Reduced intensity regimens can be successfully used for most nonmalignant disorders to minimize risk of late effects.
- C. Reduced intensity regimens can markedly decrease the risk of transplant-related mortality in patients who have underlying significant comorbidities but at the cost of more relapse and possibly more graft-versus-host disease.
- D. Non-myeloablative regimens are used for the very highest risk patients to minimize toxicity and for certain diseases such as aplastic anemia.
Correct Answer: B
Rationale: B is the correct answer because reduced intensity regimens are not suitable for most nonmalignant disorders. Myeloablative approaches are typically used for high-risk malignancies to maximize remission depth and reduce relapse likelihood. Reduced intensity regimens are used for patients with significant comorbidities to decrease transplant-related mortality, but may lead to more relapse and graft-versus-host disease. Non-myeloablative regimens are utilized for high-risk patients to minimize toxicity and for specific diseases like aplastic anemia.
Non thrombocytopenic purpura is seen in all except:
- A. vasculitis
- B. uraemia
- C. hereditary haemorrhagic telangiectasia
- D. SLE
Correct Answer: D
Rationale: The correct answer is D: SLE. Non-thrombocytopenic purpura is characterized by skin bleeding without low platelet count. SLE does not typically cause this type of purpura, as it primarily affects multiple organs through immune complex deposition. Vasculitis, uraemia, and hereditary hemorrhagic telangiectasia can all lead to non-thrombocytopenic purpura due to various mechanisms involving blood vessel inflammation, kidney dysfunction, or genetic defects in blood vessel formation, respectively.