Nokea
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis.
Step 2: Reversible inhibition means the effect is temporary and can be reversed.
Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery.
Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks.
Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk.
Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.
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A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this patient's care, the nurse should be aware of what epidemiologic fact?
- A. Early diagnosis is associated with good outcomes.
- B. Five-year survival for older adults is approximately 50%.
- C. Five-year survival for patients over 75 years old is less than 2%.
- D. Survival rates are wholly dependent on the patient's pre-illness level of health.
Correct Answer: C
Rationale: The correct answer is C: Five-year survival for patients over 75 years old is less than 2%. This is because older age is a significant risk factor for poorer outcomes in acute myeloid leukemia (AML) due to factors such as frailty, comorbidities, and reduced tolerance to aggressive treatments. Older adults are less likely to tolerate intensive chemotherapy and have lower overall survival rates compared to younger patients.
Choice A is incorrect because early diagnosis alone does not guarantee good outcomes in AML, especially in older adults. Choice B is incorrect because the five-year survival rate for older adults with AML is much lower than 50%. Choice D is incorrect because while pre-illness health may influence survival rates, age is a more significant factor in predicting outcomes in older patients with AML.
A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?
- A. PT
- B. WBC
- C. Hgb
- D. Platelets
Correct Answer: C
Rationale: The correct answer is C: Hgb (hemoglobin). Epoetin is a medication used to stimulate red blood cell production, which should increase hemoglobin levels. Higher hemoglobin levels indicate improved oxygen-carrying capacity and overall effectiveness of the therapy. PT (A), WBC (B), and Platelets (D) are not directly affected by epoetin therapy, so an increase in these values would not be indicative of the medication's effectiveness.
The nurse is reviewing the activated partial thromboplastin time for a patient receiving heparin. Which value indicates that the medication is within the therapeutic range?
- A. 2.5 to 9.5 minutes
- B. 9.5 to 11.3 seconds
- C. 1.5 to 2.0 times normal
- D. 2.0 to 3.0 times normal
Correct Answer: C
Rationale: The correct answer is C (1.5 to 2.0 times normal) because the therapeutic range for heparin is typically considered to be 1.5 to 2.5 times the normal value of activated partial thromboplastin time (aPTT). This range ensures adequate anticoagulation without increasing the risk of bleeding. Options A, B, and D are incorrect because they do not accurately reflect the therapeutic range for heparin. Option A provides a range in minutes, which is not a standard unit for aPTT measurement. Option B provides a range in seconds, which is too narrow for the therapeutic range of heparin. Option D provides a range in multiples of normal, but the upper limit of 3.0 times normal is higher than the typical upper limit of the therapeutic range for heparin.
An oncology nurse recognizes a patient's risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patient's plan of care? Select all that apply.
- A. Monitoring the patient's electrolyte levels
- B. Monitoring the patient's hepatic function
- C. Measuring the patient's weight on a daily basis
- D. Measuring and recording the patient's intake and output
Correct Answer: B
Rationale: The correct answer is B: Monitoring the patient's hepatic function. In leukemia treatment, chemotherapy drugs can affect liver function, leading to fluid imbalance. By monitoring hepatic function, the nurse can assess the liver's ability to regulate fluid balance.
A: Monitoring electrolyte levels is important but not directly related to fluid imbalance in leukemia treatment.
C: Measuring weight daily is important for fluid status assessment but does not target hepatic function specifically.
D: Measuring and recording intake and output is crucial for fluid balance monitoring but does not focus on hepatic function assessment.
Mr XY was found to be anemic. During history taking, he informed his doctor that he was a strict vegetarian who did not consume any meat, fish or milk products.
- A. Iron deficiency
- B. Vitamin B12 deficiency
- C. Defects in erythropoietin production
- D. Calcium-deficiency
Correct Answer: B
Rationale: The correct answer is B: Vitamin B12 deficiency. As a strict vegetarian who does not consume any meat, fish, or milk products, Mr XY is at risk for Vitamin B12 deficiency. Vitamin B12 is primarily found in animal products and is essential for red blood cell production. Anemia can result from Vitamin B12 deficiency, leading to symptoms such as fatigue and weakness. Iron deficiency (A) is also common in vegetarians, but in this case, the focus is on Vitamin B12 due to the exclusion of all animal products. Defects in erythropoietin production (C) are not related to Mr XY's dietary choices. Calcium-deficiency (D) is not directly related to anemia in this scenario.