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A patient who is taking warfarin (Coumadin) 5 mg daily has an international normalized ratio (INR) of 2.5. It is time to administer the next dose of Coumadin. What should the nurse do?
- A. Notify the physician STAT.
- B. Hold the dose of Coumadin.
- C. Prepare to administer vitamin K.
- D. Administer the daily Coumadin as ordered.
Correct Answer: D
Rationale: The correct answer is D: Administer the daily Coumadin as ordered.
Rationale:
1. INR of 2.5 is within the therapeutic range (2-3) for patients on warfarin.
2. Holding the dose may lead to fluctuation in INR and risk of thrombosis or bleeding.
3. Notifying the physician is not necessary as the INR is within the target range.
4. Administering vitamin K is not indicated unless the patient is experiencing significant bleeding.
In summary, administering the daily Coumadin as ordered is appropriate as the INR is within the therapeutic range, ensuring continuity of anticoagulation therapy without unnecessary intervention.
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Which of the following is wrong concerning Philadelphia chromosome:
- A. shortening of long arm of chromosome 22
- B. Philadelphia:-ve cases have bad prognosis
- C. diagnostic of CML
- D. found in lymphocytes
Correct Answer: D
Rationale: The correct answer is D, as the Philadelphia chromosome is typically found in myeloid cells, not lymphocytes. This is because the Philadelphia chromosome results from a translocation between chromosomes 9 and 22, leading to the formation of the BCR-ABL fusion gene, which is associated with chronic myeloid leukemia (CML). Choice A is correct as the Philadelphia chromosome results from the shortening of the long arm of chromosome 22. Choice B is incorrect as Philadelphia positivity in CML patients is associated with a worse prognosis. Choice C is correct as the presence of the Philadelphia chromosome is a diagnostic hallmark of CML.
The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching?
- A. Watch for excess bruising.
- B. Check for swollen lymph nodes.
- C. Take iron supplements to prevent anemia.
- D. Wash hands and avoid persons who are ill.
Correct Answer: D
Rationale: Step 1: Patient's immune system is compromised post-splenectomy.
Step 2: Washing hands and avoiding ill individuals reduce infection risk.
Step 3: Emphasizing infection prevention crucial for patient safety.
Summary: A - relates to clotting issues, B - not relevant, C - not immediate concern. Washing hands is most pertinent.
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?
- A. Protective isolation and vigilant use of standard precautions
- B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
- C. Including the family in planning the patient's activities of daily living
- D. Monitoring and treating the patient's pain
Correct Answer: A
Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML undergoing induction therapy are immunocompromised and at high risk for infection. Isolating the patient and using standard precautions help prevent exposure to pathogens.
B: Providing a high-calorie, low-texture diet and oral hygiene is important but not the priority as infection control takes precedence.
C: Including the family in planning activities of daily living is beneficial for holistic care but not the priority compared to infection prevention.
D: Monitoring and treating pain is essential, but in this case, infection prevention is the priority due to the patient's immunocompromised state.
Outstanding feature of ITP:
- A. fever
- B. gum bleeding
- C. moderate splenomegaly
- D. stema tenderness
Correct Answer: B
Rationale: The correct answer is B: gum bleeding. In Immune Thrombocytopenic Purpura (ITP), the hallmark feature is thrombocytopenia leading to mucocutaneous bleeding, including gum bleeding. Fever (choice A) is not a typical feature of ITP. Splenomegaly (choice C) can be present in chronic ITP but is not a defining feature. Sterna tenderness (choice D) is not specific to ITP and is not considered a characteristic feature. Thus, gum bleeding is the outstanding feature of ITP due to the primary pathophysiology of decreased platelet count leading to bleeding manifestations.
You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
- A. Pleuropulmonary blastoma
- B. Hepatocellular carcinoma
- C. Cystic nephroma
- D. Nephroblastoma
Correct Answer: D
Rationale: Step-by-step rationale for why the correct answer is D, Nephroblastoma:
1. The child has a cancer predisposition syndrome, likely Beckwith-Wiedemann syndrome (BWS).
2. BWS is associated with an increased risk of developing Wilms tumor (nephroblastoma).
3. The large tongue, omphalocele, and overgrowth placing the child at the 95th percentile for height and weight are all characteristic features of BWS.
4. Therefore, the patient is most at risk of developing nephroblastoma.
Summary of why the other choices are incorrect:
A: Pleuropulmonary blastoma - Not typically associated with BWS or the described clinical features.
B: Hepatocellular carcinoma - Not commonly linked to BWS or the clinical presentation provided.
C: Cystic nephroma - Not a typical tumor associated with BWS or the clinical findings described in the patient.