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A patient with a history of chronic liver disease presents with easy bruising and prolonged bleeding from minor cuts. Laboratory tests reveal prolonged PT and aPTT, and mixing studies show correction of coagulation times with normal plasma. Which of the following conditions is most likely to cause these findings?
- A. Disseminated intravascular coagulation (DIC)
- B. Vitamin K deficiency
- C. Liver cirrhosis
- D. Hemophilia A
Correct Answer: B
Rationale: Vitamin K is essential for the production of several clotting factors in the liver, including factors II, VII, IX, and X. In a patient with chronic liver disease, impaired liver function can lead to decreased synthesis of these clotting factors. As a result, there is an underlying deficiency of these clotting factors, leading to prolonged PT (prothrombin time) and aPTT (activated partial thromboplastin time). The mixing studies showing correction with normal plasma further support the diagnosis of a factor deficiency rather than an inhibitor, which helps in ruling out conditions like DIC or hemophilia.
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The patient verbalizes to the nurse about thought to kill his wife". The nurse is in dilemma whether to tell the wife about this Conversation. Given this situation which of the following is the appropriate action of the nurse?
- A. Alert immediately the proper authorities regarding the threat to safeguard the safety of the wife.
- B. Tell the wife to be very extra careful as her life is danger.
- C. Weigh carefully the situation by viewing it as dilemma between disclosing confidential information or warning appropriate authorities.
- D. Keep the information to herself and be vigilant on action of the patient to protect the wife
Correct Answer: A
Rationale: In this critical situation, the safety of the wife is of utmost importance. Whenever a healthcare provider becomes aware of a direct threat to someone's safety, especially related to potential harm or violence, it is their ethical and legal responsibility to report this information to the appropriate authorities promptly. In this case, the nurse should alert the proper authorities, such as law enforcement or a mental health crisis team, to ensure that immediate steps are taken to protect the wife from harm. Confidentiality should be breached in situations where there is a clear threat to an individual's safety. Keeping the information confidential in this scenario could result in serious harm or even loss of life. The nurse must act quickly to protect the potential victim.
After positioning the patient for surgery, the nurse notices signs of pressure injury on the patient's heels. What should the nurse do?
- A. Apply pressure-relieving devices to the heels
- B. Document the findings in the patient's chart
- C. Reposition the patient to relieve pressure
- D. Notify the surgeon about the pressure injuries
Correct Answer: A
Rationale: Pressure injuries on the heels are a concern as they can develop quickly and lead to serious complications, especially in surgical patients who are immobile for extended periods. Applying pressure-relieving devices, such as heel protectors or foam dressings, can help alleviate the pressure on the affected areas and prevent further damage. These devices are designed to distribute pressure evenly and reduce the risk of pressure injuries. It is important for the nurse to address the issue promptly to prevent additional harm to the patient's skin integrity.
A patient presents with recurrent episodes of epistaxis, particularly after blowing the nose or during dry weather. Anterior rhinoscopy reveals a friable, vascular lesion in Little's area. Which of the following interventions is most appropriate for managing this condition?
- A. Nasal packing with anterior nasal tampons
- B. Application of silver nitrate cautery
- C. Endoscopic cauterization of the sphenopalatine artery
- D. Surgical excision of the nasal polyp
Correct Answer: B
Rationale: The clinical scenario described is consistent with a diagnosis of anterior epistaxis due to a prominent vascular lesion located in Little's area, which is an important site for nosebleeds. Silver nitrate cautery is the most appropriate intervention for managing this condition. Silver nitrate cautery is a commonly used method to chemically cauterize and eliminate the friable blood vessels responsible for recurrent epistaxis. It is a cost-effective and minimally invasive technique that can be easily performed in an outpatient setting. Nasal packing with anterior nasal tampons might be considered in cases of severe or refractory epistaxis, but in this scenario, where the source of bleeding is localized and identifiable, silver nitrate cautery is the treatment of choice. Endoscopic cauterization of the sphenopalatine artery and surgical excision of a nasal polyp are unnecessary and overly invasive for the described scenario.
Which of the following is a common complication associated with Dupuytren's contracture?
- A. Trigger finger
- B. Swan-neck deformity
- C. Boutonniere deformity
- D. Mallet finger
Correct Answer: B
Rationale: Dupuytren's contracture is a condition characterized by the thickening and tightening of the tissue beneath the skin of the hand, leading to the fingers being pulled into a bent position. One of the common complications associated with Dupuytren's contracture is the development of a Swan-neck deformity. This deformity is characterized by hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint. It is important to recognize and address complications like Swan-neck deformity in individuals with Dupuytren's contracture to prevent further functional impairment and disability.
Which of the following conditions is characterized by an imbalance between bone resorption and formation, resulting in bone thinning and increased risk of fractures?
- A. Osteoarthritis
- B. Osteomyelitis
- C. Osteoporosis
- D. Osteomalacia
Correct Answer: C
Rationale: Osteoporosis is a condition characterized by an imbalance between bone resorption (breakdown of bone tissue) and bone formation, leading to bone thinning and increased risk of fractures. In osteoporosis, bones become weak and porous, making them more prone to fractures even with minor trauma. This condition is common in postmenopausal women and older individuals. Risk factors for osteoporosis include age, gender, family history, lack of physical activity, low calcium and vitamin D intake, smoking, excessive alcohol consumption, and certain medications. Treatment typically involves lifestyle modifications, including adequate calcium and vitamin D intake, weight-bearing exercises, and sometimes medication to help slow down bone loss and reduce fracture risk. Early detection and management of osteoporosis are crucial to prevent fractures and maintain bone health.