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A patient with a history of coronary artery disease is prescribed aspirin for secondary prevention. Which adverse effect is a potential concern with long-term aspirin therapy?
- A. Thrombocytopenia
- B. Gastrointestinal bleeding
- C. Hypercholesterolemia
- D. Hypertension
Correct Answer: B
Rationale: Long-term aspirin therapy, especially at higher doses, can increase the risk of gastrointestinal bleeding. Aspirin irreversibly inhibits cyclooxygenase enzyme, which is essential for the production of prostaglandins involved in mucosal protection of the gastrointestinal tract. Without these protective prostaglandins, the stomach lining becomes more susceptible to damage from gastric acid, leading to potential ulcer formation and bleeding. Patients with a history of coronary artery disease may be on aspirin for secondary prevention, and it is crucial to monitor for signs of bleeding such as black, tarry stools or abdominal pain. The benefits of aspirin in preventing cardiovascular events need to be weighed against the risk of adverse effects like gastrointestinal bleeding, especially in patients on long-term therapy.
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When caring for patients with hyperbilirubinemia, the nursing care plan should focus on the following, EXCEPT_________.
- A. informing appropriately the significant others
- B. preventing injury
- C. maintaining physiological homeostasis with bilirubin levels increasing
- D. preventing complications.
Correct Answer: C
Rationale: When caring for patients with hyperbilirubinemia, the nursing care plan should focus on informing the significant others, preventing injury, and preventing complications. The primary goal in managing hyperbilirubinemia is to prevent complications associated with high bilirubin levels, such as kernicterus. Therefore, maintaining physiological homeostasis with bilirubin levels increasing would not be appropriate and should not be the focus of the nursing care plan. It is crucial to monitor and manage bilirubin levels to prevent adverse outcomes rather than allowing them to increase.
A patient with a history of sickle cell disease presents with severe abdominal pain, fever, and jaundice. Laboratory tests reveal anemia, reticulocytosis, elevated indirect bilirubin, and presence of Howell-Jolly bodies on peripheral blood smear. Which of the following conditions is most likely to cause these findings?
- A. Acute splenic sequestration crisis
- B. Aplastic crisis
- C. Hemolytic crisis
- D. Vaso-occlusive crisis
Correct Answer: A
Rationale: Acute splenic sequestration crisis is a complication seen in patients with sickle cell disease characterized by the sudden pooling of sickled red blood cells in the spleen, leading to splenic enlargement, severe anemia, and hypovolemic shock. This pooling results in a rapid drop in hemoglobin levels, causing anemia. The spleen's sequestration of large numbers of red blood cells can cause a sudden rise in the number of immature red blood cells (reticulocytes) in the blood (reticulocytosis). The destruction of these trapped red blood cells in the spleen leads to hemolysis, evidenced by elevated indirect bilirubin levels and the presence of Howell-Jolly bodies (nuclear remnants of erythrocytes) on peripheral blood smear. Patients may present with severe abdominal pain, fever, jaundice, and signs of hemodynamic instability, which
When the patient turned 69 years old, Orinase was discontinued and NPH insulin is prescribed for her. After several months, she is determined to be suffering from sumogyi effect. Which of the following conditons will most likely result when the patient is receiving too much insulin?
- A. Developing an elevation of the blood glucose level
- B. Producing even more insulin
- C. Becoming resistant to insulin
- D. Conserving excessive amount of fluid
Correct Answer: A
Rationale: When a patient is receiving too much insulin, the most likely result is hypoglycemia, not hyperglycemia. The excess insulin causes the blood glucose level to drop too low, leading to symptoms such as sweating, tremors, confusion, and in severe cases, seizures. The body responds to hypoglycemia by releasing counterregulatory hormones such as glucagon, epinephrine, and cortisol, which work to increase the blood glucose level. This rebound effect, known as the Somogyi effect, can result in the patient experiencing high blood glucose levels after a period of insufficient glucose supply due to excessive insulin administration.
Nursing diagnosis commonly used when working with Sandro is
- A. ineffective role performance
- B. Compromised family coping
- C. impaired social interaction
- D. risk for injury.
Correct Answer: C
Rationale: When working with Sandro, who is taking an MAOI and needs to be educated on avoiding foods with tyramine, the nursing diagnosis commonly used would be "impaired social interaction." This nursing diagnosis focuses on the client's difficulty in establishing or maintaining meaningful relationships with others. In this case, Sandro's dietary restrictions due to his medication may cause challenges in social situations, leading to potential feelings of isolation or inability to engage in social activities involving food. By identifying impaired social interaction as a nursing diagnosis, the nurse can address these issues and support Sandro in maintaining social connections while adhering to his dietary requirements.
During a patient assessment, the nurse observes signs of distress and discomfort. What action should the nurse take to address the patient's needs?
- A. Ignoring the patient's distress to avoid making them uncomfortable
- B. Documenting the findings and informing the healthcare provider later
- C. Offering emotional support and actively listening to the patient's concerns
- D. Administering pain medication without further assessment
Correct Answer: C
Rationale: The correct action for the nurse to take when observing signs of distress and discomfort in a patient during assessment is to offer emotional support and actively listen to the patient's concerns. Ignoring the patient's distress may lead to worsening of the patient's condition and can be detrimental to the patient's well-being. Documenting the findings and informing the healthcare provider later is important but should not be the immediate response when a patient is in distress. Administering pain medication without further assessment is also not appropriate as the nurse needs to understand the underlying cause of the distress before providing appropriate interventions. Offering emotional support and actively listening to the patient's concerns can help the nurse understand the patient's needs, provide comfort, and potentially address the root cause of the distress.