Nokea
A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses and this result means?
- A. fibrin degradation fragment; positive for a blood clot
- B. platelet degradation protein; negative for a blood clot
- C. clotting factors; positive for a blood clot
- D. fibrin degradation fragment; negative for a blood clot
Correct Answer: D
Rationale: A d-dimer test assess fibrin degradation fragment. This test doesn't tell us where the clot may be (so it not specific) so it will need to be further investigated by the MD and a positive result doesn't necessarily mean the patient has a clot because some disease processes can cause a false positive. Also, a normal d-dimer is <500 ng/mL (FEU). However, it depends on how the lab reports the assay cut-off value for the d-dimer. Some labs have a cutoff <250 ng/mL (D-DU). However, <500 ng/mL (FEU) is equivalent to <250 ng/mL (D-DU).
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The 56-year-old client diagnosed with tuberculosis (Tb) is being discharged. Which statement made by the client indicates an understanding of the discharge instructions?
- A. I will take my medication for the full three (3) weeks prescribed.
- B. I must stay on the medication for months if I am to get well.
- C. I can be around my friends because I have started taking antibiotics.
- D. I should get a Tb skin test every three (3) months to determine if I am well.
Correct Answer: B
Rationale: TB treatment requires months of antibiotics (B) for cure. Three weeks (A) is too short, antibiotics don’t eliminate transmission risk immediately (C), and skin tests (D) monitor exposure, not cure.
Which statement indicates to the nurse the client diagnosed with asthma understands the teaching regarding mast cell stabilizer medications?
- A. I should take two (2) puffs when I begin to have an asthma attack.
- B. I must taper off the medications and not stop taking them abruptly.
- C. These drugs will be most effective if taken at bedtime.
- D. These drugs are not good at the time of an attack.
Correct Answer: D
Rationale: Mast cell stabilizers (D) prevent asthma by stabilizing mast cells, not treating acute attacks. Puffs during attack (A), tapering (B), and bedtime use (C) are incorrect.
The client is suspected of having a pulmonary embolus. Which diagnostic test suggests the presence of a pulmonary embolus and requires further investigation?
- A. Plasma D-dimer test.
- B. Arterial blood gases.
- C. Chest x-ray (CXR).
- D. Magnetic resonance imaging (MRI).
Correct Answer: A
Rationale: Elevated D-dimer (A) suggests clotting, warranting further PE investigation (e.g., CT). ABGs (B) show hypoxia, CXR (C) is nonspecific, and MRI (D) is not standard.
A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
- A. 5 mm induration
- B. 15 mm induration
- C. 9 mm induration
- D. 10 mm induration
Correct Answer: D
Rationale: 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.
Which information should the nurse include in the teaching plan for the mother of a child diagnosed with cystic fibrosis (CF)? Select all that apply.
- A. Perform postural drainage and percussion every four (4) hours.
- B. Modify activities to accommodate daily physiotherapy.
- C. Increase fluid intake to one (1) liter daily to thin secretions.
- D. Recognize and report signs and symptoms of respiratory infections.
- E. Avoid anyone suspected of having an upper respiratory infection.
Correct Answer: A,B,D,E
Rationale: Postural drainage (1) helps clear mucus in CF. Modifying activities for physiotherapy (2) ensures adherence. Recognizing infection signs (4) and avoiding respiratory infections (5) prevent exacerbations. One liter of fluid (3) is insufficient for children; fluid needs vary by age and size.