Nokea
Busulfan therapy lead to all except:
- A. hyperpigmentation
- B. pulm .Fibrosis
- C. optic neuritis
- D. BM suppression
Correct Answer: C
Rationale: The correct answer is C: Optic neuritis. Busulfan therapy is known to cause adverse effects like hyperpigmentation, pulmonary fibrosis, and bone marrow suppression due to its cytotoxic nature. However, optic neuritis is not a common side effect associated with busulfan. Optic neuritis typically occurs due to inflammation of the optic nerve and is more commonly linked to conditions like multiple sclerosis. Therefore, in the context of busulfan therapy, optic neuritis is not a expected side effect, making it the correct answer.
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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: The correct answer is D because after a splenectomy, the patient is at risk for infections due to a compromised immune system. Washing hands and avoiding sick individuals can help prevent infections.
A: Watching for excess bruising is not directly related to post-splenectomy care.
B: Checking for swollen lymph nodes is not a priority concern for a post-splenectomy patient.
C: Taking iron supplements may not be necessary immediately post-splenectomy and should be discussed with the healthcare provider.
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.
Which of the following is false regarding heparin?
- A. Subcutaneous injection of heparin is avoided because of hematomas formation.
- B. Heparin is usually stored in the mast cells.
- C. Heparin binds to plasma anti thrombin III and inhibits activated thrombin.
- D. Protamine sulfate can be used to counteract heparin overdose.
Correct Answer: A
Rationale: Step-by-step rationale:
1. Subcutaneous injection of heparin is avoided due to the risk of hematoma formation at the injection site.
2. This statement is false because heparin is commonly administered subcutaneously for prophylaxis of thromboembolic events.
3. The preferred route for heparin administration is subcutaneous or intravenous.
4. Therefore, choice A is the false statement.
Summary:
- Choice A is incorrect as heparin is commonly given subcutaneously.
- Choice B is incorrect as heparin is not stored in mast cells but in specialized granules in mast cells.
- Choice C is correct as heparin binds to plasma antithrombin III to inhibit thrombin.
- Choice D is correct as protamine sulfate can reverse heparin's anticoagulant effects in case of overdose.
Splenectomy is contraindicated in:
- A. pyruvate kinase def.
- B. ITP
- C. BM failure
- D. angiogenic myeloid metaplasia
Correct Answer: C
Rationale: The correct answer is C: BM failure. Splenectomy is contraindicated in patients with bone marrow failure due to conditions such as aplastic anemia or myelodysplastic syndromes. The spleen plays a role in removing abnormal blood cells, and removing it can worsen cytopenias in these patients. Choices A, B, and D are not contraindications for splenectomy as they do not directly involve the bone marrow function. Pyruvate kinase deficiency (A) does not affect bone marrow function, ITP (B) is a platelet disorder, and angiogenic myeloid metaplasia (D) is a condition related to abnormal blood cell production, not bone marrow failure.
In microcytic hypochromic anaemia
- A. Red cells are larger with normal staining
- B. Red blood cell count is increased
- C. Haemtocrit and mean corpuscular haemoglobin are normal
- D. Red cells are smaller with a pale large central pallor
Correct Answer: D
Rationale: In microcytic hypochromic anemia, red cells are smaller with decreased hemoglobin content, leading to pale appearance. Choice D is correct as it describes the typical characteristics of microcytic hypochromic anemia. Choice A is incorrect as red cells are smaller, not larger. Choice B is incorrect as red blood cell count is usually decreased. Choice C is incorrect as both hematocrit and mean corpuscular hemoglobin are decreased in microcytic hypochromic anemia.