Nokea
The nurse is discharging home a client at risk for venous thromboembolism on enoxaparin sodium. What instruction is a priority for the nurse to provide to this client?
- A. Notify your health care provider if your stools appear dark or tarry
- B. You must have your prothrombin time (PT)/international normalized ratio (INR) checked every 2 weeks
- C. Massage the injection site after the heparin is injected
- D. You must have your activated partial thromboplastin time (aPTT) checked every 72 hours
Correct Answer: A
Rationale: Enoxaparin, a low-molecular-weight heparin, thins blood dark, tarry stools signal GI bleed, a dire side effect needing instant reporting to halt hemorrhage. PT/INR tracks warfarin, not enoxaparin; aPTT's for unfractionated heparin. Massaging injection sites risks bruising. Nurses prioritize bleed watch, ensuring safety on this clot-busting med, a discharge must-know.
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A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy?
- A. Administer an antiemetic
- B. Administer an antimetabolite
- C. Administer a tumor antibiotic
- D. Administer an anticoagulant
Correct Answer: A
Rationale: Chemo's nastiest duo nausea and vomiting strike most patients, triggered by gut and brain reactions to drugs like cyclophosphamide. Antiemetics (e.g., ondansetron) preempt this, keeping patients eating and hydrated, a frontline move in oncology. Antimetabolites (like methotrexate) and tumor antibiotics (like doxorubicin) are chemo agents, not side-effect fixes. Anticoagulants dodge clots, not nausea. Nurses prioritize this relief, knowing it's the biggest hurdle to treatment tolerance.
A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate?
- A. Avoid getting salt water on the radiation site.
- B. Do not expose the radiation area to direct sunlight.
- C. Have a wonderful time and enjoy your vacation!
- D. Remember you should not drink alcohol for a year.
Correct Answer: B
Rationale: Post-radiation skin at the treatment site remains highly sensitive to ultraviolet (UV) rays due to damage to the epidermal layer, increasing the risk of burns, irritation, or delayed healing. The nurse's most appropriate response is to advise against exposing the radiation area to direct sunlight, a precaution that persists for at least a year after treatment to protect skin integrity. Avoiding saltwater isn't a standard concern unless the skin is broken, which isn't indicated here. Simply wishing the client well ignores the teaching opportunity and potential risk. The alcohol restriction isn't a universal post-radiation rule unless tied to specific treatments or conditions not mentioned. Educating about sun exposure empowers the client to enjoy the vacation safely, aligning with nursing's preventive care focus and ensuring the celebration isn't marred by avoidable complications.
During artificial ventilation in a patient with chronic obstructive pulmonary disease, air trapping:
- A. Leads to hypotension when venous return is reduced significantly.
- B. Is likely to be present when the capnogram fails to reach a plateau in expiration.
- C. May be reduced by using a low respiratory rate.
- D. Is reduced by decreasing the ratio of inspiratory time to expiratory time.
Correct Answer: A
Rationale: Air trapping in COPD during mechanical ventilation occurs due to incomplete exhalation from airway obstruction, leading to intrinsic positive end-expiratory pressure (auto-PEEP). This increases intrathoracic pressure, compressing the vena cava and reducing venous return, which can cause hypotension a critical complication. A capnogram failing to plateau suggests prolonged exhalation, consistent with air trapping, but it's a diagnostic sign, not a consequence. A low respiratory rate allows more exhalation time, reducing air trapping, while decreasing the inspiratory-to-expiratory time ratio (e.g., shortening inspiration) similarly helps by extending exhalation. Positive end-expiratory pressure (PEEP) can exacerbate air trapping if excessive, but its effect depends on levels used. Hypotension from reduced venous return is a direct physiological result of severe air trapping, making it the most definitive statement in this context.
Toxic shock syndrome:
- A. will often manifest without fever
- B. is a misnomer because BP is often maintained
- C. is caused by pseudomonas species
- D. often produces elevated creatinine kinase
Correct Answer: D
Rationale: TSS fever burns, BP drops, staph rules, CK jumps, rash spreads. Nurses clock this chronic toxin surge.
What is the relationship between hyperlipidaemia and non-alcoholic steatohepatitis (NASH)?
- A. Hyperlipidaemia contributes to the development of NASH
- B. NASH contributes to the development of hyperlipidaemia
- C. There is no relationship between hyperlipidaemia and NASH
- D. Answers 1 and 2 are correct
Correct Answer: D
Rationale: NASH and hyperlipidaemia dance both ways high lipids pile fat, NASH pumps them back, a chronic loop. No split or null fits nurses track this lipid-liver ping-pong.