The pathophysiology of venous thrombosis is often explained by Virchow's triad, which includes hypercoagulability, endothelial injury, and venous stasis. Based on Virchow's triad and your knowledge of risk factors for thrombosis, which of the following pediatric patients has the greatest risk of hospital-acquired venous thromboembolism?
- A. 3-day-old full-term infant admitted to hospital pediatrics for hyperbilirubinemia
- B. 6-month-old male admitted to the infectious disease unit for respiratory syncytial virus
- C. Ex-28 week premature infant, requiring NICU-level care for necrotizing enterocolitis
- D. 7-year-old male with acute lymphoblastic leukemia receiving maintenance chemotherapy admitted to hematology/oncology unit for fever and neutropenia
Correct Answer: C
Rationale: The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants are at higher risk due to their immature coagulation system and prolonged immobility. Necrotizing enterocolitis further increases the risk due to inflammation and endothelial injury. Hypercoagulability is common in premature infants. Choices A, B, and D have lower risk as they do not have the same combination of risk factors as the premature infant in choice C.
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A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?
- A. Hyperuricemia
- B. Hyponatremia
- C. Lymphocytopenia
- D. Thrombocytopenia
Correct Answer: D
Rationale: The correct answer is D: Thrombocytopenia. Clopidogrel is an antiplatelet medication that works by preventing blood clots. Thrombocytopenia is a decrease in platelet count, which can lead to bleeding issues. Monitoring for thrombocytopenia is essential as it can be a potential adverse reaction of clopidogrel.
A: Hyperuricemia is not typically associated with clopidogrel.
B: Hyponatremia is not a common adverse reaction of clopidogrel.
C: Lymphocytopenia is not a common side effect of clopidogrel.
In summary, the nurse should monitor for thrombocytopenia as a potential adverse reaction when caring for a client taking clopidogrel.
Heparin is an anticoagulant produced by the basophils. The most likely mechanism heparin prevents blood clotting is by
- A. Inhibiting the formation of vitamin K-dependent clotting factors
- B. Preventing the activation of platelets
- C. Preventing the aggregation of platelets
- D. Binding to antithrombin III to inactivate thrombin
Correct Answer: D
Rationale: The correct answer is D because heparin binds to antithrombin III, enhancing its ability to inactivate thrombin. This prevents the conversion of fibrinogen to fibrin, thereby inhibiting blood clot formation. Choices A and B are incorrect because heparin does not affect vitamin K-dependent clotting factors or platelet activation. Choice C is incorrect because heparin does not directly prevent platelet aggregation.
A 72-year-old male with enlargement of superficial lymph nodes and mild hepatosplenomegaly is diagnosed as having chronic lymphatic leukemia (CLL). The most important criteria for diagnosis of this disease is the
- A. Presence of hypogammaglobulinemia
- B. Absolute lymphocytes
- C. Male predominance
- D. Presence of enlarged lymph nodes
Correct Answer: B
Rationale: The correct answer is B: Absolute lymphocytes. In CLL, the most important diagnostic criterion is an absolute lymphocyte count of more than 5,000 cells per microliter in the peripheral blood. This is a key feature of CLL and distinguishes it from other conditions. Hypogammaglobulinemia (choice A) may occur in CLL but is not as specific for diagnosis. Male predominance (choice C) is a general characteristic of CLL but is not a diagnostic criterion. Presence of enlarged lymph nodes (choice D) is a common manifestation of CLL but not the most important criteria for diagnosis.
Outstanding feature of ITP:
- A. fever
- B. gum bleeding
- C. moderate splenomegaly
- D. stema tenderness
Correct Answer: B
Rationale: The correct answer is B: gum bleeding. In Immune Thrombocytopenic Purpura (ITP), the hallmark feature is thrombocytopenia leading to mucocutaneous bleeding, including gum bleeding. Fever (choice A) is not a typical feature of ITP. Splenomegaly (choice C) can be present in chronic ITP but is not a defining feature. Sterna tenderness (choice D) is not specific to ITP and is not considered a characteristic feature. Thus, gum bleeding is the outstanding feature of ITP due to the primary pathophysiology of decreased platelet count leading to bleeding manifestations.
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: The correct answer is A. Subcutaneous injection of heparin is avoided because it can lead to hematomas due to its anticoagulant properties. Heparin is not stored in mast cells (B), but it is synthesized in mast cells. Heparin binds to plasma antithrombin III and inhibits activated thrombin (C). Protamine sulfate can be used to counteract heparin overdose by binding to heparin and neutralizing its anticoagulant effects (D). Therefore, the statement that subcutaneous injection of heparin is avoided due to hematoma formation is the false statement among the options provided.