Marco falls off his bicycle and injures his ankle. Which of the following actions shows the initial response to the injury in the extrinsic pathway?
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Solution
Release of tissue thromboplastin
Option B: Tissue thromboplastin is released when damaged tissue comes in contact with clotting factors.
Option A: Calcium is released to assist the conversion of factors X to Xa.
Options C and D: Conversion of factors XII to XIIa and VIII to VIII a are part of the intrinsic pathway.
A female client is scheduled to receive a heart valve replacement with a porcine valve. Which of the following types of transplant is this?
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Solution
Xenogeneic
Option D: A xenogeneic transplant is between is between human and another species.
Options A, B, and C: A syngeneic transplant is between identical twins, allogeneic transplant is between two humans, and autologous is a transplant from the same individual.
Which of the following drugs would be ordered by the physician to improve the platelet count in a male client with idiopathic thrombocytopenic purpura (ITP)?
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Solution
Corticosteroids
Option B: Corticosteroid therapy can decrease antibody production and phagocytosis of the antibody-coated platelets, retaining more functioning platelets.
Option C: Methotrexate can cause thrombocytopenia.
Options A and D: Vitamin K is used to treat an excessive anticoagulate state from warfarin overload, and ASA decreases platelet aggregation.
Macario had coronary artery bypass graft (CABG) surgery 3 days ago. Which of the following conditions is suspected by the nurse when a decrease in platelet count from 230,000 ul to 5,000 ul is noted?
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Solution
Heparin-associated thrombosis and thrombocytopenia (HATT)
Option D: HATT may occur after CABG surgery due to heparin use during surgery.
Options B and C: Although DIC and ITP cause platelet aggregation and bleeding, neither is common in a client after revascularization surgery.
Option A: Pancytopenia is a reduction in all blood cells.
A female client arrives at the emergency department with chest and stomach pain and a report of black tarry stool for several months. Which of the following order should the nurse Oliver anticipate?
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Solution
Electrocardiogram, complete blood count, testing for occult blood, comprehensive serum metabolic panel.
Option C: An electrocardiogram evaluates the complaints of chest pain, laboratory tests determine anemia, and the stool test for occult blood determines blood in the stool.
Option A: Cardiac monitoring, oxygen, and creatine kinase and lactate dehydrogenase levels are appropriate for a cardiac primary problem. A basic metabolic panel and alkaline phosphatase and aspartate aminotransferase levels assess liver function.
Option B: Prothrombin time, partial thromboplastin time, fibrinogen and fibrin split products are measured to verify bleeding dyscrasias.
Option D: An electroencephalogram evaluates brain electrical activity.
After cardiac surgery, a client’s blood pressure measures 126/80 mm Hg. Nurse Katrina determines that mean arterial pressure (MAP) is which of the following?
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Solution
95 mm Hg
Option C: Use the following formula to calculate MAP
MAP = systolic + 2 (diastolic)
MAP = 126 mm Hg + 2 (80 mm Hg)
MAP = 286 mm Hg
MAP = 95 mm Hg
A male client arriving in the emergency department is receiving cardiopulmonary resuscitation from paramedics who are giving ventilations through an endotracheal (ET) tube that they placed in the client’s home. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate of beats/minute with a palpable pulse. Which of the following actions should the nurse take first?
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Solution
Check endotracheal tube placement.
Option B: ET tube placement should be confirmed as soon as the client arrives in the emergency department. Once the airways is secured, oxygenation and ventilation should be confirmed using an end-tidal carbon dioxide monitor and pulse oximetry.
Option A: Next, the nurse should make sure L.V. access is established.
Option D: If the client experiences symptomatic bradycardia, atropine is administered as ordered 0.5 to 1 mg every 3 to 5 minutes to a total of 3 mg.
Option C: Then the nurse should try to find the cause of the client’s arrest by obtaining an ABG sample. Amiodarone is indicated for ventricular tachycardia, ventricular fibrillation, and atrial flutter – not symptomatic bradycardia.
A 37-year-old male client was admitted to the coronary care unit (CCU) 2 days ago with an acute myocardial infarction. Which of the following actions would breach the client confidentiality?
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Solution
The emergency department nurse calls up the latest electrocardiogram results to check the client’s progress
Option C: The emergency department nurse is no longer directly involved with the client’s care and thus has no legal right to information about his present condition. Anyone directly involved in his care (such as the telemetry nurse and the on-call physician) has the right to information about his condition. Because the client requested that the nurse update his wife on his condition, doing so doesn’t breach confidentiality.
A male client has a reduced serum high-density lipoprotein (HDL) level and an elevated low-density lipoprotein (LDL) level. Which of the following dietary modifications is not appropriate for this client?
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Solution
Less than 30% of calories from fat
Option B: A client with low serum HDL and high serum LDL levels should get less than 30% of daily calories from fat.
Options A, C, and D: The other modifications are appropriate for this client.
The nurse is aware that one of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility?
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Solution
Inotropic agents
Option D: Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output.
Options A and B: Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decreased the workload of the heart.
Option C: Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.