Exit HESI Practice: Perfusion

A nurse is caring for a pregnant client with thrombophlebitis. Which anticoagulant medication may be prescribed? Select all that apply. 1 Heparin 2 Clopidogrel 3 Warfarin 4 Enoxaparin 5 Acetylsalicylic acid

1 Heparin 4 Enoxaparin Heparin may be used during pregnancy because it does not cross the placental barrier and will not cause hemorrhage in the fetus. Enoxaparin does not cross the placental barrier; its classification for pregnancy is B. Clopidogrel is a platelet aggregation inhibitor. It is not used for thrombophlebitis; it is used to reduce the risk of brain attack, transient ischemic attack, unstable angina, and myocardial infarction. Warfarin crosses the placental barrier, causing hemorrhage in the fetus. Acetylsalicylic acid is a platelet aggregation inhibitor and is not recommended during pregnancy (D category).

A nurse is teaching the parents of a toddler with a recent diagnosis of hemophilia about the disease. What area of the body should the nurse include as the most common site for bleeding? 1 Brain 2 Joints 3 Kidneys 4 Abdomen

2 Joints The joints are the most commonly involved areas because of weight bearing and constant movement. Neither the brain, nor the kidneys, nor the abdomen is the most common site; however, bleeding may occur in any of these areas.

Which condition is characterized by hemorrhage after a pregnant female delivers? 1 Sheehan's syndrome 2 Cushing's syndrome 3 Addison's syndrome 4 Schwartz-Bartter syndrome

1 Sheehan's syndrome A pituitary infarction is caused by postpartum hemorrhaging; this condition is known as Sheehan's syndrome. Cushing's syndrome is manifested by moon face, truncal obesity, and hypertension. Addison's disease is manifested by hyperkalemia, hypotension, and hypoglycemia. Schwartz-Bartter syndrome, also called syndrome of inappropriate antidiuretic hormone, is manifested by loss of appetite, nausea, and vomiting. Hyperkalemia in Addison's: A major function of aldosterone is to increase urinary potassium secretion... in Addison's aldosterone is decreased therefore K is not secreted. Also, Na is wasted and water follows it so hypotension

Which client is at greatest risk for the development of a venous thrombosis? 1 A 76-year-old female with a 100-pack-per-year smoking history and hypertension 2 A 68-year-old male on bed rest following a left hip fracture 3 A 59-year-old male who is an intravenous drug user with hyperlipidemia 4 A 42-year-old female with Factor V Leiden mutation on warfarin

2 A 68-year-old male on bed rest following a left hip fracture Venous thrombosis is the result of inflammation/damage to a vein, hypercoagulability, venous stasis, or a combination of the three, known as Virchow triad. Bed rest and hip fracture are two major risk factors for the development of a thrombosis. While the other options present risk factors (cigarette smoking, drug abuse, and clotting disorders), the combination of the two (venous stasis and vessel injury) results in greatest risk for thrombus development.

The nurse is caring for a client with biliary cancer. The associated jaundice gets progressively worse. The nurse is most concerned about the potential complication of what symptom? 1 Pruritus 2 Bleeding 3 Flatulence 4 Hypokalemia

2 Bleeding Obstruction of bile flow impairs absorption of phytonadione, a fat-soluble vitamin; prothrombin is not produced, and the clotting process is prolonged. Although deposition of bile salts in the skin may lead to pruritus, this is not life threatening. Although there may be an increase in flatulence with biliary disease, it is not life threatening. Obstructive jaundice does not affect potassium levels.

Before a cholecystectomy, vitamin K is prescribed. The nurse recognizes that this is ordered because vitamin K contributes to the formation of which substance? 1 Bilirubin 2 Prothrombin 3 Thromboplastin 4 Cholecystokinin

2 Prothrombin Vitamin K is necessary in the formation of prothrombin to prevent bleeding. It is a fat-soluble vitamin and is not absorbed from the gastrointestinal (GI) tract in the absence of bile. Bilirubin is the bile pigment formed by the breakdown of erythrocytes. Thromboplastin converts prothrombin into thrombin during the process of coagulation. Cholecystokinin is the hormone that stimulates contraction of the gallbladder.

A client is admitted with a marginal placenta previa. Which item should the nurse have readily available? 1 One unit of freeze-dried plasma 2 Vitamin K for intramuscular injection 3 Two units of typed and screened blood 4 Heparin sodium for intravenous injection

3 Two units of typed and screened blood A sudden, severe hemorrhage may occur because of the location of the placenta near the cervical os; blood should be ready for administration to prevent shock. Freeze-dried plasma is not used in this situation. Adults manufacture their own vitamin K, and an injection will not help prevent bleeding from the placenta. Heparin sodium is contraindicated in the presence of hemorrhage.

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1 "I will take the drug with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will notify my doctor if I develop muscular or abdominal discomfort." 4 "I will stop taking metformin for 24 hours before and after having a test involving dye."

4 "I will stop taking metformin for 24 hours before and after having a test involving dye." Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

The healthcare provider prescribes enoxaparin to be administered subcutaneously daily to a client who had a total knee replacement. To ensure client safety, which measure would the nurse take when administering this medication? 1 Remove air pocket from prepackaged syringe before administration. 2 Rub the injection site after administration for 30 seconds. 3 Administer medication over 2 minutes. 4 Administer in the abdomen area only.

4 Administer in the abdomen area only. The preferred site for enoxaparin administration is the abdomen. According to package directions, the air pocket in the prepackaged syringe should not be removed. Rubbing the injection site also is contraindicated. Subcutaneous injections should not be given over 2 minutes.

A nurse administers several vitamins as part of a client's medical regimen. Which prescribed vitamin is essential for the synthesis of prothrombin by the liver? 1 B12 2 C 3 D 4 K

4 K Prothrombin, which is present in the plasma, is synthesized in the liver in the presence of vitamin K from the amino acid glutamine; vitamin K initiates the vital process of coagulation. Vitamin B12 is needed for hemoglobin synthesis. Vitamin C plays a role in collagen formation. Vitamin D is involved in calcium absorption and metabolism.