A nurse in an emergency department is reviewing the medical record of a client who is having an acute myocardial infarction.
Which of the following findings places the client at risk if he receives alteplase?
Family history of malignant hypertension.
Hip arthroplasty 1 week ago.
Chronic obstructive pulmonary disease.
Acute renal failure 6 months ago.
The Correct Answer is B
The correct answer is B. Hip arthroplasty 1 week ago.
Alteplase is a drug that dissolves blood clots by converting plasminogen to plasmin. It can be used for acute ischemic stroke, but it has some contraindications that depend on the indication and the type of administration of the drug. Some common contraindications for alteplase are hypersensitivity, active internal bleeding, history of intracranial hemorrhage, bleeding disorders, and high blood pressure. Other contraindications may vary depending on the specific condition and the time window of treatment. Alteplase can cause serious or fatal bleeding as a side effect.
Choice A is wrong because family history of malignant hypertension is not an absolute contraindication for alteplase, although uncontrolled hypertension (>185 mmHg SBP or >110 mmHg DBP) is.
Choice C is wrong because chronic obstructive pulmonary disease is not a contraindication for alteplase, although it may increase the risk of pulmonary hemorrhage.
Choice D is wrong because acute renal failure 6 months ago is not a contraindication for alteplase, although current use of direct thrombin inhibitors or direct factor Xa inhibitors is.
Normal ranges for blood pressure are <120/80 mmHg for normal, 120-129/<80 mmHg for elevated, 130-139/80-89 mmHg for stage 1 hypertension, and ≥140/≥90 mmHg for stage 2 hypertension.
Normal ranges for platelet count are 150,000 to 450,000 platelets per microliter of blood.
Normal ranges for INR are 0.8 to 1.2 for people who are not taking blood thinners and 2 to 3 for people who are taking warfarin.
Normal ranges for aPTT are 25 to 35 seconds for people who are not taking blood thinners and 46 to 70 seconds for people who are taking heparin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. Apply intermittent pressure 2.5 cm (1 inch) below the percutaneous skin site.
- Rationale:Applying intermittent pressure slightly below the puncture site can help control bleeding without dislodging the introducer sheath,which is still in place at this early stage.
b. Apply direct pressure to the puncture site.
- Rationale:NOT the best choice.Applying direct pressure to the puncture site itself could dislodge the introducer sheath and worsen bleeding.
c. Elevate the affected extremity above the level of the heart.
- Rationale:NOT the best choice.While elevating the extremity may help reduce swelling,it is not the most effective intervention for controlling bleeding at the puncture site.
d. Leave the dressing undisturbed and notify the physician immediately.
- Rationale:NOT the best choice.While notifying the physician is important,delaying intervention to control bleeding could worsen the situation.Early intervention is crucial.
Therefore, the correct answer is a. Apply intermittent pressure 2.5 cm (1 inch) below the percutaneous skin site. This approach helps control bleeding while minimizing the risk of dislodging the introducer sheath.
Remember, in such situations, prioritizing prompt intervention and preventing further blood loss is crucial while waiting for medical assistance.
Correct Answer is D
Explanation
The correct answer is choice d. Recommend to the provider specific acute care clients for discharge.
Choice A rationale: Calling in additional medical-surgical unit nursing care staff is not the most effective initial action. The immediate priority is to create space for incoming casualties, not necessarily increasing staffing levels immediately.
Choice B rationale: Acting as a liaison between the facility and the media is not a primary responsibility for the nurse. This task typically falls to the facility's public relations team.
Choice C rationale: Determining the medical needs of incoming clients through the emergency department is the role of triage staff in the emergency department, not the responsibility of the medical-surgical unit nurse.
Choice D rationale: Recommending specific acute care clients for discharge is crucial to free up hospital beds for incoming casualties. This action helps to quickly create capacity, making it the correct and immediate priority during a mass casualty event
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