The nurse is caring for patient with a history of atrial fibrillation who is prescribed warfarin. Sometimes I forget my medication, so l double up doses when I remember " The patient's PT and INR are highly elevated. The nurse anticipates the transfusion of which blood product?

Packed Red Blood Cells (PRBC's)

Platelets

Cryoprecipitate

Fresh Frozen Plasma (FFP)

Answer and Explanation

The Correct Answer is D

A) Packed Red Blood Cells (PRBCs):
Packed Red Blood Cells are typically transfused when there is anemia or significant blood loss leading to low hemoglobin levels. In the case of warfarin overdose or elevated PT/INR, the problem is related to coagulation and not red blood cell count.

B) Platelets:
Platelets are typically transfused when there is thrombocytopenia or a need to address platelet dysfunction (e.g., in patients with bleeding due to low platelet counts). However, the elevated PT and INR in this case are related to the coagulation cascade being inhibited by warfarin, not platelet deficiency.

C) Cryoprecipitate:
Cryoprecipitate is primarily used to replace clotting factors such as fibrinogen, factor VIII, and von Willebrand factor. It is typically transfused in patients with hemophilia or bleeding disorders related to low fibrinogen levels. However, in this case, the issue is related to warfarin-induced inhibition of clotting factors (specifically the vitamin K-dependent factors: II, VII, IX, and X), not a deficiency in fibrinogen or specific clotting factors addressed by cryoprecipitate.

D) Fresh Frozen Plasma (FFP):
Fresh Frozen Plasma (FFP) is the most appropriate choice for this patient. FFP contains all the coagulation factors, including the vitamin K-dependent factors that warfarin inhibits. When a patient on warfarin presents with elevated PT and INR (which indicates impaired clotting ability), FFP is used to replace the clotting factors and help reverse the effects of warfarin.

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Correct Answer is A

Explanation

A) Ventilator-associated pneumonia (VAP):
Ventilator-associated pneumonia (VAP) is a type of pneumonia that develops in patients who have been on mechanical ventilation for more than 48 hours. It is a common and serious complication in critically ill patients on ventilators. Symptoms such as fever, green sputum, and right lower lobe crackles are indicative of a respiratory infection, which, in this case, is most likely VAP. VAP typically presents with signs of infection such as elevated temperature, purulent sputum, and new infiltrates on a chest x-ray, in addition to lung crackles.

B) Pulmonary embolism (PE):
Although pulmonary embolism (PE) can cause symptoms like tachypnea, chest pain, and dyspnea, it does not typically cause a fever, green sputum, or localized crackles in the lungs. PE is usually characterized by sudden onset of respiratory distress, often accompanied by hemoptysis or chest pain, and would not typically present with the localized findings in the lower lobe (e.g., crackles).

C) Stress ulcer:
Stress ulcers can occur in critically ill patients, especially those on mechanical ventilation, due to the stress response and reduced blood flow to the stomach. However, stress ulcers typically cause gastrointestinal symptoms, such as melena (black, tarry stools) or hematemesis (vomiting blood).

D) Pneumothorax:
A pneumothorax occurs when air accumulates in the pleural space, causing a collapse of the lung. It can lead to symptoms such as sudden chest pain, dyspnea, and diminished breath sounds on one side of the chest. However, it would not typically cause fever, green sputum, or localized crackles.

A. Clubbing of the fingers B. A heart murmur C. Barrel chest D. Bradycardia

Correct Answer is B

Explanation

A) Clubbing of the fingers
Clubbing of the fingers is typically associated with chronic hypoxia, often due to conditions like chronic obstructive pulmonary disease (COPD), congenital heart defects, or chronic respiratory disorders. While mitral valve stenosis can lead to pulmonary congestion and sometimes hypoxia, clubbing is not a hallmark finding of mitral valve stenosis.

B) A heart murmur
Mitral valve stenosis is commonly characterized by a heart murmur. The stenosis (narrowing) of the mitral valve obstructs blood flow from the left atrium to the left ventricle, leading to turbulent blood flow. This creates a characteristic diastolic murmur (a low-pitched, rumbling murmur heard best at the apex of the heart with the patient in the left lateral decubitus position).

C) Barrel chest
A barrel chest is more commonly associated with chronic obstructive pulmonary disease (COPD), emphysema, and other conditions that cause long-term hyperinflation of the lungs. It is not a typical finding in mitral valve stenosis. The shape of the chest may change over time in patients with severe left-sided heart failure, but this is not a primary or direct consequence of mitral valve stenosis.

D) Bradycardia
Bradycardia (a slow heart rate) is not a characteristic finding of mitral valve stenosis. In fact, mitral valve stenosis can lead to increased heart rates due to reduced cardiac output and compensatory mechanisms. As the left atrium becomes increasingly distended from the obstruction, atrial fibrillation (a rapid, irregular heartbeat) is common in mitral valve stenosis.

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The nurse is caring for patient with a history of atrial fibrillation who is prescribed warfarin. Sometimes I forget my medication, so l double up doses when I remember " The patient's PT and INR are highly elevated. The nurse anticipates the transfusion of which blood product?

Nursing Test Bank

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Explanation

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Correct Answer is B

Explanation

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