Chapter 53: Drugs for Hemophilia

Chapter 53: Drugs for Hemophilia

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1. A patient with epistaxis and a history of hemophilia A is admitted to the unit and is scheduled for replacement therapy. The nurse should prepare to administer

ANS:   D

The cornerstone of treatment for hemophilia A is replacement therapy with factor VIII.

Tranexamic acid and aminocaproic acid are antifibrinolytic agents that act primarily by preventing the formation of plasmin from its precursor.

Desmopressin promotes the release of factor VIII from the vascular endothelium and has the advantage of being cheaper than factor VIII. Also, it can be administered by nasal spray as well as by IV infusion. However, repeated use of desmopressin can deplete stored factor VIII.

DIF:    Cognitive Level: Application             REF:    p. 626

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A nurse prepares to administer routine immunizations to a child with hemophilia. By which route and methods should the nurse administer the immunizations?

ANS:   B

To achieve maximum efficacy of the immunizations, the vaccines should be administered intramuscularly, and prolonged pressure should be applied to the site to prevent bleeding.

Some clinicians inject the vaccine subcutaneously rather than intramuscularly to avoid muscle hemorrhage; however, the efficacy of these vaccinations is seriously questioned.

Intravenous and intradermal methods are not used to administer vaccines.

DIF:    Cognitive Level: Application             REF:    p. 627

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient with hemophilia complains of mild pain after a dental procedure. Which analgesic would be the most appropriate for this patient?

ANS:   C

For mild pain, acetaminophen is the drug of choice, because it does not inhibit platelet aggregation.

NSAIDs should be avoided, because they inhibit platelet aggregation.

Regardless of the severity of the pain, aspirin should always be avoided, because it can induce GI ulceration and bleeding and irreversibly inhibit platelet aggregation.

An opioid analgesic would be needed only for severe pain.

DIF:    Cognitive Level: Application             REF:    p. 627

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A nurse provides patient education about immunizations to the parents of a child newly diagnosed with hemophilia. The nurse explains that the child should receive _________ to reduce the risk of _____________.

ANS:   B

To minimize the risk of hepatitis, all patients newly diagnosed with hemophilia should be vaccinated with hepatitis A and B vaccines.

Polio vaccine, tetanus immunization, and MMR may be indicated for all children; however, a child with hemophilia especially should be protected against hepatitis because of the risk of acquiring blood-borne disease during blood transfusions.

DIF:    Cognitive Level: Application             REF:    p. 627

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential