A nurse is caring for a child with hemophilia. While reviewing ...

[Zulu123]

A nurse is caring for a child with hemophilia.
 
  While reviewing this child's immunization records, the nurse notes that the child needs the tetanus and reduced diphtheria toxoids and acellular pertussis (Tdap) vaccine and the hepatitis A vaccine. The nurse should notify the provider and obtain an order to give:
  a. both vaccines intramuscularly.
  b. both vaccines subcutaneously.
  c. the hepatitis A vaccine only subcutaneously.
  d. the Tdap vaccine only intramuscularly.

Question 2

A patient with hemophilia B is admitted to the hospital for surgery. The patient's history reveals long-term use of factor replacement as prophylaxis for bleeding episodes.
 
  The nurse anticipates that the provider will order which medication to prevent excessive perioperative bleeding?
  a. Desmopressin
  b. Factor VIII
  c. Ibuprofen
  d. Tranexamic acid

[aloop]

Answer to Question 1

ANS: A
To minimize the risk of hepatitis, all patients with hemophilia should be fully vaccinated, and all newly diagnosed patients should receive both the hepatitis A and hepatitis B vaccines to minimize the risk of hepatitis from infusions. Clinicians should inject vaccines intramuscularly, taking precautions to prevent excessive bleeding, because subcutaneous administration does not guarantee efficacy. There is no reason to withhold any vaccine in children with hemophilia.

Answer to Question 2

ANS: D
Antifibrinolytic drugs, such as tranexamic acid, which prevent the breakdown of fibrin, are used as adjuncts to replacement factor in special cases in which bleeding is likely. Desmopressin is used in patients with mild hemophilia A to help control bleeding episodes. Hemophilia B is a deficiency of factor IX, so giving factor VIII would not be appropriate. Ibuprofen would only reduce clotting and should not be used.

[Zulu123]

TYSM

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