Author Question: A nurse is caring for an African American patient with severe hemophilia A who has been admitted for ... (Read 59 times)

jerry coleman · **on:** Jul 23, 2018

A nurse is caring for an African American patient with severe hemophilia A who has been admitted for bleeding into the knee joint. The prescriber has ordered intravenous factor VIIa NovoSeven RT.

A nursing student wants to know why this patient is not receiving factor VIII. Which statement by the nurse is correct? a. Factor VIIa is stronger than factor VIII and will work faster.
b. Factor VIII is used for prophylaxis, and factor VIIa is used for acute episodes.
c. Factor VIIa is used when patients devel-op antibodies against factor VIII.
d. Factor VIIa provides immune tolerance therapy so that factor VIII will be more effective.

Question 2

A child with hemophilia A who weighs 30 kg receives factor VIII on an ongoing basis as prophylaxis. The provider orders desmopressin Stimate to be used for nosebleeds.

The nurse will instruct the child's parents to give the medication as ____ nostril as needed. a. 1 spray in each
b. 1 spray in one
c. 2 sprays in each
d. 2 sprays in one

tanna.moeller · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

C
When patients develop antibodies against factor VIII, activated factor VII is used, because it has the same actions as factor VIII. Patients with severe hemophilia A have a 20 to 30 likelihood of developing antibodies to factor VIII and the risk of inhibitor development is unusually high in African American and Hispanic patients, so this patient has an increased risk. Factor VIIa is not stronger than factor VIII. It is not used for prophylaxis only. Immune tolerance therapy describes the use of repeated administration of factor replacement products to eliminate inhibitor produc-tion.

Answer to Question 2

B
Children who weigh less than 50 kg should use 1 spray in one nostril for a dose of 150 mcg. Each spray delivers 150 mcg, so 1 spray in both nostrils would give a dose of 300 mcg. Using 2 sprays in one nostril would give a dose of 300 mcg; using 2 sprays in both nostrils would give a dose of 600 mcg.