A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best?

Correct Answer: A

Rationale: The correct answer is A: It inhibits thrombin. Rivaroxaban is a direct factor Xa inhibitor that works by inhibiting thrombin formation, thus preventing blood clots. Thrombin is a key enzyme in the coagulation cascade. Choices B and D are incorrect because rivaroxaban specifically targets factor Xa and not fibrinogen or vitamin K. Choice C is incorrect as rivaroxaban does not actually "thin" the blood; it works by preventing clot formation.

Correct Answer: A

Rationale: Step 1: Time to marrow relapse since initial diagnosis is crucial because early relapse indicates aggressive disease behavior. Step 2: Early relapse implies a higher likelihood of resistance to treatment, leading to poorer survival outcomes. Step 3: Rapid relapse often signifies a more challenging disease course, requiring prompt and aggressive interventions for better prognosis. Summary: - Choice A is correct as early relapse indicates aggressive disease behavior and resistance to treatment. - Choices B, C, and D are incorrect as they do not directly impact the urgency and aggressiveness of treatment needed for survival post-relapse.

Correct Answer: D

Rationale: The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's negative peripheral blood test for Fanconi anemia does not rule out the possibility of having this condition. Skin fibroblast culture testing is more sensitive for detecting Fanconi anemia compared to peripheral blood testing. Given the family history of aplastic anemia and leukemia, along with the sister's poor response to treatment, it is crucial to definitively confirm or rule out Fanconi anemia as the underlying cause. Administering ATG and cyclosporine (choice A) without confirming the diagnosis may not be effective. Searching for a donor for matched unrelated transplant (choice B) is premature without confirming the diagnosis. Sending a bone marrow aspirate for Fanconi anemia testing (choice C) may not be as sensitive as skin fibroblast culture testing.

Correct Answer: E

Rationale: Rationale for Correct Answer (E): The correct statement is likely about the fact that her hemoglobinopathy, Hb Indianapolis, is associated with ineffective erythropoiesis, leading to anemia, jaundice, and extramedullary hematopoiesis. This is a rare condition and not typically detected on newborn screens. Additionally, splenectomy may not entirely resolve her anemia due to the systemic nature of the disease. Since she has transfusion-dependent anemia, she is at risk for gallstones due to chronic hemolysis. Summary of Incorrect Choices: A: Incorrect because Hb Indianapolis is rare and not typically detected on newborn screens. B: Incorrect because extramedullary hematopoiesis can lead to nucleated red cells in the peripheral blood smear. C: Incorrect because the disease is systemic, and splenectomy may not fully resolve the anemia. D: Incorrect because chronic hemolysis from the disease increases the risk of gallstones despite transf

Correct Answer: C

Rationale: The correct answer is C: Stage III. Rationale: 1. In the St. Jude (Murphy) staging system for non-Hodgkin lymphoma, Stage III is defined as the presence of a mediastinal mass that is greater than 33% of the thoracic diameter. 2. The patient in the scenario has a large mediastinal mass that meets this criteria, placing her in Stage III. 3. The absence of disease in other sites, as confirmed by the metastatic work-up, indicates that the disease is localized to the mediastinum. 4. Therefore, based on the specific criteria of the St. Jude (Murphy) staging system, the correct stage for this patient's non-Hodgkin lymphoma is Stage III. Summary of other choices: - Choice A: Stage I would not be appropriate as the mass is not localized to a single lymph node region. - Choice B: Stage II would not be correct as the mass extends beyond a