Aligned with the American Association of Critical-Care Nurses and American Nurses Credentialing Center format. Authored & peer-reviewed by Adult-Gerontology Acute Care NPs.
Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.
A 26-year-old man presents with clinically significant mucosal bleeding and hematuria following a traumatic motor vehicle collision. He reports he has hemophilia B. What is the most appropriate treatment for this patient?
Hemophilia B is a congenital deficiency of coagulation factor IX. It occurs less frequently than hemophilia A and is an X-linked recessive condition affecting male patients in greater numbers. Factor IX, activated by factor VIII, subsequently activates factor X, which helps with the conversion of fibrinogen to fibrin. Factor IX deficiency interferes with the clotting cascade, which can lead to spontaneous hemorrhage or hemorrhage associated with trauma. Signs and symptoms of factor IX deficiency include easy bruising, hematuria, epistaxis, and hemarthrosis. Diagnosis is determined through analysis of bleeding scores and through coagulation screening testing and coagulation factor assays. Reproducible low factor IX activity levels, with exclusion of other possible causes, is consistent with hemophilia B. It can be considered mild, moderate, or severe based on the degree of bleeding. Treatment for all cases consists of bolus intravenous dosing of factor IX product followed by dosing every 8 hours until hemostasis is obtained. Plasma-derived factor IX concentrates use fractionation to separate screened donor plasma. Recombinant factor IX has been genetically engineered and is equally proven safe and effective with the treatment of hemophilia B. Treatment for major bleeding should aim to keep factor activity level at 50–80%. Adjunctive aminocaproic acid may be necessary for high-risk procedures.
Desmopressin (A) is used in the treatment of minor and major cases of bleeding in mild hemophilia A, minor and major bleeding cases of type 1 von Willebrand disease, and minor bleeding cases in type 2 von Willebrand disease. Factor VIII product (C) is used in the treatment of minor and major cases of moderate to severe hemophilia A. Fresh frozen plasma (D) is indicated in the treatment of minor and major bleeding in factor XI deficiency.
Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.
Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.
Your personal analytics allow you to see your progress at all times, so you can create an efficient and effective learning strategy and stay on pace with your plan.
Deep insights to determine your strengths and weaknesses so you can spend your time on the subjects that matter.
Discover how your answer choices align with those selected by learners across the country.
Using data generated by previous users, your Qbank gives a prediction of how likely you are to pass your exam.
After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.
Hemophilia B (Christmas Disease)
These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.