Questions

Just like the actual exam

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.

  • Must address important content
  • Must be well structured

Question

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?

A Desmopressin
B Factor IX product
C Factor VIII product
D Fresh frozen plasma

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.


Explanations

Written with a purpose

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.

  • Created for optimal learning and recall
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  • Focus on the essential information

Illustrations

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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.

hemophilia A vs hemophilia B

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One Step Further

Taking your learning to the next level

After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Q: What is the most common inherited bleeding disorder?

REVEAL ANSWER

A: Von Willebrand disease.

Hemophilia B (Christmas Disease)

  • Patient with a history of minor trauma causing large amounts of bleeding or hemarthrosis
  • Complaining of spontaneous bleeding episodes involving skin, mucous membranes, and joints
  • Labs will show prolonged activated partial thromboplastin time (aPTT) and normal prothrombin time (PT)
  • Most commonly caused by X-linked recessive factor IX deficiency
  • Treatment is exogenous factor IX concentrate

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information
I’ve been a nurse for 10 years and used Rosh Review for my NP exam and loved it. The content is in-depth and did a great job to help me learn what I needed for the exam.

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Every question in your Qbank is based on topics found in the most recent version of your specialty’s practice model. As you review each question, the category that correlates with the material being tested will appear on the screen. If it’s not in the model, it won’t be on the exam.

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