Correct Answer: A

Rationale: The correct answer is A: Palliative. Palliative surgery is aimed at relieving symptoms and improving quality of life when a cure is not possible. In this scenario, where the cancer has recurred and metastasized, the goal of surgery would be to alleviate symptoms rather than to cure the disease.

Choices B, C, and D are incorrect because reconstructive surgery aims to restore function or appearance, salvage surgery aims to remove or salvage tissue to prevent further complications, and prophylactic surgery aims to prevent the development of a condition rather than treat its progression.

Correct Answer: D

Rationale: The course of polycythemia vera can be best ascertained by monitoring the patient's hematocrit, which should remain below 45%. Hematocrit levels are a key indicator in assessing the progression of the disease.

Choices A, B, and C are not the most appropriate methods for gauging the course of polycythemia vera. Monitoring the color of the patient's palms and face, or their response to erythropoietin injections, may not provide an accurate reflection of the disease's progression. Similarly, while erythrocyte sedimentation rate can be affected in polycythemia vera, it is not the primary marker for monitoring the disease's course.

Correct Answer: C

Rationale: The correct answer is to gently inquire about advance directives. Superior vena cava syndrome is often a late-stage manifestation, indicating a serious condition. Discussing advance directives with the client is crucial to ensure their wishes are known in case of deterioration. Administering allopurinol (
Choice
A) is not indicated for superior vena cava syndrome. Assessing the client's serum potassium level (
Choice
B) is not the priority when managing this syndrome. Emergency surgery (
Choice
D) is not typically the initial treatment for superior vena cava syndrome.

Correct Answer: C

Rationale: The correct answer is C: Muscle weakness. In patients with multiple myeloma who have developed hypercalcemia, monitoring for muscle weakness is crucial. Hypercalcemia can lead to muscle weakness due to its effects on neuromuscular function.
Choice A, increased heart rate, is more commonly associated with conditions like dehydration or anxiety rather than hypercalcemia.
Choice B, decreased urine output, is commonly seen in conditions leading to acute kidney injury rather than hypercalcemia.
Choice D, hypertension, is not a typical symptom of hypercalcemia and is more commonly associated with other conditions like uncontrolled high blood pressure.

Correct Answer: A

Rationale: The correct answer is A. Secondary MDS can occur at any age and results from prior toxic exposure to chemicals, including chemotherapeutic medications. Asking about exposure to toxic chemicals in previous jobs directly addresses the potential etiology of this patient's health problem.

Choices B, C, and D are not as directly related to the etiology of secondary MDS. Recurrent infections (
Choice
B) are not a known cause of MDS. Family history (
Choice
C) is more pertinent to primary MDS, which has a genetic component, while sun exposure (
Choice
D) is not associated with the etiology of MDS.