A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?

Correct Answer: D

Rationale: The correct answer is D because in this scenario, the patient is experiencing symptoms of a transfusion reaction, likely a hemolytic transfusion reaction due to ABO incompatibility. The presence of a positive Direct Antiglobulin Test (DAT) for C3 indicates complement activation, supporting the diagnosis. Choice A (Spherocytes on peripheral blood smear) is incorrect as spherocytes are seen in autoimmune hemolytic anemia, not typically in transfusion reactions. Choice B (Gram-negative Bacillus on gram stain of remaining RBC unit) is unlikely as the symptoms are more indicative of a hemolytic reaction rather than an infection. Choice C (Chest x-ray with bilateral pulmonary infiltrates) is suggestive of transfusion-related acute lung injury (TRALI), but the symptoms described in the question (fever, chills, rigors) are more indicative of a hemolytic reaction rather than TRALI.

Correct Answer: D

Rationale: Rationale: The correct answer is D, continuing with MAP chemotherapy. The 40% necrosis rate indicates a good response to the current regimen. Continuing MAP ensures completion of the planned therapy and maximizes the benefit of the initial treatment's response. Choice A (Ifosfamide and etoposide) and B (MAPIE) are not indicated as the response to MAP was favorable. Choice C (Gemcitabine docetaxel) is not the standard of care for osteosarcoma. Continuing with MAP is the most appropriate option for this patient.

Correct Answer: D

Rationale: The correct answer is D: Place the client on safety precautions. With a platelet count of 58,000/mm3, the client is at risk for bleeding due to thrombocytopenia. Placing the client on safety precautions will help prevent injuries and minimize bleeding risks. This includes using a soft-bristled toothbrush, avoiding IM injections, and using caution with activities that may cause trauma. A: Encouraging high-protein foods is not directly related to managing the client's thrombocytopenia. B: Neutropenic precautions are for clients with low white blood cell counts, not low platelet counts. C: Limiting visitors to healthy adults is important for clients with compromised immune systems, not specifically for thrombocytopenia.

Correct Answer: C

Rationale: The correct answer is C: Excessive alcohol consumption. Excessive alcohol intake can lead to hematologic health problems such as anemia and abnormal blood clotting. Alcohol interferes with the production of red blood cells and impairs the function of platelets. Therefore, documenting excessive alcohol consumption is crucial in assessing a client's risk for hematologic issues. Explanation for why other choices are incorrect: A: Family history of military excellence - This choice is irrelevant to hematologic health problems and does not pose a risk factor. B: Diet low in iron and protein - While a poor diet can contribute to hematologic issues, this specific choice does not directly indicate a risk factor for hematologic problems. D: Family history of allergies - Allergies are not directly related to hematologic health problems, so this choice is not relevant in this context.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Subcutaneous injection of heparin is avoided due to the risk of hematoma formation at the injection site. 2. This statement is false because heparin is commonly administered subcutaneously for prophylaxis of thromboembolic events. 3. The preferred route for heparin administration is subcutaneous or intravenous. 4. Therefore, choice A is the false statement. Summary: - Choice A is incorrect as heparin is commonly given subcutaneously. - Choice B is incorrect as heparin is not stored in mast cells but in specialized granules in mast cells. - Choice C is correct as heparin binds to plasma antithrombin III to inhibit thrombin. - Choice D is correct as protamine sulfate can reverse heparin's anticoagulant effects in case of overdose.