A 19-year-old woman with axillary Hodgkin lymphoma. Best next step in evaluation?

Correct Answer: D

Rationale: The correct answer is D: CT scan of chest, abdomen, pelvis. This is the best next step as it helps in staging the disease extent and planning treatment. A bone marrow biopsy (A) is not typically needed in Hodgkin lymphoma. Liver biopsy (B) is not the initial step in evaluation. Staging laparotomy (C) is an invasive procedure and not the first-line investigation. CT scan (D) is preferred for initial staging due to its ability to detect lymph node involvement and assess organ involvement.

Correct Answer: C

Rationale: The correct answer is C: Folate deficiency. In this case, the patient presents with macrocytic anemia (elevated MCV) and hypersegmented neutrophils, which are characteristic of folate deficiency. Folate is essential for DNA synthesis and red blood cell production. Alcoholism can lead to folate deficiency due to poor dietary intake and malabsorption. Sideroblastic anemia (A) presents with ringed sideroblasts in the bone marrow, thalassemia (B) shows microcytic anemia, and anemia of renal disease (D) is typically normocytic normochromic.

Correct Answer: A

Rationale: The correct answer is A: Obtain stool specimens for Hemoccult slides. This task is appropriate for a nursing assistant as it involves a non-invasive procedure that can be easily taught and performed under supervision. The other options involve more complex tasks that require a higher level of training and knowledge. Having the patient sign a consent form (B) and giving GoLYTELY (C) involve patient interaction and medication administration, which are typically tasks for licensed nurses. Checking for allergies to contrast dye (D) requires knowledge of medication administration and possible adverse reactions, making it unsuitable for delegation to a nursing assistant.

Correct Answer: C

Rationale: Step 1: Patient showing signs of transfusion reaction (flushed, tachypneic, chills). Step 2: Immediate concern for potential serious reaction. Step 3: Stop transfusion to prevent worsening of symptoms. Step 4: Safety first to prevent adverse outcomes. Summary: A: Obtaining a warm blanket does not address the serious reaction. B: Checking oral temperature is not a priority in this urgent situation. D: Administering oxygen may be needed, but stopping the transfusion is the first crucial step in managing the reaction.

Correct Answer: A

Rationale: The correct answer is A because a 1-year-old with hemophilia B and decreased responsiveness indicates a potentially life-threatening situation requiring immediate assessment. Hemophilia B can lead to severe bleeding, and decreased responsiveness suggests a critical condition. Choice B can wait as DDAVP is a scheduled medication. Choice C's thrombocytopenia in a 7-year-old with ALL is serious but not as urgent as a potentially unconscious child with hemophilia B. Choice D's RLQ pain in a 16-year-old with sickle cell is concerning but not as critical as decreased responsiveness in a young child with hemophilia B. Prioritizing based on urgency and potential severity is key in pediatric care.