A 20-year-old man with bone pain, requests narcotics for sickle cell crisis. Feature suggesting alternative diagnosis?

Correct Answer: C

Rationale: The correct answer is C: Splenomegaly. In a 20-year-old man with sickle cell anemia requesting narcotics for a crisis, splenomegaly suggests an alternative diagnosis such as acute infectious process like osteomyelitis, which can present similarly to a sickle cell crisis. Scleral icterus (A) is a sign of jaundice common in hemolytic anemias like sickle cell, not exclusive to sickle cell crisis. A systolic murmur (B) may be heard in sickle cell anemia due to chronic anemia but is not specific to an alternative diagnosis. Ankle ulcers (D) are common in patients with sickle cell anemia due to vaso-occlusive crises, so it is less likely to suggest an alternative diagnosis.

Correct Answer: C

Rationale: The correct answer is C because the first priority in a sickle cell crisis is to establish IV access for hydration and medication administration. Hydration helps prevent vaso-occlusive crises. Choice A (Morphine) and B (Oxygen) are important interventions but come after IV access. Choice D (Vaccines) is important for long-term prevention but not immediate management of a crisis.

Correct Answer: B

Rationale: The correct answer is B: Check BP and pulse after ambulation. This task is appropriate to delegate to a nursing assistant as it involves monitoring vital signs post-activity, which is within their scope of practice. Nursing assistants are trained to perform basic assessments and report findings to the nurse. Choices A, C, and D involve assessing and making decisions about the patient's care, which should be done by a licensed nurse based on the patient's condition and individualized care plan. Checking BP and pulse after ambulation directly relates to the patient's activity intolerance and allows for immediate assessment of their response to activity, making it the most appropriate task to delegate in this scenario.

Correct Answer: A

Rationale: The correct answer is A because a 20-year-old with possible acute myeloid leukemia (AML) who just arrived requires immediate assessment for potential critical conditions. AML is an aggressive cancer that can rapidly progress, necessitating timely intervention. The other choices are incorrect because aplastic anemia (B) and lymphedema (C) are chronic conditions that do not typically require immediate assessment. The patient refusing chemo for lymphoma (D) also does not pose an immediate threat compared to the urgency of assessing a new patient with possible AML.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Plasma is the liquid portion of blood. 2. Phospholipid is a component of platelet membrane needed for coagulation. 3. Calcium is required for the activation of coagulation factors. Therefore, the correct answer is A. Summary: B: Thromboplastin is not an ingredient in PTT. C: Thromboplastin is not part of PTT. D: Thrombin is a product of the coagulation cascade, not an ingredient in PTT.