A 30-year-old man with pallor, jaundice after malaria prophylaxis, Hct drop to 30%. Next step?

Correct Answer: D

Rationale: Rationale for Answer D (No additional treatment): In this scenario, the patient likely has drug-induced hemolysis from the malaria prophylaxis. Since the hematocrit is not critically low and the patient is stable, the initial step is to discontinue the offending drug and monitor the patient closely. Additional treatment is not required unless the patient deteriorates or develops severe anemia. Summary of other choices: A: Splenectomy is not indicated in this case as the primary issue is drug-induced hemolysis, not a splenic disorder. B: Methylene blue is used for methemoglobinemia, not hemolysis caused by drug toxicity. C: Vitamin E is not the appropriate treatment for drug-induced hemolysis; it is more commonly used for conditions like vitamin E deficiency or antioxidant therapy.

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.

Correct Answer: A

Rationale: The correct answer is A: PT (INR). The PT evaluates the extrinsic pathway by measuring the time it takes for blood to clot after adding tissue factor. This pathway involves factors outside the blood vessel. PTT (choice B) evaluates the intrinsic pathway, TT (choice C) evaluates the common pathway, and closure time (choice D) assesses platelet function, not the extrinsic pathway. Therefore, PT is the most appropriate choice for evaluating the extrinsic pathway.