A 37-year-old woman with 1.5-cm breast mass, normal mammogram. Most appropriate next step?

Correct Answer: A

Rationale: The correct answer is A: Refer to surgeon. Given the presence of a palpable breast mass in a woman over 30, further evaluation is necessary to rule out malignancy. Referring to a surgeon for a biopsy or excision is crucial for definitive diagnosis. Choice B delays necessary evaluation. Choice C is not indicated as oral contraceptives have no role in evaluating breast masses. Choice D is inappropriate without further assessment.

Correct Answer: A

Rationale: The correct answer is A because increasing intake of green salads and fruit will potentially increase the intake of Vitamin K, which can interfere with the effectiveness of warfarin. Warfarin works by inhibiting Vitamin K-dependent clotting factors, so a sudden increase in Vitamin K intake can reduce the medication's efficacy. Choice B is important as constipation can lead to unpredictable absorption of warfarin. Choice C is valid as warfarin should be taken with food to reduce nausea. Choice D is accurate as regular blood tests are necessary to monitor warfarin's effectiveness and adjust dosage accordingly.

Correct Answer: D

Rationale: The correct answer is D because neutropenia (low neutrophil count) from chemotherapy puts the patient at high risk for infections. This information is crucial for the LTC nurse to monitor the patient closely, implement infection control measures, and promptly recognize and manage any signs of infection to prevent complications. Choices A, B, and C are less relevant in the context of patient safety and immediate care needs compared to neutropenia. A: Philadelphia chromosome is important for diagnosis but does not impact immediate care in LTC. B: Elevated glucose may require monitoring but is not as urgent as neutropenia. C: Weight loss is concerning but not as immediately life-threatening as neutropenia.

Correct Answer: D

Rationale: The principal goal of hydroxyurea therapy is to increase circulating fetal hemoglobin (HbF), which has anti-sickling properties and reduces the frequency of sickle cell crises. Hydroxyurea stimulates HbF production by inducing the expression of gamma-globin genes. This helps to inhibit the polymerization of sickle hemoglobin (HbS) and decrease the proportion of sickled cells in circulation. Choices A and B are incorrect because the goal is not to decrease circulating HbS or increase its polymerization. Choice C is incorrect as hydroxyurea does not directly affect the water content of red cells. The correct answer, choice D, aligns with the therapeutic mechanism of hydroxyurea in increasing levels of HbF to improve clinical outcomes in sickle cell disease.

Correct Answer: D

Rationale: The correct answer is D, Rituximab + CHOP, for advanced diffuse large B-cell lymphoma due to proven efficacy in clinical trials. Rituximab targets CD20 on B-cells, enhancing CHOP's effectiveness. A: m-BACOD and B: PROMACE-CytaBOM are outdated regimens. C: CHOP alone lacks the benefit of rituximab's targeted therapy.