A 43-year-old woman with fatigue, night sweats, itching, diffuse lymphadenopathy. Best next step?

Correct Answer: A

Rationale: The correct answer is A: Excisional lymph node biopsy. Given the symptoms of fatigue, night sweats, itching, and diffuse lymphadenopathy, the best next step is to perform an excisional lymph node biopsy to determine the underlying cause, which could be lymphoma or another malignancy. This procedure provides a definitive diagnosis by examining the lymph node histology and immunophenotype. Choice B: Monospot test is used to diagnose infectious mononucleosis caused by the Epstein-Barr virus, but it is not the most appropriate test for these symptoms. Choice C: Toxoplasmosis IgG is a test for Toxoplasma gondii infection, which is unlikely to be the cause of these symptoms. Choice D: Serum ACE level is useful for diagnosing sarcoidosis but is not the best initial test for these symptoms.

Correct Answer: D

Rationale: The correct answer is D: Bacterial contamination. Fever and hypotension during platelet transfusion suggest a transfusion reaction caused by bacterial contamination. Platelet transfusions are stored at room temperature, making them susceptible to bacterial growth. Bacterial contamination can lead to septic reactions, causing fever and hypotension. Volume overload (A) is characterized by hypertension and not hypotension. Donor antibodies vs. recipient (B) and IgE vs. donor IgA (C) are not typically associated with fever and hypotension during platelet transfusion.

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.