A 47-year-old woman with fatigue, itching, splenomegaly, Hb 18.7 g/dL, platelets 560,000/µL. Most likely process?

Correct Answer: B

Rationale: The correct answer is B: Myeloproliferative syndrome. Given the patient's symptoms (fatigue, itching, splenomegaly) and lab results (elevated Hb and platelets), it suggests an overproduction of blood cells, characteristic of myeloproliferative syndromes. Myelodysplastic syndrome (choice A) presents with cytopenias, not elevated blood counts. Paraneoplastic syndrome (choice C) is associated with malignancies, not blood disorders. Cushing syndrome (choice D) is characterized by hypercortisolism, not blood abnormalities.

Correct Answer: C

Rationale: The correct answer is C because priming the transfusion set with dextrose in lactated Ringer solution can cause hemolysis of the red blood cells due to the incompatibility between the solution and PRBCs. This can lead to serious complications for the patient. Choice A is incorrect because waiting 20 minutes before starting the infusion is a standard practice to allow for compatibility checks and patient assessment. Choice B is incorrect because starting an IV with a 22-gauge catheter is appropriate for blood transfusions. Choice D is incorrect because informing the patient about potential reactions is an essential part of the consent process and patient education.

Correct Answer: D

Rationale: The correct answer is D because a patient with neutropenia and fever is at high risk for infection, which can quickly become life-threatening. Assessing and addressing this patient's condition promptly is crucial for preventing sepsis. Choices A, B, and C, although important, do not pose an immediate threat to the patient's life like neutropenia with fever does. Thalassemia with low Hb, sickle cell crisis, and emotional distress in lymphoma are important but do not require immediate assessment compared to a potentially septic patient.

Correct Answer: D

Rationale: The correct answer is D because cleaning the skin with mild soap is within the nursing assistant's scope of practice and is essential for maintaining skin integrity in patients receiving radiation therapy. Checking skin for redness/peeling (A) and explaining skin care (C) involve assessment and education, which should be done by a registered nurse. Assisting with clothing choice (B) is not directly related to preventing impaired tissue integrity. In summary, choice D is correct as it addresses the immediate need for skin care within the nursing assistant's role, while the other choices involve tasks beyond their scope or not directly related to the issue at hand.

Correct Answer: B

Rationale: The correct answer is B: Protein C. Protein C is an anti-clotting substance that inhibits factors V and VIII in the coagulation cascade. Factor V and VIII are essential for the conversion of prothrombin to thrombin, a key step in blood clot formation. By inhibiting these factors, Protein C helps regulate the clotting process. Rationale: A: ATIII primarily inhibits factors IIa (thrombin) and Xa. C: TFPI (Tissue Factor Pathway Inhibitor) inhibits the extrinsic pathway of coagulation by binding to and inhibiting factor VIIa. D: Plasmin is involved in fibrinolysis, breaking down blood clots, and does not directly inhibit factors V and VIII in the coagulation cascade.