A 52-year-old man with cirrhosis, weight loss, liver mass. Most important initial diagnostic study?

Correct Answer: A

Rationale: The correct answer is A: Serum α-fetoprotein level. In a patient with cirrhosis and liver mass, an elevated α-fetoprotein level suggests hepatocellular carcinoma. This is important for early detection and management. Choice B (Colonoscopy) is not indicated for liver masses. Choice C (Hepatitis C viral RNA) is relevant for hepatitis C diagnosis but not specific for evaluating a liver mass. Choice D (Upper GI endoscopy) is used for assessing upper gastrointestinal issues, not liver masses. Therefore, Serum α-fetoprotein level is the most appropriate initial diagnostic study in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Aggressive, may be cured with chemo. In large cell lymphoma, aggressive treatment with chemotherapy has shown potential for cure. This is supported by studies showing high response rates and long-term survival in patients receiving appropriate chemo regimens. Indolent lymphomas (choice A) are slow-growing and typically do not require aggressive treatment. Aggressive lymphomas with poor chemo response (choice B) have a worse prognosis compared to large cell lymphomas. Responding but relapsing (choice D) indicates a temporary response followed by disease recurrence, which is less favorable than potential cure with chemo.

Correct Answer: D

Rationale: The correct answer is D: Anemia of chronic disease. In this case, the patient's high ferritin levels and chronic inflammatory condition (rheumatoid arthritis) are indicative of anemia of chronic disease. This type of anemia is characterized by low iron utilization due to inflammation, leading to a state of functional iron deficiency despite high ferritin levels. Thalassemia (Choice A) typically presents with microcytic anemia but would not have high ferritin levels. Iron deficiency anemia (Choice B) would present with low ferritin levels. Sideroblastic anemia (Choice C) is characterized by ringed sideroblasts on bone marrow biopsy, which is not mentioned in the case.

Correct Answer: B

Rationale: The correct answer is B: Transfuse factor VIII concentrate. In hemophilia A, deficiency of factor VIII leads to impaired blood clotting. Therefore, administering factor VIII concentrate is crucial to control bleeding in this patient. This step takes priority over other options as it addresses the underlying issue of hemophilia A. Choice A is not the priority as stabilizing the patient's bleeding takes precedence over radiography. Choice C is unnecessary until the patient's bleeding is controlled. Choice D, infusing normal saline, does not address the primary concern of bleeding in a hemophiliac patient.

Correct Answer: C

Rationale: Correct Answer: C - LPN with 2 years oncology experience Rationale: An LPN with 2 years of oncology experience is the best choice as they have specific knowledge and skills in oncology care, which is crucial when managing a patient with a low ANC. They can provide appropriate care under the supervision of an oncology RN. Incorrect Choices: A: LPN from same-day surgery - Lacks oncology-specific experience. B: RN from agency on orientation - Limited experience in oncology care. D: RN new from ED - Limited oncology knowledge and experience.