A 58-year-old man with rheumatoid arthritis, microcytic anemia, high ferritin. Anemia?

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: 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.

Correct Answer: B

Rationale: The correct answer is B: Valine for glutamic acid. This substitution occurs in sickle hemoglobin, where a single nucleotide change leads to the replacement of glutamic acid by valine at the sixth position of the beta chain. This change results in the characteristic sickling of red blood cells. Choices A, C, and D do not correspond to the specific substitution seen in sickle hemoglobin and are therefore incorrect. It is crucial to understand the molecular basis of the disease to differentiate the correct answer from the distractors.

Correct Answer: C

Rationale: The correct answer is C: Surgical lymph node excision. This is the most appropriate diagnostic test for lymphadenopathy with suspected lymphoma as it provides an adequate tissue sample for definitive diagnosis through histopathological examination. Fine-needle aspirate (B) may not yield enough tissue for accurate diagnosis. Abdominal x-ray (A) and bone scan (D) are not specific for assessing lymphoma and do not provide tissue for histological examination. Surgical excision allows for comprehensive evaluation of the lymph node architecture and cellular characteristics, aiding in accurate diagnosis and treatment planning.

Correct Answer: C

Rationale: The correct answer is C, Aplastic anemia. Aplastic anemia is characterized by pancytopenia, which includes low red blood cell count (MCV 90 fL) and low reticulocyte production index. Thalassemia (A) would typically present with microcytic anemia, not normocytic. Vitamin B12 deficiency (B) would present with macrocytic anemia. Iron deficiency anemia (D) would present with microcytic anemia. Therefore, based on the given data, the most likely cause is aplastic anemia.