A 60-year-old man with abdominal fullness, fatigue, leukocytes 40,000/µL, platelets 500,000/µL, Philadelphia chromosome. Most likely diagnosis?

Correct Answer: B

Rationale: The correct answer is B: Chronic Myelogenous Leukemia (CML). The presentation of a 60-year-old man with abdominal fullness, fatigue, leukocytosis, thrombocytosis, and the presence of the Philadelphia chromosome strongly suggests CML. The Philadelphia chromosome results from a reciprocal translocation between chromosomes 9 and 22, leading to the formation of the BCR-ABL fusion gene characteristic of CML. This gene encodes a constitutively active tyrosine kinase, driving uncontrolled proliferation of myeloid cells. Acute myeloid leukemia (A) typically presents with bone marrow failure, not leukocytosis and thrombocytosis. Chronic lymphocytic leukemia (C) is more common in older adults, but it is characterized by lymphocytosis, not leukocytosis. Acute lymphocytic leukemia (D) usually presents with pancytopenia and blast cells in the peripheral blood, not leuk

Correct Answer: D

Rationale: Rationale for Answer D (No additional treatment): In this scenario, the patient likely has drug-induced hemolysis from the malaria prophylaxis. Since the hematocrit is not critically low and the patient is stable, the initial step is to discontinue the offending drug and monitor the patient closely. Additional treatment is not required unless the patient deteriorates or develops severe anemia. Summary of other choices: A: Splenectomy is not indicated in this case as the primary issue is drug-induced hemolysis, not a splenic disorder. B: Methylene blue is used for methemoglobinemia, not hemolysis caused by drug toxicity. C: Vitamin E is not the appropriate treatment for drug-induced hemolysis; it is more commonly used for conditions like vitamin E deficiency or antioxidant therapy.

Correct Answer: C

Rationale: The correct answer is C: Folate deficiency. In this case, the patient presents with macrocytic anemia (elevated MCV) and hypersegmented neutrophils, which are characteristic of folate deficiency. Folate is essential for DNA synthesis and red blood cell production. Alcoholism can lead to folate deficiency due to poor dietary intake and malabsorption. Sideroblastic anemia (A) presents with ringed sideroblasts in the bone marrow, thalassemia (B) shows microcytic anemia, and anemia of renal disease (D) is typically normocytic normochromic.

Correct Answer: A

Rationale: The correct answer is A: Obtain stool specimens for Hemoccult slides. This task is appropriate for a nursing assistant as it involves a non-invasive procedure that can be easily taught and performed under supervision. The other options involve more complex tasks that require a higher level of training and knowledge. Having the patient sign a consent form (B) and giving GoLYTELY (C) involve patient interaction and medication administration, which are typically tasks for licensed nurses. Checking for allergies to contrast dye (D) requires knowledge of medication administration and possible adverse reactions, making it unsuitable for delegation to a nursing assistant.

Correct Answer: C

Rationale: Step 1: Patient showing signs of transfusion reaction (flushed, tachypneic, chills). Step 2: Immediate concern for potential serious reaction. Step 3: Stop transfusion to prevent worsening of symptoms. Step 4: Safety first to prevent adverse outcomes. Summary: A: Obtaining a warm blanket does not address the serious reaction. B: Checking oral temperature is not a priority in this urgent situation. D: Administering oxygen may be needed, but stopping the transfusion is the first crucial step in managing the reaction.