A 60-year-old man with flank pain, hematuria, Hb 18 g/dL, Ca 11 mg/dL. Most likely diagnosis?

Correct Answer: D

Rationale: The correct answer is D: Renal cell carcinoma. In this case, the presentation of flank pain, hematuria, high hemoglobin, and high calcium levels is classic for renal cell carcinoma. The flank pain suggests tumor involvement, hematuria is a common symptom, high Hb can be due to erythropoietin production by the tumor, and high Ca can be from paraneoplastic syndrome. Polycystic kidney disease (A) typically presents with enlarged kidneys but not with these symptoms. Pheochromocytoma (B) usually presents with hypertension and palpitations. Adrenal carcinoma (C) is less likely given the presentation of flank pain and hematuria, which are more indicative of renal involvement.

Correct Answer: A

Rationale: The correct answer is A: Refer to surgeon. Given the presence of a palpable breast mass in a woman over 30, further evaluation is necessary to rule out malignancy. Referring to a surgeon for a biopsy or excision is crucial for definitive diagnosis. Choice B delays necessary evaluation. Choice C is not indicated as oral contraceptives have no role in evaluating breast masses. Choice D is inappropriate without further assessment.

Correct Answer: B

Rationale: The correct answer is B: Iron deficiency anemia. This woman presents with fatigue, heavy periods, low iron, and ferritin levels, which are classic symptoms of iron deficiency anemia. Iron is essential for red blood cell production, and a deficiency leads to decreased oxygen-carrying capacity causing fatigue. Thalassemia (choice A) would show microcytic anemia with normal iron studies. Sideroblastic anemia (choice C) presents with ringed sideroblasts on bone marrow biopsy. Anemia of chronic disease (choice D) is typically normocytic or microcytic and occurs in chronic inflammatory conditions.

Correct Answer: A

Rationale: The correct answer is A because increasing intake of green salads and fruit will potentially increase the intake of Vitamin K, which can interfere with the effectiveness of warfarin. Warfarin works by inhibiting Vitamin K-dependent clotting factors, so a sudden increase in Vitamin K intake can reduce the medication's efficacy. Choice B is important as constipation can lead to unpredictable absorption of warfarin. Choice C is valid as warfarin should be taken with food to reduce nausea. Choice D is accurate as regular blood tests are necessary to monitor warfarin's effectiveness and adjust dosage accordingly.

Correct Answer: D

Rationale: The correct answer is D because neutropenia (low neutrophil count) from chemotherapy puts the patient at high risk for infections. This information is crucial for the LTC nurse to monitor the patient closely, implement infection control measures, and promptly recognize and manage any signs of infection to prevent complications. Choices A, B, and C are less relevant in the context of patient safety and immediate care needs compared to neutropenia. A: Philadelphia chromosome is important for diagnosis but does not impact immediate care in LTC. B: Elevated glucose may require monitoring but is not as urgent as neutropenia. C: Weight loss is concerning but not as immediately life-threatening as neutropenia.