A 60-year-old man with numbness, wide gait, prior gastrectomy, hypersegmented neutrophils on smear. Most likely cause?

Correct Answer: B

Rationale: The correct answer is B: Vitamin B12 deficiency. This patient presents with symptoms of ataxia, paresthesias, macrocytic anemia, and hypersegmented neutrophils, which are classic signs of B12 deficiency. The prior gastrectomy suggests impaired intrinsic factor production, leading to malabsorption of B12. Folic acid deficiency (Choice A) can also cause macrocytic anemia but does not typically present with neurological symptoms. Vitamin K deficiency (Choice C) leads to bleeding disorders, not neurological symptoms. Iron deficiency (Choice D) results in microcytic anemia and does not explain the neurological findings in this patient.

Correct Answer: C

Rationale: The correct answer is C: Splenomegaly. In a 20-year-old man with sickle cell anemia requesting narcotics for a crisis, splenomegaly suggests an alternative diagnosis such as acute infectious process like osteomyelitis, which can present similarly to a sickle cell crisis. Scleral icterus (A) is a sign of jaundice common in hemolytic anemias like sickle cell, not exclusive to sickle cell crisis. A systolic murmur (B) may be heard in sickle cell anemia due to chronic anemia but is not specific to an alternative diagnosis. Ankle ulcers (D) are common in patients with sickle cell anemia due to vaso-occlusive crises, so it is less likely to suggest an alternative diagnosis.

Correct Answer: D

Rationale: The correct answer is D: Bacterial contamination. Fever and hypotension during platelet transfusion suggest a transfusion reaction caused by bacterial contamination. Platelet transfusions are stored at room temperature, making them susceptible to bacterial growth. Bacterial contamination can lead to septic reactions, causing fever and hypotension. Volume overload (A) is characterized by hypertension and not hypotension. Donor antibodies vs. recipient (B) and IgE vs. donor IgA (C) are not typically associated with fever and hypotension during platelet transfusion.

Correct Answer: C

Rationale: The correct answer is C because the first priority in a sickle cell crisis is to establish IV access for hydration and medication administration. Hydration helps prevent vaso-occlusive crises. Choice A (Morphine) and B (Oxygen) are important interventions but come after IV access. Choice D (Vaccines) is important for long-term prevention but not immediate management of a crisis.

Correct Answer: B

Rationale: The correct answer is B: Check BP and pulse after ambulation. This task is appropriate to delegate to a nursing assistant as it involves monitoring vital signs post-activity, which is within their scope of practice. Nursing assistants are trained to perform basic assessments and report findings to the nurse. Choices A, C, and D involve assessing and making decisions about the patient's care, which should be done by a licensed nurse based on the patient's condition and individualized care plan. Checking BP and pulse after ambulation directly relates to the patient's activity intolerance and allows for immediate assessment of their response to activity, making it the most appropriate task to delegate in this scenario.