A 65-year-old man with hemochromatosis, weight loss, liver pain. Best next step?

Correct Answer: B

Rationale: The correct answer is B: Obtain α-fetoprotein and CT scan. In a patient with hemochromatosis presenting with weight loss, liver pain, and other concerning symptoms, the best next step is to evaluate for possible hepatocellular carcinoma (HCC) due to the increased risk in patients with liver disease. Obtaining α-fetoprotein levels and performing a CT scan can help detect any potential liver malignancy. Increasing phlebotomy (Choice A) may exacerbate the symptoms without addressing the underlying issue. Checking serum ferritin (Choice D) is not sufficient to rule out HCC. Hepatitis B serology (Choice C) is not indicated based on the patient's presentation.

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.

Correct Answer: D

Rationale: The principal goal of hydroxyurea therapy is to increase circulating fetal hemoglobin (HbF), which has anti-sickling properties and reduces the frequency of sickle cell crises. Hydroxyurea stimulates HbF production by inducing the expression of gamma-globin genes. This helps to inhibit the polymerization of sickle hemoglobin (HbS) and decrease the proportion of sickled cells in circulation. Choices A and B are incorrect because the goal is not to decrease circulating HbS or increase its polymerization. Choice C is incorrect as hydroxyurea does not directly affect the water content of red cells. The correct answer, choice D, aligns with the therapeutic mechanism of hydroxyurea in increasing levels of HbF to improve clinical outcomes in sickle cell disease.