A client is having a bone marrow aspiration and biopsy and is extremely anxious. What action by the nurse is the most appropriate?

Correct Answer: A

Rationale: The correct answer is A: Assess the client's fears and coping mechanisms. This is the most appropriate action because it allows the nurse to understand the client's specific anxieties and provide personalized support. By assessing the client's fears and coping mechanisms, the nurse can address any concerns and implement tailored strategies to help the client feel more comfortable. Choice B is incorrect because simply reassuring the client may not be effective in alleviating their anxiety. Choice C is incorrect as sedating the client should only be considered if other interventions are ineffective. Choice D is incorrect because bone marrow aspiration and biopsy are typically done with local anesthesia, not general anesthesia, so telling the client they will be asleep would be misleading.

Correct Answer: A

Rationale: The correct answer is A: Immunophenotype - mature B cell. In acute lymphoblastic leukemia, a mature B cell immunophenotype is associated with a poor prognosis due to its resistance to treatment. Gender being female is a good prognostic factor as females tend to have better outcomes. Hyperploidy is favorable as it indicates a better response to treatment. Age 4 to 10 years old is also a good prognostic factor as younger age groups have better survival rates.

Correct Answer: A

Rationale: The correct answer is A: Nodular sclerosis. This subtype of Hodgkin's lymphoma is more common in young women and has a good prognosis due to its characteristic fibrotic bands dividing the lymph node into nodules. These nodules contain a mixture of inflammatory cells and Reed-Sternberg cells. Choice B: Mixed cellularity is more common in older patients and has a less favorable prognosis due to its heterogeneous cell population with abundant Reed-Sternberg cells. Choice C: Lymphocyte predominance typically affects young adults and has an indolent course with a good prognosis, but it is not as common in young women as nodular sclerosis. Choice D: Lymphocyte depletion is a rare subtype seen in older individuals with a poor prognosis due to the paucity of lymphocytes and an abundance of Reed-Sternberg cells.

Correct Answer: A

Rationale: The correct answer is A: Low total iron binding capacity. In this case, the patient is showing signs of iron deficiency anemia. Low total iron binding capacity is not expected because in iron deficiency anemia, the total iron binding capacity is typically elevated as the body tries to increase its capacity to bind and transport iron. High serum transferrin and low iron: total iron binding capacity ratio are expected findings in iron deficiency anemia, as the body increases the production of transferrin to compensate for low iron levels. Low serum ferritin is also expected as it is a marker of decreased iron stores in the body. Therefore, choice A is the correct answer as it contradicts the typical laboratory findings seen in iron deficiency anemia.

Correct Answer: B

Rationale: Rationale for Choice B: Defects in the peripheral proteins are the most likely cause of spherocytosis. Spherocytosis is characterized by spherical-shaped red blood cells due to a deficiency in peripheral membrane proteins like spectrin, leading to reduced cell flexibility and membrane stability. This results in premature destruction of red blood cells in the spleen, causing hemolytic anemia. Summary: A: Abnormal antigenic properties are not the primary cause of spherocytosis; the issue lies in membrane protein defects. C: Increased formation of ropalux is not a known factor in spherocytosis. D: Formation of sickle-shaped cells is characteristic of sickle cell anemia, not spherocytosis.