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

Correct Answer: A

Rationale: The correct answer is A: Assess client fears and coping mechanisms. This is the best action because it allows the nurse to understand the specific concerns and anxieties of the client, enabling personalized support and interventions. It shows empathy and provides a tailored approach to address the client's needs. Summary: - Choice B: Reassuring the client is helpful but may not address the root of the anxiety. - Choice C: Sedating the client may not be necessary if underlying concerns are addressed. - Choice D: Providing false information about being asleep is not ethical and can lead to distrust.

Correct Answer: D

Rationale: The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's negative peripheral blood test for Fanconi anemia does not rule out the possibility of having this condition. Skin fibroblast culture testing is more sensitive for detecting Fanconi anemia compared to peripheral blood testing. Given the family history of aplastic anemia and leukemia, along with the sister's poor response to treatment, it is crucial to definitively confirm or rule out Fanconi anemia as the underlying cause. Administering ATG and cyclosporine (choice A) without confirming the diagnosis may not be effective. Searching for a donor for matched unrelated transplant (choice B) is premature without confirming the diagnosis. Sending a bone marrow aspirate for Fanconi anemia testing (choice C) may not be as sensitive as skin fibroblast culture testing.

Correct Answer: E

Rationale: Rationale for Correct Answer (E): The correct statement is likely about the fact that her hemoglobinopathy, Hb Indianapolis, is associated with ineffective erythropoiesis, leading to anemia, jaundice, and extramedullary hematopoiesis. This is a rare condition and not typically detected on newborn screens. Additionally, splenectomy may not entirely resolve her anemia due to the systemic nature of the disease. Since she has transfusion-dependent anemia, she is at risk for gallstones due to chronic hemolysis. Summary of Incorrect Choices: A: Incorrect because Hb Indianapolis is rare and not typically detected on newborn screens. B: Incorrect because extramedullary hematopoiesis can lead to nucleated red cells in the peripheral blood smear. C: Incorrect because the disease is systemic, and splenectomy may not fully resolve the anemia. D: Incorrect because chronic hemolysis from the disease increases the risk of gallstones despite transf

Correct Answer: C

Rationale: The correct answer is C: Stage III. Rationale: 1. In the St. Jude (Murphy) staging system for non-Hodgkin lymphoma, Stage III is defined as the presence of a mediastinal mass that is greater than 33% of the thoracic diameter. 2. The patient in the scenario has a large mediastinal mass that meets this criteria, placing her in Stage III. 3. The absence of disease in other sites, as confirmed by the metastatic work-up, indicates that the disease is localized to the mediastinum. 4. Therefore, based on the specific criteria of the St. Jude (Murphy) staging system, the correct stage for this patient's non-Hodgkin lymphoma is Stage III. Summary of other choices: - Choice A: Stage I would not be appropriate as the mass is not localized to a single lymph node region. - Choice B: Stage II would not be correct as the mass extends beyond a

Correct Answer: C

Rationale: The correct answer is C: Granisetron, dexamethasone at 50% dosing, and арrepitant. This regimen is recommended by guidelines for moderate emetogenic chemotherapy in children. Granisetron is a first-line antiemetic for children, and combining it with dexamethasone and арrepitant provides a synergistic effect in preventing CINV. Dexamethasone at 50% dosing is preferred in children to reduce the risk of side effects. Palonosetron and olanzapine (choice A) are not typically recommended as first-line agents in pediatric patients. Dexamethasone and арrepitant (choice B) do not cover the full spectrum of CINV prevention compared to the correct regimen. Using dexamethasone at 100% dosing (choice D) may increase the risk of side effects in children without additional benefit in preventing CINV