A client presents at the primary health care provider's office with complaints of a ring-like rash on his upper leg. Which question should the nurse ask first?

Correct Answer: B

Rationale: The correct answer is B: "Have you been camping in the last month?" This question is the first one to ask because the client presenting with a ring-like rash on the upper leg suggests a possible exposure to ticks, which are commonly found in outdoor environments like camping areas. Ticks can transmit Lyme disease, which often presents with a characteristic rash called erythema migrans. By asking about recent camping activities, the nurse can gather crucial information to assess the likelihood of a tick bite and the need for further evaluation or treatment. Choices A, C, and D are incorrect because they do not directly address the potential exposure to ticks from outdoor activities like camping. Asking about cats in the home (choice A) is more relevant for conditions like cat scratch fever. Inquiring about flu-like symptoms (choice C) and physical contact with others with a similar rash (choice D) may be important but are not as pertinent as determining outdoor activities that could lead to a tick bite.

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: A

Rationale: The correct answer is A: Excisional lymph node biopsy. Given the symptoms of fatigue, night sweats, itching, and diffuse lymphadenopathy, the best next step is to perform an excisional lymph node biopsy to determine the underlying cause, which could be lymphoma or another malignancy. This procedure provides a definitive diagnosis by examining the lymph node histology and immunophenotype. Choice B: Monospot test is used to diagnose infectious mononucleosis caused by the Epstein-Barr virus, but it is not the most appropriate test for these symptoms. Choice C: Toxoplasmosis IgG is a test for Toxoplasma gondii infection, which is unlikely to be the cause of these symptoms. Choice D: Serum ACE level is useful for diagnosing sarcoidosis but is not the best initial test for these symptoms.

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.