A client who is human immunodeficiency virus seropositive has been taking stavudine. The nurse should monitor which most closely while the client is taking this medication?

Correct Answer: A

Rationale: The correct answer is A: Gait. Stavudine has been associated with peripheral neuropathy, which can lead to gait disturbances. Monitoring the client's gait closely is crucial to detect any signs of peripheral neuropathy early on. Other choices (B) Appetite, (C) Level of consciousness, and (D) Gastrointestinal function are not directly associated with stavudine use. Peripheral neuropathy is a known side effect of stavudine, making monitoring gait the priority in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Keep in hospital, discontinue heparin, start lepirudin. In this scenario, the patient has heparin-induced thrombocytopenia (HIT) with a platelet drop and is at risk for thrombosis. Lepirudin, a direct thrombin inhibitor, is the preferred anticoagulant in HIT. Dismissing on heparin and warfarin (choice A) is not appropriate due to HIT. Discontinuing heparin and adding aspirin (choice B) is not sufficient in managing HIT. Adding low-molecular-weight heparin (choice D) may worsen the thrombocytopenia.

Correct Answer: B

Rationale: The correct answer is B: Treat underlying disease. In this scenario, the patient is presenting with signs of disseminated intravascular coagulation (DIC) due to gram-negative sepsis. The priority is to address the underlying cause, which is the sepsis, to help improve the patient's condition. Treating the sepsis will help reduce the systemic inflammatory response and subsequent coagulopathy. The other options are not appropriate in this context: A (Begin heparin) can worsen bleeding in a patient with DIC, C (Begin plasmapheresis) is not indicated for DIC in sepsis, and D (Give vitamin K) does not address the main issue of sepsis-induced DIC.

Correct Answer: D

Rationale: The correct answer is D: Migratory thrombophlebitis. In a patient with a pancreatic mass and weight loss, migratory thrombophlebitis, also known as Trousseau syndrome, is a paraneoplastic syndrome commonly associated with pancreatic adenocarcinoma. This syndrome results from the release of procoagulant substances by the tumor, leading to migratory superficial thrombophlebitis. The other choices are not typically associated with pancreatic cancer. A: Hypercalcemia is more commonly seen in hyperparathyroidism or certain types of cancer. B: SIADH is commonly associated with small cell lung cancer. C: Hypoglycemia is seen in pancreatic insulinomas, not pancreatic adenocarcinoma.

Correct Answer: B

Rationale: The correct answer is B because applying cold packs can worsen vaso-occlusive crisis by causing vasoconstriction and increasing pain. Cold can exacerbate sickling of red blood cells. Immediate intervention is necessary to prevent further harm. Option A is not urgent during a crisis. Option C may be appropriate for infection control but is not the most critical action. Option D is important but not as urgent as avoiding cold packs.