A client with autoimmune thrombocytopenia and a platelet count of 8,000/ul develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery-this will go away on its own". In considering her response to the client, the nurse must depend on the ethical principle of:

Correct Answer: C

Rationale: The ethical principle most relevant in this situation is autonomy. Autonomy refers to a person's right to make decisions about their own care and treatment. In this case, the client is expressing her wish to avoid surgery and believes her condition will improve on its own. It is important for the nurse to respect the client's autonomy and involve her in the decision-making process regarding her treatment. The nurse should provide information, support, and guidance to help the client make an informed decision that aligns with her values and preferences. While the nurse can provide education and encourage the client to consider the physician's recommendation, ultimately the decision should respect the client's autonomy.

Correct Answer: C

Rationale: A client with HIV undergoing intradermal anergy testing with Candida and mumps antigens is suspected to be immunodeficient, making them unable to mount a normal skin response to these antigens. In an immunodeficient individual, the immune system is weakened, leading to a lack of response when exposed to these antigens. A lack of induration or reaction in the 3 days following the test suggests that the client's immune system is not able to mount a normal response, indicating immunodeficiency. The absence of a reaction does not necessarily indicate lack of exposure (Option A), presence of antibodies (Option B), or the absence of allergies (Option D), but rather points to a compromised immune system in an individual with HIV.

Correct Answer: A

Rationale: Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach. It is essential for the absorption of vitamin B12 in the intestine. Vitamin B12 binds to intrinsic factor in the stomach, forming a complex that is absorbed in the ileum of the small intestine. Without intrinsic factor, vitamin B12 absorption is significantly impaired, leading to conditions like pernicious anemia, which is a type of megaloblastic anemia caused by vitamin B12 deficiency. By administering cyanocobalamin (Betalin-12) intramuscularly, the need for intrinsic factor in the absorption process is bypassed, which is necessary in cases where intrinsic factor production or function is disrupted.

Correct Answer: B

Rationale: In addition to weakness and fatigue, the nurse should expect Aisa to exhibit an increased pulse rate. Weakness and fatigue are common symptoms of anemia, a condition characterized by a decrease in the number of red blood cells or hemoglobin in the blood. Anemia can lead to the heart working harder to pump oxygen-rich blood to the body, resulting in an increased pulse rate. Therefore, it is important for the nurse to assess for signs of tachycardia (elevated heart rate) in a patient with anemia.

Correct Answer: A

Rationale: An 18-gauge IV cannula is the most appropriate choice when preparing to initiate a blood transfusion. This larger size allows for the rapid administration of blood products, which is important to prevent clotting and ensure a stable flow of the transfusion. Smaller gauge sizes, such as 22, 24, or 28, may be too slow for transfusion purposes and could potentially lead to delays or complications during the procedure. Therefore, the optimal choice for initiating a blood transfusion is an 18-gauge IV cannula.