A healthy 17-year-old African American male presents with a thrombosis of the right upper extremity. His past medical history is remarkable only for sickle cell trait. The history is negative for recent risk factors for thrombosis (illness, surgery, immobility). He is the pitcher for his high school baseball team. Imaging confirms anatomical compression/narrowing of the right subclavian vein. Which of the following interventions is most likely to decrease this patient's long-term risk of recurrent thrombosis?

Correct Answer: D

Rationale: The correct answer is D: Resection of right first rib. The patient's presentation with thrombosis of the right upper extremity, anatomical compression/narrowing of the right subclavian vein, and being a high school baseball pitcher suggests Paget-Schroetter syndrome (effort thrombosis). The first rib can compress the subclavian vein in people with certain anatomical variations, leading to thrombosis. Resection of the right first rib (first rib resection) is the definitive treatment for this condition, as it removes the mechanical compression, reducing the risk of recurrent thrombosis. A: Systemic thrombolysis involves using medications to dissolve blood clots throughout the body and is not the first-line treatment for Paget-Schroetter syndrome. B: Catheter-directed thrombolysis is not indicated for anatomical compression/narrowing as seen in this patient. C: Extended anticoagulation with LMWH does not address the underlying mechanical

Correct Answer: B

Rationale: The correct answer is B, multiple petechiae and large bruises. This finding is indicative of potential hematologic health problems such as thrombocytopenia or clotting disorders, which can be serious and require immediate medical attention. Petechiae are small, pinpoint hemorrhages under the skin, and large bruises suggest abnormal bleeding. Poor skin turgor (choice A) is more indicative of dehydration. Dry, flaky skin (choice C) may be related to skin conditions or inadequate hydration. Decreased body hair distribution (choice D) could be related to hormonal imbalances or aging, but it is not as concerning as signs of abnormal bleeding.

Correct Answer: A

Rationale: The correct answer is A because assessing the client's fears and coping mechanisms allows the nurse to provide individualized support and interventions to address the client's anxiety effectively. By understanding the client's specific concerns, the nurse can provide tailored information, emotional support, and coping strategies to help the client feel more comfortable during the procedure. Option B is incorrect as simply reassuring the client may not address the underlying anxieties and fears. Option C is inappropriate as sedation should only be used if absolutely necessary and after other non-pharmacological interventions have been exhausted. Option D is incorrect because bone marrow aspiration and biopsy are typically performed with local anesthesia, so the client will not be asleep during the procedure.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. Thrombotic thrombocytopenic purpura (TTP) is characterized by microangiopathic hemolytic anemia and thrombocytopenia. 2. Neurologic deficits are common due to microvascular thrombi affecting the brain. 3. Thrombosis is a hallmark feature of TTP, with platelet aggregation leading to microthrombi formation. 4. Therefore, choice A is not associated with TTP because thrombosis is a defining feature.

Correct Answer: A

Rationale: The correct answer is A. Immunophenotype of mature B cell is not a good prognostic factor in acute lymphoblastic leukemia (ALL) because it indicates a more aggressive subtype. B: Gender being female is a good prognostic factor in ALL as females generally have better outcomes. C: Chromosomal number hyperploidy is a good prognostic factor as it is associated with a favorable prognosis. D: Age 4 to 10 years old is also a good prognostic factor as children in this age group tend to have better outcomes in ALL.