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 likely has thoracic outlet syndrome (TOS), which is causing compression of the subclavian vein leading to thrombosis. Resection of the right first rib is the definitive treatment for TOS, as it relieves the compression on the vein. This intervention addresses the root cause of the thrombosis, reducing the risk of recurrence. A: Systemic thrombolysis is not indicated in this case as it carries an increased risk of bleeding and may not address the underlying cause of the thrombosis. B: Catheter-directed thrombolysis is not the primary treatment for TOS and may not prevent recurrence. C: Anticoagulation with LMWH does not address the underlying compression of the vein and is not the primary treatment for TOS.

Correct Answer: B

Rationale: The correct answer is B - Multiple petechiae and large bruises. This finding indicates potential bleeding issues or clotting disorders, which are serious hematologic health problems. Petechiae and bruises may suggest thrombocytopenia or other underlying conditions. Reporting this to the primary health care provider is crucial for further evaluation and management. A: Poor skin turgor on both forearms - Indicates dehydration, not necessarily a hematologic issue. C: Dry, flaky skin on arms and legs - Suggests a skin condition, not directly related to hematologic problems. D: Decreased body hair distribution - More indicative of endocrine or nutritional issues, not specific to hematologic health problems.

Correct Answer: A

Rationale: The correct answer is A: Assess the client's fears and coping mechanisms. This is the most appropriate action because it allows the nurse to understand the client's specific anxieties and provide personalized support. By assessing the client's fears and coping mechanisms, the nurse can address any concerns and implement tailored strategies to help the client feel more comfortable. Choice B is incorrect because simply reassuring the client may not be effective in alleviating their anxiety. Choice C is incorrect as sedating the client should only be considered if other interventions are ineffective. Choice D is incorrect because bone marrow aspiration and biopsy are typically done with local anesthesia, not general anesthesia, so telling the client they will be asleep would be misleading.

Correct Answer: A

Rationale: The correct answer is A: Thrombosis. Thrombotic thrombocytopenic purpura (TTP) is characterized by microangiopathic hemolytic anemia and thrombocytopenia, not thrombosis. In TTP, there is excessive platelet aggregation leading to microthrombi formation in small blood vessels, causing hemolysis and thrombocytopenia. Neurologic deficits are also common due to microvascular ischemia. Thrombosis is not a typical feature of TTP and is more commonly associated with conditions like deep vein thrombosis or pulmonary embolism. Thrombosis is not a hallmark of TTP, making choice A the correct answer.

Correct Answer: A

Rationale: The correct answer is A: Immunophenotype - mature B cell. In acute lymphoblastic leukemia, a mature B cell immunophenotype is associated with a poor prognosis due to its resistance to treatment. Gender being female is a good prognostic factor as females tend to have better outcomes. Hyperploidy is favorable as it indicates a better response to treatment. Age 4 to 10 years old is also a good prognostic factor as younger age groups have better survival rates.