A nurse is reviewing laboratory values for an adult client who has sickle cell anemia and has a history of receiving blood transfusions. For which of the following complications should the nurse monitor?

Correct Answer: A

Rationale: The correct answer is A: Iron toxicity. Patients with sickle cell anemia often require frequent blood transfusions, which can lead to iron overload. This excess iron can accumulate in organs such as the liver, heart, and pancreas, causing toxicity. Monitoring for signs of iron toxicity is crucial to prevent organ damage. B: Vitamin B12 deficiency is not typically associated with sickle cell anemia or blood transfusions. C: Hypokalemia is not a common complication of sickle cell anemia or blood transfusions. D: Infection is a risk with blood transfusions, but the question specifically asks about complications related to sickle cell anemia and blood transfusions, making iron toxicity the most relevant concern.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Diclofenac is a NSAID commonly used for pain relief and inflammation. 2. NSAIDs inhibit the enzyme cyclooxygenase, reducing inflammation. 3. Celecoxib is a selective NSAID, but not the only true NSAID. 4. Methotrexate is an immunosuppressant used for autoimmune diseases. 5. Leflunomide is a disease-modifying antirheumatic drug (DMARD), not an NSAID. Summary: Diclofenac is the correct answer as it is a traditional NSAID that inhibits cyclooxygenase. Celecoxib is a selective NSAID, while Methotrexate and Leflunomide are not categorized as NSAIDs but serve different purposes in treatment.

Correct Answer: A

Rationale: The correct answer is A: Leflunomide, as it is an immunomodulator that acts by inhibiting pyrimidine synthesis, thereby suppressing the immune response in autoimmune diseases like rheumatoid arthritis. Methotrexate (B) is an immunosuppressant that inhibits DNA synthesis. Hydroxychloroquine (C) is an antimalarial drug with immunomodulatory effects but is not primarily used for this purpose. Adalimumab (D) is a biologic agent that targets tumor necrosis factor-alpha and is classified as a TNF inhibitor, not an immunomodulator.

Correct Answer: D

Rationale: The correct answer is D: Retinal damage. Xanthine oxidase inhibitors like allopurinol can lead to retinal damage, causing vision problems. This is due to the drug's potential to accumulate in the retina. Bone marrow suppression, nausea, and vomiting are not common side effects of xanthine oxidase inhibitors, making them incorrect choices.

Correct Answer: B

Rationale: The correct answer is B because correctly identifying the client prior to a blood transfusion helps prevent a type II hypersensitivity reaction by ensuring compatibility between the donor and recipient blood types. This prevents the recipient's immune system from attacking the transfused blood, which can lead to a reaction. Administering steroids for a positive TB test (choice A) is unrelated to preventing type II hypersensitivity reactions. Keeping the client free of the offending agent (choice C) is more relevant to preventing type IV hypersensitivity reactions. Providing a latex-free environment for the client (choice D) is important for preventing latex allergies, a type I hypersensitivity reaction, not type II.