A patient with endocarditis on warfarin, rifampin stopped. Best next step?

Correct Answer: C

Rationale: Rationale: 1. Rifampin induces warfarin metabolism, reducing its efficacy. 2. Discontinuing rifampin causes a sudden increase in warfarin levels. 3. To avoid bleeding risk, reduce warfarin dosage. Summary: A: Increasing dosage can lead to over-anticoagulation. B: Continuing 15 mg/d without rifampin can cause overdose. D: Stopping warfarin abruptly can lead to thrombotic events.

Correct Answer: D

Rationale: The correct answer is D: Anemia of chronic disease. In this case, the patient's high ferritin levels and chronic inflammatory condition (rheumatoid arthritis) are indicative of anemia of chronic disease. This type of anemia is characterized by low iron utilization due to inflammation, leading to a state of functional iron deficiency despite high ferritin levels. Thalassemia (Choice A) typically presents with microcytic anemia but would not have high ferritin levels. Iron deficiency anemia (Choice B) would present with low ferritin levels. Sideroblastic anemia (Choice C) is characterized by ringed sideroblasts on bone marrow biopsy, which is not mentioned in the case.

Correct Answer: B

Rationale: The correct answer is B: Transfuse factor VIII concentrate. In hemophilia A, deficiency of factor VIII leads to impaired blood clotting. Therefore, administering factor VIII concentrate is crucial to control bleeding in this patient. This step takes priority over other options as it addresses the underlying issue of hemophilia A. Choice A is not the priority as stabilizing the patient's bleeding takes precedence over radiography. Choice C is unnecessary until the patient's bleeding is controlled. Choice D, infusing normal saline, does not address the primary concern of bleeding in a hemophiliac patient.

Correct Answer: C

Rationale: Correct Answer: C - LPN with 2 years oncology experience Rationale: An LPN with 2 years of oncology experience is the best choice as they have specific knowledge and skills in oncology care, which is crucial when managing a patient with a low ANC. They can provide appropriate care under the supervision of an oncology RN. Incorrect Choices: A: LPN from same-day surgery - Lacks oncology-specific experience. B: RN from agency on orientation - Limited experience in oncology care. D: RN new from ED - Limited oncology knowledge and experience.

Correct Answer: B

Rationale: The correct answer is B: Valine for glutamic acid. This substitution occurs in sickle hemoglobin, where a single nucleotide change leads to the replacement of glutamic acid by valine at the sixth position of the beta chain. This change results in the characteristic sickling of red blood cells. Choices A, C, and D do not correspond to the specific substitution seen in sickle hemoglobin and are therefore incorrect. It is crucial to understand the molecular basis of the disease to differentiate the correct answer from the distractors.