Assuming that adherence has been excellent, which of the following should have returned to normal 6 weeks following appropriate oral iron treatment for a child with severe dietary iron deficiency (hemoglobin [Hgb] 5.0 g/dL and mean corpuscular volume [MCV] 48 fL at the beginning of therapy)?

Correct Answer: A

Rationale: Rationale for Correct Answer (A): Hgb concentration reflects the amount of hemoglobin in the blood, which is directly affected by iron levels. After 6 weeks of appropriate oral iron treatment, the child's severe iron deficiency should have improved, leading to an increase in Hgb concentration back to normal levels. Explanation of Incorrect Choices: B: MCV measures the size of red blood cells, which is affected by iron deficiency anemia. However, it may take longer than 6 weeks for MCV to return to normal. C: Red cell distribution width indicates the variation in red blood cell sizes and is not directly related to iron levels. It may not necessarily return to normal within 6 weeks. D: Peripheral blood smear provides information on the morphology of red blood cells but does not directly reflect iron levels. It may not show significant changes within 6 weeks of iron treatment.

Correct Answer: C

Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting. A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT. B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment. D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.

Correct Answer: C

Rationale: Rationale: C: Progressive loss or thinning of hair occurs in the geriatric population due to age-related changes in the hair follicles. As individuals age, the hair follicles shrink, leading to hair thinning or loss. Incorrect Choices: A: Dentition deteriorating with more cavities is related to oral health, not the hematologic system. B: Strong and smooth nails are not directly related to age-related changes in the hematologic system. D: Sclerae turning yellow or pale is indicative of potential liver dysfunction, not a direct age-related change in the hematologic system.

Correct Answer: C

Rationale: The correct answer is C: Tapeworm infestation. The symptoms described are consistent with vitamin B12 deficiency, which can result in macrocytic anemia and neurological symptoms. Chronic atrophic gastritis and ileal resection can impair absorption of vitamin B12, leading to deficiency. Alcoholism can also lead to malnutrition and vitamin deficiencies. Tapeworm infestation, on the other hand, does not directly affect vitamin B12 absorption. Therefore, tapeworm infestation is not a factor causing the condition described.

Correct Answer: D

Rationale: The correct answer is D: Monocytosis. In chronic bacterial infections, monocytosis occurs due to the increased presence of monocytes in response to the persistent infection. Monocytes differentiate into macrophages to help eliminate the bacteria. Neutrophilia (A) is more common in acute bacterial infections. Basophilia (B) is associated with conditions like chronic myeloid leukemia, not bacterial infections. Lymphocytosis (C) is often seen in viral infections or chronic inflammatory conditions, not specifically in chronic bacterial infections.