On examination of a peripheral blood film of a patient with sickle cell disease, some nuclear remnants are seen on the red blood cells. This finding is strongly suggestive of:

Correct Answer: B

Rationale: Rationale: The presence of nuclear remnants on red blood cells in sickle cell disease indicates Howell-Jolly bodies, a sign of functional asplenia due to autosplenectomy. This occurs in sickle cell disease due to chronic vaso-occlusive crises leading to infarction and fibrosis of the spleen. Asplenism increases the risk of infections, particularly encapsulated organisms. Summary: A: Hypersplenism is incorrect because it would result in increased removal of red blood cells without nuclear remnants. C: Hepatomegaly is incorrect as it is not typically associated with the presence of nuclear remnants on red blood cells. D: Bone marrow failure is incorrect as it does not specifically lead to the presence of Howell-Jolly bodies on red blood cells in sickle cell disease.

Correct Answer: B

Rationale: The correct answer is B: Administer corticosteroids as prescribed for inflammation. In scleroderma, corticosteroids are commonly prescribed to reduce inflammation and manage symptoms. Bed rest (A) is not typically recommended as it can lead to muscle weakness. Remaining supine after meals (C) is not necessary for scleroderma. Keeping the room temperature warm during the day and cool at night (D) may provide comfort but does not directly address the underlying condition of scleroderma.

Correct Answer: C

Rationale: The correct answer is C: Blood pressure. Cyclosporine, a medication used in postrenal transplantation clients, can cause hypertension as a side effect. Therefore, an increase in blood pressure is the most likely vital sign to be elevated. Pulse, respirations, and pulse oximetry are less likely to be directly affected by cyclosporine. Pulse and respirations may be elevated due to pain from the headache, but the primary concern in this case would be the blood pressure due to the medication's known side effects. Pulse oximetry is not typically affected by cyclosporine and is more related to oxygen saturation levels.

Correct Answer: B

Rationale: The correct answer is B: Chronic Myelogenous Leukemia (CML). The presentation of a 60-year-old man with abdominal fullness, fatigue, leukocytosis, thrombocytosis, and the presence of the Philadelphia chromosome strongly suggests CML. The Philadelphia chromosome results from a reciprocal translocation between chromosomes 9 and 22, leading to the formation of the BCR-ABL fusion gene characteristic of CML. This gene encodes a constitutively active tyrosine kinase, driving uncontrolled proliferation of myeloid cells. Acute myeloid leukemia (A) typically presents with bone marrow failure, not leukocytosis and thrombocytosis. Chronic lymphocytic leukemia (C) is more common in older adults, but it is characterized by lymphocytosis, not leukocytosis. Acute lymphocytic leukemia (D) usually presents with pancytopenia and blast cells in the peripheral blood, not leuk

Correct Answer: D

Rationale: The correct answer is D: CT scan of chest, abdomen, pelvis. This is the best next step as it helps in staging the disease extent and planning treatment. A bone marrow biopsy (A) is not typically needed in Hodgkin lymphoma. Liver biopsy (B) is not the initial step in evaluation. Staging laparotomy (C) is an invasive procedure and not the first-line investigation. CT scan (D) is preferred for initial staging due to its ability to detect lymph node involvement and assess organ involvement.