PRBC transfusion 5 minutes in, patient flushed, tachypneic, chills. First action?

Correct Answer: C

Rationale: Step 1: Patient showing signs of transfusion reaction (flushed, tachypneic, chills). Step 2: Immediate concern for potential serious reaction. Step 3: Stop transfusion to prevent worsening of symptoms. Step 4: Safety first to prevent adverse outcomes. Summary: A: Obtaining a warm blanket does not address the serious reaction. B: Checking oral temperature is not a priority in this urgent situation. D: Administering oxygen may be needed, but stopping the transfusion is the first crucial step in managing the reaction.

Correct Answer: A

Rationale: The correct answer is A: PT (INR). The PT evaluates the extrinsic pathway by measuring the time it takes for blood to clot after adding tissue factor. This pathway involves factors outside the blood vessel. PTT (choice B) evaluates the intrinsic pathway, TT (choice C) evaluates the common pathway, and closure time (choice D) assesses platelet function, not the extrinsic pathway. Therefore, PT is the most appropriate choice for evaluating the extrinsic pathway.

Correct Answer: D

Rationale: The correct answer is D: Gastrointestinal blood loss. In the elderly, gastrointestinal blood loss is the most common cause of iron-deficiency anemia due to conditions like peptic ulcers, gastritis, and colorectal cancer. Blood loss leads to decreased iron levels, causing anemia. Malnutrition (A) can contribute but is less common in the elderly. Chronic kidney disease (B) typically leads to anemia of chronic disease, not iron-deficiency anemia. Medication side effects (C) may cause anemia, but gastrointestinal blood loss is more prevalent in the elderly population.

Correct Answer: D

Rationale: The correct answer is D: Vitamin K deficiency. Prolonged PT and aPTT indicate impaired coagulation factors, which are dependent on Vitamin K for synthesis. The normal blood test rules out hemophilia A, a genetic deficiency of factor VIII (choice A), thrombocytopenia, a low platelet count (choice B), and Von Willebrand disease, a deficiency in a blood protein that helps with clotting (choice C). Therefore, the most likely diagnosis is Vitamin K deficiency due to the abnormal coagulation factors.

Correct Answer: B

Rationale: The correct answer is B: Vitamin B12 deficiency. Anemia in a strict vegetarian is likely due to inadequate intake of Vitamin B12 found in animal products essential for red blood cell production. Iron deficiency (A) is common in vegetarians but not the primary cause of anemia in this case. Erythropoietin defect (C) is rare and not specific to vegetarianism. Calcium deficiency (D) does not directly cause anemia.