Splenectomy is contraindicated in:

Correct Answer: C

Rationale: The correct answer is C: BM failure. Splenectomy is contraindicated in patients with bone marrow failure due to conditions such as aplastic anemia or myelodysplastic syndromes. The spleen plays a role in removing abnormal blood cells, and removing it can worsen cytopenias in these patients. Choices A, B, and D are not contraindications for splenectomy as they do not directly involve the bone marrow function. Pyruvate kinase deficiency (A) does not affect bone marrow function, ITP (B) is a platelet disorder, and angiogenic myeloid metaplasia (D) is a condition related to abnormal blood cell production, not bone marrow failure.

Correct Answer: D

Rationale: The correct answer is D: Helping the patient manage the opioid analgesic regimen. This is the priority intervention for severe bone pain in multiple myeloma because opioids are the most effective for managing severe pain. Opioids target the central nervous system to reduce pain perception, providing significant relief. Implementing distraction techniques (A) may offer temporary relief but will not address the underlying pain. Educating about hot and cold packs (B) may be helpful for mild pain but is not sufficient for severe bone pain. Teaching NSAIDs (C) is not recommended for multiple myeloma pain management due to potential kidney issues.

Correct Answer: A

Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML are at high risk for infections due to compromised immune systems. Isolation and strict infection control measures help prevent exposure to pathogens. B is incorrect as the main priority is infection prevention, not diet. C is incorrect as involving the family is important but not the priority. D is incorrect as pain monitoring is important but not the priority in this case.

Correct Answer: B

Rationale: The correct answer is B because assisting the patient to a chair during awake times, as tolerated, is the most appropriate intervention for a patient experiencing debilitating fatigue during consolidation therapy for leukemia. This option promotes mobility and prevents further deconditioning without overwhelming the patient. A: Teaching about risks and benefits may not directly address the immediate need for physical activity. C: Stair exercises may be too strenuous for a fatigued patient and could potentially exacerbate their condition. D: Deep breathing and coughing exercises are important but do not directly address the need for physical activity to combat fatigue.