Splenectomy is contraindicated in:

Correct Answer: C

Rationale: Splenectomy is contraindicated in bone marrow (BM) failure because the spleen plays a crucial role in hematopoiesis and immune function. Removing the spleen can worsen BM failure by disrupting hematopoiesis and exacerbating the existing condition. In pyruvate kinase deficiency, splenectomy can improve symptoms by reducing hemolysis. In immune thrombocytopenic purpura (ITP), splenectomy may be considered as a treatment option to increase platelet count. Angiogenic myeloid metaplasia does not have a direct contraindication for splenectomy, as the primary concern is the underlying disease pathology, not the surgical intervention.

Correct Answer: D

Rationale: The correct answer is D because severe bone pain in multiple myeloma often requires strong analgesics like opioids for effective pain management. Distraction techniques (A) may provide temporary relief but may not address the underlying pain. Hot and cold packs (B) are more suited for musculoskeletal injuries, not severe bone pain. NSAIDs (C) are usually not sufficient for managing severe bone pain in multiple myeloma. Therefore, helping the patient manage the opioid analgesic regimen (D) is the priority for effective pain control.

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 undergoing induction therapy are immunocompromised and at high risk for infection. Isolating the patient and using standard precautions help prevent exposure to pathogens. B: Providing a high-calorie, low-texture diet and oral hygiene is important but not the priority as infection control takes precedence. C: Including the family in planning activities of daily living is beneficial for holistic care but not the priority compared to infection prevention. D: Monitoring and treating pain is essential, but in this case, infection prevention is the priority due to the patient's immunocompromised state.

Correct Answer: B

Rationale: The correct answer is B because assisting the patient to a chair during awake times allows for gradual physical activity, promoting mobility without overwhelming the patient. This option supports the patient's need for movement while considering their current level of fatigue. A is incorrect because educating the patient about the benefits of exercise may not be feasible or appropriate given the patient's current fatigue levels. C is incorrect as stair exercises may be too strenuous for a patient experiencing debilitating fatigue, potentially leading to further exhaustion and risk of injury. D is incorrect because deep breathing and coughing exercises primarily focus on respiratory health and may not directly address the patient's need for physical activity to combat fatigue.

Correct Answer: A

Rationale: The correct answer is A: Clarify the prescription with the provider. Desmopressin is a medication that can cause hyponatremia, especially in patients with low sodium levels like this client. Before administering desmopressin, the nurse should consult with the provider to ensure it is safe to administer the medication given the client's sodium level. Administering the drug without clarifying may worsen the hyponatremia. Choice B is incorrect because administering the drug with an analgesic is not necessary or relevant in this situation. Choice C is incorrect because desmopressin is typically administered via injection, not orally. Choice D is incorrect because assessing factor IX levels is not directly related to the administration of desmopressin in this scenario.