The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse understands that this has been confirmed by which finding?

Correct Answer: C

Rationale: The correct answer is C: Positive punch biopsy of the cutaneous lesions. A definitive diagnosis of Kaposi's sarcoma is confirmed by the presence of spindle cells and red blood cell extravasation in cutaneous lesions, which can be identified through a punch biopsy. This procedure allows for a histological examination to accurately diagnose Kaposi's sarcoma. Incorrect choices: A: Swelling in the genital area - Kaposi's sarcoma does not typically present with swelling in the genital area. B: Swelling in the lower extremities - Swelling in the lower extremities is not a specific indicator of Kaposi's sarcoma. D: Appearance of reddish-blue lesions noted on the skin - While reddish-blue lesions are characteristic of Kaposi's sarcoma, a punch biopsy is required to confirm the diagnosis definitively.

Correct Answer: C

Rationale: The correct approach is a bone marrow biopsy. The patient presents with pancytopenia (low Hb, WBC, platelets) which suggests a bone marrow issue. Bone marrow biopsy can reveal the cause of pancytopenia such as aplastic anemia, myelodysplastic syndrome, or leukemia. Erythropoietin level (A) is not indicated as low levels are expected in anemia. Serum B12 (B) is used for diagnosing B12 deficiency anemia, not pancytopenia. Liver spleen scan (D) is not helpful in this scenario. Bone marrow biopsy is the most direct and appropriate diagnostic test in this case.

Correct Answer: C

Rationale: The correct answer is C: Keep in hospital, discontinue heparin, start lepirudin. In this scenario, the patient has heparin-induced thrombocytopenia (HIT) with a platelet drop and is at risk for thrombosis. Lepirudin, a direct thrombin inhibitor, is the preferred anticoagulant in HIT. Dismissing on heparin and warfarin (choice A) is not appropriate due to HIT. Discontinuing heparin and adding aspirin (choice B) is not sufficient in managing HIT. Adding low-molecular-weight heparin (choice D) may worsen the thrombocytopenia.

Correct Answer: B

Rationale: The correct answer is B: Treat underlying disease. In this scenario, the patient is presenting with signs of disseminated intravascular coagulation (DIC) due to gram-negative sepsis. The priority is to address the underlying cause, which is the sepsis, to help improve the patient's condition. Treating the sepsis will help reduce the systemic inflammatory response and subsequent coagulopathy. The other options are not appropriate in this context: A (Begin heparin) can worsen bleeding in a patient with DIC, C (Begin plasmapheresis) is not indicated for DIC in sepsis, and D (Give vitamin K) does not address the main issue of sepsis-induced DIC.

Correct Answer: D

Rationale: The correct answer is D: Migratory thrombophlebitis. In a patient with a pancreatic mass and weight loss, migratory thrombophlebitis, also known as Trousseau syndrome, is a paraneoplastic syndrome commonly associated with pancreatic adenocarcinoma. This syndrome results from the release of procoagulant substances by the tumor, leading to migratory superficial thrombophlebitis. The other choices are not typically associated with pancreatic cancer. A: Hypercalcemia is more commonly seen in hyperparathyroidism or certain types of cancer. B: SIADH is commonly associated with small cell lung cancer. C: Hypoglycemia is seen in pancreatic insulinomas, not pancreatic adenocarcinoma.