The nurse is caring for a client who has been taking a sulfonamide and should monitor for signs and symptoms of which adverse effects of the medication?

Correct Answer: C

Rationale: The correct answer is C: Bone marrow suppression. Sulfonamides are known to cause hematologic adverse effects, such as bone marrow suppression leading to decreased production of blood cells. This can manifest as anemia, leukopenia, or thrombocytopenia. Monitoring for signs and symptoms of bone marrow suppression, such as fatigue, pallor, easy bruising, and increased susceptibility to infections, is crucial. Explanation of other choices: A: Ototoxicity - Sulfonamides do not typically cause ototoxicity. B: Nephrotoxicity - While sulfonamides can cause kidney damage in some cases, bone marrow suppression is a more common adverse effect. D: Increased white blood cell (WBC) count - Sulfonamides do not typically lead to an increase in WBC count; instead, they are more likely to cause a decrease due to bone marrow suppression.

Correct Answer: D

Rationale: The correct answer is D: Cystoscopy and retrograde pyelography. This is the most useful test for evaluating painless hematuria in a 65-year-old smoker. Cystoscopy allows direct visualization of the bladder and can identify potential sources of bleeding. Retrograde pyelography helps assess the upper urinary tract for any abnormalities. The other choices are not as relevant in this context: A (urine culture) is used for diagnosing urinary tract infections, B (PSA) is for prostate cancer screening, and C (bladder scan) is used for assessing bladder volume, not for evaluating hematuria.

Correct Answer: B

Rationale: The correct answer is B: Myeloproliferative syndrome. Given the patient's symptoms (fatigue, itching, splenomegaly) and lab results (elevated Hb and platelets), it suggests an overproduction of blood cells, characteristic of myeloproliferative syndromes. Myelodysplastic syndrome (choice A) presents with cytopenias, not elevated blood counts. Paraneoplastic syndrome (choice C) is associated with malignancies, not blood disorders. Cushing syndrome (choice D) is characterized by hypercortisolism, not blood abnormalities.

Correct Answer: B

Rationale: The correct answer is B: Donor antibodies vs. recipient. Since the woman developed pulmonary edema post-transfusion, it suggests an immune reaction due to donor antibodies targeting recipient antigens, leading to inflammation and increased vascular permeability. This immune response results in fluid leakage into the lungs, causing pulmonary edema. Volume overload (A) is unlikely as the patient had pulmonary edema, not generalized edema. Recipient antibodies vs. donor (C) is incorrect as the recipient's antibodies would not cause immediate pulmonary edema post-transfusion. Bacterial contamination (D) can lead to septic reactions but is less likely to cause pulmonary edema in this context.

Correct Answer: C

Rationale: The correct answer is C because priming the transfusion set with dextrose in lactated Ringer solution can cause hemolysis of the red blood cells due to the incompatibility between the solution and PRBCs. This can lead to serious complications for the patient. Choice A is incorrect because waiting 20 minutes before starting the infusion is a standard practice to allow for compatibility checks and patient assessment. Choice B is incorrect because starting an IV with a 22-gauge catheter is appropriate for blood transfusions. Choice D is incorrect because informing the patient about potential reactions is an essential part of the consent process and patient education.