The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What vital sign is most likely increased?

Correct Answer: C

Rationale: The correct answer is C: Blood pressure. Cyclosporine, a medication used in postrenal transplantation clients, can cause hypertension as a side effect. Therefore, an increase in blood pressure is the most likely vital sign to be elevated. Pulse, respirations, and pulse oximetry are less likely to be directly affected by cyclosporine. Pulse and respirations may be elevated due to pain from the headache, but the primary concern in this case would be the blood pressure due to the medication's known side effects. Pulse oximetry is not typically affected by cyclosporine and is more related to oxygen saturation levels.

Correct Answer: D

Rationale: The correct answer is D: CT scan of chest, abdomen, pelvis. This is the best next step as it helps in staging the disease extent and planning treatment. A bone marrow biopsy (A) is not typically needed in Hodgkin lymphoma. Liver biopsy (B) is not the initial step in evaluation. Staging laparotomy (C) is an invasive procedure and not the first-line investigation. CT scan (D) is preferred for initial staging due to its ability to detect lymph node involvement and assess organ involvement.

Correct Answer: D

Rationale: Rationale for Answer D (No additional treatment): In this scenario, the patient likely has drug-induced hemolysis from the malaria prophylaxis. Since the hematocrit is not critically low and the patient is stable, the initial step is to discontinue the offending drug and monitor the patient closely. Additional treatment is not required unless the patient deteriorates or develops severe anemia. Summary of other choices: A: Splenectomy is not indicated in this case as the primary issue is drug-induced hemolysis, not a splenic disorder. B: Methylene blue is used for methemoglobinemia, not hemolysis caused by drug toxicity. C: Vitamin E is not the appropriate treatment for drug-induced hemolysis; it is more commonly used for conditions like vitamin E deficiency or antioxidant therapy.

Correct Answer: C

Rationale: The correct answer is C: Folate deficiency. In this case, the patient presents with macrocytic anemia (elevated MCV) and hypersegmented neutrophils, which are characteristic of folate deficiency. Folate is essential for DNA synthesis and red blood cell production. Alcoholism can lead to folate deficiency due to poor dietary intake and malabsorption. Sideroblastic anemia (A) presents with ringed sideroblasts in the bone marrow, thalassemia (B) shows microcytic anemia, and anemia of renal disease (D) is typically normocytic normochromic.

Correct Answer: A

Rationale: The correct answer is A: Obtain stool specimens for Hemoccult slides. This task is appropriate for a nursing assistant as it involves a non-invasive procedure that can be easily taught and performed under supervision. The other options involve more complex tasks that require a higher level of training and knowledge. Having the patient sign a consent form (B) and giving GoLYTELY (C) involve patient interaction and medication administration, which are typically tasks for licensed nurses. Checking for allergies to contrast dye (D) requires knowledge of medication administration and possible adverse reactions, making it unsuitable for delegation to a nursing assistant.