The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine. The nurse interprets that the client may have the medication discontinued by the health care provider if which elevated result is noted?

Correct Answer: C

Rationale: The correct answer is C: Serum amylase level. Elevated serum amylase levels indicate pancreatic toxicity, a known adverse effect of didanosine. The nurse should be concerned as this can lead to pancreatitis. Discontinuation of the medication is necessary to prevent further complications. A: Serum protein level is not directly related to didanosine toxicity. B: Blood glucose level is not typically affected by didanosine. D: Serum creatinine level is not typically affected by didanosine and does not indicate the need for discontinuation of the medication.

Correct Answer: A

Rationale: The correct answer is A: Excisional lymph node biopsy. Given the symptoms of fatigue, night sweats, itching, and diffuse lymphadenopathy, the best next step is to perform an excisional lymph node biopsy to determine the underlying cause, which could be lymphoma or another malignancy. This procedure provides a definitive diagnosis by examining the lymph node histology and immunophenotype. Choice B: Monospot test is used to diagnose infectious mononucleosis caused by the Epstein-Barr virus, but it is not the most appropriate test for these symptoms. Choice C: Toxoplasmosis IgG is a test for Toxoplasma gondii infection, which is unlikely to be the cause of these symptoms. Choice D: Serum ACE level is useful for diagnosing sarcoidosis but is not the best initial test for these symptoms.

Correct Answer: C

Rationale: The correct answer is C: Splenomegaly. In a 20-year-old man with sickle cell anemia requesting narcotics for a crisis, splenomegaly suggests an alternative diagnosis such as acute infectious process like osteomyelitis, which can present similarly to a sickle cell crisis. Scleral icterus (A) is a sign of jaundice common in hemolytic anemias like sickle cell, not exclusive to sickle cell crisis. A systolic murmur (B) may be heard in sickle cell anemia due to chronic anemia but is not specific to an alternative diagnosis. Ankle ulcers (D) are common in patients with sickle cell anemia due to vaso-occlusive crises, so it is less likely to suggest an alternative diagnosis.

Correct Answer: D

Rationale: The correct answer is D: Bacterial contamination. Fever and hypotension during platelet transfusion suggest a transfusion reaction caused by bacterial contamination. Platelet transfusions are stored at room temperature, making them susceptible to bacterial growth. Bacterial contamination can lead to septic reactions, causing fever and hypotension. Volume overload (A) is characterized by hypertension and not hypotension. Donor antibodies vs. recipient (B) and IgE vs. donor IgA (C) are not typically associated with fever and hypotension during platelet transfusion.

Correct Answer: C

Rationale: The correct answer is C because the first priority in a sickle cell crisis is to establish IV access for hydration and medication administration. Hydration helps prevent vaso-occlusive crises. Choice A (Morphine) and B (Oxygen) are important interventions but come after IV access. Choice D (Vaccines) is important for long-term prevention but not immediate management of a crisis.