The patient diagnosed with iron deficiency anemia tells you that she constantly feels tired and exhausted. She tells you that she is concerned about this problem. What is the nurse's best initial response?

Correct Answer: B

Rationale: The correct initial response is B: "How has this affected your life?" This response demonstrates therapeutic communication by acknowledging the patient's feelings and concerns, and encourages the patient to express their thoughts and emotions. By asking about the impact on her life, the nurse can gather more information about the patient's symptoms, daily activities, and overall well-being, which can help in developing a comprehensive care plan. Choice A is incorrect because simply instructing the patient to continue taking supplements without further assessment of the situation may not address the underlying issues causing the fatigue. Choice C is incorrect as it suggests a solution without understanding the patient's specific situation. Choice D is incorrect because it assumes stress is the primary cause of the tiredness without exploring other potential factors contributing to the symptoms.

Correct Answer: D

Rationale: The correct answer is D: Verifies that the client has given informed consent. Before performing any invasive procedure like a bone marrow aspiration, it is crucial for the nurse to ensure that the client has given informed consent. This involves explaining the procedure, risks, benefits, and alternatives to the client, allowing them to ask questions, and obtaining their signature on the consent form. This step is essential to ensure the client understands the procedure and willingly agrees to it. Choice A is incorrect because cleaning the biopsy site with an antiseptic should be done in the treatment room, not before taking the client there. Choice B, holding the client's hand and asking about concerns, is a good practice for providing emotional support but does not address the necessary step of verifying informed consent. Choice C, reviewing the client's platelet count, is important for assessing the client's readiness for the procedure but does not address the consent aspect, which is crucial before any invasive procedure.

Correct Answer: C

Rationale: The Schilling test assesses the client's ability to absorb vitamin B12, as it evaluates the absorption of an orally administered radioactive B12. First, the client is given a dose of radioactive B12 orally, and urine samples are collected to measure how much of the radioactive B12 is excreted. If the client is unable to absorb vitamin B12 properly, a second test is performed with intrinsic factor to determine the cause. Choices A, B, and D are incorrect as the Schilling test specifically focuses on the absorption, not storage, digestion, or production of vitamin B12.

Correct Answer: A

Rationale: The iliac crest is the best source for active bone marrow in a 20-year-old because it contains a high concentration of hematopoietic stem cells responsible for blood cell production. It is easily accessible, minimizing risks associated with harvesting. The femur, distal radius, and tibia have lower concentrations of active bone marrow and are less commonly used for bone marrow aspiration. Therefore, the iliac crest is the optimal choice for obtaining active bone marrow in this scenario.

Correct Answer: B

Rationale: Step 1: Decitabine is a DNA methyltransferase inhibitor, NOT an inducer. Step 2: Fetal hemoglobin production is regulated by gene expression, not DNA methylation. Step 3: The switch from gamma to beta-globin production is primarily controlled by transcription factors. Step 4: Therefore, the statement that decitabine prevents the switch by inducing DNA methylation is FALSE. Summary: Choice B is correct because decitabine does not induce DNA methylation to increase fetal hemoglobin production. Choices A, C, and D are incorrect due to the lack of evidence supporting them.