What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy?

Correct Answer: C

Rationale: The correct answer is C: Check the pressure dressing frequently for signs of excessive or active bleeding. This is the priority because post bone marrow aspiration and biopsy, there is a risk of bleeding due to the procedure. By checking the dressing, the nurse can assess for any signs of excessive bleeding or hematoma formation, which are crucial to prevent complications. A: Teaching the client to avoid activity is important but not the priority immediately post-procedure. B: Administering NSAIDs may not be appropriate as they can increase the risk of bleeding. D: Reporting the lab results is important but not the priority over ensuring immediate post-procedure safety.

Correct Answer: C

Rationale: Rationale: A low reticulocyte production index indicates decreased bone marrow response to anemia. Aplastic anemia is characterized by bone marrow failure leading to pancytopenia, causing anemia. Thalassemia results in microcytic anemia, not macrocytic. Vitamin B12 deficiency causes macrocytic anemia due to impaired DNA synthesis. Sideroblastic anemia leads to microcytic anemia due to defective heme synthesis. Therefore, the most likely cause of anemia in this patient with a low reticulocyte production index and normal mean cell volume is aplastic anemia.

Correct Answer: D

Rationale: The correct answer is D: Vitamin K deficiency. Prolonged prothrombin time and activated partial thromboplastin time indicate impaired blood clotting, which is a characteristic of Vitamin K deficiency. Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X. Hemophilia A (Choice A) is a genetic disorder resulting in a deficiency of clotting factor VIII, leading to prolonged activated partial thromboplastin time only. Thrombocytopenia (Choice B) is a condition characterized by low platelet count, which can lead to bleeding but does not affect clotting factors. Von Willebrand disease (Choice C) is a genetic disorder affecting von Willebrand factor and platelet function, not clotting factors.

Correct Answer: A

Rationale: The correct answer is A because Burkitt's lymphoma is associated with the translocation of the c-myc gene on chromosome 8, not chromosome 18. This translocation results in the overexpression of c-myc, leading to uncontrolled cell proliferation. Choice B is incorrect as Burkitt's lymphoma commonly presents with jaw or facial bone involvement in HIV patients. Choice C is incorrect as Burkitt's lymphoma is commonly seen in African children due to Epstein-Barr virus infection, not necessarily after malaria exposure. Choice D is incorrect as Burkitt's lymphoma is histologically characterized by a "starry sky" appearance due to the presence of numerous macrophages engulfing debris from apoptotic cells.

Correct Answer: D

Rationale: Step-by-step rationale for why D is correct: 1. Koilonychias is characterized by spoon-shaped nails, a common symptom of iron deficiency anemia due to decreased hemoglobin levels. 2. Iron is essential for normal nail growth, and its deficiency can lead to changes in nail shape. 3. Hemolytic anemia (A) is characterized by the premature destruction of red blood cells, not typically associated with koilonychias. 4. Sickle cell disease (B) causes abnormal hemoglobin, leading to sickle-shaped red blood cells, not related to koilonychias. 5. Thalassemia major (C) is a genetic disorder affecting hemoglobin production, but it does not directly cause koilonychias.