A 22-year-old woman presents with cyclic pelvic pain, dysmenorrhea, and infertility. On pelvic examination, the uterus is retroverted and enlarged. Which of the following conditions is most likely to be responsible for these findings?

Correct Answer: B

Rationale: Adenomyosis is a condition characterized by the presence of endometrial tissue within the myometrium (muscle wall) of the uterus. It can present with symptoms such as cyclic pelvic pain, dysmenorrhea (painful periods), and infertility. On pelvic examination, the uterus may be retroverted (tilted backward) and enlarged due to the presence of adenomyotic nodules within the uterine muscle. Adenomyosis can also cause heavy menstrual bleeding (menorrhagia). Endometriosis, on the other hand, involves the presence of endometrial tissue outside the uterus and can cause similar symptoms but is less likely to result in uterine enlargement or retroversion. Leiomyomas (uterine fibroids) are benign tumors of the uterine muscle and can also cause pelvic pain and abnormal uterine enlargement but are less likely to be associated with dysmenorrhea and infertility

Correct Answer: C

Rationale: The clinical presentation described with fever, headache, maculopapular rash starting on the face and spreading to the trunk and extremities, along with leukopenia and thrombocytopenia suggests a likely diagnosis of Rocky Mountain spotted fever (RMSF), which is caused by the bacterium Rickettsia rickettsii.

Correct Answer: B

Rationale: Teaching the patient diaphragmatic breathing exercises for respiratory support would be the most appropriate intervention to address the symptoms of dyspnea and anxiety in this scenario. Diaphragmatic breathing, also known as belly breathing, focuses on engaging the diaphragm for deep, slow breaths, which can help improve lung expansion and ventilation. This technique can help the patient manage their breathing difficulty and reduce anxiety by promoting relaxation and improving oxygen exchange in the lungs. It empowers the patient with a coping strategy they can use independently to alleviate distressing symptoms at any time. Administering oxygen therapy may be beneficial, but the priority is to teach the patient a technique they can use proactively and routinely. Prescribing benzodiazepines should be considered as an adjunct if non-pharmacological interventions are ineffective in managing anxiety. Referring to a pulmonologist may be necessary for comprehensive evaluation and treatment but may not directly address the immediate symptoms of dyspnea and anxiety.

Correct Answer: D

Rationale: The aim of human sciences, including nursing as a human science, is to make meaningful interpretations of the phenomena being studied. Unlike natural sciences that may focus on prediction, control, or seeking causal explanations, the human sciences aim to understand and interpret human experiences, behaviors, and relationships in a meaningful way. In nursing, this involves not only understanding the biological aspects of health and illness but also considering the holistic and humanistic aspects of care, such as emotions, values, beliefs, and perceptions. By making meaningful interpretations, nurses can better understand their patients and provide individualized and patient-centered care.

Correct Answer: C

Rationale: Rabies is a viral disease that affects the central nervous system. It is primarily transmitted through the bite of an infected animal, such as dogs, bats, raccoons, and foxes. The causative agent of rabies is the rabies virus, specifically from the genus Lyssavirus. Once the virus enters the body, it spreads through the nervous system to the brain, leading to severe neurological symptoms and, if left untreated, is almost always fatal. This is why prompt medical attention and vaccination following an animal bite are crucial in preventing the development of rabies in humans.

Correct Answer: C

Rationale: Meperidine (Demerol) is an opioid analgesic. Overdose of Meperidine can lead to respiratory depression, characterized by slow and shallow breathing. As a result of respiratory depression, hypercapnia, which is an increased level of carbon dioxide in the blood, can occur. This is a serious concern and requires immediate medical intervention to support respiratory function. Therefore, hypercapnia would be the assessment by the nurse that causes a concern for Meperidine overdose.

Correct Answer: C

Rationale: Postpartum hemorrhage is a serious complication that can occur within the first 24 hours after childbirth. It is the leading cause of maternal mortality worldwide. Therefore, during the immediate postpartum period, the first priority nursing intervention should be focused on observing for signs and symptoms of postpartum hemorrhage, such as excessive bleeding, abnormal vital signs, and changes in uterine tone. Early detection and prompt intervention can prevent severe complications and save the mother's life. Monitoring urinary output, taking vital signs, and checking level of responsiveness are important aspects of postpartum care but observing for postpartum hemorrhage takes precedence due to its critical nature.

Correct Answer: B

Rationale: A vegetative state, now more commonly referred to as unresponsive wakefulness syndrome, describes a condition where the patient is awake but with no awareness of themselves or their surroundings. This state usually follows a severe brain injury, such as traumatic brain injury. Patients in a vegetative state may have sleep-wake cycles, open their eyes, and even exhibit reflex movements, but they do not demonstrate any meaningful interaction with the environment. Differentiating between coma and vegetative state is important, as coma implies a complete lack of consciousness, while patients in a vegetative state have preserved wakefulness without awareness. Minimally conscious state (choice C) refers to a condition where there are some minimal signs of awareness or purposeful interaction, making it a different state than the one described in the scenario. Locked-in syndrome (choice D) is a condition where the patient is conscious and aware but unable to move or communicate due to paralysis, which is not consistent

Correct Answer: C

Rationale: Sevelamer is a medication commonly prescribed to reduce serum phosphate levels in patients with chronic kidney disease. Sevelamer is a phosphate binder that works by binding to dietary phosphate in the gut, preventing its absorption into the bloodstream. By reducing serum phosphate levels, sevelamer helps manage complications associated with hyperphosphatemia in chronic kidney disease patients, such as mineral and bone disorders. Other medications like epoetin alfa are used to treat anemia commonly seen in chronic kidney disease patients, while cinacalcet is used to manage secondary hyperparathyroidism. Allopurinol, on the other hand, is used to treat gout by reducing uric acid levels and is not indicated for reducing serum phosphate levels in chronic kidney disease patients.