A 25-year-old woman presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia. On pelvic examination, the uterus is retroverted, and a tender, nodular mass is palpated behind the uterus. Which of the following conditions is most likely to be responsible for these findings?

Correct Answer: A

Rationale: The scenario described, including cyclic pelvic pain, dysmenorrhea, dyspareunia, retroverted uterus, and a nodular mass behind the uterus, is most indicative of endometriosis. Endometriosis is a gynecological condition in which tissue similar to the endometrium (the tissue that lines the uterus) is found outside the uterus, typically on structures within the pelvis. The presence of endometrial tissue in abnormal locations can lead to symptoms such as pelvic pain, especially during menstruation (dysmenorrhea), painful intercourse (dyspareunia), and the formation of nodular masses (endometriomas) that can be felt on pelvic examination. It is important to note that while adenomyosis and uterine fibroids (leiomyomas) can also cause pelvic pain and dysmenorrhea, the specific findings of retroverted uterus and palpable nodular mass behind

Correct Answer: D

Rationale: Pemoline (Cylert) is a central nervous system stimulant used in the treatment of ADHD. One of the significant potential side effects of pemoline is hepatotoxicity, which can manifest as elevated liver function test results. Therefore, the nurse must monitor the patient's liver function regularly while they are taking pemoline to monitor for any signs of liver damage or dysfunction. It is essential to educate the patient about the signs and symptoms of liver problems, such as jaundice (yellowing of the skin or eyes), abdominal pain, nausea, or dark urine, and to report any such symptoms immediately to their healthcare provider. Regular monitoring and early detection of liver function abnormalities can help prevent severe liver damage in patients taking pemoline.

Correct Answer: B

Rationale: Vitamin K is essential for the production of several clotting factors in the liver, including factors II, VII, IX, and X. In a patient with chronic liver disease, impaired liver function can lead to decreased synthesis of these clotting factors. As a result, there is an underlying deficiency of these clotting factors, leading to prolonged PT (prothrombin time) and aPTT (activated partial thromboplastin time). The mixing studies showing correction with normal plasma further support the diagnosis of a factor deficiency rather than an inhibitor, which helps in ruling out conditions like DIC or hemophilia.

Correct Answer: C

Rationale: When a pregnant woman is diagnosed with preeclampsia, the focus of health care shifts to the individual woman herself. Preeclampsia is a serious condition that affects the health of the pregnant woman and her unborn child. The healthcare team will prioritize the care and treatment of the woman to ensure her well-being and safety. In this scenario, the emphasis is on providing personalized and targeted care to address the needs of the individual patient, rather than a broader focus on population groups, communities, or families.

Correct Answer: B

Rationale: First-voided morning urine is the best urine sample to be used for an accurate result of a pregnancy test done at home because it is more concentrated compared to urine samples collected at other times of the day. Overnight, the hCG hormone (human chorionic gonadotropin) builds up in a woman's body, making the early morning urine more likely to contain higher levels of hCG if a woman is pregnant. The concentrated nature of first-morning urine reduces the chances of false-negative results since it provides a higher concentration of the hormone that the test is designed to detect. Therefore, using first-morning urine increases the sensitivity of the pregnancy test and improves the accuracy of the results.

Correct Answer: B

Rationale: The statement provided clearly outlines the expectation regarding the dress code in the facility. By explicitly mentioning that wearing blue jeans while on duty is not included in the dress code, the individual is being informed about a specific expectation they are expected to adhere to. Stating expectations is a crucial step in giving constructive criticism as it sets a clear standard for behavior or performance. In this case, by mentioning the dress code policy, it helps guide the individual on what is acceptable and what is not when it comes to attire while at work.

Correct Answer: D

Rationale: Physiologic jaundice among newborn babies typically occurs between the 2nd and the 3rd day after birth. This type of jaundice is considered normal and harmless and is caused by the breakdown of red blood cells and the immaturity of the newborn baby's liver in processing bilirubin. The bilirubin levels rise in the blood, leading to a yellowish discoloration of the skin and eyes. This type of jaundice usually peaks around the 3rd to 4th day after birth and then gradually resolves without treatment within the first week of life. It is important for healthcare providers to monitor bilirubin levels and ensure that they do not reach dangerous levels that could potentially harm the newborn.

Correct Answer: B

Rationale: In this scenario, the firm and midline fundus at three hours postpartum indicates that the uterus is contracting well. The presence of a small constant trickle of blood on perineal inspection suggests ongoing bleeding. This combination of findings is concerning for retained placenta, where a portion of the placenta remains attached to the uterine wall and prevents proper contraction and closure of the blood vessels at the placental site. Retained placenta can lead to postpartum hemorrhage and requires prompt evaluation and intervention to prevent complications. Nurse Kayla should escalate this finding to the healthcare provider for further assessment and management.

Correct Answer: D

Rationale: During the active phase of labor, a cervical dilation of 6 cm and regular contractions lasting 60 seconds each, occurring every 3 minutes indicate good progress in labor. The nurse should continue to monitor the progress closely by assessing the mother's vital signs, fetal heart rate, and the pattern of contractions. It is important to provide support and encouragement to the mother, continue with comfort measures, and be prepared to assist with the delivery when the cervix is fully dilated. This stage of labor is focused on active dilation and effacement of the cervix, and it is not yet time for the mother to push or for the nurse to administer oxytocin to augment labor.