A nurse is preparing to perform a chest tube insertion for a patient with a pneumothorax. What action should the nurse prioritize to ensure proper placement of the chest tube?

Correct Answer: D

Rationale: The correct answer is D because confirming the insertion site and direction using imaging guidance ensures precise placement of the chest tube, minimizing the risk of complications. Imaging guidance allows the nurse to visualize the exact location of the pneumothorax and guide the tube insertion accurately. A: Positioning the patient in a semi-Fowler's position with arms elevated may be beneficial for comfort but does not directly ensure proper chest tube placement. B: Marking the insertion site with a pen may help as a reference point but does not guarantee accurate placement. C: Administering analgesia is important for the patient's comfort but does not impact the placement of the chest tube. In summary, choice D is the most critical step to ensure the chest tube is correctly placed and effectively treats the pneumothorax.

Correct Answer: B

Rationale: The primary reason for surgical repair of myelomeningocele is to correct the neurologic defect. This is because myelomeningocele is a type of neural tube defect where the spinal cord and its protective covering do not close properly. Surgical repair aims to close the opening in the spinal cord to prevent further damage, improve neurological function, and reduce the risk of complications such as paralysis and infection. The other choices are incorrect as they are not the primary goal of the surgery. Preventing infection (Choice A) is important but not the primary reason. Seizure disorders (Choice C) and hydrocephalus (Choice D) may be associated complications but are not the main purpose of the surgical repair.

Correct Answer: C

Rationale: Step-by-step rationale for the correct answer (C: I and II): 1. Choice I (The expression of pain is affected by learned behavior) is correct because cultural beliefs and upbringing influence how individuals express and perceive pain. 2. Choice II (Physiologically, all individuals experience pain in a similar manner) is correct because pain perception is largely influenced by biological factors that are universal. 3. Choice III (Some Asian people have a high response to pain medications) is incorrect as it focuses on a specific cultural group, which is not a general characteristic emphasized in culturally sensitive care. 4. Choice IV (Patients should be assessed for pain regardless of overt symptomatology) is incorrect as it is not specifically related to cultural sensitivity in pain management.

Correct Answer: C

Rationale: The correct answer is C: Acquired von Willebrand syndrome. This condition is characterized by a defect in von Willebrand factor function, leading to prolonged bleeding time and mucocutaneous bleeding. Normal platelet count rules out Glanzmann thrombasthenia and Bernard-Soulier syndrome which are platelet disorders. Normal PT and aPTT rule out Hemophilia A, a coagulation factor deficiency. Acquired von Willebrand syndrome is the most likely cause based on the clinical presentation and laboratory findings.

Correct Answer: A

Rationale: The correct answer is A: Amoxicillin. Amoxicillin is the first-line treatment for GAS pharyngitis due to its effectiveness against Streptococcus bacteria. It is a penicillin-class antibiotic recommended by guidelines. Azithromycin is an alternative for patients allergic to penicillin. Cephalexin is not the first-line choice for GAS. Clindamycin is reserved for patients allergic to both penicillin and macrolides.

Correct Answer: D

Rationale: The correct answer is D: Subarachnoid hemorrhage. This condition presents with sudden-onset severe headache, vomiting, and altered mental status due to bleeding in the subarachnoid space. This type of hemorrhage is typically noncontrast-enhancing on imaging. A: Ischemic stroke does not typically present with sudden-onset severe headache and vomiting. B: Subdural hematoma usually presents with a slower onset of symptoms and often develops after head trauma. C: Intracerebral hemorrhage presents with focal neurological deficits rather than altered mental status and vomiting. In summary, based on the sudden onset of symptoms, imaging findings, and clinical presentation, subarachnoid hemorrhage is the most likely diagnosis in this case.

Correct Answer: B

Rationale: The correct answer is B: Relieves pain by increasing pain threshold. Meperidine and codeine are opioid analgesics that work by binding to opioid receptors in the brain and spinal cord, thus increasing the pain threshold and reducing the perception of pain. This leads to pain relief without necessarily affecting sexual stimulation (choice A), craving for alcohol (choice C), or concentration/alertness (choice D). The primary physiological effect of these drugs is to modulate the perception of pain, making choice B the most appropriate answer in this context.

Correct Answer: D

Rationale: The correct answer is D because informed consent should be obtained from both the participants and their parents to ensure full understanding and agreement from all parties involved. This is crucial when working with minors to protect their rights and ensure ethical standards are met. Choice A is incorrect as it excludes parental consent, which is necessary for minors. Choice B is also incorrect as it neglects the participants' direct involvement in consenting to participate. Choice C is incorrect because it only includes available relatives, which may not be legally authorized to provide consent on behalf of the participants.

Correct Answer: A

Rationale: Correct Answer: A - sterile clamps Rationale: 1. **Immediate action**: Sterile clamps are essential to clamp the chest tube to prevent air from entering the pleural space. 2. **Prevent lung collapse**: Clamping the tube will prevent lung collapse and maintain positive pressure in the pleural space. 3. **Buy time**: By clamping the tube, you buy time to properly reattach the tube or secure it with a new connection. 4. **Safety**: Sterile clamps are a quick and effective solution to prevent a potentially life-threatening situation. Summary of other choices: B: Sterile dressing - Not the first priority as the immediate concern is preventing air from entering the pleural space. C: Another chest tube - Not necessary initially as clamping can buy time to reattach the disconnected tube. D: A bottle of sterile water - Not needed for emergency management of a disconnected chest tube.