A patient presents with abdominal pain, fever, and peripheral blood smear showing fragmented red blood cells (schistocytes). Laboratory tests reveal elevated lactate dehydrogenase (LDH), decreased haptoglobin, and increased indirect bilirubin. Which of the following conditions is most likely to cause these findings?

Correct Answer: B

Rationale: Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, fever, neurological abnormalities, and renal dysfunction. The peripheral blood smear in TTP typically shows fragmented red blood cells (schistocytes) due to mechanical destruction within small blood vessels. Laboratory findings in TTP commonly include elevated lactate dehydrogenase (LDH), decreased haptoglobin (as it is consumed in the clearance of free hemoglobin), and increased indirect bilirubin due to increased red blood cell breakdown. This combination of clinical presentation and laboratory abnormalities is classic for TTP. Hemolytic uremic syndrome (HUS) may present similarly but is more commonly associated with renal dysfunction and is often triggered by infection with Shiga toxin-producing E. coli.

Correct Answer: C

Rationale: Prolonged labor is a condition in which labor lasts for an extended period, typically more than 20 hours for first-time mothers and more than 14 hours for experienced mothers. Prolonged labor can contribute to slowing down uterine involution because the prolonged pressure and strain on the uterus can affect its ability to return to its pre-pregnancy size and position. The prolonged contractions and stretching of the uterine muscles can hinder the normal process of uterine involution, leading to a delay in the uterus shrinking back to its non-pregnant state. Additionally, prolonged labor can increase the risk of postpartum complications such as excessive bleeding and infection, which can further impact uterine involution. Therefore, it is crucial for healthcare providers to monitor labor progress closely to prevent prolonged labor and its potential effects on uterine involution.

Correct Answer: B

Rationale: Radiologic procedures are typically not used as the least screening assessment by nurses in a perinatal unit. The nurse's initial screening assessments usually focus on gathering information through techniques such as physical examination, interviews, and reviewing laboratory results. Radiologic procedures, such as X-rays or CT scans, are usually ordered by physicians once a more specific diagnostic need has been identified, based on the initial screening assessments performed by the nurse. Therefore, in this scenario, the least screening assessment to be used by the nurse would be radiologic procedures.

Correct Answer: B

Rationale: Nephrotic syndrome is a kidney disorder characterized by increased glomerular permeability, leading to protein loss in the urine. One of the hallmarks of nephrotic syndrome is hypoalbuminemia, which refers to low levels of albumin in the blood due to its excessive loss in the urine. This loss of albumin results in decreased oncotic pressure, leading to edema and ascites. Hematuria (choice A) is not typically found in nephrotic syndrome but may be present in other kidney conditions. Hyperkalemia (choice C) is not specific to nephrotic syndrome and may be more common in conditions affecting potassium regulation. Hypocalcemia (choice D) is also not a characteristic feature of nephrotic syndrome.

Correct Answer: B

Rationale: The symptoms described in the patient, such as tremors, rigidity, bradykinesia (slow movement), and postural instability, along with the presence of a shuffling gait, stooped posture, and masked facies, are classic features of Parkinson's disease. These motor symptoms are primarily caused by the degeneration of dopamine-producing neurons in the substantia nigra region of the brain. This results in an imbalance of neurotransmitters, particularly dopamine, leading to motor dysfunction and characteristic movement abnormalities seen in Parkinson's disease.

Correct Answer: A

Rationale: Encouraging frequent position changes, including the hands-and-knees position, is the most appropriate nursing intervention in this scenario. This position is known to help rotate the baby from a persistent posterior position to an optimal anterior position for delivery. The hands-and-knees position can help take pressure off the mother's back, alleviate back pain, and facilitate the rotation of the baby's head to engage in the mother's pelvis, thus promoting labor progress. It is a non-invasive and effective way to promote fetal rotation without the need for immediate instrumental delivery or intravenous analgesics. Continuous fetal monitoring is important for assessing fetal well-being but would not directly address the issue of posterior fetal position and the associated prolonged labor.

Correct Answer: A

Rationale: The most appropriate intervention for managing hepatic encephalopathy in this patient receiving palliative care for end-stage liver disease is to administer lactulose or other ammonia-lowering agents to reduce ammonia levels. Hepatic encephalopathy is believed to be primarily caused by the accumulation of ammonia in the bloodstream due to compromised liver function. Lactulose works by acidifying the gut lumen, which facilitates the excretion of ammonia in the form of ammonium ions. By reducing ammonia levels, hepatic encephalopathy symptoms, such as confusion and altered mental status, can be improved. Initiating other supportive measures like managing precipitating factors, maintaining hydration, and addressing nutritional issues should also be part of the holistic approach in managing hepatic encephalopathy in palliative care. However, addressing the underlying cause by reducing ammonia levels with lactulose is the priority intervention in this scenario.

Correct Answer: A

Rationale: Rheumatoid arthritis is a common cause of secondary osteoporosis. Chronic inflammation in rheumatoid arthritis can lead to bone loss due to increased osteoclast activity and decreased bone formation. Patients with rheumatoid arthritis are at an increased risk for developing osteoporosis, resulting in decreased bone density and increased fracture risk. Monitoring and managing bone health is an important aspect of care for individuals with rheumatoid arthritis to help prevent osteoporosis-related complications.

Correct Answer: C

Rationale: The nurse's primary responsibility in responding to a patient's questions about their diagnosis and treatment options is to listen actively and provide accurate, honest, and comprehensive answers. This approach helps build trust between the patient and the healthcare team, allows the patient to make informed decisions about their care, and ensures that the patient understands their condition and the recommended treatment plan. Providing vague answers or ignoring the patient's questions can lead to confusion, anxiety, and mistrust, which can hinder the patient's overall care and recovery. Referring the patient to the physician for all questions may be appropriate for certain medical inquiries, but the nurse plays a crucial role in educating and supporting the patient throughout their healthcare journey.