A patient presents with multiple, hyperpigmented, velvety plaques in flexural areas such as the axillae and neck. The lesions are associated with obesity and insulin resistance. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: Acanthosis nigricans is a skin condition characterized by multiple, hyperpigmented, velvety plaques typically seen in flexural areas such as the axillae, neck, and groin. These lesions are often associated with obesity and insulin resistance. The appearance of acanthosis nigricans is distinct from other skin conditions such as seborrheic keratosis, dermatofibroma, and epidermal nevus. Acanthosis nigricans is commonly seen in conditions like obesity, type 2 diabetes, and metabolic syndrome due to the insulin resistance that leads to the overgrowth of keratinocytes.

Correct Answer: B

Rationale: It is important for the nurse to have a direct and easily accessible means of communication with the patient who is expected to be in and out of the hospital due to their chronic illness like leukemia. By asking for the patient's phone number, the nurse can quickly reach out to them for updates, clarification, or any urgent matters that may arise. This direct communication line helps in ensuring continuity of care and addressing the patient's needs promptly. This approach is more practical and efficient compared to options such as asking the patient to call the hospital number listed in the yellow pages or relying on chart information which may not always be up to date. Writing down the number and giving it to the ward clerk may cause unnecessary delays in communication.

Correct Answer: A

Rationale: Selective IgA deficiency is a primary immunodeficiency disorder characterized by low or absent levels of immunoglobulin A (IgA) in the blood. Since IgA plays a crucial role in mucosal immunity and defense against pathogens at mucosal surfaces, individuals with this deficiency are more susceptible to recurrent bacterial infections, particularly of the respiratory and gastrointestinal tracts. In contrast, severe combined immunodeficiency (SCID) is a more severe immunodeficiency disorder affecting T and B lymphocytes, chronic granulomatous disease (CGD) is a disorder of phagocytes, and autoimmune hemolytic anemia is an autoimmune disease involving red blood cells, none of which are directly associated with selective IgA deficiency.

Correct Answer: A

Rationale: A nursing assistant can be delegated the task of changing wound dressings because it is considered a basic nursing care activity that does not require specialized training or knowledge. Nursing assistants are trained to perform tasks related to personal care, hygiene, and basic wound care under the supervision of a registered nurse. Changing wound dressings is a routine nursing task that can be safely delegated to a nursing assistant, allowing the nurse to focus on other aspects of patient care that require specialized nursing skills and knowledge.

Correct Answer: B

Rationale: The extraneous variable in a study is a variable that is not the main focus of the study but could potentially impact the results. In this case, the length of stay is an extraneous variable because it is not directly related to the research question or objective of the study. The study is likely focused on factors such as patient age, complications, or date of admission, making the length of stay an irrelevant variable in this context.

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: A

Rationale: A safe patient environment should address the physical, emotional, and psychological well-being of the patient. While socio-economic needs are important for overall patient care, they are not directly related to creating a safe environment within a healthcare setting. Factors such as maintaining sanitation, meeting basic needs, and reducing physical hazards are crucial to ensuring the safety and well-being of patients. However, addressing socio-economic needs falls more within the realm of holistic patient care beyond just the physical safety aspect.

Correct Answer: D

Rationale: Complete abortion is the most likely cause of the symptoms described. In a complete abortion, all products of conception are expelled from the uterus. Symptoms include vaginal bleeding, passage of tissue, and dilation of the cervix. In this scenario, the presentation of a dilated cervix with visualized products of conception is classic for a complete abortion at 10 weeks gestation.

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.