A patient presents with petechiae, ecchymoses, and gingival bleeding. Laboratory tests reveal prolonged bleeding time, normal platelet count, and normal PT and aPTT. Which of the following conditions is most likely to cause these findings?

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: Muscle pain or weakness. Statins can cause muscle-related side effects, including rhabdomyolysis, a severe condition that can lead to muscle pain and weakness. Monitoring for these symptoms is crucial to prevent serious complications. B: Dry cough is not a common side effect of statins. C: Hypertension is not directly associated with statin use. D: Hyperkalemia is not a typical adverse effect of statins.

Correct Answer: D

Rationale: The correct answer is D because Nurse Florence was asked why she requested permission to enroll in the Graduate Program for the second semester, not about her interest in Pediatric Nursing. A: Having an impressive resume to be competitive aligns with career advancement. B: Connecting with people professionally can lead to networking opportunities. C: Investing for the future implies long-term career growth. Therefore, D is the least relevant response to the question asked.

Correct Answer: B

Rationale: The correct answer is B: Report any irregular vaginal bleeding. This is important because irregular vaginal bleeding can indicate potential issues such as breakthrough bleeding or hormonal imbalances, which may require adjustments to the contraceptive regimen. Other choices are incorrect because: A) Restricting sexual activity is not necessary with this medication, C) Increasing calcium intake is not directly related to taking biphasic anti-ovulatory medication, and D) Bi-monthly Pap smears are not specifically required due to this type of contraception.

Correct Answer: C

Rationale: The correct answer is C: Systematic sampling. Nurse Sandy is adopting systematic sampling by selecting every third patient with MI after a random start. This method ensures equal chance of selection for each patient and maintains randomness. In contrast, simple random sampling (A) entails each patient having an equal chance of being selected independently. Stratified sampling (B) divides patients into groups based on certain characteristics, which is not the case here. Cluster sampling (D) involves grouping patients and selecting entire groups, which is different from the individual selection in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Trigeminal neuralgia. This condition is characterized by recurrent, severe, stabbing pain in the trigeminal nerve distribution triggered by touch, chewing, or cold exposure. The key feature is the characteristic lancinating pain, which is not typical of migraine (choice A), cluster headache (choice B), or tension-type headache (choice C). Migraine typically presents with pulsating, moderate to severe headache associated with nausea and sensitivity to light and sound. Cluster headache is characterized by severe, unilateral pain around the eye associated with autonomic symptoms. Tension-type headache presents with bilateral, pressing or tightening pain without specific triggers. Therefore, based on the description of the symptoms in the question, trigeminal neuralgia is the most likely diagnosis.

Correct Answer: B

Rationale: The correct initial step before starting TPN is to evaluate the patient's tolerance to glucose. This is crucial to ensure the patient can metabolize the glucose effectively and avoid complications such as hyperglycemia. Assessing affordability (A) is important but not the immediate concern. Identifying allergies (C) should be done but is not the first step. Assessing the patient's understanding (D) is important but not as critical as evaluating glucose tolerance before starting TPN.

Correct Answer: B

Rationale: When a woman in active labor exhibits signs of prolonged second stage, such as ineffective pushing efforts and slow fetal descent, one of the maternal conditions that should be considered is pelvic floor dysfunction. The pelvic floor muscles play a crucial role in supporting the uterus, bladder, and rectum. If these muscles are weak or dysfunctional, it can lead to difficulty in pushing effectively and impede the descent of the fetus through the birth canal. This can result in prolonged labor and increase the risk of complications for both the mother and the baby. Therefore, assessing for pelvic floor dysfunction is important in addressing the abnormal labor pattern and providing appropriate interventions to support the progress of labor.

Correct Answer: D

Rationale: The correct immediate action for the nurse is to notify the anesthesia provider immediately (Option D). This is crucial because a sudden change in the patient's level of consciousness during surgery could indicate a serious issue related to anesthesia administration. Notifying the anesthesia provider promptly allows for quick assessment and intervention to address the underlying cause, potentially preventing complications or even saving the patient's life. Administering a reversal agent (Option A) without proper evaluation by the anesthesia provider could be dangerous. Documenting the change in the patient's chart (Option B) is important but not the most immediate action. Checking the patient's vital signs (Option C) is also important but may not provide immediate insight into the cause of the change in consciousness.