A patient with a history of chronic liver disease presents with easy bruising and prolonged bleeding from minor cuts. Laboratory tests reveal prolonged PT and aPTT, and mixing studies show correction of coagulation times with normal plasma. Which of the following conditions is most likely to cause these findings?

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: D

Rationale: Radical abdominal hysterectomy involves the removal of the uterus, ovaries, ligaments (including round ligaments and uterosacral ligaments), and fallopian tubes. This extensive procedure is typically done for cases of invasive gynecologic cancers, most commonly cervical or ovarian cancer. The goal of radical hysterectomy is to remove as much of the cancerous tissue as possible to improve the chances of successful treatment and reduce the risk of cancer recurrence.

Correct Answer: C

Rationale: The most commonly associated adverse effect with ACE inhibitors is a dry cough. This cough is non-productive and can be quite bothersome for patients, often leading to non-compliance with the medication. The cough is thought to be due to the accumulation of bradykinin and substance P, which are vasodilatory and bronchoconstrictive peptides that are normally degraded by ACE. When ACE is inhibited, these peptides accumulate and can lead to irritation of the respiratory tract, resulting in the dry cough. It's important for healthcare providers to be aware of this common side effect and consider alternative medications if the cough becomes problematic for the patient.

Correct Answer: D

Rationale: Sonography, also known as ultrasound, is a non-invasive imaging technique that uses high-frequency sound waves to create images of structures inside the body. In the context of a patient who is pregnant, sonography is commonly used to assess the well-being of the fetus. It allows healthcare providers to monitor the growth and development of the fetus, evaluate the placenta, amniotic fluid levels, and detect any abnormalities that may be present.

Correct Answer: A

Rationale: Naloxone is a medication used to reverse the effects of an opioid overdose by binding to opioid receptors and displacing the opioids. Administering naloxone intravenously is the recommended intervention for managing a patient with a suspected opioid overdose as it can quickly reverse respiratory depression, sedation, and other effects of opioids. This intervention can be life-saving in cases of opioid overdose and is a critical step in the management of such patients. Providing respiratory support with bag-valve-mask ventilation may be necessary in addition to naloxone administration to ensure adequate oxygenation, but naloxone remains the primary intervention to reverse the effects of opioids. Encouraging the patient to drink fluids rapidly or administering benzodiazepines for sedation are not recommended interventions for managing a suspected opioid overdose.

Correct Answer: D

Rationale: The most appropriate diagnostic examination to confirm the incidence of hypertension among residents is blood pressure (BP) monitoring. Hypertension is defined by elevated blood pressure readings consistently measured over time. Monitoring of blood pressure is essential for diagnosing hypertension and determining the severity of the condition. Chest x-ray, ultrasound, and electrocardiogram are not specific tests for diagnosing hypertension. While these tests may be useful in assessing potential complications or causes of hypertension, they do not directly confirm the presence of high blood pressure. Regular BP monitoring with the use of a sphygmomanometer or automated blood pressure device is crucial in diagnosing and managing hypertension.

Correct Answer: B

Rationale: Administering ice packs to the perineum is the priority nursing intervention to provide relief for perineal pain and discomfort in a postpartum client. Ice packs help to reduce swelling and inflammation in the perineal area, which can help alleviate pain. It is a safe and effective method to provide immediate relief and promote comfort for the client. Other interventions such as encouraging ambulation, administering analgesics, and recommending warm sitz baths can also be beneficial, but in the initial management of perineal pain, ice packs are the most appropriate choice.

Correct Answer: A

Rationale: The purpose of a tracheostomy is to establish an artificial airway in the trachea through a surgical procedure. This is done to bypass obstructions in the upper airway, assist with breathing, or facilitate the removal of secretions from the lungs. A tracheostomy helps in maintaining a clear and secure airway for patients who have difficulty breathing or require long-term mechanical ventilation support.

Correct Answer: A

Rationale: Grilled chicken breast is a suitable choice for a low-phosphorus diet because poultry is typically lower in phosphorus compared to dairy products (like cheese), nuts (like almonds), and whole grains (like wheat toast). This option indicates an understanding of the need to restrict phosphorus intake, which is important for individuals with chronic kidney disease to prevent complications.