A patient with acute respiratory distress syndrome (ARDS) develops refractory hypoxemia despite maximal ventilatory support and prone positioning. Which of the following adjunctive therapies is most likely to improve oxygenation and reduce mortality in this patient?

Correct Answer: C

Rationale: In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.

Correct Answer: C

Rationale: The member of the health team responsible for preparing pre-operative orders for a patient undergoing surgery, such as a coronary arterial bypass graft (CABG), is typically the anesthesiologist. Anesthesiologists are specialized physicians who are trained to administer anesthesia and manage the patient's well-being during surgery. They are responsible for assessing the patient's medical history, determining the appropriate anesthesia plan, and prescribing pre-operative medications. Cardiologists focus on diagnosing and treating heart conditions, surgeons perform the actual surgical procedure, and medical internists specialize in the diagnosis and non-surgical treatment of internal diseases. The anesthesiologist plays a crucial role in ensuring the safety and comfort of the patient before, during, and after surgery.

Correct Answer: A

Rationale: Calcium carbonate should be taken with meals because it requires the presence of stomach acid to be properly absorbed. Taking it with meals helps ensure optimal absorption and effectiveness as a phosphate binder in patients with chronic kidney disease. Administering calcium carbonate on an empty stomach may lead to gastrointestinal side effects such as upset stomach, bloating, and constipation. Taking it with a full glass of water is also recommended to help prevent potential gastrointestinal issues and to ensure proper hydration. Crushing tablets before administration is not advised unless specifically instructed by a healthcare provider, as it can alter the drug's release and absorption properties.

Correct Answer: C

Rationale: The considered ideal fetal position for a healthy delivery is left transverse anterior with moderate flexion. This position allows for an easier descent through the birth canal and reduces the chances of complications during delivery. This position is optimal for a smoother and safer delivery process for both the mother and the baby.

Correct Answer: C

Rationale: The most likely causative agent in this scenario is Borrelia burgdorferi, which is the bacterium responsible for causing Lyme disease. The classic presentation of Lyme disease includes fever, malaise, and a skin lesion resembling a "bull's eye" rash, known as erythema migrans. This rash typically appears at the site of a tick bite. If left untreated, Lyme disease can progress to involve multiple organ systems and lead to more severe complications. Plasmodium falciparum is the causative agent of malaria, which typically presents with symptoms such as fever, chills, and fatigue, but it does not cause a "bull's eye" rash. Trypanosoma cruzi is the parasite responsible for Chagas disease, which presents with symptoms such as fever, swelling at the site of entry (typically the bite wound), and enlarged lymph nodes, but it does not

Correct Answer: B

Rationale: The Right to Information pertains to the patient's right to be informed about their condition, treatment plan, and to have access to relevant medical information. It does not include specific details about payment or insurance coverage, such as the extent to which payment may be expected from PhilHealth. While financial information is important for patients, it does not fall under the scope of the Right to Information in a healthcare context, which focuses more on medical information and decision-making processes.

Correct Answer: D

Rationale: When a postpartum client exhibits signs of postpartum psychosis such as hallucinations, delusions, and disorganized behavior, it is crucial to involve the healthcare provider immediately. Postpartum psychosis is a psychiatric emergency that requires prompt assessment and intervention by mental health professionals. The healthcare provider can determine the appropriate course of action, which may include hospitalization, medication management, and specialized psychiatric care. Delaying notification can lead to serious consequences for both the client and her infant, so timely intervention is essential in managing postpartum psychosis.

Correct Answer: A

Rationale: Immunological memory is primarily maintained by the clonal expansion of memory B cells. Memory B cells are a type of long-lived immune cell that originates from previously activated B cells during an immune response to a pathogen. When the immune system encounters the same pathogen again, memory B cells can quickly recognize and respond to it by undergoing rapid clonal expansion and differentiation into plasma cells that produce specific antibodies. This quick and robust response leads to the more efficient elimination of the pathogen during secondary exposure, resulting in the faster and stronger immune response characteristic of immunological memory.

Correct Answer: A

Rationale: Immersing oneself in the local community and participating in their everyday activities allows the nurse, as a community organizer, to establish trust and build rapport with the people. By actively engaging with the community members, the nurse can show genuine interest and commitment to their well-being, which fosters a sense of connection and mutual understanding. This approach is crucial for gaining the trust of the community, as it demonstrates that the nurse is invested in listening to their needs and working together to address health concerns effectively.