Correct Answer: C

Rationale: Mastitis is an infection of the breast tissue that may occur in postpartum clients. When a postpartum client exhibits signs of mastitis, including breast tenderness, erythema, and warmth, it is crucial to notify the healthcare provider immediately. Prompt medical evaluation is necessary to determine the appropriate treatment plan, which may include antibiotics. Delay in treatment can lead to complications, such as abscess formation. Encouraging the client to continue breastfeeding and applying warm compresses may provide some relief but do not address the underlying infection. Administering oral antibiotics would require a prescription from the healthcare provider, hence notifying the provider is the most appropriate initial nursing action in this situation.

Correct Answer: A

Rationale: At the concrete operational stage according to Piaget's theory, children typically demonstrate logical thinking abilities and are able to understand and work with concrete objects and events. They can also grasp concepts such as conservation and classification. These children are able to think logically about concrete events but may still struggle with abstract and hypothetical situations. Therefore, Belle, functioning at the concrete operational stage, would exhibit behaviors such as thinking logically and being able to see possibilities, as described in option A.

Correct Answer: D

Rationale: The clinical presentation of a patient with chronic kidney disease (CKD) presenting with weakness, anorexia, confusion, severe anemia, low reticulocyte count, elevated serum creatinine, and decreased erythropoietin levels is most consistent with renal failure-associated anemia. In CKD, the kidneys are unable to produce adequate amounts of erythropoietin, a hormone responsible for stimulating red blood cell production in the bone marrow. The decreased erythropoietin levels lead to a state of anemia, characterized by low hemoglobin levels and subsequent symptoms of fatigue and weakness. The anemia in renal failure is typically normocytic and normochromic. Additionally, the elevated serum creatinine in this patient is a hallmark of kidney dysfunction.

Correct Answer: A

Rationale: In this case, the patient is experiencing respiratory acidosis as indicated by the low pH (7.28), elevated PaCO2 (65 mmHg), and elevated HCO3- (30 mEq/L). The primary acid-base disturbance is respiratory acidosis due to the retention of carbon dioxide (PaCO2 >45 mmHg) leading to an increase in HCO3- as a compensatory mechanism to maintain pH within normal limits. The elevated HCO3- levels (metabolic compensation) are trying to counterbalance the increased PaCO2 levels (respiratory acidosis) by increasing bicarbonate to attempt to normalize the pH. Overall, the ABG analysis shows respiratory acidosis with metabolic compensation in this COPD patient with an acute exacerbation and severe dyspnea.

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.