Correct Answer: B

Rationale: In a pregnant woman presenting with severe abdominal pain and vaginal bleeding at 8 weeks gestation with a closed cervix, the most likely cause of these symptoms is a threatened abortion. A threatened abortion is a common complication of early pregnancy characterized by vaginal bleeding and lower abdominal pain without cervical dilation. The cervix remains closed, indicating that the pregnancy is still intact but at risk of potential miscarriage. Placenta previa typically presents with painless vaginal bleeding in the second or third trimester, whereas ectopic pregnancy usually presents with abdominal pain and vaginal bleeding in the setting of a closed cervix but is less likely at 8 weeks gestation. Gestational trophoblastic disease is a rare cause of vaginal bleeding in pregnancy and typically presents in the first trimester with signs of hyperemesis gravidarum, uterine enlargement, and elevated β-hCG levels.

Correct Answer: C

Rationale: According to Erikson's theory of psychosocial development, the stage of Identity versus Role Confusion occurs during adolescence, which is typically around the ages of 12 to 18 years old. This stage is characterized by the individual exploring and developing their personal identity, values, and beliefs.

Correct Answer: A

Rationale: Showing positive interpersonal relationships is the best evidence of a family coping well when their family coping index on therapeutic competence is rated as coping well. Positive interpersonal relationships indicate that family members are effectively communicating, supporting each other, and resolving conflicts in a healthy manner. This reflects strong family dynamics, emotional resilience, and adaptability which are important aspects of effective coping. While the other options (B, C, D) are beneficial activities or behaviors, positive interpersonal relationships directly demonstrate the family's ability to cope well together, making it the most relevant evidence for a high therapeutic competence rating.

Correct Answer: B

Rationale: Pelvic inflammatory disease (PID) is the most likely cause of the symptoms described in the pregnant woman. PID is an infection of the female reproductive organs, typically caused by sexually transmitted bacteria like Chlamydia or Gonorrhea. The classic presentation includes lower abdominal pain, fever, vaginal discharge, cervical motion tenderness, and bilateral adnexal tenderness on examination. This condition can lead to serious complications if not promptly treated, including infertility, ectopic pregnancy, and chronic pelvic pain. Therefore, it is crucial to diagnose and manage PID promptly, especially in pregnant women, to prevent adverse outcomes.

Correct Answer: D

Rationale: Quality improvement focuses on proactive measures rather than reactive responses. The medical director would be more interested in establishing processes and systems that prevent issues from occurring in the first place, rather than just reacting to problems as they arise. Continuous improvement involves identifying problems, analyzing root causes, and implementing long-term solutions to prevent the issues from recurring. Therefore, reacting to correct or bad situations is not a characteristic of quality improvement that the medical director would prioritize.