A pregnant woman presents with severe lower abdominal pain and vaginal bleeding. On examination, cervical motion tenderness and unilateral adnexal tenderness are noted, along with an adnexal mass on the affected side. Which of the following conditions is the most likely cause of these symptoms?

Correct Answer: A

Rationale: The clinical presentation of severe lower abdominal pain and vaginal bleeding in a pregnant woman, along with cervical motion tenderness, unilateral adnexal tenderness, and an adnexal mass on the affected side, is highly concerning for an ectopic pregnancy. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. The presence of an adnexal mass and tenderness on one side is indicative of potential tubal involvement and can mimic symptoms of pelvic inflammatory disease. Prompt evaluation and management are crucial in ectopic pregnancy to prevent life-threatening complications associated with rupture of the fallopian tube.

Correct Answer: C

Rationale: When controlling severe external bleeding from an extremity, the recommended action is to apply direct pressure with a sterile dressing. Direct pressure helps to stop the bleeding by promoting clot formation and reducing blood flow from the wound. This method is effective in most cases and should be the first response to control bleeding. Elevating the extremity above the level of the heart can be helpful in some cases, but direct pressure is the initial recommended action. Applying a tourniquet proximal to the injury site should only be done as a last resort when other methods are not successful, as it can lead to complications such as tissue damage. Removing any impaled objects can actually worsen the bleeding and should be avoided unless necessary for immediate life-saving measures.

Correct Answer: C

Rationale: When the nurse interacts with patients face-to-face to gather information during the assessment phase of the nursing process, the level of communication is considered interpersonal. Interpersonal communication involves two or more individuals who are connected in a meaningful way. In this scenario, the nurse and the patient are engaging in a personal exchange of information, thoughts, and feelings. This type of communication is essential in building rapport, understanding the patient's needs, and providing effective care. It focuses on creating a supportive and therapeutic relationship between the nurse and the patient, which is crucial for delivering high-quality nursing care.

Correct Answer: D

Rationale: The priority nursing initiative for Nurse May should be to set up a mental health program in the community. This proactive approach focuses on prevention, early intervention, and support for individuals experiencing mental health issues. By setting up a mental health program, Nurse May can address the root causes of mental problems in young adults in the community, provide education and awareness, offer counseling services, and promote mental well-being. This initiative can have a long-term impact on the mental health of individuals and help reduce the incidence of mental problems in the community. Setting up a mental health program is a holistic and sustainable approach to addressing mental health issues in the community.

Correct Answer: C

Rationale: Prioritizing the application of a topical anesthetic cream to the biopsy site is essential to ensure patient comfort during the bone marrow biopsy procedure. This will help numb the area where the biopsy needle will be inserted, reducing the pain and discomfort experienced by the patient. Administering intravenous sedation may not always be needed for a bone marrow biopsy and should be decided by the healthcare provider based on the patient's individual needs. Providing distraction techniques such as music or relaxation exercises can be helpful, but they may not be as effective at reducing the physical discomfort caused by the procedure. Allowing the patient to eat or drink up to one hour before the procedure is important for other reasons, such as preventing potential complications during sedation or anesthesia, but it is not directly related to ensuring comfort during the biopsy itself.

Correct Answer: D

Rationale: The main goal of ethical practice in the nursing profession, including in the community setting, is centered on the welfare of clients and protecting their rights. Nurses have a professional and ethical obligation to prioritize the well-being and best interests of their patients. This includes providing high-quality care, advocating for their patients, supporting their autonomy, and upholding their rights. Ethical nursing practice is not focused on protecting the nurse or co-workers, preventing reprimand from physicians, or solely meeting the satisfaction of patients' families. Ensuring the welfare and rights of clients is the fundamental ethical principle that guides nursing practice.

Correct Answer: C

Rationale: The nurse explains to the mother that the uterus will return to its pre-pregnancy state in about four to six weeks after giving birth. This timeframe is an average estimation of how long it takes for the uterus to shrink back to its normal size and position after going through the process of supporting and nourishing a developing fetus. The process of the uterus returning to its pre-pregnancy state is known as involution, where the uterus undergoes contractions to shed the excess lining and reduce in size. This period is crucial for the body to heal and recover from the changes that occurred during pregnancy and childbirth.

Correct Answer: B

Rationale: When one has Cushing's disease, the focal structure affected is the pituitary gland. Cushing's disease is caused by the overproduction of adrenocorticotropic hormone (ACTH) by the pituitary gland. This excess ACTH stimulates the adrenal glands to produce too much cortisol, leading to the symptoms associated with Cushing's disease. Therefore, the primary issue originates in the pituitary gland, not the other structures mentioned in the question.

Correct Answer: D

Rationale: In a situation where a patient with terminal cancer is experiencing severe pain despite receiving analgesics, consulting with a pain management specialist is the most appropriate intervention. Pain management specialists have expertise in managing complex pain situations, especially in cases of terminal illness where pain control is crucial for improving quality of life. The specialist can review the current pain management plan, suggest alternative or adjunct therapies, adjust medication dosages, or explore different types of analgesics to optimize pain relief for the patient. Collaborating with a pain management specialist can help ensure the patient receives the most effective and personalized pain management approach tailored to their specific needs. Increasing the dose of analgesics, administering a different type of analgesic, or recommending non-pharmacological techniques may be appropriate interventions but should be guided by a specialist to ensure safe and effective pain management in a palliative care setting.