A pregnant woman presents with sudden onset of severe abdominal pain and vaginal bleeding. On examination, her abdomen is rigid, and fetal parts are palpable abdominally. Which of the following conditions is the most likely cause of these symptoms?

Correct Answer: C

Rationale: Uterine rupture is the most likely cause of these symptoms in a pregnant woman presenting with sudden onset of severe abdominal pain, vaginal bleeding, rigidity of the abdomen, and palpable fetal parts abdominally. Uterine rupture is a rare but serious complication of pregnancy, typically occurring during labor in women with a previous cesarean delivery or other uterine scars. The sudden onset of severe abdominal pain can be associated with vaginal bleeding due to the tearing of the uterine wall, causing fetal parts to be palpable abdominally. This is a life-threatening emergency that requires immediate medical intervention. Ectopic pregnancy, pelvic inflammatory disease, and ovarian torsion may present with abdominal pain and vaginal bleeding but would not typically present with palpable fetal parts abdominally in a pregnant woman.

Correct Answer: B

Rationale: The severe abdominal cramps experienced by the multiparous patient Amy, 28 hours after a Cesarean delivery (CS) and while breastfeeding, are likely caused by the release of Oxytocin during the breastfeeding session. Oxytocin is a hormone that is naturally produced during breastfeeding to stimulate the contraction of the uterus and help reduce postpartum bleeding. These contractions may result in cramping sensations in the abdomen, specifically at the site of the uterus. It is a normal physiological response and an indication that the body is working as it should to support the postpartum recovery process.

Correct Answer: C

Rationale: Ciprofloxacin is an antibiotic commonly prescribed for the prevention of bacterial infections that can result from animal bites, such as dog bites. Dog bites are often contaminated with bacteria and can lead to infections, particularly from organisms such as Pasteurella multocida. Ciprofloxacin is effective against a broad range of bacteria, including those commonly found in animal bites, making it a suitable choice for infection prophylaxis in this scenario. Ibuprofen is a pain reliever and anti-inflammatory medication, tetanus toxoid is given to prevent tetanus infection, and meperidine is a narcotic analgesic used for pain relief, but none of these options specifically target bacterial prevention in the case of a dog bite.

Correct Answer: A

Rationale: A retrospective audit involves reviewing past cases or data to evaluate processes, outcomes, or compliance with standards. In this scenario, the nursing team plans to audit post-op patients who developed pressure sores over the past year at the Orthopedic unit. By looking at historical data from the past year, the audit is considered retrospective as it assesses what has occurred over a specified period. This type of audit helps identify trends, patterns, and areas for improvement based on past events.

Correct Answer: B

Rationale: Disseminated intravascular coagulation (DIC) is a condition characterized by widespread activation of coagulation leading to both thrombosis and hemorrhage. In patients with chronic liver disease, especially in the setting of advanced cirrhosis, DIC can develop due to factors such as decreased synthesis of coagulation factors and impaired clearance of activated clotting factors. The patient in this scenario presents with signs of both abnormal bleeding (bruising, petechiae, mucosal bleeding) and laboratory findings consistent with DIC, including prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) along with decreased platelet count.

Correct Answer: A

Rationale: Molluscum contagiosum is a viral skin infection caused by the poxvirus. It commonly presents as flesh-colored, dome-shaped papules with central umbilication on the face, trunk, and extremities. The central umbilication indicates the presence of a crater-like indentation in the center of the lesion. It is a benign condition and usually self-limited, but it can be persistent and contagious. Treatment options include cryotherapy, curettage, topical therapies, and observation. Acne vulgaris presents with comedones, papules, pustules, and nodules primarily on the face, chest, and back. Sebaceous hyperplasia is characterized by yellowish papules with central dell on the face. Basal cell carcinoma typically presents as a pearly papule with telangiectasias and may have ulceration or bleeding.

Correct Answer: A

Rationale: Endometriosis is the most likely condition responsible for the symptoms described in this scenario. Endometriosis is a chronic condition in which endometrial-like tissue grows outside the uterus, commonly affecting the pelvic structures such as the ovaries, fallopian tubes, and pelvic peritoneum. The main symptoms include cyclic pelvic pain, dysmenorrhea (painful periods), and dyspareunia (pain during intercourse). The retroverted and fixed uterus on examination may be due to adhesions from endometriosis, causing the uterus to be fixed in position. Endometriosis should be considered in women of reproductive age presenting with these symptoms and pelvic examination findings.

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: B

Rationale: As an epidemiology nurse, Nurse Rona's primary function and responsibility is to implement public health surveillance. Epidemiology nurses play a crucial role in monitoring and controlling the spread of diseases within communities. This involves conducting surveillance activities to identify patterns of disease occurrence, investigating outbreaks, collecting and analyzing data, and collaborating with various stakeholders to develop strategies for disease prevention and control. While providing nursing care to sick residents is important, the primary focus of an epidemiology nurse is on population-based health issues rather than individual patient care. Additionally, while Nurse Rona may assist epidemiologists in making reports and follow up cases and contacts, her main role is to implement public health surveillance to protect and promote the health of the community as a whole.