A woman in active labor demonstrates signs of prolonged second stage, characterized by ineffective pushing efforts and slow fetal descent. What maternal condition should the nurse assess for that may contribute to this abnormal labor pattern?

Correct Answer: B

Rationale: When a woman in active labor exhibits signs of prolonged second stage, such as ineffective pushing efforts and slow fetal descent, one of the maternal conditions that should be considered is pelvic floor dysfunction. The pelvic floor muscles play a crucial role in supporting the uterus, bladder, and rectum. If these muscles are weak or dysfunctional, it can lead to difficulty in pushing effectively and impede the descent of the fetus through the birth canal. This can result in prolonged labor and increase the risk of complications for both the mother and the baby. Therefore, assessing for pelvic floor dysfunction is important in addressing the abnormal labor pattern and providing appropriate interventions to support the progress of labor.

Correct Answer: A

Rationale: The correct answer is A: Pulmonary embolism. This is the most likely cause of the symptoms based on the presentation of chest pain, dyspnea, hemoptysis, and a mismatched defect on the V/Q scan. A pulmonary embolism occurs when a blood clot travels to the lungs, causing a blockage in the pulmonary artery. This can lead to symptoms like chest pain, shortness of breath, and coughing up blood. The V/Q scan showing a mismatched defect indicates a ventilation-perfusion mismatch, which is a classic finding in pulmonary embolism. Pericarditis (B), acute myocardial infarction (C), and aortic dissection (D) typically present with different sets of symptoms and do not match the V/Q scan findings in this case.

Correct Answer: A

Rationale: The correct answer is A because it includes all the major endocrine glands: pituitary, thyroid, parathyroid, adrenals, pancreatic islets, and hypothalamus. The pituitary gland is known as the "master gland" as it controls other endocrine glands. The thyroid gland regulates metabolism, while the parathyroid glands regulate calcium levels. The adrenal glands produce hormones involved in stress response. Pancreatic islets produce insulin and glucagon. The hypothalamus plays a key role in hormone regulation. Choice B is incorrect because it includes ovaries and testes, which are not endocrine glands. Choice C is incorrect because it omits the hypothalamus. Choice D is incorrect because it includes ovaries and testes which are not endocrine glands.

Correct Answer: A

Rationale: The correct answer is A: Enhances the delivery of quality nursing care. Supervision and delegation are essential in ensuring efficient and effective healthcare delivery. By supervising and delegating tasks appropriately, the head nurse can ensure that staff members are performing their duties competently, which ultimately leads to improved quality of patient care. Supervision helps in monitoring staff performance, providing feedback, and offering guidance when needed. Delegation ensures that tasks are allocated to the right staff members based on their skills and abilities, optimizing the workflow. Choices B, C, and D are incorrect because they do not directly relate to the primary purpose of supervision and delegation, which is to enhance the quality of nursing care through effective oversight and task allocation.

Correct Answer: B

Rationale: The correct answer is B: Acute glomerulonephritis. Glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys, leading to symptoms like hematuria (blood in urine), proteinuria (excess protein in urine), and hypertension (high blood pressure). Acute tubular necrosis (A) involves damage to the renal tubules, not the glomeruli. Chronic kidney disease (C) refers to long-term kidney damage and may not always present with the classic symptoms mentioned. Nephrotic syndrome (D) involves excessive protein loss in urine but may not always involve inflammation of the glomeruli.

Correct Answer: D

Rationale: The correct immediate action for the nurse is to notify the anesthesia provider immediately (Option D). This is crucial because a sudden change in the patient's level of consciousness during surgery could indicate a serious issue related to anesthesia administration. Notifying the anesthesia provider promptly allows for quick assessment and intervention to address the underlying cause, potentially preventing complications or even saving the patient's life. Administering a reversal agent (Option A) without proper evaluation by the anesthesia provider could be dangerous. Documenting the change in the patient's chart (Option B) is important but not the most immediate action. Checking the patient's vital signs (Option C) is also important but may not provide immediate insight into the cause of the change in consciousness.

Correct Answer: B

Rationale: The correct answer is B: IgA. In multiple myeloma, there is a proliferation of abnormal plasma cells, leading to a decrease in normal antibody production. IgA is the most abundant immunoglobulin in mucosal secretions and plays a crucial role in mucosal immunity. Therefore, a deficiency in IgA is common in patients with multiple myeloma. IgG is the most abundant immunoglobulin in the blood and is typically less affected in multiple myeloma. IgM is the first antibody produced in response to an infection and is less likely to be deficient in this case. IgE is primarily involved in allergic responses and is not typically affected in multiple myeloma.

Correct Answer: C

Rationale: The correct answer is C: Notify the anesthesia provider for further assessment. This is the most appropriate action because an anesthesia provider is trained to assess and manage changes in blood pressure during surgery. Administering antihypertensive medication (A) without proper assessment can be dangerous. Documenting the readings (B) is important but not the immediate action. Continuing to monitor closely (D) is necessary but notifying the anesthesia provider for further assessment should be the priority.

Correct Answer: A

Rationale: The correct answer is A: Rotator cuff tear. The presentation of acute shoulder pain and limited range of motion after a fall onto an outstretched hand, along with tenderness over the greater tuberosity and pain with passive abduction and external rotation, is classic for a rotator cuff tear. The mechanism of injury and physical exam findings are consistent with this condition. B: Glenohumeral dislocation typically presents with a visibly deformed shoulder and loss of normal shoulder contour. C: Acromioclavicular joint separation would present with tenderness over the AC joint rather than the greater tuberosity, and typically involves a history of direct trauma to the shoulder. D: Proximal humerus fracture would present with more diffuse shoulder pain and swelling, and not specific tenderness over the greater tuberosity.