A woman in active labor experiences frequent and intense uterine contractions with minimal rest intervals, leading to maternal fatigue and decreased fetal oxygenation. What maternal condition should the nurse assess for that may contribute to this abnormal labor pattern?

Correct Answer: B

Rationale: Uterine hyperstimulation is a condition in which the uterus contracts too frequently or too intensely, leading to decreased blood flow and oxygenation to the placenta. This can result in maternal fatigue and decreased fetal oxygenation due to the lack of sufficient rest intervals between contractions. Uterine hyperstimulation can be caused by factors such as the use of synthetic oxytocin (Pitocin) to induce or augment labor, uterine abnormalities, or maternal conditions like pre-eclampsia. It is important for the nurse to assess for uterine hyperstimulation in a woman experiencing frequent and intense contractions to intervene promptly and prevent adverse outcomes for both the mother and the baby.

Correct Answer: D

Rationale: Taking off the room lights and drawing the window shades would provide a calm and soothing environment for the five-year-old patient admitted due to pneumonia with symptoms of cough, respiratory distress, anxiety, and dehydration. By creating a dim and quiet atmosphere, it can help reduce the child's anxiety levels, promote rest and relaxation, and potentially aid in the management of distress caused by pneumonia. Providing a quiet and dark environment can also support the child's comfort and recovery process during the hospital stay.

Correct Answer: A

Rationale: A patient with a severe viral infection exhibiting reduced levels of circulating lymphocytes is likely due to the apoptosis of infected lymphocytes. When a virus enters the body, it can infect and replicate within lymphocytes, subsequently triggering the immune system to induce apoptosis in infected cells to prevent further spread of the virus. This process is part of the body's defense mechanism to control the viral infection. As a result, the circulating lymphocyte levels may decrease as infected lymphocytes are targeted for apoptosis. This phenomenon helps to limit viral replication and spread within the body, thereby aiding in the immune response to eliminate the virus.

Correct Answer: A

Rationale: Flexibility is the most important criterion in budgeting because it allows for adjustments to be made as circumstances change. Budgeting is a dynamic process, and having a flexible budget enables organizations or individuals to adapt to unexpected changes in income or expenses. This helps in ensuring that resources are allocated efficiently and effectively to meet the overall financial goals. Consistency, standardization, and cost-effectiveness are also important considerations in budgeting, but flexibility is key to successfully managing financial resources in a changing environment.

Correct Answer: D

Rationale: Record keeping involves several key steps such as structuring, securing, and storing information. However, easy disposal is not a step in record keeping. In fact, it is important to carefully consider the disposal of records in a secure and responsible manner to protect sensitive information and comply with relevant regulations. Proper disposal methods should be followed to ensure that records are not accessible to unauthorized individuals and that any sensitive information is properly destroyed to prevent misuse or breaches of privacy. Therefore, easy disposal is not a recommended practice in effective record keeping.

Correct Answer: D

Rationale: Erosion is the dental condition characterized by the destruction of tooth structure due to exposure to acidic substances, such as gastric acid from conditions like gastroesophageal reflux disease (GERD) or acidic beverages like sodas and citrus fruits. This acidic attack softens and wears away the enamel, leading to the erosion of tooth structure. Unlike dental caries, which is caused by bacteria producing acid from sugars in the mouth, erosion is primarily a result of external acidic sources. Attrition refers to the wear of tooth structure from tooth-to-tooth contact, and abrasion refers to the wear of tooth structure due to forces like brushing too hard or using abrasive toothpaste.

Correct Answer: C

Rationale: Sensitivity refers to the ability of an instrument to detect small or fine differences among the subjects being studied. In the context of research or measurement tools, sensitivity is crucial for identifying subtle variations in the data that may hold importance in the analysis. A sensitive instrument can accurately measure and record even the smallest changes, making it a valuable criterion when assessing the quality of a measurement tool in research studies. High sensitivity indicates that the instrument is more likely to pick up on nuances and variations in the data, providing researchers with more detailed and accurate information to work with.

Correct Answer: C

Rationale: The correct information that the incoming nurse should chart is that she received 800 cc of IV fluid. It is crucial for the charting to accurately reflect the actual situation to provide an accurate record for the patient's care. In this scenario, the discrepancy between the endorsed amount (400 cc) and the observed amount (800 cc) should be documented to ensure transparency and continuity of care. This deviation from the expected amount should be clearly recorded for proper monitoring and evaluation of the patient's condition.

Correct Answer: A

Rationale: Turning and repositioning the patient every 2 hours is the most effective nursing intervention in preventing pressure ulcers in a patient with a history of stroke and immobility. Pressure ulcers, also known as bedsores, are caused by prolonged pressure on the skin, leading to reduced blood flow and tissue damage. By regularly turning and repositioning the patient, pressure is relieved from specific areas of the body, helping to prevent the development of pressure ulcers. This intervention helps to redistribute pressure, improve blood flow, and reduce the risk of skin breakdown, thus promoting skin integrity in immobile patients.