A woman in active labor presents with a prolonged latent phase, characterized by irregular and infrequent contractions. What maternal condition should the nurse assess for that may contribute to this abnormal labor pattern?

Correct Answer: A

Rationale: Maternal dehydration can contribute to a prolonged latent phase during labor. Dehydration can lead to reduced blood volume and electrolyte imbalances, which can result in ineffective uterine contractions. Without adequate hydration, the uterus may not contract effectively, causing irregular and infrequent contractions. It is important for the nurse to assess the woman's hydration status and encourage her to stay hydrated during labor to help regulate contractions and progress labor.

Correct Answer: A

Rationale: As a nurse manager, the most effective way to let the staff imbibe the culture of quality at the health center is to become a role model. Leading by example is a powerful way to influence behavior and attitudes within a team. By demonstrating a commitment to quality in your own work, behavior, and decision-making, you set a positive example for your staff to follow. This proactive approach creates a culture of quality that is more likely to be embraced by the team as they see it being consistently demonstrated by their leader. This can result in improved staff morale, motivation, and overall performance in delivering quality care to patients. Additionally, being a role model fosters trust and respect among the staff, which is essential for building a strong team dynamic centered around quality healthcare delivery.

Correct Answer: C

Rationale: When a nurse discovers a discrepancy between the medication order and the patient's medication record, the priority action is to verify the medication order with the prescriber to ensure accuracy and patient safety. Administering the medication without clarification can put the patient at risk. Documenting the discrepancy and informing the charge nurse is important, but it should not delay verifying the order with the prescriber. Contacting the pharmacy for clarification may be necessary in some cases, but the immediate action should be to confirm the prescription with the prescriber to prevent errors and ensure the patient receives the correct medication.

Correct Answer: C

Rationale: Osteoarthritis in the hip joint can lead to weakness or dysfunction in the hip abductor muscles, causing a Trendelenburg gait. This gait abnormality is characterized by a dropping of the pelvis on the opposite side of the affected hip during weight-bearing on the affected leg. It is a common clinical manifestation of hip osteoarthritis due to the muscle weakness and altered mechanics in the hip joint. Baker's cyst is associated with knee osteoarthritis, Heberden's nodes are commonly seen in osteoarthritis of the fingers, and Swan-neck deformity is typically seen in rheumatoid arthritis, not osteoarthritis.

Correct Answer: A

Rationale: The most important intervention for managing ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in a patient undergoing mechanical ventilation in the ICU is to start appropriate antimicrobial therapy targeting MRSA. Vancomycin or linezolid are commonly used antibiotics for MRSA infections. These medications are effective against MRSA and can help in treating the infection and preventing further complications. It is crucial to initiate antimicrobial therapy promptly once the diagnosis of VAP caused by MRSA is suspected or confirmed to improve patient outcomes. Other interventions such as bronchoalveolar lavage for diagnostic purposes, contact precautions, or antifungal therapy may be relevant but the priority is to start effective antibiotic therapy to target the specific pathogen causing the infection.

Correct Answer: C

Rationale: The sudden onset of shortness of breath, chest pain, and cyanosis in a postpartum client could be indicative of a pulmonary embolism, a potentially life-threatening condition. Therefore, it is crucial to notify the healthcare provider immediately for further assessment and management. Prompt intervention is essential in this situation to prevent any potential complications and ensure the client receives appropriate care as soon as possible. Placing the client in a semi-Fowler's position or administering supplemental oxygen therapy may provide temporary relief, but the priority is to seek immediate medical attention. Consulting with the healthcare provider ensures that the client receives the necessary interventions promptly.

Correct Answer: B

Rationale: The laboratory test used to monitor the therapeutic effect of warfarin therapy is the International Normalized Ratio (INR). Warfarin is a commonly prescribed anticoagulant medication that works by inhibiting the action of vitamin K-dependent clotting factors. Maintaining the INR within the target range specific to the indication for anticoagulation (e.g., DVT prevention or treatment) is essential to balance the risk of bleeding and clotting.

Correct Answer: A

Rationale: In a pregnant woman presenting with severe abdominal pain, syncope, signs of hypovolemic shock, and gestational age of 6 weeks, the most likely cause is an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, commonly in the fallopian tube. As the pregnancy grows and the tube stretches, it can lead to rupture, causing severe abdominal pain, internal bleeding, and signs of shock. This is a life-threatening emergency that requires prompt diagnosis and management. It is important to consider ectopic pregnancy in any pregnant woman presenting with abdominal pain and signs of shock, especially in the first trimester.

Correct Answer: D

Rationale: The principle of beneficence emphasizes the duty to do good and act in the best interest of others. By ensuring that all necessary supplies and medicines are available for the care of the community, Nurse Erica is practicing beneficence. She is fulfilling her obligation to promote the health and well-being of the community members by providing them with the resources they need for their care. This demonstrates her commitment to doing good and acting in a way that benefits those under her care, which aligns with the principle of beneficence in nursing practice.