Janet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows serum bilirubin approximately 2 gdL, albumin 3.1 gdL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to

Correct Answer: B

Rationale: The correct answer is B: Infuse albumin and fresh frozen plasma. Given Janet's post-hepatic resection status and abnormal lab values indicating liver dysfunction (elevated bilirubin, low albumin, prolonged prothrombin time, elevated AST and ALT), she is at risk for coagulopathy and hypoalbuminemia. Infusing albumin can help improve her oncotic pressure and fluid balance, while fresh frozen plasma can replenish clotting factors to address the prolonged prothrombin time. This intervention aims to stabilize her condition before transferring to the general medical floor. Canceling the transfer (Choice A) is not necessary if appropriate interventions can be taken. Repeating labs the next day (Choice C) delays potentially needed treatments. Preparing for reoperation (Choice D) is not indicated based on the information provided.

Correct Answer: B

Rationale: The correct answer is B. It is important to manage medications appropriately preoperatively to minimize complications. Metoprolol, a beta blocker, should be continued up until the day of surgery to prevent rebound hypertension or tachycardia. Metformin should be held on the day of surgery to avoid potential lactic acidosis due to its effects on kidney function. Warfarin should be discontinued 5-7 days before surgery to reduce the risk of bleeding. Vitamin E can increase bleeding risk and should be discontinued. Choice A is incorrect as not all medications should be taken until the morning of surgery. Choice C is incorrect as warfarin should be held earlier than 5 days before surgery. Choice D is incorrect as metformin should be held on the day of surgery, regardless of blood sugar levels, to prevent lactic acidosis.

Correct Answer: B

Rationale: The correct answer is B: Low acidity levels which favor growth of candida albicans. During pregnancy, hormonal changes can lead to increased vaginal pH, creating a more alkaline environment that promotes the growth of candida albicans, causing vulvovaginitis. Choice A is incorrect as E. coli thrives in alkaline environments. Choice C, existing chronic hypertension, is unrelated to the development of vulvovaginitis. Choice D, lowered osmotic pressure, does not directly influence the growth of candida albicans.

Correct Answer: A

Rationale: The correct answer is A because signs of obstructed labor include a dry vagina due to prolonged pressure, oedema of the cervix due to prolonged contractions, and caput succedaneum which is swelling of the baby's scalp from prolonged pressure. Choice B is incorrect because plenty of amniotic fluid is not a sign of obstructed labor. A hot/dry vagina is not a typical sign of obstructed labor. Meconium-stained liquor can be a sign of fetal distress, but not specifically obstructed labor. Choice C is incorrect because meconium-stained liquor is a sign of fetal distress, not necessarily obstructed labor. A hot/dry vagina is not a typical sign of obstructed labor. Diluted urine is not a typical sign of obstructed labor. Choice D is incorrect because while caput succedaneum is a sign of obstructed labor, oedema of the cervix is more indicative of obstructed labor than plenty of amni

Correct Answer: A

Rationale: The correct answer is A: Veracity and beneficence. Veracity refers to truthfulness, and the AGACNP is facing a conflict between being honest with the patient about the need for reintubation (veracity) and providing beneficence by ensuring the patient receives necessary medical care to prevent harm. The patient's autonomy and right to make decisions are not directly in conflict since the patient is conscious, and autonomy is respected by honoring the patient's wishes. Justice is also not in conflict here as it does not pertain to the immediate ethical dilemma of reintubation. Autonomy and beneficence are not in direct conflict as the patient's autonomy is being respected by allowing them to make an informed decision. Nonmalfeasance is not directly applicable in this scenario.

Correct Answer: C

Rationale: The correct answer is C because precipitate labor is defined as labor that is concluded in less than three hours. This rapid progression can lead to complications such as increased risk of tearing and fetal distress. Choice A is incorrect because it describes a different condition where the cervix fails to dilate despite good contractions. Choice B is incorrect as it contradicts the definition of precipitate labor. Choice D is incorrect as it describes a scenario where the cervix fails to dilate due to poor uterine contractions, which is not characteristic of precipitate labor. Therefore, choice C is the correct answer based on the definition and characteristics of precipitate labor.

Correct Answer: D

Rationale: The correct answer is D because the placenta performs multiple functions in managing fetal waste products. It filters toxins, facilitates nutrient absorption, and removes carbon dioxide. The placenta acts as a barrier between the mother and the fetus, allowing for the exchange of nutrients and waste products. Therefore, all of the above choices are correct in describing the role of the placenta in managing fetal waste products. The other choices are incorrect because they do not encompass all the functions that the placenta serves in this context.

Correct Answer: C

Rationale: The correct answer is C because culture and level of education can significantly impact how women perceive and react to labor pain. Culture shapes beliefs, norms, and attitudes towards pain, influencing coping mechanisms. Education can enhance understanding of pain management techniques. Option A lacks specificity on how preparedness and fatigue affect perception. Option B oversimplifies by only considering culture and age. Option D overlooks the influence of education and focuses solely on anxiety and number of deliveries.

Correct Answer: B

Rationale: The correct answer is B: Fundus. In uterine inversion, the uterus is turned inside out, with the fundus protruding through the cervix. The fundus is the last part to be replaced during the reduction process because it is the uppermost part of the uterus. The cervix, isthmus, and body are other parts of the uterus that are not the last to be replaced in uterine inversion. The cervix is the lower part, the isthmus is the narrow portion, and the body is the main part of the uterus. Hence, the fundus is the correct choice for the last part to be replaced in uterine inversion.