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: D

Rationale: The correct answer is D because both statements A and C are true. Older mothers have a higher risk of developing preeclampsia due to age-related complications. Additionally, advanced maternal age is associated with an increased likelihood of requiring a cesarean section due to factors like decreased uterine elasticity. Statement B is incorrect as younger mothers are not at higher risk of miscarriage compared to older mothers. This is because maternal age is not a significant factor in miscarriage risk.

Correct Answer: C

Rationale: The correct answer is C: A long history of alcohol use. In this case, T. S. is brain dead and has a donor notation. However, a long history of alcohol use can lead to liver damage, making her liver unsuitable for donation. Encephalopathy (A) is a brain disorder but does not necessarily impact liver suitability. Hepatitis C infection (B) can affect the liver, but it doesn't automatically disqualify someone from being a donor. Biliary cirrhosis (D) refers to a specific liver condition, but it does not preclude someone from being a liver donor unless it has severely damaged the liver beyond use.

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.

Correct Answer: C

Rationale: The correct answer is C: Gastric retention. Mrs. Coates' symptoms of persistent and progressive discomfort are not likely due to gastric retention because she underwent a duodenal resection for a bleeding ulcer, which would bypass the stomach. Therefore, gastric retention is not a possible cause. A: Colic due to return of peristalsis is a possible cause as peristalsis returning after surgery can cause discomfort. B: Leakage from the duodenal stump is a possible cause as it can lead to abdominal discomfort postoperatively. D: Hemorrhage is a possible cause given her history of bleeding ulcer and surgery.

Correct Answer: B

Rationale: The correct answer is B: Placental insufficiency. Prolonged pregnancy can lead to decreased placental function, resulting in inadequate oxygen and nutrients for the fetus. This can lead to complications such as intra-uterine growth restriction and fetal distress. Option A (Intra-uterine oligohydramnios) is a consequence of decreased amniotic fluid levels but not directly associated with prolonged pregnancy. Option C (Fetal post-maturity syndrome) refers to the complications seen in a post-term newborn, not maternal risks. Option D (Large for gestational age baby) is a consequence of prolonged pregnancy but does not directly impact maternal health.

Correct Answer: B

Rationale: The correct answer is B: Hypoglycaemia. Neonates born to diabetic mothers are at risk of hypoglycaemia due to high insulin levels in utero. Feeding the newborn within the first 15 minutes helps maintain blood glucose levels. Hypocalcaemia, hyponatraemia, and hypokalaemia are not typically immediate concerns in neonates born to diabetic mothers.

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: A

Rationale: The correct answer is A: No further care, because the chest radiograph is negative. In this scenario, Jennifer has a positive PPD test with a 12-mm induration but a negative chest radiograph, indicating latent TB infection. The negative chest radiograph rules out active TB disease. As a result, Jennifer does not require further evaluation or treatment for active TB. The positive PPD alone does not warrant further investigations such as Quantiferon assay (B) or prophylactic therapy (C) as these are not indicated for latent TB infection without active disease. Beginning therapy for pulmonary TB (D) is unnecessary and potentially harmful as Jennifer does not have active TB. Thus, the correct course of action is to provide no further care based on the negative chest radiograph.