Nurse Sarah reads the physician's prescription to administer methylergonovine maleate (Methergin) intramuscularly after delivery. The rationale for giving this medication is which of the following?

Correct Answer: B

Rationale: The correct answer is B: Prevents postpartum hemorrhage. Methylergonovine maleate is a uterotonic medication used to prevent and treat postpartum hemorrhage by causing strong uterine contractions, which help to control bleeding after delivery. It is not used to reduce lochia drainage (choice A), decrease uterine contractions (choice C), or maintain normal blood pressure (choice D). By understanding the pharmacological action of methylergonovine maleate in preventing postpartum hemorrhage, we can confidently select choice B as the correct answer.

Correct Answer: D

Rationale: The correct answer is D because referring the patient to a pain management specialist for evaluation is essential in this scenario. The specialist can conduct a comprehensive assessment to identify the underlying causes of the intractable pain and recommend a tailored pain management plan. This approach ensures a multidisciplinary approach to address the complex nature of the patient's pain. Choice A is incorrect because simply increasing the dosage of the current opioid medication may not effectively address the underlying cause of the pain and can lead to potential side effects or opioid tolerance. Choice B is incorrect as switching to a different opioid medication without a thorough evaluation may not guarantee better pain control and can increase the risk of adverse effects or inadequate pain relief. Choice C is incorrect as administering adjuvant analgesic medications without addressing the root cause of the pain may not provide adequate pain relief and does not address the need for a specialized pain management plan.

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: Administer opioid analgesics to alleviate abdominal pain and discomfort. Opioid analgesics are effective in managing severe pain associated with malignant bowel obstruction. By providing adequate pain relief, the patient's comfort and quality of life can be significantly improved. Choice A is incorrect because initiating bowel rest and maintaining the patient in a semi-Fowler's position may not effectively address the severe pain and discomfort experienced by the patient. Choice C is incorrect as surgical intervention in this scenario may not be appropriate or feasible due to the advanced stage of cancer and the presence of malignant bowel obstruction. Choice D is incorrect as antiemetic medications primarily target nausea and vomiting, which may not be the primary symptoms of concern in this case. Focusing on pain management should be the priority.

Correct Answer: D

Rationale: The correct answer is D: Breastfeeding. HIV transmission from mother to infant can occur through breast milk due to the presence of the virus in breast milk. Other choices such as A: Bathing, B: Bottlefeeding, and C: Washing of vagina do not involve direct contact with potentially infected body fluids like breast milk, making them less likely to transmit the virus. Breastfeeding is a well-documented mode of HIV transmission from mother to infant, hence it is the correct choice in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Group A beta-hemolytic Streptococcus (GAS). GAS is the most likely organism responsible for this presentation, known as acute bacterial tonsillitis. GAS commonly causes symptoms such as throat pain, odynophagia, fever, tonsillar enlargement with exudates, and cervical lymphadenopathy. Streptococcal pharyngitis is a common bacterial infection of the throat caused by GAS. The other options are less likely as Streptococcus pneumoniae typically causes pneumonia and Haemophilus influenzae is associated with respiratory tract infections. Epstein-Barr virus (EBV) commonly causes infectious mononucleosis, which presents with different symptoms than those described in the question.

Correct Answer: A

Rationale: The correct answer is A: Empiric antibiotic therapy directed against common pathogens. This is recommended for managing PID because it helps treat the infection and prevent complications. Antibiotics target the underlying bacterial infection causing PID. Surgical exploration (B) is not the initial treatment for PID. Hormonal therapy (C) is not indicated for PID management. Symptomatic treatment with NSAIDs (D) can help with pain but does not address the infection itself.

Correct Answer: C

Rationale: In a postpartum client who presents with severe abdominal pain, nausea, and vomiting, it is crucial to assess for signs of peritonitis or surgical abdomen. These signs may include rebound tenderness, guarding, rigidity, and fever. Peritonitis is a serious condition that may require immediate surgical intervention. Administering antiemetic medication, encouraging clear fluids, or providing a heating pad may not address the underlying cause of the symptoms and delay appropriate treatment. Assessing for signs of peritonitis or surgical abdomen is crucial for prompt identification and management of the client's condition.

Correct Answer: B

Rationale: The correct answer is B: Initiate non-invasive positive pressure ventilation (NIPPV) for respiratory support. In acute exacerbations of COPD, NIPPV helps improve ventilation and oxygenation, reducing the work of breathing and preventing the need for intubation. This intervention is a priority as it can rapidly stabilize the patient's respiratory status. A: Administering bronchodilator medications is important in COPD management, but in severe exacerbations, NIPPV takes precedence. C: Arterial blood gas analysis is important for assessing oxygenation and ventilation status, but it does not directly address the acute respiratory distress. D: Chest physiotherapy can help with airway clearance in COPD, but in acute exacerbations, respiratory support with NIPPV is more urgent.