Sara S. is a 41-year-old patient who has just had a bone marrow transplant. The AGACNP knows that which medication will be used to decrease her risk of graft-versus-host reaction?

Correct Answer: B

Rationale: The correct answer is B: Cyclosporine. Cyclosporine is an immunosuppressant medication commonly used post-bone marrow transplant to prevent graft-versus-host disease. It works by inhibiting T-cell activation and proliferation, reducing the risk of the donor's immune cells attacking the recipient's tissues. Immune globulin (A) is used for passive immunization, not prevention of graft-versus-host reaction. Prophylactic antibiotics (C) are used to prevent infections post-transplant, not graft-versus-host disease. Systemic corticosteroids (D) may be used to treat graft-versus-host disease but are not the first-line prophylactic medication.

Correct Answer: B

Rationale: The correct answer is B: reduce serum sodium concentration by infusing a 0.45% sodium chloride solution. In hyponatremic hyperosmolality, the primary goal is to correct the low serum sodium levels. A 0.45% sodium chloride solution is hypotonic, which helps to slowly correct the serum sodium concentration without causing rapid shifts in osmolality. Infusing a hypotonic solution will gradually increase the serum sodium levels, addressing the underlying issue. Choices A, C, and D are incorrect because they do not directly address the low serum sodium levels, which is essential in treating hyponatremic hyperosmolality. Infusing a 5% dextrose in 0.2% sodium chloride solution (Choice A) or a 5% dextrose in water solution (Choice D) would not correct the low sodium levels. Replenishing volume with a 0.9% sodium chloride solution (Choice C) would not directly

Correct Answer: A

Rationale: The correct answer is A: Bradycardia. Hypothermia neonatorum is characterized by low body temperature in newborns, which can lead to bradycardia as the heart rate decreases in response to the cold stress. Bradycardia is a common physiological response to hypothermia as the body tries to conserve energy and maintain vital functions. Hyperglycemia, hypoventilation, and hyperventilation are not specific clinical features of hypothermia neonatorum. Hyperglycemia is more commonly associated with conditions like diabetes, hypoventilation could be a sign of respiratory distress, and hyperventilation is usually seen in response to metabolic acidosis or anxiety.

Correct Answer: B

Rationale: The correct answer is B: Preservation of sensorineural hearing. In cholesteatoma, surgery aims to remove the lesion and prevent further damage to the ossicles and inner ear structures. Preserving sensorineural hearing is crucial to maintain auditory function post-surgery. A: Production of a dry ear is important to prevent recurrence, but not the primary goal. C: Debridement of infection is necessary, but the main aim is to address the cholesteatoma itself. D: Restoration of the tympanic membrane may be needed but is not the primary objective in cholesteatoma surgery.

Correct Answer: D

Rationale: The correct answer is D (>90%). Mr. Mettenberger had a reexpansion of his second spontaneous pneumothorax this year, indicating a high recurrence risk. Spontaneous pneumothorax recurrence rates are high, especially in young males. Factors such as smoking history, gender, and prior occurrences contribute to increased risk. Mr. Mettenberger's cessation of smoking reduces but does not eliminate the risk. Choices A, B, and C are too low, given his history and current situation. Choice D is the most appropriate due to the high likelihood of recurrence based on his medical history and risk factors.

Correct Answer: C

Rationale: The correct answer is C because partial response in cancer therapy typically refers to a reduction in tumor size by more than 50%. This reduction indicates some positive effect of the treatment on the tumor. Choice A is incorrect because partial response is not solely based on the percentage of patients demonstrating remission, it is about the tumor response. Choice B is incorrect because survival at 5 years is related to overall survival rate, not specifically to the tumor response. Choice D is incorrect because the conversion from unresectable to resectable is more related to the operability of the tumor, rather than the response to chemotherapy.

Correct Answer: B

Rationale: The correct answer is B: Hyperbaric oxygen. Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room, which can help reduce gas cysts in the gastrointestinal tract by increasing oxygen delivery to tissues. This promotes healing and reduces symptoms associated with pneumatosis. A: Several days of oxygen by face mask is not as effective as hyperbaric oxygen therapy in treating pneumatosis, as it does not provide the same level of pressurized oxygen delivery to tissues. C: Surgical resection may be considered in severe cases of pneumatosis where conservative treatments have failed, but it is not the first-line treatment option. D: Treatment of underlying disease is important in managing pneumatosis, but it may not directly address the gas cysts themselves. Hyperbaric oxygen therapy specifically targets the gas cysts to alleviate symptoms.

Correct Answer: A

Rationale: The correct answer is A because immediate cesarean is crucial to prevent further complications and ensure the safety of the mother and baby. Monitoring for signs of shock is essential to detect any deterioration in the mother's condition. Fluid resuscitation helps stabilize the mother's hemodynamic status. Option B is incorrect as observation alone may delay necessary interventions. Option C is partially correct as immediate cesarean is necessary but does not address monitoring for shock and fluid resuscitation. Option D is incorrect as continuous monitoring alone is insufficient to manage incomplete uterine rupture.

Correct Answer: C

Rationale: The presence of a turtle sign during delivery is indicative of shoulder dystocia. This occurs when the baby's shoulders get stuck behind the mother's pelvic bones during delivery, leading to difficulty in delivering the baby's shoulders. The turtle sign refers to the retraction of the baby's head back into the birth canal after delivery of the head, resembling a turtle retracting into its shell. This sign is a clear indicator of shoulder dystocia. Choices A, B, and D are incorrect because prolonged labor, occipito-posterior position, and shoulder presentation do not specifically involve the retraction of the baby's head like in shoulder dystocia.