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: D

Rationale: The correct answer is D: Compound. In compound presentation, a hand or foot is alongside the presenting part, usually the head. This can complicate the delivery process. A: Footling presentation means the foot presents first. B: Transverse presentation is when the baby is lying sideways. C: Cephalic presentation is normal, with the head presenting first. In this scenario, D is the correct answer as it specifically describes the situation where a hand or foot is alongside the presenting part.

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: Mallory-Weiss syndrome is caused by severe vomiting leading to tears in the esophagus. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy, which can result in Mallory-Weiss syndrome. Placenta praevia, cardiac disease, and postpartum hemorrhage are not directly associated with Mallory-Weiss syndrome.

Correct Answer: B

Rationale: The correct answer is B: Retroperitoneal bleeding. The physical survey described focuses on assessing for internal bleeding within the retroperitoneal space following a serious motor vehicle accident. The rectovaginal examination, inspection of the urethral meatus, and palpation of pelvic landmarks help evaluate for signs of pelvic fracture and internal bleeding. These assessments help identify potential sources of retroperitoneal bleeding, which can be a life-threatening complication of trauma. Peritoneal bleeding (choice A) involves bleeding within the abdominal cavity, which is less likely in this scenario. Paresthesia (choice C) refers to abnormal sensations like tingling or numbness, which are not typically assessed through physical examination in this context. Pelvic fracture (choice D) is a possible outcome of trauma but does not directly assess for retroperitoneal bleeding.

Correct Answer: C

Rationale: The correct answer is C: Place the client in knee-chest position. This helps relieve pressure on the cord and prevents further compression, ensuring adequate blood flow to the fetus. Pushing the cord back in (A) can worsen the situation. Covering the cord (B) does not address the urgent need to relieve pressure. Immediate vaginal delivery (D) may not be possible or safe at 32 weeks. Placing the client in the knee-chest position is the most immediate and effective action to manage cord prolapse.

Correct Answer: A

Rationale: The correct statement about shoulder dystocia is A: It’s an impaction of the anterior shoulder after delivery of the head. This is accurate as shoulder dystocia occurs when the anterior shoulder becomes impacted behind the maternal pubic symphysis. This can lead to difficulty delivering the shoulders after the head is delivered. B is incorrect as shoulder dystocia involves the anterior shoulder, not the posterior. C is incorrect as shoulder dystocia is not related to compound presentation. D is incorrect as shoulder dystocia is an obstetric emergency that requires prompt intervention to prevent complications for both the mother and the baby.

Correct Answer: C

Rationale: The correct answer is C: Puerperal pyrexia. Maternal febrile condition within the first three weeks postpartum is suggestive of puerperal pyrexia, which is defined as a fever of 38°C or higher occurring after the first 24 hours post-delivery. This condition is commonly caused by endometritis, a uterine infection following childbirth. Puerperal sepsis (choice A) is a more severe form of infection involving systemic symptoms, while puerperal thrombosis (choice B) refers to blood clot formation. Puerperal shock (choice D) is a life-threatening condition resulting from severe infection or hemorrhage, which may present with fever but is not the primary symptom.

Correct Answer: D

Rationale: The correct answer is D because all the choices (A, B, and C) are risks associated with cesarean sections. Infection can occur at the incision site, blood loss is a common concern during surgery, and cesarean sections typically have a longer recovery time compared to vaginal delivery. Therefore, all of these risks are potential complications of undergoing a cesarean section. The other choices (A, B, and C) are incorrect individually because they only represent a subset of the risks associated with cesarean sections, while choice D encompasses all potential risks.