The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNRthe patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here?

Correct Answer: C

Rationale: The correct answer is C: Autonomy and beneficence. Autonomy refers to the patient's right to make their own decisions regarding their healthcare. In this case, the patient is refusing reintubation, exercising his autonomy. However, beneficence, the duty to act in the patient's best interest, also comes into play as the patient's refusal could lead to respiratory failure and death. The conflict arises from balancing the patient's autonomy with the healthcare provider's duty to provide beneficial care. Choices A, B, and D are incorrect because they do not accurately capture the ethical conflict present in the scenario. Veracity (A) refers to truthfulness, which is not the primary issue here. Nonmalfeasance (B) is the duty to do no harm, which is not directly relevant to the conflict between the patient's autonomy and the need for beneficial care. Justice (D) relates to fairness in resource allocation and is not the primary issue in this case.

Correct Answer: D

Rationale: Step-by-step rationale for why choice D (Atelectasis) is correct: 1. Ascorbic acid deficiency can lead to impaired lung function, increasing the risk of atelectasis. 2. Anemia can cause decreased oxygen-carrying capacity, contributing to atelectasis. 3. Volume contraction can lead to reduced lung expansion, further predisposing to atelectasis. Summary: - Choice A (Prolonged intubation): Intubation duration is more related to respiratory complications, not directly linked to the mentioned risk factors. - Choice B (Thromboembolism): Risk factors like immobility and hypercoagulability are more relevant to thromboembolism. - Choice C (Delayed wound healing): More associated with factors like malnutrition and impaired immune function rather than the mentioned risk factors.

Correct Answer: C

Rationale: The correct answer is C: Extraplacental haemorrhage. Incidental antepartum haemorrhage refers to bleeding from a source other than the placenta, such as the cervix or vagina, before delivery. Intraplacental haemorrhage (choice A) refers to bleeding within the placenta itself, not outside it. Intrapartum haemorrhage (choice B) occurs during labor and delivery, not before. Preterm haemorrhage (choice D) is not a specific term used to describe antepartum bleeding. Therefore, the correct term for antepartum bleeding from a non-placental source is extraplacental haemorrhage.

Correct Answer: A

Rationale: The correct answer is A: Avoidance of elective surgery and nonessential medications. This is the initial management for a patient with thrombocytopenia and abnormal bleeding time, possibly indicating immune thrombocytopenic purpura (ITP). Avoiding surgery and medications that can worsen thrombocytopenia is crucial to prevent bleeding complications. Prednisone (B) is not the first-line treatment for ITP, especially without confirming the diagnosis. Monoclonal antibody therapy (C) such as rituximab is usually reserved for refractory cases. Splenectomy (D) is considered only if other treatments fail as a last resort.

Correct Answer: D

Rationale: The correct answer is D because the main aims of an exchange transfusion procedure are to control haemolysis (process of breaking down red blood cells) and restore hemoglobin levels. This procedure involves removing the baby's blood and replacing it with donor blood to prevent complications from severe jaundice or other conditions. Choice A is incorrect because exchange transfusion does not necessarily cure haemolysis, but it helps control it. Choice B is incorrect as the procedure focuses on managing specific issues rather than removing all toxic materials. Choice C is incorrect because it does not directly address the primary goals of an exchange transfusion.

Correct Answer: C

Rationale: The correct answer is C: Oligohydramnios. Shoulder presentation occurs when the baby presents shoulder-first rather than head-first during birth. Oligohydramnios, a condition characterized by low levels of amniotic fluid, can lead to decreased uterine space, increasing the chances of abnormal fetal positioning. Macerated fetus (A) is associated with fetal decomposition, not shoulder presentation. Postdates pregnancy (B) is linked to increased risk of macrosomia but not shoulder presentation. Placenta abruption (D) is a separation of the placenta from the uterus, not a direct cause of shoulder presentation.

Correct Answer: B

Rationale: It is important to monitor blood pressure in pregnant women to detect preeclampsia, a serious condition that can lead to complications for both the mother and the baby. Preeclampsia is characterized by high blood pressure and protein in the urine, and early detection is crucial for timely intervention. Regular monitoring allows healthcare providers to identify and manage preeclampsia promptly, reducing the risk of severe complications such as eclampsia and organ damage. Anemia, preterm labor, and gestational diabetes are important aspects of prenatal care but are not directly related to the need for regular blood pressure monitoring in pregnant women.

Correct Answer: C

Rationale: The correct answer is C: Precipitate labor. Precipitate labor refers to a rapid labor and delivery process. It is matched with the statement in column A because it is associated with a sudden and quick progression of labor, leading to a rapid delivery of the baby. The other choices are incorrect because: A: Colicky uterus - This term is not related to rapid labor but rather refers to uterine contractions that are painful and intermittent. B: Constriction ring dystocia - This term describes a condition where there is a tight band around the uterus, causing difficulty in the delivery process, which is different from the rapid progression seen in precipitate labor. D: Cervical dystocia - This term refers to a condition where there are issues with the dilation or effacement of the cervix, not directly related to the speed of labor as in precipitate labor.

Correct Answer: C

Rationale: The correct answer is C: Baseline cardiac catheterization. Given the presence of a new onset grade IIVI crescendo-decrescendo cardiac murmur, a baseline cardiac catheterization is necessary to assess the severity and etiology of the murmur. This procedure will provide crucial information on the structure and function of the heart, helping to determine the appropriate management plan. A: Annual or biannual serial echocardiography is not necessary as the patient is currently asymptomatic and echocardiography has already revealed mild aortic calcification. B: Modification of activity level is not the immediate priority as the patient is very active physically and not reporting any limitations to daily activities. D: Statin therapy is not indicated based solely on the presence of a new murmur without further assessment of cardiac function through cardiac catheterization.