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: B

Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.

Correct Answer: A

Rationale: The correct answer is A: Inspiration. Laryngeal stridor is caused by narrowed or obstructed airway, resulting in noisy breathing. During inspiration, the air is drawn through the narrowed larynx, causing the stridor sound. During expiration, the air is leaving the body, so the noise may not be as prominent. Choices C and D, feeding and play, are unrelated to the respiratory process and do not affect the presence of laryngeal stridor.

Correct Answer: A

Rationale: The correct answer is A: Clonic stage. In eclampsia, the clonic stage is characterized by violent contraction and relaxation of the whole body due to generalized seizures. During this stage, rhythmic jerking movements occur. The other choices are incorrect because: B: Coma stage - In this stage, the individual is unconscious and not experiencing violent body movements. C: Premonitory stage - This stage includes warning signs like headache and visual disturbances, but not the violent body movements seen in eclampsia. D: Tonic stage - This stage involves sustained muscle contractions without relaxation, unlike the alternating contraction and relaxation seen in the clonic stage of eclampsia.

Correct Answer: D

Rationale: The correct answer is D: All of the above. Multiple gestations are at higher risk for complications such as premature labor, where contractions start before 37 weeks, leading to preterm birth. Twin-to-twin transfusion syndrome can occur in identical twins sharing a placenta, causing unequal blood flow. Preeclampsia, characterized by high blood pressure and organ damage, is more common in multiple pregnancies. Therefore, all choices A, B, and C are correct as they are common complications associated with multiple gestations.

Correct Answer: C

Rationale: The correct answer is C: Occipito-posterior. This position occurs when the baby's head is facing forward but towards the mother's spine. This position can cause intense back pain during labor because the baby's head puts pressure on the mother's lower back. Occipito-anterior (A) is the most common and ideal position for labor. Transverse position (B) is when the baby is lying sideways, which may cause prolonged labor but not necessarily intense back pain. Occipito-lateral (D) is a less common position where the baby's head is facing sideways, which may not specifically cause intense back pain.

Correct Answer: A

Rationale: The correct answer is A: Prescribe anti-nausea medication. This is the most appropriate choice to manage hyperemesis gravidarum, a severe form of morning sickness. Anti-nausea medication can help alleviate symptoms and prevent dehydration. Choice B (Recommend bed rest) may not directly address the nausea and vomiting associated with hyperemesis gravidarum. Choice C (Suggest a high-protein diet) and D (Advise on exercise) may not be effective in managing the condition or providing immediate relief from symptoms. Anti-nausea medication is the most evidence-based approach to support a woman with hyperemesis gravidarum.

Correct Answer: C

Rationale: The correct answer is C: Mauriceau-Smellie-Veit maneuver for delivery of breech with an extended head. This maneuver involves flexing the head while still in the vagina to allow for easier delivery. The Burns Marshall maneuver (A) is for impacted fetal shoulders, Lovset maneuver (B) is for shoulder dystocia, and McRobert's maneuver (D) is for shoulder dystocia as well. The Mauriceau-Smellie-Veit maneuver is specifically designed for delivering a breech with an extended head, making it the correct choice in this scenario.