The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal

Correct Answer: A

Rationale: The correct answer is A: Increased MCV. Following splenectomy, there is a compensatory increase in red blood cell production, leading to an increase in Mean Corpuscular Volume (MCV) due to the release of larger, younger red blood cells into circulation. This is known as stress erythropoiesis. Summary: B: Increased Hgb - Hgb levels may not necessarily increase post-splenectomy as it depends on factors such as bleeding or hydration status. C: Increased platelets - Platelet count is not expected to increase immediately post-splenectomy. D: Increased albumin - Albumin levels are not directly influenced by splenectomy for idiopathic thrombocytopenia purpura.

Correct Answer: D

Rationale: The correct answer is D because Down syndrome is primarily caused by trisomy of chromosome 21. This means there is an extra copy of chromosome 21, leading to the characteristic features of the syndrome. Mosaicism and translocation of chromosome 21 can also result in Down syndrome, albeit less frequently. Option A includes deletion, which is not a common cause of Down syndrome. Option B lists duplication, which is not a typical mechanism for Down syndrome. Option C includes deletion and mosaicism, but trisomy is the main cause of Down syndrome, making option D the most accurate choice.

Correct Answer: A

Rationale: The correct answer is A because uterine rupture can lead to severe complications such as hemorrhage from blood vessels tearing, uterine atony causing failure of the uterus to contract, infection due to exposure of internal tissues, and peritonitis from inflammation of the abdominal lining. Choices B and C are incorrect as they list complications that are not directly associated with uterine rupture. Preterm labor, cord prolapse, uterine prolapse, fetal distress, placental abruption are potential consequences of other obstetric complications but not specifically uterine rupture. Therefore, choice A is the most appropriate answer given the context of uterine rupture.

Correct Answer: D

Rationale: The correct answer is D: Splenectomy. In this case, the patient presents with signs of immune thrombocytopenic purpura (ITP) with low platelet count and bleeding time prolongation. Splenectomy is the definitive treatment for ITP as the spleen is the site of platelet destruction. Avoiding elective surgery and medications (choice A) may be necessary to prevent bleeding complications but do not address the underlying issue. Prednisone (choice B) is used for acute treatment but not for long-term management. Monoclonal antibody therapy (choice C) is an option for refractory cases but not first-line therapy.

Correct Answer: B

Rationale: The correct answer is B: Adjuvant therapies. Adjuvant therapies are additional treatments given after the primary treatment, usually surgery, to reduce the risk of cancer recurrence. In the context of fixed tumors, adjuvant therapies can help target any remaining cancer cells that may not have been completely removed during surgery, thus improving the chances of a successful outcome. En bloc resection (A) is important for complete tumor removal but may not always be feasible in fixed tumors. Neoadjuvant therapies (C) are given before surgery and are not typically used for fixed tumors. Elective lymph node dissection (D) may be necessary in some cases but is not the best approach for curative surgery in fixed tumors.