Correct Answer: A

Rationale: Asking the patient to clench their teeth is a common way to assess muscle strength in the face, particularly the muscles involved in the jaw. Clenching the teeth engages the muscles responsible for this action, such as the masseter muscle. Assessing the ability to clench the teeth provides insight into the strength and function of these facial muscles.

Correct Answer: A

Rationale: The theory of constructivism holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and interpretations. This theory emphasizes that learners actively construct their knowledge and understanding of the world through their experiences and interactions. In constructivism, learning is seen as a process of building upon prior knowledge, rather than passively receiving information. Learners are encouraged to explore, question, and make sense of new information based on their existing beliefs and experiences. Therefore, the constructivist theory aligns with the idea that learning involves the assimilation and accommodation of new experiences and interpretations.

Correct Answer: A

Rationale: A. Measuring abdominal girth every 4 to 8 hours is important to monitor for signs of fluid accumulation in the abdominal cavity, indicating potential fluid volume deficit.

Correct Answer: A

Rationale: The most appropriate response by the nurse is Option A, "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure." This response is accurate because anaphylactic shock, which is caused by severe allergic reactions, can be life-threatening if not treated promptly with epinephrine (EpiPen™). While heart failure is a serious type of shock, anaphylactic shock is specifically related to severe allergic reactions and not heart failure. The nurse's response educates the mother about the seriousness of anaphylactic shock in relation to allergic responses and highlights that other types of shock can involve different organ system failures.

Correct Answer: A

Rationale: Disseminated intravascular coagulation (DIC) is a complex, life-threatening condition characterized by widespread activation of coagulation within the blood vessels. In the early stages of DIC, there is excessive clot formation (formation of small clots) throughout the body due to the dysregulation of coagulation factors. As the disease progresses, the body's clotting factors become depleted, leading to a state of systemic anticoagulation. This anticoagulant state increases the risk of hemorrhage (bleeding) as the blood is no longer able to adequately clot. Therefore, hemorrhage is a pathological change that occurs late in the course of DIC.