The physician ordered sonography. The nurse informs the ultrasound unit in charge and prepares the patient for the procedure. The patient asks the importance of the procedure, the nurse CORRECT response is________.

Correct Answer: D

Rationale: Sonography, also known as ultrasound, is a non-invasive imaging technique that uses high-frequency sound waves to create images of structures inside the body. In the context of a patient who is pregnant, sonography is commonly used to assess the well-being of the fetus. It allows healthcare providers to monitor the growth and development of the fetus, evaluate the placenta, amniotic fluid levels, and detect any abnormalities that may be present.

Correct Answer: D

Rationale: After childbirth, the uterus undergoes involution, which is the process of returning to its pre-pregnant size and location. Initially, the fundus is firm and located at or just below the level of the umbilicus immediately after delivery. Over the next 24 hours, the fundus should gradually decrease in height as involution progresses. By the day after delivery, the nurse would expect the fundal assessment to be in line with the umbilicus or slightly below it, indicating normal involution of the uterus. If the fundus remains high or deviates from this expected progression, further assessment and intervention may be needed to prevent complications such as postpartum hemorrhage.

Correct Answer: B

Rationale: The patient's presenting symptoms of chest pain worsened by inspiration and relieved by sitting forward, with associated DVT in the lower extremity, suggest a high likelihood of pulmonary embolism. Chest pain that worsens with inspiration due to pleuritic involvement is a classic symptom of pulmonary embolism. Additionally, the presence of DVT in the lower extremity represents a risk factor for the development of pulmonary embolism, as clots originating in the deep veins can travel to the pulmonary circulation to cause an obstruction. Patients with pulmonary embolism may also exhibit signs of right heart strain, such as tachycardia, tachypnea, and sometimes hemoptysis.

Correct Answer: B

Rationale: Vitamin K is essential for the production of several clotting factors in the liver, including factors II, VII, IX, and X. In a patient with chronic liver disease, impaired liver function can lead to decreased synthesis of these clotting factors. As a result, there is an underlying deficiency of these clotting factors, leading to prolonged PT (prothrombin time) and aPTT (activated partial thromboplastin time). The mixing studies showing correction with normal plasma further support the diagnosis of a factor deficiency rather than an inhibitor, which helps in ruling out conditions like DIC or hemophilia.

Correct Answer: C

Rationale: Choosing option C, asking the patient about their cultural beliefs and preferences related to pain, demonstrates cultural competence in pain assessment. Pain experiences can vary greatly across different cultures, and a patient's cultural background can influence how they perceive and express pain. By inquiring about the patient's cultural beliefs and preferences, the nurse can gain a better understanding of the patient's perspective on pain. This information is crucial for providing individualized and culturally sensitive pain management interventions. It also shows respect for the patient's unique cultural background and helps build a trusting and collaborative relationship between the nurse and the patient.

Correct Answer: C

Rationale: Introducing solid food to a three-month-old baby is considered a poor healthcare attitude as it goes against the recommended guidelines for infant feeding. The World Health Organization (WHO) and other health authorities suggest exclusive breastfeeding for the first six months of a baby's life, followed by the introduction of safe and appropriate complementary foods. Introducing solid food too early can increase the risk of food allergies, obesity, and other health issues in babies. Therefore, a young mother introducing solid food to her three-month-old baby is evidence of a poor family coping index related to healthcare attitudes.

Correct Answer: A

Rationale: Von Willebrand disease is a hereditary bleeding disorder that results from a deficiency or dysfunction of von Willebrand factor (vWF), a protein that plays a key role in platelet adhesion and the initiation of primary hemostasis. The clinical manifestations of von Willebrand disease include recurrent mucocutaneous bleeding, such as nosebleeds, easy bruising, and gum bleeding. Laboratory findings typically show a prolonged bleeding time due to impaired platelet function, while platelet count, PT (prothrombin time), and aPTT (activated partial thromboplastin time) are usually normal. This distinguishes von Willebrand disease from other bleeding disorders such as hemophilia A (Factor VIII deficiency), which would show abnormal PT and aPTT due to deficiencies in specific clotting factors. Thrombocytopenia, on the other hand, would be characterized by a low platelet count

Correct Answer: B

Rationale: Assisting the client to a seated position on the toilet should be implemented first. This position promotes relaxation of the pelvic floor muscles and can help facilitate urinary elimination. It is a non-invasive and least intrusive intervention compared to performing intermittent catheterization or administering diuretic medication. Encouraging the client to drink plenty of fluids is important for promoting overall urinary function, but in this case, the priority is to aid the client in attempting to void first.

Correct Answer: A

Rationale: The theory that categorizes professionals as Novice to experts is by Patricia Benner. Patricia Benner developed the Novice to Expert model, which describes how individuals progress through five levels of proficiency in a skill or field. The five levels are Novice, Advanced Beginner, Competent, Proficient, and Expert. Benner's model is widely used in nursing education and research to understand how nurses develop their clinical skills and expertise over time.