Which of the following conditions does the nurse explain to the patient the contributory factor that slows uterine involution?

Correct Answer: C

Rationale: Prolonged labor is a condition in which labor lasts for an extended period, typically more than 20 hours for first-time mothers and more than 14 hours for experienced mothers. Prolonged labor can contribute to slowing down uterine involution because the prolonged pressure and strain on the uterus can affect its ability to return to its pre-pregnancy size and position. The prolonged contractions and stretching of the uterine muscles can hinder the normal process of uterine involution, leading to a delay in the uterus shrinking back to its non-pregnant state. Additionally, prolonged labor can increase the risk of postpartum complications such as excessive bleeding and infection, which can further impact uterine involution. Therefore, it is crucial for healthcare providers to monitor labor progress closely to prevent prolonged labor and its potential effects on uterine involution.

Correct Answer: B

Rationale: The first step that a nurse must keep in mind to start a nursing improvement project is to determine the nursing standards. This is crucial because nursing standards provide guidelines and benchmarks for quality care delivery. By identifying and understanding the established standards, nurses can assess current practices, identify areas that need improvement, and develop strategies to enhance patient care. Setting a clear foundation based on nursing standards is essential before moving forward with implementing corrective actions, determining findings for correction, or collecting data. Understanding and aligning with nursing standards from the outset ensures that the improvement project is focused on promoting best practices and achieving positive outcomes for patients.

Correct Answer: B

Rationale: The patient's presentation with recurrent episodes of vertigo, nausea, and nystagmus triggered by head movements, along with a positive Dix-Hallpike maneuver eliciting positional vertigo and rotary nystagmus, is classic for Benign Paroxysmal Positional Vertigo (BPPV). BPPV is the most common cause of vertigo due to a mechanical problem in the inner ear. In BPPV, brief episodes of vertigo are typically triggered by specific head movements, such as rolling over in bed or looking up. The characteristic rotary nystagmus observed in BPPV is consistent with the brief, intense episodes of vertigo that patients experience. The Dix-Hallpike maneuver, commonly used to diagnose BPPV, involves moving the patient from sitting to a supine head-hanging position and can induce vertigo and nystagmus in affected

Correct Answer: C

Rationale: In a postpartum client exhibiting signs of anxiety, restlessness, and palpitations, it is essential to prioritize notifying the healthcare provider immediately. These symptoms could indicate a serious condition such as postpartum preeclampsia, postpartum hemorrhage, or postpartum cardiomyopathy, which require urgent medical attention. It is crucial to rule out any life-threatening conditions and ensure the client receives appropriate treatment promptly. While relaxation techniques and deep breathing exercises can be helpful for anxiety management in some cases, in this situation, the priority is to ensure the client's safety and well-being by seeking medical evaluation and intervention. Administering a benzodiazepine without consulting the healthcare provider first could potentially mask symptoms or interact with other medications the client may be taking, making it unsafe to proceed without professional guidance.

Correct Answer: C

Rationale: A dental abscess is characterized by a localized collection of pus that results from a bacterial infection of the tooth pulp, leading to swelling, pain, and inflammation. The infection typically occurs when bacteria enter the tooth through a cavity, crack, or other dental injury. The abscess can cause significant pain and discomfort and must be treated promptly by a dentist to prevent further complications. Dental caries refer to tooth decay or cavities that result from the breakdown of tooth structure by acids produced by bacteria. Periodontitis is a severe gum infection that damages the soft tissue and destroys the bone that supports the teeth. Oral candidiasis is a fungal infection that affects the mouth and throat.

Correct Answer: B

Rationale: In planning their care, Nurse Gina should consider holistic care, which emphasizes treating the patient as a whole person - including their physical, mental, emotional, and spiritual needs. By addressing all aspects of the patient's well-being, Nurse Gina can provide comprehensive care that promotes overall health and wellness. This approach recognizes that physical health is interconnected with other aspects of a person's life and aims to support the individual in achieving balance and harmony in all areas. Holistic care also encourages the patient to be actively involved in their own healing process, fostering a sense of empowerment and self-awareness.

Correct Answer: A

Rationale: The most appropriate intervention for managing hepatic encephalopathy in this patient receiving palliative care for end-stage liver disease is to administer lactulose or other ammonia-lowering agents to reduce ammonia levels. Hepatic encephalopathy is believed to be primarily caused by the accumulation of ammonia in the bloodstream due to compromised liver function. Lactulose works by acidifying the gut lumen, which facilitates the excretion of ammonia in the form of ammonium ions. By reducing ammonia levels, hepatic encephalopathy symptoms, such as confusion and altered mental status, can be improved. Initiating other supportive measures like managing precipitating factors, maintaining hydration, and addressing nutritional issues should also be part of the holistic approach in managing hepatic encephalopathy in palliative care. However, addressing the underlying cause by reducing ammonia levels with lactulose is the priority intervention in this scenario.

Correct Answer: D

Rationale: Papillary thyroid carcinoma is the most common type of thyroid cancer and is known for presenting as a painless unilateral enlargement of the thyroid gland. Fine-needle aspiration cytology typically reveals classic features such as numerous microfollicles and psammoma bodies. Thyroglossal duct cyst, Hashimoto's thyroiditis, and thyroid adenoma would not typically present with these cytological features or with painless thyroid enlargement as seen in papillary thyroid carcinoma.

Correct Answer: C

Rationale: Humoral immunity is primarily responsible for protecting against infections by pathogens like viruses. In the case of the hepatitis B virus (HBV), the individual is exposed to the virus and develops immunity, which is typically mediated by antibodies produced by B cells. These antibodies circulate in the blood and can neutralize the virus, preventing future infections. This type of immunity is known as humoral immunity, as it involves the production of antibodies that target specific antigens, such as those present on the surface of the hepatitis B virus. In contrast, passive immunity is when antibodies are transferred from an external source, innate immunity provides immediate, non-specific defenses against pathogens, and cell-mediated immunity involves the activation of T cells to combat intracellular pathogens.