Which of the following interventions is most appropriate for a patient with a tension pneumothorax?

Correct Answer: A

Rationale: In the scenario of a tension pneumothorax, the most appropriate intervention is needle decompression (Option A). This procedure involves inserting a large-bore needle into the chest to relieve the pressure buildup in the pleural space. Tension pneumothorax is a life-threatening condition where air accumulates in the pleural space, causing lung collapse and shifting of mediastinal structures, compromising cardiac output and lung function. Needle decompression is a rapid and potentially life-saving intervention to restore normal lung function by releasing the trapped air. Option B, chest tube insertion, is not the initial intervention for a tension pneumothorax. While a chest tube may be needed after needle decompression to further drain the air, it is not the first-line treatment for this emergent situation. High-flow oxygen therapy (Option C) is important in treating hypoxemia but is not the primary intervention for a tension pneumothorax. Providing oxygen alone will not address the underlying issue of trapped air in the pleural space. Incentive spirometry (Option D) is a breathing exercise used to improve lung function and prevent atelectasis but is not appropriate for managing a tension pneumothorax. Understanding the correct management of tension pneumothorax is crucial for nurses caring for patients in acute settings. Recognizing the signs and symptoms, and knowing the appropriate interventions can make a significant difference in patient outcomes. Rapid assessment and intervention can save lives in critical situations like tension pneumothorax.

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: 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: A

Rationale: The combination of recurrent joint pain, swelling, and limited range of motion in multiple joints along with elevated ESR, positive RF, and presence of anti-CCP antibodies is classic for rheumatoid arthritis (RA). Elevated ESR indicates inflammation, positive rheumatoid factor (RF) is an autoantibody commonly found in the serum of patients with RA, and the presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies further supports the diagnosis of RA. These laboratory findings along with the clinical presentation are highly suggestive of rheumatoid arthritis. Systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) can have overlapping symptoms with RA, but the specific combination of elevated ESR, positive RF, and anti-CCP antibodies points more towards RA in this scenario.

Correct Answer: B

Rationale: Vestibular neuritis is a condition characterized by the acute onset of severe vertigo, nausea, vomiting, and nystagmus. These symptoms are typically worsened by head movement. Vestibular neuritis is caused by inflammation of the vestibular nerve, which plays a key role in balance and spatial orientation. The classic presentation of these symptoms, along with the absence of hearing loss (which is seen in labyrinthitis), points towards vestibular neuritis as the most likely cause in this scenario. Meniere's disease presents with recurrent episodes of vertigo, hearing loss, tinnitus, and sensation of fullness in the ear. Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo triggered by changes in head position.