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Which of the following clinical manifestations is most indicative of acute respiratory distress syndrome (ARDS)?
- A. Hypocapnia with respiratory alkalosis
- B. Bradypnea with metabolic acidosis
- C. Tachypnea with hypoxemia refractory to supplemental oxygen
- D. Hypercapnia with hyperkalemia
Correct Answer: C
Rationale: Rationale:
- ARDS is characterized by severe hypoxemia and respiratory distress.
- Tachypnea is a hallmark sign of ARDS due to the body's compensatory mechanism to increase oxygenation.
- Hypoxemia refractory to supplemental oxygen signifies the inability to improve oxygen levels despite intervention.
- Choices A, B, and D do not align with typical manifestations of ARDS, as they do not directly reflect severe hypoxemia or respiratory distress.
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A patient presents with severe sore throat, fever, and enlarged tonsils with exudate. Rapid antigen testing confirms group A beta-hemolytic Streptococcus (GAS) infection. Which of the following medications is the first-line treatment for this condition?
- A. Amoxicillin
- B. Azithromycin
- C. Cephalexin
- D. Clindamycin
Correct Answer: A
Rationale: The correct answer is A: Amoxicillin. Amoxicillin is the first-line treatment for GAS pharyngitis due to its effectiveness against Streptococcus bacteria. It is a penicillin-class antibiotic recommended by guidelines. Azithromycin is an alternative for patients allergic to penicillin. Cephalexin is not the first-line choice for GAS. Clindamycin is reserved for patients allergic to both penicillin and macrolides.
During the active phase of labor, a woman's cervical dilation is progressing slowly despite regular contractions. What maternal condition should the nurse assess for that may contribute to abnormal labor progression?
- A. Maternal exhaustion
- B. Pelvic outlet obstruction
- C. Fetal macrosomia
- D. Uterine hyperstimulation
Correct Answer: B
Rationale: One potential maternal condition that may contribute to abnormal labor progression with slow cervical dilation despite regular contractions is pelvic outlet obstruction. This can occur if the maternal pelvis is too small, misshapen, or has an obstruction such as a fibroid tumor. The inadequate space in the pelvis can prevent the fetus from descending properly and can result in a prolonged or difficult labor. If suspected, interventions such as a cesarean delivery may be necessary to prevent complications for both the mother and baby. It is essential for the nurse to assess for signs of pelvic outlet obstruction and work with the healthcare team to address any issues promptly to ensure a safe delivery.
A patient presents with pruritic, erythematous patches with silvery scales on the elbows, knees, and scalp. Which of the following conditions is most likely responsible for this presentation?
- A. Eczema
- B. Psoriasis
- C. Pityriasis rosea
- D. Seborrheic dermatitis
Correct Answer: B
Rationale: The correct answer is B: Psoriasis. Psoriasis is characterized by pruritic, erythematous patches with silvery scales, commonly found on the elbows, knees, and scalp. This presentation matches the patient's symptoms. Eczema (choice A) typically presents with red, inflamed, and itchy skin patches. Pityriasis rosea (choice C) manifests as a herald patch followed by smaller scaly patches in a "Christmas tree" distribution. Seborrheic dermatitis (choice D) involves oily, yellowish, scaly patches mainly on the scalp, face, and ears, and does not typically present with silvery scales.
Mr. M is receiving hospice care for a terminal illness. He wants to make sure his daughter is allowed to make any decisions regarding his care should he become unable to do so. What document would permit his daughter to do this?
- A. Expressed contract
- B. Implied contract
- C. Durable power of attorney
- D. Living will
Correct Answer: C
Rationale: The correct answer is C: Durable power of attorney. This legal document allows Mr. M to appoint his daughter as his healthcare proxy, granting her the authority to make medical decisions on his behalf if he becomes incapacitated. A: Expressed contract involves clear terms agreed upon by both parties, not relevant here. B: Implied contract arises from actions rather than explicit agreement, not applicable in this situation. D: A living will outlines an individual's medical treatment preferences, but does not grant decision-making authority to another person.
A patient with chronic kidney disease presents with fatigue, dyspnea on exertion, peripheral edema, and hypertension. Laboratory findings reveal elevated serum creatinine and urea levels, metabolic acidosis, and hyperkalemia. What is the most appropriate initial management for this patient?
- A. Initiation of angiotensin-converting enzyme (ACE) inhibitor therapy
- B. Hemodialysis
- C. Intravenous administration of calcium gluconate
- D. Sodium bicarbonate administration
Correct Answer: B
Rationale: The most appropriate initial management for the patient described is hemodialysis. Hemodialysis is essential for managing chronic kidney disease with severe symptoms and electrolyte imbalances like hyperkalemia and metabolic acidosis. Hemodialysis helps to remove urea and creatinine from the blood, correct electrolyte abnormalities, and improve symptoms such as fatigue, dyspnea, and peripheral edema. Initiation of ACE inhibitor therapy (Choice A) is contraindicated in severe kidney disease due to the risk of worsening renal function. Intravenous administration of calcium gluconate (Choice C) is used for acute hyperkalemia with cardiac toxicity, not for initial management. Sodium bicarbonate administration (Choice D) may help correct metabolic acidosis, but it does not address the underlying cause or the need for urgent renal replacement therapy.