Nokea
Indicate whether the following statements are TRUE (T) or FALSE (F): a) The most common cause of immediate postpartum haemorrhage is trauma to the genital tract during delivery. b) There are four major principles to follow in the specific management of a mother with immediate postpartum haemorrhage.
- A. TRUE
- B. FALSE
- C. TRUE
- D. FALSE
Correct Answer: B
Rationale: The most common cause of postpartum haemorrhage is uterine atony, not trauma.
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How can maternal nutrition affect fetal development?
- A. Ensures proper growth
- B. Prevents birth defects
- C. Reduces the risk of preterm birth
- D. All of the above
Correct Answer: D
Rationale: Maternal nutrition supports fetal growth, prevents birth defects, and reduces preterm birth risks.
Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is really wrong. She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?
- A. Abdominal radiographs
- B. CT scan of the abdomen with contrast
- C. Right upper quadrant ultrasound
- D. A HIDA scan
Correct Answer: A
Rationale: Given Janice's presentation of significant abdominal pain localized to the right upper quadrant with tenderness on deep palpation, the most appropriate initial imaging study to investigate the likely cause is a right upper quadrant ultrasound. This imaging modality is commonly used to evaluate the liver, gallbladder, bile ducts, and adjacent structures. It can help identify common causes of right upper quadrant pain such as gallstones, cholecystitis, or biliary duct obstruction. The non-invasive nature of ultrasound and its ability to provide real-time imaging make it a valuable tool in the initial assessment of patients with abdominal pain. Depending on the findings of the ultrasound, further imaging studies or interventions may be pursued. Abdominal radiographs may not provide sufficient detail of the biliary system, while a CT scan with contrast or a HIDA scan may be reserved for further evaluation if needed based on the ultrasound findings.
M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it wont go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred probably it was a few days ago. She reports that she is always constipated. On physical examination, she is tachycardic but otherwise has normal vital signs her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanicthere is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects
- A. Perforated bowel
- B. Peritonitis
- C. Ischemic bowel
- D. Intestinal abscess
Correct Answer: B
Rationale: The patient's presentation with significant abdominal pain, tachycardia, tensely rigid abdomen, rebound tenderness, hypoactive and intermittent bowel sounds, and tympanic percussion of the entire abdomen is concerning for peritonitis. Peritonitis is inflammation of the peritoneum, which is the lining of the abdominal cavity. It is often caused by an infection or irritation, such as from a perforated bowel, which can lead to the leakage of bowel contents into the peritoneal cavity. The presentation of peritonitis includes severe abdominal pain, guarding, rebound tenderness, abdominal distension, and signs of systemic inflammation like tachycardia and fever. In this case, the lack of point tenderness to palpation and the absence of dullness over the upper quadrants make perforated bowel less likely, while the tense rigidity of the abdomen and rebound tenderness are more suggestive of diffuse peritonitis. Ischem
Total loss of polarity and fundal dominance leads to
- A. Precipitate labour
- B. Colicky uterus
- C. Spontaneous labour
- D. Cervical dystocia
Correct Answer: A
Rationale: Loss of polarity and fundal dominance can lead to precipitate labor.
There are no other abnormal findings. This suggests that Mr. Thornton
- A. Is having anterior wall ischemia
- B. Is having an anterior wall infarction
- C. Has a history of anterior wall NSTEMI
- D. Has a history of anterior wall STEMI
Correct Answer: D
Rationale: In the given scenario where there are no other abnormal findings, it suggests that Mr. Thornton is experiencing anterior wall ischemia. Ischemia occurs due to inadequate blood supply to the heart muscles, often caused by a partial blockage in the coronary arteries. The absence of abnormal findings, such as ST-segment elevation or specific changes on the electrocardiogram (ECG), indicates that the issue is more likely ischemia rather than infarction. Infarction, whether NSTEMI or STEMI, would typically be associated with specific ECG changes and significant abnormalities beyond just the absence of findings. In the absence of these features, the more likely diagnosis is anterior wall ischemia.