Nokea
During neonatal resuscitation, dry wiping is aimed at
- A. Preventing hypothermia and facilitating tactile stimulation
- B. Preventing hemorrhage and clearing of the airway
- C. Preventing infection and facilitating tactile stimulation
- D. Improving the appearance and preventing infection
Correct Answer: A
Rationale: The correct answer is A: Preventing hypothermia and facilitating tactile stimulation. Dry wiping during neonatal resuscitation helps prevent hypothermia by removing wetness from the baby's skin. It also facilitates tactile stimulation, which can help stimulate the baby's breathing.
Summary:
B: Preventing hemorrhage and clearing of the airway - Dry wiping does not prevent hemorrhage or clear the airway directly.
C: Preventing infection and facilitating tactile stimulation - While dry wiping can help prevent infection, its primary aim during neonatal resuscitation is to prevent hypothermia.
D: Improving the appearance and preventing infection - Dry wiping is not done for cosmetic reasons; its main purpose is to prevent hypothermia.
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S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 gdL, an MCV of 72 fL and a platelet count of 65,000L the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include
- A. Avoidance of elective surgery and nonessential medications
- B. Prednisone 60 mg daily until platelets normal
- C. Monoclonal antibody therapy such as rituximab
- D. Splenectomy
Correct Answer: A
Rationale: The correct answer is A: Avoidance of elective surgery and nonessential medications. This is the initial management for a patient with thrombocytopenia and abnormal bleeding time, possibly indicating immune thrombocytopenic purpura (ITP). Avoiding surgery and medications that can worsen thrombocytopenia is crucial to prevent bleeding complications. Prednisone (B) is not the first-line treatment for ITP, especially without confirming the diagnosis. Monoclonal antibody therapy (C) such as rituximab is usually reserved for refractory cases. Splenectomy (D) is considered only if other treatments fail as a last resort.
T. S. is a 31-year-old female who is admitted following a catastrophic industrial accident. She had multiple injuries, and after a 10-day hospital stay that included several operations and attempts to save her, she is declared brain dead. She had an organ donor notation on her drivers license. Which of the following circumstances precludes her from serving as a liver donor?
- A. Encephalopathy
- B. Hepatitis C infection
- C. A long history of alcohol use
- D. Biliary cirrhosis
Correct Answer: C
Rationale: The correct answer is C: A long history of alcohol use. In this case, the patient T. S. is brain dead following a catastrophic accident. Although she had an organ donor notation, her long history of alcohol use precludes her from serving as a liver donor. Chronic alcohol use can lead to liver damage and compromise the quality of the liver for transplantation. Encephalopathy (choice A) is a potential complication of liver disease, but it does not preclude her from being a liver donor. Hepatitis C infection (choice B) and biliary cirrhosis (choice D) may affect the liver, but they do not automatically disqualify her as a donor.
Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except
- A. Gamma-aminobutyric acid (GABA)
- B. Ammonia
- C. False neurotransmitters
- D. Serotonin
Correct Answer: D
Rationale: The correct answer is D: Serotonin. Serotonin is not a primary chemical mediator of hepatic encephalopathy. The main chemical mediators involved in hepatic encephalopathy are A: Gamma-aminobutyric acid (GABA), B: Ammonia, and C: False neurotransmitters. GABA plays a role in inhibiting neurotransmission, ammonia is a key factor in the pathogenesis of hepatic encephalopathy, and false neurotransmitters are produced due to altered amino acid metabolism in the liver. Serotonin is not a key player in the development of hepatic encephalopathy, hence it is the correct answer.
The AGACNP knows that treatment for this likely will include
- A. Observation
- B. Hyperextension casting
- C. Jewett brace
- D. Surgical intervention
Correct Answer: B
Rationale: The correct answer is B: Hyperextension casting. The AGACNP knows that this treatment is appropriate for a condition that requires immobilization and support while allowing controlled movement. Hyperextension casting provides stability and support while promoting healing. Observation (A) would not provide adequate treatment for a condition requiring immobilization. Jewett brace (C) is typically used for spinal fractures, not for conditions that require hyperextension casting. Surgical intervention (D) would be considered if conservative measures like casting have failed.
What are the risks of untreated gestational hypertension?
- A. Preeclampsia
- B. Placental abruption
- C. Preterm labor
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D, All of the above. Untreated gestational hypertension can lead to serious complications such as preeclampsia, characterized by high blood pressure and organ damage, placental abruption which is the separation of the placenta from the uterine wall, and preterm labor, resulting in premature birth. Each of these complications poses significant risks to both the mother and the baby, highlighting the importance of managing gestational hypertension. Therefore, all the choices A, B, and C are consequences of untreated gestational hypertension.