Nokea
A cause of shoulder presentation is
- A. Macerated fetus
- B. Postdates pregnancy
- C. Oligohydramnios
- D. Placenta abruption
Correct Answer: C
Rationale: The correct answer is C: Oligohydramnios. Shoulder presentation occurs when the baby presents shoulder-first rather than head-first during birth. Oligohydramnios, a condition characterized by low levels of amniotic fluid, can lead to decreased uterine space, increasing the chances of abnormal fetal positioning. Macerated fetus (A) is associated with fetal decomposition, not shoulder presentation. Postdates pregnancy (B) is linked to increased risk of macrosomia but not shoulder presentation. Placenta abruption (D) is a separation of the placenta from the uterus, not a direct cause of shoulder presentation.
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The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNRthe patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here?
- A. Veracity and beneficence
- B. Beneficence and nonmalfeasance
- C. Autonomy and beneficence
- D. Justice and autonomy
Correct Answer: C
Rationale: The correct answer is C: Autonomy and beneficence. Autonomy refers to the patient's right to make their own decisions regarding their healthcare. In this case, the patient is refusing reintubation, exercising his autonomy. However, beneficence, the duty to act in the patient's best interest, also comes into play as the patient's refusal could lead to respiratory failure and death. The conflict arises from balancing the patient's autonomy with the healthcare provider's duty to provide beneficial care.
Choices A, B, and D are incorrect because they do not accurately capture the ethical conflict present in the scenario. Veracity (A) refers to truthfulness, which is not the primary issue here. Nonmalfeasance (B) is the duty to do no harm, which is not directly relevant to the conflict between the patient's autonomy and the need for beneficial care. Justice (D) relates to fairness in resource allocation and is not the primary issue in this case.
V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade IIVI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. The AGACNP knows that ongoing management for R. V. must include
- A. Annual or biannual serial echocardiography
- B. Modification of activity level
- C. Baseline cardiac catheterization
- D. Statin therapy
Correct Answer: C
Rationale: The correct answer is C: Baseline cardiac catheterization. Given the presence of a new onset grade IIVI crescendo-decrescendo cardiac murmur, a baseline cardiac catheterization is necessary to assess the severity and etiology of the murmur. This procedure will provide crucial information on the structure and function of the heart, helping to determine the appropriate management plan.
A: Annual or biannual serial echocardiography is not necessary as the patient is currently asymptomatic and echocardiography has already revealed mild aortic calcification.
B: Modification of activity level is not the immediate priority as the patient is very active physically and not reporting any limitations to daily activities.
D: Statin therapy is not indicated based solely on the presence of a new murmur without further assessment of cardiac function through cardiac catheterization.
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.
In obstructed labor, edema of the vulva presents early due to
- A. Prolonged effort of the mother to push the baby
- B. Pressure applied on cervix by the presenting part
- C. An ill-fitting presenting part pressing on the cervix
- D. Large presenting diameters stretching the vulva
Correct Answer: B
Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.
In the preoperative assessment of a patient for the likelihood of postoperative risk, ascorbic acid deficiency, anemia, and volume contraction are all risk factors for
- A. Prolonged intubation
- B. Thromboembolism
- C. Delayed wound healing
- D. Atelectasis
Correct Answer: D
Rationale: Step-by-step rationale for why choice D (Atelectasis) is correct:
1. Ascorbic acid deficiency can lead to impaired lung function, increasing the risk of atelectasis.
2. Anemia can cause decreased oxygen-carrying capacity, contributing to atelectasis.
3. Volume contraction can lead to reduced lung expansion, further predisposing to atelectasis.
Summary:
- Choice A (Prolonged intubation): Intubation duration is more related to respiratory complications, not directly linked to the mentioned risk factors.
- Choice B (Thromboembolism): Risk factors like immobility and hypercoagulability are more relevant to thromboembolism.
- Choice C (Delayed wound healing): More associated with factors like malnutrition and impaired immune function rather than the mentioned risk factors.