Nokea
A client diagnosed with gestational diabetes at 24 weeks is scheduled for ANC care every
- A. Weekly up to 28 weeks
- B. Two weekly up to 28 weeks
- C. Four weekly up to 28 weeks
- D. Three weekly up to 28 weeks
Correct Answer: C
Rationale: The correct answer is C: Four weekly up to 28 weeks. Gestational diabetes requires close monitoring of blood sugar levels and fetal well-being. ANC care every four weeks up to 28 weeks ensures proper management and early detection of any complications. Weekly or two weekly visits (options A and B) may be too frequent and unnecessary at this stage unless there are specific concerns. Three weekly visits (option D) may not provide adequate monitoring intervals. Therefore, option C is the most appropriate choice for the optimal management of gestational diabetes at this stage of pregnancy.
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The CORRECT statement with regards to face to pubis delivery is
- A. It results due to a 135˚ anterior rotation of the occiput
- B. It results due to a persistent occipito posterior position
- C. It results due to a 45˚ anterior rotation of the occiput
- D. It results due to a 45˚ anterior rotation of the sinciput
Correct Answer: C
Rationale: Rationale:
Face to pubis delivery occurs when the fetal face presents towards the mother's pubic bone during birth. Choice C is correct because a 45˚ anterior rotation of the occiput is needed for this positioning. This allows the fetal face to be directed towards the mother's pubis for a successful face to pubis delivery. Choices A and D are incorrect as they mention incorrect angles of rotation. Choice B is incorrect as a persistent occipito posterior position would result in a face to sacrum delivery, not face to pubis.
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal
- A. Increased MCV
- B. Increased Hgb
- C. Increased platelets
- D. Increased albumin
Correct Answer: B
Rationale: Step 1: Post-splenectomy, platelet count typically drops temporarily, leading to a risk of bleeding.
Step 2: To compensate, the body increases hemoglobin (Hgb) levels to maintain oxygen-carrying capacity.
Step 3: Therefore, on postoperative day 2, an increased Hgb level is expected.
Summary: A is incorrect because MCV is not typically affected in this scenario. C is incorrect because platelet count usually decreases post-splenectomy. D is incorrect as albumin levels are not directly impacted by splenectomy for ITP.
Ms. OReilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?
- A. All medications should be taken up to and including the morning of surgery
- B. The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgery
- C. Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgery
- D. Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgery
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Metformin should be held if the morning blood sugar is < 200 mg/dL to reduce the risk of lactic acidosis postoperatively.
2. Warfarin should be held 5 days before surgery to prevent excessive bleeding during the procedure.
3. Beta blocker (metoprolol) can be continued on the day of surgery to prevent rebound hypertension.
4. Vitamin E can be continued as it does not have significant interactions or adverse effects in this scenario.
Summary:
- Choice A is incorrect as it does not address the need to hold metformin and warfarin appropriately.
- Choice B is incorrect as it discontinues medications too early and does not address metformin management.
- Choice C is incorrect as it only addresses warfarin and does not consider metformin or other medications.
- Choice D is the most appropriate approach as it addresses the specific considerations for each medication based on their effects and interactions.
In which form of hypospadias should circumcision be deferred in order to preserve the prepuce for later surgical repair?
- A. Ventral displacement
- B. Proximal displacement
- C. Midscrotal hypospadias
- D. Meatus proximal to the corona
Correct Answer: A
Rationale: In ventral displacement hypospadias, circumcision should be deferred to preserve prepuce for later surgical repair as the prepuce is needed for reconstruction. The prepuce can be used as a tissue graft to correct the hypospadias. In proximal displacement, the urethral opening is closer to the scrotum, making prepuce preservation less critical. Midscrotal hypospadias and meatus proximal to the corona do not typically involve prepuce preservation for surgical repair.
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.