Nokea
A client is declared fit for a vaginal birth after cesarean section if
- A. Her previous C/S was due to cephalopelvic disproportion
- B. The current pregnancy is confirmed a multiple pregnancy
- C. Previous delivery was via cesarean section
- D. Previous delivery was via spontaneous vertex delivery
Correct Answer: D
Rationale: The correct answer is D because a client is declared fit for a vaginal birth after cesarean section if their previous delivery was via spontaneous vertex delivery. This indicates that the client has successfully given birth vaginally before, reducing the risk associated with a vaginal birth after cesarean section.
A, B, and C are incorrect:
A: Cephalopelvic disproportion was the reason for the previous C/S, indicating potential difficulty in vaginal delivery.
B: Confirmation of a multiple pregnancy does not impact the client's eligibility for a vaginal birth after cesarean section.
C: Previous cesarean section does not necessarily mean the client is fit for a vaginal birth after cesarean section.
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Inability to eat or retain feeds throughout the day prenatally is highly associated with
- A. Weight gain control
- B. Hyperemesis gravidarum
- C. Morning sickness
- D. Presence of preeclampsia
Correct Answer: B
Rationale: The correct answer is B: Hyperemesis gravidarum. This condition is characterized by severe nausea and vomiting during pregnancy, leading to inability to eat or retain feeds. It is associated with significant weight loss and dehydration. Other choices are incorrect because:
A: Weight gain control is not the primary concern when hyperemesis gravidarum is present.
C: Morning sickness typically does not cause severe inability to eat or retain feeds.
D: Preeclampsia is a separate condition characterized by high blood pressure and organ damage, not directly related to feeding difficulties.
The drug of choice in the management of eclampsia is
- A. Phenobarbitone
- B. Magnesium sulphate
- C. Calcium gluconate
- D. Sodium bicarbonate
Correct Answer: B
Rationale: The correct answer is B: Magnesium sulphate. It is the drug of choice for managing eclampsia due to its ability to prevent and control seizures. Magnesium sulfate acts as a central nervous system depressant and smooth muscle relaxant, helping to prevent further seizures. Phenobarbitone (A) is not the first-line treatment for eclampsia. Calcium gluconate (C) is used to counteract calcium channel blocker toxicity, not for eclampsia. Sodium bicarbonate (D) is used to treat metabolic acidosis, not eclampsia.
Based upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma?
- A. Hypogastrinemia and acid hyposecretion
- B. Hypergastrinemia and acid hyposecretion
- C. Hypogastrinemia and acid hypersecretion
- D. Hypergastrinemia and acid hypersecretion
Correct Answer: A
Rationale: The correct answer is A: Hypogastrinemia and acid hyposecretion. Gastrinoma is a tumor that secretes excessive gastrin, leading to hypergastrinemia and increased acid secretion. However, due to a negative feedback mechanism, chronic exposure to high gastrin levels can cause downregulation of gastrin receptors on parietal cells, leading to decreased acid secretion. Therefore, in gastrinoma, despite high gastrin levels, acid secretion may be reduced due to this negative feedback loop. Choices B, C, and D are incorrect because they do not align with the expected relationship between gastrin levels and acid secretion in gastrinoma.
According to the American College of Cardiology Foundation and the American Heart Association (ACCFAHA), the recommendation regarding antiplatelet therapy in patients with cardiovascular disease preoperatively is that
- A. Antiplatelet therapy should be held for 10 days preoperatively
- B. Cardiac consultation is required before an operation in patients who are on antiplatelet therapy
- C. Medications should be continued unless concerns about hemostasis are significant
- D. Antiplatelet therapy should be initiated in all high-risk cardiac procedures
Correct Answer: B
Rationale: Step-by-step rationale for why choice B is correct:
1. The ACCF/AHA recommends cardiac consultation before an operation for patients on antiplatelet therapy to assess the risk of bleeding versus thrombotic events.
2. Cardiac consultation helps determine the necessity of continuing, modifying, or stopping antiplatelet therapy.
3. This individualized approach ensures optimal perioperative management based on the patient's cardiovascular risk profile.
4. Choice A is incorrect as stopping antiplatelet therapy for 10 days can increase the risk of thrombotic events.
5. Choice C is incorrect as it oversimplifies the decision-making process without considering the patient's specific risks.
6. Choice D is incorrect because initiating antiplatelet therapy in all high-risk cardiac procedures may not be necessary for every patient.
TB in pregnancy predisposes a mother to premature labour due to
- A. Poor maternal appetite
- B. Severe anaemia experienced
- C. Adverse reactions of anti-TB drugs
- D. The fever experienced
Correct Answer: D
Rationale: The correct answer is D. TB in pregnancy can lead to premature labor due to the fever experienced. Fever increases the risk of premature labor by triggering uterine contractions. Poor maternal appetite (A) and severe anemia (B) may impact the mother's health but are not directly linked to premature labor. Adverse reactions of anti-TB drugs (C) could potentially affect the mother's health but are not a direct cause of premature labor.