Nokea
A patient admitted for management of sepsis is critically ill and wants to talk with a hospital representative about donating her organs if she dies. She has a fairly complex medical history that includes traumatic brain injury, breast cancer, and dialysis-dependent renal failure. The patient is advised that she is ineligible to donate due to her
- A. Renal failure
- B. Traumatic brain injury
- C. Gram negative infection
- D. Breast cancer
Correct Answer: C
Rationale: The correct answer is C: Gram negative infection. In sepsis, especially with a Gram negative infection, organ donation may pose a risk of transmitting the infection to the recipient. This can be life-threatening for the organ recipient. Renal failure (choice A), traumatic brain injury (choice B), and breast cancer (choice D) are not direct contraindications to organ donation. Renal failure may limit the suitability of certain organs, but it does not automatically disqualify a patient from donating other organs. Traumatic brain injury may impact brain donation but does not rule out other organ donation. Breast cancer may affect eligibility for certain organs but does not universally disqualify a patient from organ donation.
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Which one of the following clinical features indicates neonatal intracranial injury?
- A. An oedematous swelling on the newborn’s scalp that resolves in 48 hours
- B. Notable bleeding between the epicranial aponeurosis & the periosteum
- C. Evidence of excessive molding or abnormal stretching of the fetal head
- D. Peripheral cyanosis as noted by the midwife on the neonate’s peripheries
Correct Answer: C
Rationale: Rationale for choice C:
1. Excessive molding or abnormal stretching of the fetal head can indicate neonatal intracranial injury due to the trauma during birth.
2. This feature suggests possible compression or trauma to the baby's head during delivery.
3. It may lead to intracranial hemorrhage or other injuries, requiring close monitoring and medical intervention.
Summary of other choices:
A. An oedematous swelling resolving in 48 hours is likely a normal finding (cephalohematoma) and not specific to intracranial injury.
B. Notable bleeding between the epicranial aponeurosis & periosteum may indicate cephalohematoma or caput succedaneum, not necessarily intracranial injury.
D. Peripheral cyanosis is related to oxygenation and circulation, not specific to intracranial injury.
The progression of coronary artery plaque formation can lead to a variety of pathologic conditions. When subtotal plaque disruption occurs resulting in vasoconstriction, platelet activation, and embolization, it most commonly causes which clinical phenomenon?
- A. Endothelial cell dysfunction
- B. Prinzmetal’s angina
- C. Transmural myocardial infarction
- D. Non-ST elevation myocardial infarction
Correct Answer: C
Rationale: The correct answer is C: Transmural myocardial infarction. Subtotal plaque disruption leads to vasoconstriction, platelet activation, and embolization, causing complete occlusion of a coronary artery. This results in ischemia of the entire thickness of the myocardial wall, leading to transmural myocardial infarction. Endothelial cell dysfunction (A) is an early event in atherosclerosis but does not directly result from subtotal plaque disruption. Prinzmetal's angina (B) is caused by transient coronary artery spasm rather than plaque disruption. Non-ST elevation myocardial infarction (D) involves incomplete blockage of a coronary artery and typically does not result from subtotal plaque disruption.
Psychosis during puerperium mostly manifests as
- A. Mania
- B. Bipolar
- C. Depression
- D. Infection
Correct Answer: C
Rationale: The correct answer is C: Depression. Psychosis during puerperium commonly manifests as postpartum depression, characterized by feelings of extreme sadness, anxiety, and fatigue. This is due to hormonal changes and stress associated with childbirth. Mania (choice A) and bipolar disorder (choice B) are less common during this period. Infection (choice D) is not a typical manifestation of psychosis during puerperium. Overall, postpartum depression is the most prevalent and well-documented form of psychosis in the postpartum period.
Which of the following is an indication for forceps delivery?
- A. Cephalopelvic disproportion
- B. Occipito posterior position
- C. Breech presentation
- D. Placenta abruption
Correct Answer: B
Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery.
Incorrect choices:
A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis.
C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery.
D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.
enna is a 41-year-old female who presents to the emergency room complaining of sudden hearing loss. She is generally very healthyshe denies any significant medical history, and her only daily medication is a combined oral contraceptive. She does admit that she is just getting over a head cold, but other than that she offers no relevant history. A comprehensive history and physical examination results in a diagnosis of sudden sensorineural hearing loss (SSHL) of unknown origin. The AGACNP knows that the next step in the patients management should include
- A. Acyclovir
- B. Furosemide
- C. Warfarin
- D. Hyperbaric oxygen
Correct Answer: A
Rationale: The correct answer is A: Acyclovir. The rationale is that sudden sensorineural hearing loss (SSHL) can sometimes be associated with viral infections, such as herpes simplex virus. Acyclovir is an antiviral medication that can potentially help treat the underlying viral infection causing SSHL. It is important to address the potential viral etiology before considering other treatments.
Summary of other choices:
B: Furosemide is a diuretic used to treat conditions like high blood pressure and edema, not SSHL.
C: Warfarin is an anticoagulant used to prevent blood clots, not indicated for SSHL.
D: Hyperbaric oxygen therapy is sometimes used for SSHL, but addressing any potential viral infection with Acyclovir would be a more appropriate initial step.