Nokea
A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?
- A. Isoproterenol 0.2 to 0.6 mg IV bolus
- B. External pacemaking
- C. Atropine 0.5 mg IV
- D. Epinephrine 1 mg IV
Correct Answer: A
Rationale: The correct answer is A: Isoproterenol 0.2 to 0.6 mg IV bolus. Isoproterenol is a non-selective beta-adrenergic agonist that can worsen graft rejection in heart transplant patients. The appropriate intervention for bradyarrhythmia in posttransplant patients is external pacemaking or pharmacological agents like atropine or epinephrine. Isoproterenol should be avoided due to its potential to stimulate the immune system and increase the risk of rejection. It is crucial to choose interventions that address the bradycardia without compromising the patient's transplant graft.
You may also like to solve these questions
The type of cord prolapse characterized by presence of the fetal umbilical cord alongside the presenting part is
- A. Occult umbilical cord prolapse
- B. Overt umbilical cord prolapse
- C. Funic cord prolapse
- D. Complete cord prolapse
Correct Answer: C
Rationale: The correct answer is C: Funic cord prolapse. Funic cord prolapse is characterized by the fetal umbilical cord being alongside the presenting part. This type of cord prolapse is a more specific term used to describe the exact position of the cord in relation to the presenting part.
The other choices are incorrect because:
- A: Occult umbilical cord prolapse refers to a hidden or concealed cord prolapse, where the cord is not visible externally.
- B: Overt umbilical cord prolapse is when the cord is visible externally before the presenting part.
- D: Complete cord prolapse implies that the entire cord has descended through the cervix before the presenting part, not just alongside it.
Therefore, the correct choice is C as it accurately describes the specific positioning of the umbilical cord in relation to the presenting part during cord prolapse.
The commonest major cause of primary postpartum haemorrhage is
- A. Trauma of the genital tract
- B. Blood coagulation disorder
- C. Prolonged 3rd stage
- D. Atony of the uterus
Correct Answer: D
Rationale: Step 1: Atony of the uterus is the most common cause of primary postpartum hemorrhage due to inadequate uterine contractions.
Step 2: Trauma of the genital tract can lead to bleeding but is not as common as atony of the uterus in postpartum hemorrhage.
Step 3: Blood coagulation disorder can contribute to excessive bleeding but is not the primary cause of postpartum hemorrhage.
Step 4: Prolonged 3rd stage can result in postpartum hemorrhage but is typically secondary to uterine atony.
Mr. Novello is an 81-year old male patient who presents with crampy abdominal pain in the hypogastrum and a vague history as to his last normal bowel movement. Physical examination reveals distention and high-pitched bowel sounds. The patient says he has never has this kind of problem before and denies any history of abdominal surgery. Abdominal radiographs reveal a frame pattern of colonic distention. The AGACNP considers
- A. A stimulant laxative to relieve bowel contents
- B. Carcinoma of the bowel as a leading diagnosis
- C. Decompression of the colon with rectal tube
- D. Angiography to rule out mesenteric ischemia
Correct Answer: C
Rationale: The correct answer is C: Decompression of the colon with rectal tube. This is the most appropriate intervention for a patient with acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome. In this condition, there is colonic distention without an actual mechanical obstruction, leading to symptoms like abdominal pain, distention, and high-pitched bowel sounds. Decompression with a rectal tube can help relieve the distention and prevent complications like perforation.
Choice A (stimulant laxative) is incorrect because ACPO is not due to simple constipation, so laxatives would not be effective. Choice B (carcinoma of the bowel) is unlikely given the acute onset and lack of risk factors. Choice D (angiography for mesenteric ischemia) is not indicated in this case as there are no signs of acute ischemia.
In summary, the correct choice is C because it directly addresses the underlying issue of colonic distention in
Placenta praevia is also referred to as unavoidable haemorrhage because
- A. Bleeding results as the segment prepares for true labour
- B. Bleeding results from pathological processes of the placenta
- C. Bleeding always occurs after a gestation of 37 complete weeks
- D. Of the high morbidity and mortality rate to the mother and neonate
Correct Answer: D
Rationale: The correct answer is D because placenta praevia can lead to life-threatening bleeding during labor due to the placenta partially or completely covering the cervix. This condition poses a high risk of morbidity and mortality to both the mother and the baby.
A: Incorrect. Bleeding in placenta praevia is not related to the segment preparing for labor.
B: Incorrect. While bleeding is due to placental issues, it is specifically due to the placenta's abnormal positioning, not a pathological process.
C: Incorrect. Bleeding can occur before 37 weeks in cases of placenta praevia, and the timing of bleeding is not linked to gestational age.
The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kgday. The best approach to this patients management is to
- A. Continue the current regimen
- B. D/C the spironolactone and begin a loop diuretic
- C. Add a loop diuretic to the spironolactone
- D. Proceed to large-volume paracentesis
Correct Answer: A
Rationale: The correct answer is A: Continue the current regimen. Spironolactone is a potassium-sparing diuretic commonly used to treat ascites. The weight loss of 0.75 kg/day indicates that the current regimen is effective. Continuing the regimen is appropriate to avoid electrolyte imbalances. Discontinuing spironolactone (Choice B) can lead to rebound edema. Adding a loop diuretic (Choice C) may increase the risk of electrolyte disturbances. Large-volume paracentesis (Choice D) is reserved for cases of refractory ascites.