Nokea
A patient with suspected Cushings syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate
- A. Low ACTH and low cortisol
- B. Low ACTH and high cortisol
- C. High ACTH and low cortisol
- D. High ACTH and high cortisol
Correct Answer: A
Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low.
Explanation for other choices:
B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome.
C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome.
D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.
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Sara S. is a 41-year-old patient who has just had a bone marrow transplant. The AGACNP knows that which medication will be used to decrease her risk of graft-versus-host reaction?
- A. Immune globulin
- B. Cyclosporine
- C. Prophylactic antibiotics
- D. Systemic corticosteroids
Correct Answer: A
Rationale: The correct answer is A: Immune globulin. Post bone marrow transplant, immune globulin is used to decrease the risk of graft-versus-host reaction by providing passive immunity. This helps in reducing the chances of the donor's immune cells attacking the recipient's tissues. Immune globulin does not suppress the immune system like cyclosporine (B) or systemic corticosteroids (D) do, which could increase the risk of infections post-transplant. Prophylactic antibiotics (C) are used to prevent infections but do not specifically target graft-versus-host reaction.
When examining a patient with abdominal pain, the AGACNP knows that tenderness to percussion is analogous to
- A. Tympany
- B. Guarding
- C. Rebound tenderness
- D. Somatic pain
Correct Answer: A
Rationale: The correct answer is A: Tympany. Tenderness to percussion is analogous to tympany as both indicate the presence of gas-filled structures. When a patient experiences tenderness to percussion in the abdomen, it suggests that there is gas or air present in the abdomen, leading to a hollow, drum-like sound upon percussion, which is characteristic of tympany. Guarding (B) is the involuntary contraction of abdominal muscles to protect the underlying organs, not related to percussion. Rebound tenderness (C) is the pain experienced when pressure is released during palpation, not percussion. Somatic pain (D) refers to pain originating from the skin, muscles, or bones, not related to percussion findings.
During induction of labor with syntocinon, drops increase is stopped prematurely on
- A. Achieving three moderate contractions
- B. Realizing normal maternal observations
- C. Achieving progressive cervical dilatation
- D. Observing normal fetal-related observations
Correct Answer: C
Rationale: Step-by-step rationale for choice C:
1. Progressive cervical dilatation indicates effective labor progress.
2. Stopping the syntocinon drops prematurely allows natural labor progression.
3. Prematurely stopping drops before reaching full dilation may hinder labor.
4. Achieving cervical dilatation is a crucial indicator for successful labor.
Summary:
A: Contractions should be strong, not just moderate.
B: Maternal observations alone do not determine labor progress.
D: Fetal-related observations are important but not the primary indicator for stopping drops.
The recommended number of chest compressions for neonatal resuscitation is
- A. 60 compressions coordinated with 30 breaths per minute
- B. 3 compressions coordinated with 1 breath per minute
- C. 1 compression coordinated with 3 breaths per minute
- D. 90 compressions coordinated with 30 breaths per minute
Correct Answer: A
Rationale: The correct answer is A: 60 compressions coordinated with 30 breaths per minute. In neonatal resuscitation, the recommended compression-to-ventilation ratio is 3:1. This means 3 compressions are given followed by 1 breath. With a target compression rate of 120 per minute, this translates to 60 compressions coordinated with 30 breaths per minute. Each compression should be at a depth of about one-third the anterior-posterior diameter of the chest. This ratio and rate are crucial for maintaining adequate circulation and oxygenation during neonatal resuscitation.
Choice B: 3 compressions coordinated with 1 breath per minute is too slow and would not provide enough support for the neonate's circulation.
Choice C: 1 compression coordinated with 3 breaths per minute would not provide sufficient compressions to maintain circulation.
Choice D: 90 compressions coordinated with 30 breaths per minute would result in an incorrect compression-to-vent
The Brain Trauma Foundation recommends intracranial pressure monitoring for all of the following patients except those with
- A. GCS of 3 to 8 and abnormal head CT
- B. GCS of 3 to 8 and hypotension
- C. GCS of 3 to 8 and > 40 years old
- D. GCS of 3 to 8 and bradycardia
Correct Answer: A
Rationale: The correct answer is A because the Brain Trauma Foundation recommends intracranial pressure monitoring for patients with traumatic brain injury and a GCS of 3 to 8, regardless of the head CT findings. Intracranial pressure monitoring helps in the management of elevated intracranial pressure, which can be life-threatening. Abnormal head CT findings may indicate the need for immediate intervention, but intracranial pressure monitoring is still recommended for all patients in this GCS range to guide treatment decisions. Choices B, C, and D are incorrect because hypotension, age > 40 years old, and bradycardia are not factors that would exclude a patient from needing intracranial pressure monitoring in the presence of a GCS of 3 to 8.