Nokea
An inorganic risk factor to birth injuries includes
- A. Maternal short stature
- B. Prenatal oligohydramnios
- C. External cephalic version
- D. Fetal macrosomia
Correct Answer: D
Rationale: The correct answer is D: Fetal macrosomia. Fetal macrosomia, which refers to a baby being significantly larger than average, is an inorganic risk factor for birth injuries because it can lead to difficult delivery and increase the risk of birth trauma such as shoulder dystocia. Maternal short stature (A) is a biological risk factor, not inorganic. Prenatal oligohydramnios (B) refers to low levels of amniotic fluid and is a maternal condition, not an inorganic factor. External cephalic version (C) is a procedure to turn a breech baby and is not a risk factor for birth injuries.
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A characteristic of monozygotic twins is that
- A. They are always of the same sex
- B. They share a similar fingerprint pattern
- C. They have different blood groups
- D. Superfetation is a common finding
Correct Answer: A
Rationale: The correct answer is A: They are always of the same sex. This is because monozygotic twins, also known as identical twins, develop from a single fertilized egg that splits into two embryos. As a result, they share the same genetic material and are always of the same sex.
Choice B is incorrect because fingerprint patterns are not determined by genetics and can vary even between identical twins. Choice C is incorrect because monozygotic twins share the same blood type since they have the same genetic makeup. Choice D is incorrect as superfetation, the occurrence of multiple pregnancies in the same uterus but from different ovulations, is extremely rare and not a common finding in monozygotic twins.
Janet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows serum bilirubin approximately 2 gdL, albumin 3.1 gdL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to
- A. Cancel the transfer and keep her in the ICU
- B. Infuse albumin and fresh frozen plasma
- C. Repeat the labs the next day
- D. Prepare for reoperation
Correct Answer: B
Rationale: The correct answer is B: Infuse albumin and fresh frozen plasma. Given Janet's post-hepatic resection status and abnormal lab values indicating liver dysfunction (elevated bilirubin, low albumin, prolonged prothrombin time, elevated AST and ALT), she is at risk for coagulopathy and hypoalbuminemia. Infusing albumin can help improve her oncotic pressure and fluid balance, while fresh frozen plasma can replenish clotting factors to address the prolonged prothrombin time. This intervention aims to stabilize her condition before transferring to the general medical floor.
Canceling the transfer (Choice A) is not necessary if appropriate interventions can be taken. Repeating labs the next day (Choice C) delays potentially needed treatments. Preparing for reoperation (Choice D) is not indicated based on the information provided.
Vaginal delivery is possible in
- A. Brow presentation
- B. Face presentation
- C. Shoulder presentation
- D. Unstable lie
Correct Answer: B
Rationale: The correct answer is B: Face presentation. Vaginal delivery is possible in face presentation as the fetus is in a position where the face is presenting first, allowing for delivery. In this presentation, the chin is usually tucked onto the chest, making it easier for the baby's head to pass through the birth canal.
A: Brow presentation is incorrect because it indicates the baby's head is extended slightly, making it more difficult for vaginal delivery.
C: Shoulder presentation is incorrect as it can lead to a shoulder dystocia, making vaginal delivery dangerous and difficult.
D: Unstable lie is incorrect because it refers to the baby being in a transverse position, making vaginal delivery impossible without intervention.
In myelodysplastic syndromes, the primary indications for splenectomy include
- A. Major hemolysis unresponsive to medical management
- B. Severe symptoms of massive splenomegaly
- C. Sustained leukocyte elevation above 30,000 cells/µL
- D. Portal hypertension
Correct Answer: D
Rationale: The correct answer is D: Portal hypertension. In myelodysplastic syndromes, splenectomy is indicated primarily for portal hypertension due to extramedullary hematopoiesjson in the spleen, leading to increased blood flow and pressure in the portal vein. This can alleviate symptoms such as ascites and variceal bleeding. Choices A, B, and C are incorrect as major hemolysis, massive splenomegaly, and sustained leukocyte elevation are not primary indications for splenectomy in myelodysplastic syndromes.
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms include all of the following except
- A. Colic due to return of peristalsis
- B. Leakage from the duodenal stump
- C. Gastric retention
- D. Hemorrhage
Correct Answer: C
Rationale: The correct answer is C: Gastric retention. Mrs. Coates' symptoms of persistent and progressive discomfort are not likely due to gastric retention because she underwent a duodenal resection for a bleeding ulcer, which would bypass the stomach. Therefore, gastric retention is not a possible cause.
A: Colic due to return of peristalsis is a possible cause as peristalsis returning after surgery can cause discomfort.
B: Leakage from the duodenal stump is a possible cause as it can lead to abdominal discomfort postoperatively.
D: Hemorrhage is a possible cause given her history of bleeding ulcer and surgery.