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Arrested active phase of labor in a multiparous woman denotes an abnormal labor pattern as characterized by
- A. Cessation of cervical dilatation for more than 2 hours
- B. Cessation of cervical dilatation for more than 4 hours
- C. Duration of latent phase of labor lasting more than 8 hours
- D. Cessation of descent of the presenting part for more than 1 hour
Correct Answer: B
Rationale: Arrested active phase is characterized by cessation of cervical dilatation for more than 4 hours.
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When counseling a patient about his surgical options for an ulcer that has been refractory to medical therapy, the AGACNP advises the patient that he will need
- A. Lifelong vitamin D replacement
- B. Excision of the ulcer, which produces an 80% cure rate
- C. To eat much smaller, more frequent meals
- D. Some form of vagotomy
Correct Answer: C
Rationale: When counseling a patient about surgical options for an ulcer that has been refractory to medical therapy, advising the patient that he will need some form of vagotomy is important. Vagotomy is a surgical procedure in which the vagus nerve is partially or completely severed. This procedure is commonly performed for patients with ulcers that have not responded to medical treatment. Vagotomy reduces the acid secretion in the stomach, which can help in the healing of the ulcer and prevent recurrence. It is an effective option for treating ulcers that have not responded to conservative medical management.
The most common complication of respiratory distress syndrome is
- A. Cerebral palsy
- B. Pneumothorax
- C. Klumpke’s palsy
- D. Fractured ribs
Correct Answer: B
Rationale: Pneumothorax is a common complication of respiratory distress syndrome in neonates.
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?
- A. A temperature of 101.5°F
- B. A leukocyte count of 18,000/µL
- C. A palpable gallbladder
- D. A positive Murphy’s sign
Correct Answer: A
Rationale: A leukocyte count of 18,000/µL suggests an elevated white blood cell count, which is indicative of an inflammatory or infectious process. In the context of biliary colic, an elevated white blood cell count could be a sign of complications such as cholecystitis (inflammation of the gallbladder) or choledocholithiasis (bile duct obstruction). These complications may require urgent surgical evaluation and intervention. The other options, although concerning, do not specifically suggest a complication that necessitates immediate surgical evaluation.
The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?
- A. Radiographs
- B. CT scan without contrast
- C. MRI
- D. PET scan
Correct Answer: A
Rationale: An MRI (Magnetic Resonance Imaging) would be the most useful head imaging study in assessing for findings consistent with a history of abuse in this patient. MRI is superior to CT in detecting subtle changes in the brain, such as small hemorrhages, edema, or shearing injuries, which may be present in cases of physical abuse. In cases of suspected abuse, it is important to evaluate for both acute and chronic changes that may not be clearly visible on other imaging modalities. While CT scans can detect acute hemorrhages or fractures, they may miss more subtle findings that can be seen on MRI. Therefore, an MRI would provide a more comprehensive evaluation of the brain and surrounding structures in this case.
Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1 packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows temperature 99.1F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 13784 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal?
- A. A complete blood count and RBC differential
- B. Liver function enzymes
- C. Serum amylase, lipase, and glucose
- D. A basic metabolic panel
Correct Answer: A
Rationale: Given the patient's presentation of acute onset severe abdominal pain, the AGACNP anticipates abnormalities in serum amylase and lipase levels, as this can indicate pancreatitis. The presence of symptoms such as severe upper abdominal pain, along with the patient's risk factors such as heavy alcohol consumption, smoking, and dyslipidemia, increase suspicion for acute pancreatitis. Additionally, the evaluation of serum glucose levels is important to assess for potential hyperglycemia, which can be seen in acute pancreatitis. Liver function enzymes and basic metabolic panel may also be abnormal in the setting of pancreatitis; however, the most specific and sensitive tests for diagnosing acute pancreatitis are serum amylase and lipase levels.