Nokea
Complications of deep venous thrombosis include:
- A. Pulmonary embolism, varicosity
- B. Moist gangrene, secondary postpartum hemorrhage
- C. Hydronephrosis, hematoma formation
- D. Prolonged labor, disseminated intravascular coagulopathy
Correct Answer: A
Rationale: Pulmonary embolism and varicosity are common complications of deep venous thrombosis.
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Prior to application of traction in forceps delivery, it’s MOST important to note
- A. When the contraction ends
- B. When the client feels the contraction
- C. When the contraction begins
- D. When the fetal heart rate drops
Correct Answer: C
Rationale: It is important to apply traction during contractions to help with the delivery process.
K. W. is a 50-year-old woman who presents for surgical resection of the liver for treatment of metastatic colon cancer. Preoperatively, the surgeon tells her that he is planning to remove 50 to 75 of her liver. The patient is concerned that she will not be able to recover normal liver function with that much removed. The AGACNP counsels her that
- A. Such a high-volume resection is utilized only in people with markedly compromised hepatic function
- B. Major regeneration occurs within 10 days, and the process is complete by 5 weeks
- C. Liver function will probably recover to 50% baseline, but that is enough for normal function
- D. Up to 95% of the liver can be removed without any apparent consequence to the patient
Correct Answer: B
Rationale: The liver is known for its remarkable ability to regenerate. Major regeneration can occur within 10 days after partial hepatectomy (liver resection) as a compensatory mechanism. The process is typically complete within 5 weeks. This regenerative capacity allows for safe removal of a significant portion of the liver for procedures such as liver resection for cancer. The remaining liver tissue is able to rapidly proliferate and restore normal liver function. The patient should be reassured that even with 50 to 75% of her liver being removed, she can expect a significant amount of liver function recovery postoperatively.
On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection consists of
- A. Cyclosporine
- B. Azathioprine
- C. Methylprednisolone
- D. Sirolimus
Correct Answer: D
Rationale: The first-line treatment for acute rejection following hepatic transplant is high-dose corticosteroids, such as methylprednisolone. This is because corticosteroids have potent anti-inflammatory and immunosuppressive effects that can help suppress the immune response causing rejection. Cyclosporine, azathioprine, and sirolimus are also commonly used immunosuppressive medications in transplant patients, but in this case of acute rejection, the immediate treatment of choice is methylprednisolone.
The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?
- A. Alpha-adrenergic antagonists
- B. Beta-adrenergic antagonists
- C. Intravenous vasodilators
- D. Arteriolar dilators
Correct Answer: C
Rationale: Surgical manipulation of the adrenal medulla during resection of a pheochromocytoma can result in the release of catecholamines leading to a hypertensive crisis. Alpha-adrenergic antagonists, such as phenoxybenzamine or prazosin, are the drugs of choice for managing hypertensive crisis in this situation. These medications block the alpha-adrenergic receptors, leading to vasodilation and lowering of blood pressure. Beta-adrenergic antagonists are contraindicated in this scenario due to the risk of unopposed alpha-adrenergic stimulation that could worsen the hypertension. Intravenous vasodilators and arteriolar dilators may be used as adjunctive therapy but alpha-adrenergic antagonists are the primary agents for managing hypertensive crisis in this context.
The diagnostic factor of polyhydramnious, based on percussion, is
- A. Muffled fetal heart sounds
- B. Presence of a dull sound
- C. Excessive fetal movements
- D. Presence of a fluid thrill
Correct Answer: D
Rationale: Fluid thrill is a key diagnostic sign of polyhydramnious.