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Delivery of the head in a breech presentation is usually accomplished through
- A. Lovset maneuver
- B. Burns Marshall Method
- C. Mauriceau-Smellie-Veit maneuver
- D. Reverse woodscrew maneuver
Correct Answer: C
Rationale: The Mauriceau-Smellie-Veit maneuver is the correct answer for delivering the head in a breech presentation. This maneuver involves applying pressure to the fetal head with the fingers in the mouth to flex the head, guiding it through the pelvis. This technique helps prevent hyperextension of the head and facilitates a safe delivery. The Lovset maneuver involves rotating the fetus to disengage the impacted shoulder, not for delivering the head. The Burns Marshall Method is used for delivering the aftercoming head in a breech presentation. The Reverse woodscrew maneuver is a technique to disimpact a shoulder dystocia, not for delivering the head in a breech presentation.
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The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?
- A. Pyuria
- B. Fever
- C. CVA tenderness
- D. Gross hematuria
Correct Answer: A
Rationale: The correct answer is A: Pyuria. Pyuria is a common feature in acute pyelonephritis, as it indicates the presence of white blood cells in the urine due to the infection. Fever, CVA tenderness, and gross hematuria are all common features of acute pyelonephritis. Fever is a systemic response to infection, CVA tenderness indicates inflammation of the kidney, and gross hematuria is often seen due to inflammation and damage to the kidney tissue. Therefore, the absence of pyuria would be unexpected in a patient with suspected acute pyelonephritis.
The most severe type of urinary tract trauma is that which presents with
- A. Retention of urine
- B. Stress incontinence
- C. Scalding sensation
- D. Fistula formation
Correct Answer: D
Rationale: The correct answer is D: Fistula formation. Fistula formation is the most severe type of urinary tract trauma as it involves an abnormal connection between the urinary tract and another organ or the skin. This condition can lead to severe complications such as recurrent infections, incontinence, and even sepsis. Retention of urine (A) is a symptom of urinary tract obstruction, not necessarily the most severe type of trauma. Stress incontinence (B) is a common condition but is not indicative of severe trauma. Scalding sensation (C) can be a symptom of a urinary tract infection but does not necessarily indicate severe trauma like fistula formation.
A correct statement about shoulder dystocia is
- A. It is an impaction of the anterior shoulder after delivery of the head
- B. It is an impaction of the posterior shoulder after delivery of the head
- C. Shoulder dystocia occurs due to compound presentation of the fetus
- D. Shoulder dystocia is not an emergency and resolves on its own effort gradually
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Shoulder dystocia is an impaction of the anterior shoulder after delivery of the head because the anterior shoulder gets stuck behind the pubic symphysis during childbirth. This can lead to serious complications for both the mother and the baby if not managed promptly.
Summary of Incorrect Choices:
B: Impaction of the posterior shoulder is not referred to as shoulder dystocia; it is the impaction of the anterior shoulder that causes the complication.
C: Shoulder dystocia is not caused by a compound presentation of the fetus, which refers to a situation where more than one fetal part presents at the maternal pelvis simultaneously.
D: Shoulder dystocia is indeed an emergency that requires immediate intervention, as delays can lead to birth injuries and complications. It does not resolve on its own and needs medical assistance.
Melanie is a 31-year-old patient who is being evaluated following a routine urinalysis that revealed microscopic hematuria. She was between menses and has no other identifiable explanation for hematuria. She has no significant medical history and otherwise is without complaint. The AGACNP knows that workup for Melanie should include
- A. A urology consultation
- B. CT urogram
- C. Upper urinary imaging
- D. Cystoscopy
Correct Answer: B
Rationale: The correct answer is B: CT urogram. This is the appropriate next step in the workup for Melanie's microscopic hematuria. A CT urogram can provide detailed imaging of the urinary tract to identify any structural abnormalities or causes of hematuria. A urology consultation (choice A) may be necessary after the imaging results. Upper urinary imaging (choice C) is not specific enough and may not provide a comprehensive evaluation. Cystoscopy (choice D) is invasive and typically reserved for cases where lower urinary tract issues are suspected, which is not indicated in Melanie's case without further evaluation.
Ms. Carpenter is a 28-year-old female who presents in significant pain she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?
- A. Temperature > 102°F
- B. White blood cell count > 14,000 cells/µL
- C. Vomiting
- D. Hematuria
Correct Answer: A
Rationale: The correct answer is A: Temperature > 102°F. A high fever in the context of right lower quadrant colicky pain raises concern for ureteral colic, which is often caused by kidney stones. Fever may indicate infection or obstruction, requiring urgent medical attention. Choices B, C, and D are incorrect because they are common findings in cases of ureteral colic but are not as specific to raise the index of suspicion. White blood cell count elevation and hematuria are common with kidney stones, while vomiting is a common symptom due to severe pain. However, fever is a more concerning sign that necessitates prompt evaluation.