Nokea
In breech delivery, the midwife is advised to keep her hands off the breech as it progressively descends so as to
- A. Ascertain the fetal wellbeing in utero
- B. Allow enough room for the fetus to pass
- C. Allow gravitating descent of the fetus
- D. Prevent excessive traction being applied
Correct Answer: D
Rationale: The correct answer is D: Prevent excessive traction being applied. This is because in a breech delivery, excessive traction can lead to complications such as fetal injuries or umbilical cord prolapse. The midwife should avoid pulling on the baby's legs or body to prevent undue stress on the baby. The other choices are incorrect because: A: Ascertain the fetal wellbeing in utero - this is typically done through other means such as fetal monitoring. B: Allow enough room for the fetus to pass - this should be done by ensuring proper positioning and allowing natural descent. C: Allow gravitating descent of the fetus - this is not a recommended practice as it can cause complications.
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The MAIN aim of encouraging plenty of fluids to a postnatal client with urinary tract trauma is to
- A. Keep client well hydrated
- B. Maintain proper fluid balance
- C. Facilitate proper healing
- D. Control growth of organisms
Correct Answer: A
Rationale: The correct answer is A: Keep client well hydrated. Encouraging plenty of fluids helps prevent dehydration, maintain adequate urine output, and promote flushing of the urinary tract to prevent infections, all crucial for postnatal clients with urinary tract trauma. Proper hydration also supports overall health and aids in the healing process.
B: Maintain proper fluid balance - While important, the main aim is to keep the client well hydrated to support healing.
C: Facilitate proper healing - Proper hydration does facilitate healing, but the primary aim is to keep the client well hydrated.
D: Control growth of organisms - While hydration can help in preventing infections, the main aim is to keep the client well hydrated.
The factor indicative of an abnormal labour pattern on vaginal examination is
- A. The vagina is warm and moist
- B. Cervical canal is long and thick
- C. Cervical canal is short and thin
- D. The vagina is hot and dry
Correct Answer: C
Rationale: Step 1: In normal labor, the cervix undergoes effacement and dilation.
Step 2: A short and thin cervical canal indicates progression towards labor.
Step 3: Long and thick cervical canal suggests a delay in labor progress.
Step 4: Choice C, short and thin cervical canal, is indicative of abnormal labor.
Summary: A, B, and D do not reflect changes in the cervix seen in labor, making them incorrect choices.
When counseling a patient about treatment modalities for achalasia, the AGACNP advised that which of the following is the treatment of choice?
- A. Calcium channel antagonists
- B. Intrasphincter botulinum injection
- C. Pneumatic dilation
- D. Myotomy and partial fundoplication
Correct Answer: A
Rationale: Rationale for choice A: Calcium channel antagonists are the treatment of choice for achalasia as they help relax the lower esophageal sphincter, improving swallowing. This is a non-invasive option that can provide symptom relief for many patients.
Summary for other choices:
B: Intrasphincter botulinum injection is a temporary solution and not considered the treatment of choice.
C: Pneumatic dilation is another option for achalasia but is typically used if calcium channel antagonists are ineffective.
D: Myotomy and partial fundoplication is a more invasive surgical option and usually considered if other treatments fail.
What is a common cause of oligohydramnios during pregnancy?
- A. Maternal hypertension
- B. Multiple gestations
- C. Premature rupture of membranes
- D. Fetal macrosomia
Correct Answer: C
Rationale: The correct answer is C: Premature rupture of membranes. Oligohydramnios is a condition characterized by low levels of amniotic fluid which can be caused by the premature rupture of membranes, leading to the leakage of amniotic fluid. This condition can result in various complications such as fetal growth restriction and compression of the umbilical cord. Maternal hypertension (choice A) is not a direct cause of oligohydramnios. Multiple gestations (choice B) may lead to polyhydramnios (excessive amniotic fluid) rather than oligohydramnios. Fetal macrosomia (choice D) is associated with increased amniotic fluid levels rather than decreased levels seen in oligohydramnios.
Prior to taking a patient for an emergency cesarean section, it is MOST important to assess that:
- A. A signed informed consent has been given
- B. A Foley’s catheter has been inserted
- C. An intravenous line has been started
- D. The perineal area has been shaved adequately
Correct Answer: C
Rationale: The correct answer is C because establishing an intravenous line is essential for immediate access to administer fluids, medications, and blood products during the emergency cesarean section. This step ensures that the patient's vital signs can be supported, and any emergent interventions can be readily delivered.
A: While informed consent is important, in an emergency situation, the priority is to ensure the patient's immediate medical needs are met.
B: Inserting a Foley's catheter may be necessary during the procedure, but it is not the most critical assessment prior to the cesarean section.
D: Shaving the perineal area is not a priority in an emergency situation and may be done during the preparation for surgery.