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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: C
Rationale: The correct answer is C. In myelodysplastic syndromes, splenectomy is indicated for sustained leukocyte elevation above 30,000 cells/µL to manage symptomatic splenomegaly and cytopenias. This is because an enlarged spleen can sequester and destroy blood cells, leading to low blood cell counts. Choices A, B, and D are incorrect as splenectomy is not typically indicated for major hemolysis unresponsive to medical management, severe symptoms of massive splenomegaly, or portal hypertension in the context of myelodysplastic syndromes.
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Placental parasitation is associated with
- A. Candidiasis prenatally
- B. Tuberculosis prenatally
- C. Multiple gestation
- D. Malaria prenatally
Correct Answer: D
Rationale: Placental parasitation is associated with Malaria prenatally because the Plasmodium parasite can infect the placenta through the bloodstream, leading to severe complications for both the mother and the fetus. This infection can result in low birth weight, preterm birth, and even stillbirth. Candidiasis, Tuberculosis, and Multiple gestation are not directly associated with placental parasitation. Candidiasis is a fungal infection, Tuberculosis is a bacterial infection, and Multiple gestation refers to carrying more than one fetus during pregnancy. Therefore, the correct answer is D, Malaria prenatally, due to the direct impact of Plasmodium parasite on the placenta and its implications on pregnancy outcomes.
Hypoplastic left heart syndrome is characterized by underdevelopment of
- A. Pulmonary veins, ventricles and aortic valve
- B. Left ventricle, atrium and pulmonary vessels
- C. Aorta arch, venacava and right atrium
- D. Left ventricle, aortic valve and arch
Correct Answer: D
Rationale: The correct answer is D because hypoplastic left heart syndrome involves underdevelopment of the left ventricle, aortic valve, and aortic arch. The left ventricle is typically small and unable to adequately pump blood to the body. The aortic valve is often malformed, leading to difficulties in blood flow from the heart to the body. Additionally, the aortic arch may be narrow or underdeveloped, further impacting blood circulation.
Choice A is incorrect as it includes the pulmonary veins, which are not typically affected in hypoplastic left heart syndrome. Choice B is incorrect as it focuses on the left atrium and pulmonary vessels, which are not the primary structures affected in this condition. Choice C is incorrect as it mentions the aorta arch, venacava, and right atrium, which are not primarily associated with hypoplastic left heart syndrome.
Obstructed labor MAINLY results due to
- A. Maternal exhaustion
- B. Cephalopelvic disproportion
- C. Microsomic fetus
- D. Fetal exsanguination
Correct Answer: B
Rationale: The correct answer is B: Cephalopelvic disproportion. This condition occurs when the baby's head is too large to pass through the mother's pelvis during labor. This leads to obstructed labor, causing complications for both the mother and the baby. Maternal exhaustion (A) may occur as a result of prolonged labor but is not the primary cause of obstructed labor. Microsomic fetus (C) refers to a small baby and would not typically cause obstructed labor. Fetal exsanguination (D) is the loss of blood from the fetus and is not a common cause of obstructed labor. Cephalopelvic disproportion is the most common reason for obstructed labor as it directly affects the passage of the baby through the birth canal.
When caring for a mother following an assisted vaginal delivery, it’s MOST important to remember that
- A. A vacuum extractor is safer than forceps because it causes less trauma to the baby & the mother’s perineum
- B. The baby will develop a cephalhematoma as a result of the instrumentation which is a normal expected outcome
- C. The use of instruments during the birth process is a fairly rare occurrence for women
- D. Additional nursing interventions are needed to ensure an uncomplicated postpartum
Correct Answer: D
Rationale: The correct answer is D because additional nursing interventions are necessary to ensure an uncomplicated postpartum period. After an assisted vaginal delivery, the mother may experience increased pain, perineal trauma, and a higher risk of postpartum hemorrhage. Nursing interventions such as pain management, wound care, monitoring for signs of infection, and emotional support are crucial for the mother's recovery.
A is incorrect because both vacuum extractors and forceps can cause trauma to the baby and mother's perineum, and the safety of one over the other depends on various factors.
B is incorrect as the development of a cephalhematoma is not a normal expected outcome of assisted vaginal delivery and should be monitored and managed appropriately if it occurs.
C is incorrect as the use of instruments during childbirth, while not as common as spontaneous vaginal deliveries, is not rare and can be necessary in certain situations to ensure the safety of the mother and baby.
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.