Nokea
Mechanism of labour in left Sacro-anterior position (breech):
- A. Flexion, internal rotation, extension, external rotation
- B. Descent, engagement, flexion, internal rotation
- C. Flexion, external rotation, descent, expulsion
- D. Extension, flexion, engagement, delivery
Correct Answer: A
Rationale: The mechanism includes flexion, internal rotation, and extension of the breech baby.
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Based on vaginal examination findings, indicators of abnormal labor are
- A. Bandl’s ring and oedematous vulva
- B. Oedematous cervix and fetal hypoxia
- C. Hot, dry vagina and arrest in descent
- D. Maternal distress and severe moulding
Correct Answer: C
Rationale: A hot, dry vagina and lack of descent suggest abnormal labor patterns.
The AGACNP is going over preoperative information and instructions with a patient who is having a major transverse abdominal procedure tomorrow morning. The patient is very nervous and is asking a lot of questions. The AGACNP prescribes a sleeping agent because he knows that anxiety and sleeplessness may
- A. Lead to hypoxia due to hyperventilation
- B. Increase the physiologic stress response postoperatively
- C. Contribute to risk of delirium and prolonged length of stay
- D. Decreasep.o. intake and produce nutritional risk
Correct Answer: C
Rationale: Anxiety and sleeplessness can contribute to the risk of delirium and prolonged length of stay for the patient undergoing a major transverse abdominal procedure. Delirium is a common complication seen in patients who are anxious and sleep-deprived, especially postoperatively. It is important to address these issues preoperatively to help prevent delirium and ensure a smoother recovery process for the patient. By prescribing a sleeping agent, the AGACNP aims to reduce anxiety and promote a good night's sleep, which can ultimately decrease the risk of delirium and lead to better outcomes for the patient.
When resuscitating an asphyxiated baby, the purpose of ensuring adequate ventilation prior to administration of sodium bicarbonate is because
- A. The drug decreases carbon dioxide tension
- B. The drug increases carbon dioxide tension
- C. The drug is effective in the correction of metabolic acidosis
- D. The drug is effective in the correction of metabolic alkalosis
Correct Answer: C
Rationale: Sodium bicarbonate is used to correct metabolic acidosis, not to influence carbon dioxide levels directly.
Acute inflammatory mastitis can be prevented postnatally by encouraging breastfeeding mothers to
- A. Use prophylactic antibiotics
- B. Use bras of the right size
- C. Wash the breasts thoroughly before breastfeeding
- D. Empty the breast completely after breastfeeding
Correct Answer: D
Rationale: Emptying the breast completely when breastfeeding prevents mastitis by ensuring proper drainage of milk.
P. T. is a 58-year-old female who is admitted with chest pain and shortness of breath and is found to have a large pulmonary embolus. Her systolic blood pressure is falling, and a diagnosis of obstructive shock is made. Cardiac pressure would likely demonstrate
- A. Elevated atrial and decreased ventricular pressures
- B. Elevated right-sided and decreased left-sided pressures
- C. Elevated left ventricular pressure and decreased cardiac output
- D. Elevated left ventricular pressure and decreased systemic vascular resistance
Correct Answer: B
Rationale: Obstructive shock, such as in this case of a large pulmonary embolus causing obstructive shock, results in a sudden increase in right ventricular afterload due to obstruction of blood flow. This leads to right heart failure and decreased left ventricular preload, ultimately resulting in decreased cardiac output. The elevated right-sided pressures will be reflected by elevated right atrial and ventricular pressures, while the left ventricular pressures will be decreased due to decreased preload. This commonly leads to a situation known as acute cor pulmonale, where the right heart becomes dilated and dysfunctional in response to the increased afterload.