Nokea
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.
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A correct statement denoting the purpose of vitamin K administration to neonates is
- A. All neonates need vitamin K to develop their own immunity
- B. Vitamin K prevents neonates from developing jaundice
- C. Vitamin K promotes the growth of normal GIT bacteria
- D. All neonates need vitamin K for activation of thrombokinase
Correct Answer: D
Rationale: The correct answer is D: All neonates need vitamin K for activation of thrombokinase. Vitamin K is essential for the synthesis of clotting factors in the liver, including thrombokinase, which plays a crucial role in blood clotting. In neonates, there is a deficiency of vitamin K due to limited transfer across the placenta and low levels in breast milk. Administering vitamin K at birth helps prevent hemorrhagic disease of the newborn. Choices A, B, and C are incorrect because vitamin K does not directly impact immunity, prevent jaundice, or promote normal gut bacteria growth in neonates.
Excessive bleeding from the genital tract after the first 24 hours, but within the puerperium period, is referred to as
- A. Primary postpartum haemorrhage
- B. Tertiary postpartum haemorrhage
- C. Secondary postpartum haemorrhage
- D. Incidental postpartum haemorrhage
Correct Answer: C
Rationale: The correct answer is C: Secondary postpartum haemorrhage. This term refers to excessive bleeding from the genital tract after the first 24 hours but within the puerperium period (6 weeks postpartum).
A: Primary postpartum haemorrhage occurs within the first 24 hours after delivery.
B: Tertiary postpartum haemorrhage occurs more than 6 weeks postpartum.
D: Incidental postpartum haemorrhage is not a recognized medical term for postpartum bleeding.
Effects of pregnancy on malaria are
- A. Development of severe anaemia and severe jaundice
- B. Blood smear is always positive and severe anaemia
- C. Therapy limitation and few parasites in severe cases
- D. Loss of pregnancy and severe condition in few parasites
Correct Answer: A
Rationale: Step-by-step rationale for why choice A is correct:
1. Pregnancy can lead to severe anaemia due to increased demand for iron and folate.
2. Pregnancy-induced physiological changes can exacerbate malaria-related anaemia.
3. Severe jaundice may occur in pregnant women with malaria due to liver dysfunction.
4. These effects are common during pregnancy and can worsen with malaria infection.
Summary of why other choices are incorrect:
- Choice B: Blood smear positivity is not always guaranteed in malaria, and severe anaemia is not the only effect.
- Choice C: Therapy limitations can occur, but the presence of few parasites in severe cases is not a defining feature.
- Choice D: Loss of pregnancy can happen, but it is not a universal effect of malaria during pregnancy, and severity is not based on parasite count alone.
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ resection following a catastrophic motor vehicle accident. Due to the nature of his injuries, a large portion of his jejunum had to be resected. In planning for his recovery and nutritional needs, the AGACNP considers that
- A. He will probably be able to transition to oral nutrition but will have lifetime issues with diarrhea
- B. His procedure has put him at significant risk for B12 absorption problems
- C. Most jejunum absorption functions will be assumed by the ileum
- D. Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
Correct Answer: B
Rationale: The correct answer is B: His procedure has put him at significant risk for B12 absorption problems.
Rationale:
1. Jejunum is primarily responsible for nutrient absorption, including B12.
2. Resection of a large portion of the jejunum can lead to malabsorption of B12.
3. B12 is essential for neurological function and red blood cell production.
4. Patients with significant jejunum resection are at high risk for B12 deficiency.
5. Monitoring B12 levels and potentially requiring supplementation is crucial for patients like Jake.
Summary of other choices:
A: Incorrect. Lifetime issues with diarrhea are not necessarily expected following jejunum resection.
C: Incorrect. The ileum may assume some functions of the jejunum but cannot fully compensate.
D: Incorrect. Enteral nutrition should not be delayed for months as it is essential for Jake's recovery and nutritional needs.
Which one of the following is an endogenous cause of puerperal sepsis?
- A. Chlamydia trachomatis
- B. Escherichia coli
- C. Clostridium tetani
- D. Pseudomonas aeruginosa
Correct Answer: B
Rationale: The correct answer is B: Escherichia coli. Puerperal sepsis is often caused by endogenous bacteria from the mother's own flora. E. coli is a common endogenous bacteria found in the gastrointestinal tract and can cause infection during childbirth. Chlamydia trachomatis is a sexually transmitted infection, not typically associated with puerperal sepsis. Clostridium tetani causes tetanus, not puerperal sepsis. Pseudomonas aeruginosa is an environmental pathogen, not typically an endogenous cause of puerperal sepsis.