Varneys Midwifery 6th Edition Test Bank

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Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms include all of the following except

  • A. Colic due to return of peristalsis
  • B. Leakage from the duodenal stump
  • C. Gastric retention
  • D. Hemorrhage
Correct Answer: D

Rationale: In the scenario described, Mrs. Coates is a 65-year-old female who is on the first day postoperatively following a duodenal resection for a bleeding ulcer. Given her surgical history and the progression of her abdominal discomfort, the likely causes to consider are complications related to the surgery. Options B, C, and D are all potential postoperative complications following a duodenal resection:

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Priority nursing diagnoses for Mrs. Q (Breech presentation):

  • A. Risk of uterine rupture, risk of fetal distress, pain
  • B. Risk of infection, risk of fetal distress, risk of preterm birth
  • C. Risk of hemorrhage, risk of cord prolapse, pain
  • D. Risk of fetal malpresentation, impaired maternal coping
Correct Answer: A

Rationale: Nursing diagnoses include risks of uterine rupture, fetal distress, and pain management.

Which of the following is associated with diazygotic twinning?

  • A. Conjoined twins
  • B. Polyhydramnious
  • C. Superfecundation
  • D. Foetus compressus
Correct Answer: C

Rationale: Superfecundation can occur with dizygotic twinning, leading to multiple paternity.

Lester R. is a 58-year-old male who is being evaluated for nocturia. He reports that he has to get up 2 to 3 times nightly to void. Additional assessment reveals urinary urgency and appreciable post-void dribbling. A digital rectal examination reveals a normal-sized prostate with no appreciable hypertrophy. The best approach to this patient includes

  • A. Administration of the American Urological Association (AUA) Symptom Scale
  • B. Laboratory assessment to include a PSA
  • C. Ordering a prostate ultrasound
  • D. Assessment of nonprostate causes of nocturia
Correct Answer: C

Rationale: In this case, the best approach to the patient includes assessment of nonprostate causes of nocturia. Despite the lack of significant prostate hypertrophy on digital rectal examination, the patient is experiencing bothersome lower urinary tract symptoms such as nocturia, urinary urgency, and post-void dribbling. These symptoms suggest the need to consider alternative causes beyond prostate enlargement. Factors such as overactive bladder, urinary tract infections, diabetes, sleep apnea, medications, or other systemic conditions could be contributing to the patient's symptoms. Therefore, a comprehensive evaluation to identify potential nonprostate causes of the patient's nocturia is warranted before considering more invasive prostate-specific tests like PSA, ultrasound, or symptom scales.

The most common complication of respiratory distress syndrome is

  • A. Cerebral palsy
  • B. Pneumothorax
  • C. Klumpke’s palsy
  • D. Fractured ribs
Correct Answer: B

Rationale: Pneumothorax is a common complication of respiratory distress syndrome in neonates.

R. S. is a 66-year-old female with Cushings syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates

  • A. Rapid reversal of symptoms, with good pituitary function
  • B. Transient rebound release of remaining pituitary hormones
  • C. Markedly improved dexamethasone suppression test
  • D. Hyponatremia and compensatory SIADH
Correct Answer: A

Rationale: In patients with Cushing's syndrome due to an ACTH-producing pituitary tumor, removal of the tumor can result in a transient rebound release of remaining pituitary hormones. This occurs because the suppressed pituitary gland begins to recover and overproduce hormones in response to the sudden decrease in negative feedback from the removed tumor. As a result, patients may experience transient hormonal fluctuations before the pituitary gland establishes a new equilibrium. Therefore, when seeing the patient in follow-up after surgery, the AGACNP should anticipate a transient rebound release of remaining pituitary hormones rather than immediate and rapid reversal of symptoms or markedly improved test results. Additionally, hyponatremia and compensatory SIADH are less likely in this scenario unless there are other underlying factors contributing to it.

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