Nokea
Mrs. Jenner is a 41-year-old female who is being evaluated for persistent nausea. She had an abdominal CT scan that reported three hepatic hemangiomas ranging from 3 to 5 cm. The AGACNP knows that the appropriate response to this report is to
- A. Arrange for large-bore needle biopsy
- B. Order hepatic ultrasound annually to follow progression
- C. Consult surgery for resection
- D. Document the finding in the patient’s chart
Correct Answer: B
Rationale: The correct answer is B. Ordering hepatic ultrasound annually to follow progression is the appropriate response for hepatic hemangiomas. Biopsy is not recommended due to the risk of bleeding. Surgery is usually not required unless there are complications. Documenting the finding is important but does not address the need for monitoring. Ultrasound allows for non-invasive monitoring of the hemangiomas over time to assess for growth or complications, guiding further management if needed.
You may also like to solve these questions
A characteristic of monozygotic twins includes
- A. Always of the same sex
- B. Share a similar fingerprint pattern
- C. Have different blood groups
- D. Superfetation is a common finding
Correct Answer: A
Rationale: The correct answer is A: Always of the same sex. Monozygotic twins develop from a single fertilized egg, so they have the same genetic material, making them always the same sex. This is due to the fact that the sex of an individual is determined by the chromosomes inherited from the parents. This is a fundamental principle of genetics. Choices B, C, and D are incorrect because monozygotic twins can have different fingerprints, blood groups, and superfetation (conception that occurs during an existing pregnancy) is not common in monozygotic twins.
R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?
- A. CT scan with IV, oral, and rectal contrast
- B. CBC with WBC differential
- C. Colonoscopy
- D. Barium enema
Correct Answer: B
Rationale: The correct answer is B: CBC with WBC differential. This test can help rule out infectious causes of left lower quadrant pain, such as diverticulitis or colitis, by assessing for elevated white blood cell count and left shift. A CT scan (A) with contrast may be indicated if the patient's condition worsens or if initial tests are inconclusive. Colonoscopy (C) is more appropriate for evaluating chronic or intermittent abdominal pain, not acute symptoms. Barium enema (D) is an outdated test and not commonly used for diagnosing acute abdominal pain.
An indication for forceps delivery is
- A. Inadequate size of the pelvis
- B. Delay in second stage of labor
- C. Unsuccessful vacuum extraction
- D. Fetal distress in first stage of labor
Correct Answer: B
Rationale: The correct answer is B: Delay in second stage of labor. Forceps delivery is indicated when there is a delay in the second stage of labor to expedite delivery and prevent maternal and fetal complications. This could be due to factors such as maternal exhaustion, fetal distress, or ineffective pushing. Inadequate pelvis size (A) may necessitate a C-section, unsuccessful vacuum extraction (C) may require alternative interventions, and fetal distress in the first stage of labor (D) may not necessarily indicate the need for forceps delivery immediately.
Which of the following is not a true statement with respect to decision making for a cognitively impaired patient?
- A. Only a court can declare a patient incompetent
- B. Impaired cognition does not make a person incompetent
- C. Living wills typically are honored if a person is terminally ill
- D. A patient can give informed consent if not declared incompetent
Correct Answer: C
Rationale: The correct answer is C because living wills typically are not always honored for cognitively impaired patients. Step-by-step rationale: A) Incorrect - A court can declare a patient incompetent if they are unable to make decisions. B) Incorrect - Impaired cognition can indeed make a person incompetent. D) Incorrect - A patient must have the capacity to understand information and make decisions to give informed consent.
Presence of a turtle’s sign is clearly indicative of
- A. Prolonged labor
- B. Occipito-posterior position
- C. Shoulder dystocia
- D. Shoulder presentation
Correct Answer: C
Rationale: The presence of a turtle sign during delivery is indicative of shoulder dystocia. This occurs when the baby's shoulders get stuck behind the mother's pelvic bones during delivery, leading to difficulty in delivering the baby's shoulders. The turtle sign refers to the retraction of the baby's head back into the birth canal after delivery of the head, resembling a turtle retracting into its shell. This sign is a clear indicator of shoulder dystocia. Choices A, B, and D are incorrect because prolonged labor, occipito-posterior position, and shoulder presentation do not specifically involve the retraction of the baby's head like in shoulder dystocia.