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: A
Rationale: Rationale:
A needle biopsy is appropriate for definitive diagnosis of hepatic hemangiomas, ruling out other liver lesions. It helps determine if they are benign or malignant. This will guide further management decisions.
Summary:
B: Annual ultrasound is unnecessary for benign hemangiomas.
C: Surgery is not indicated for asymptomatic hepatic hemangiomas.
D: Documenting the finding is important but not the appropriate next step in management.
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A client is declared fit for a vaginal birth after cesarean section if
- A. Her previous C/S was due to cephalopelvic disproportion
- B. The current pregnancy is confirmed a multiple pregnancy
- C. Previous delivery was via cesarean section
- D. Previous delivery was via spontaneous vertex delivery
Correct Answer: D
Rationale: The correct answer is D because a client is declared fit for a vaginal birth after cesarean section if their previous delivery was via spontaneous vertex delivery. This indicates that the client has successfully given birth vaginally before, reducing the risk associated with a vaginal birth after cesarean section.
A, B, and C are incorrect:
A: Cephalopelvic disproportion was the reason for the previous C/S, indicating potential difficulty in vaginal delivery.
B: Confirmation of a multiple pregnancy does not impact the client's eligibility for a vaginal birth after cesarean section.
C: Previous cesarean section does not necessarily mean the client is fit for a vaginal birth after cesarean section.
The recommended number of chest compressions for neonatal resuscitation is
- A. 60 compressions coordinated with 30 breaths per minute
- B. 3 compressions coordinated with 1 breath per minute
- C. 1 compression coordinated with 3 breaths per minute
- D. 90 compressions coordinated with 30 breaths per minute
Correct Answer: A
Rationale: The correct answer is A: 60 compressions coordinated with 30 breaths per minute. In neonatal resuscitation, the recommended compression-to-ventilation ratio is 3:1. This means 3 compressions are given followed by 1 breath. With a target compression rate of 120 per minute, this translates to 60 compressions coordinated with 30 breaths per minute. Each compression should be at a depth of about one-third the anterior-posterior diameter of the chest. This ratio and rate are crucial for maintaining adequate circulation and oxygenation during neonatal resuscitation.
Choice B: 3 compressions coordinated with 1 breath per minute is too slow and would not provide enough support for the neonate's circulation.
Choice C: 1 compression coordinated with 3 breaths per minute would not provide sufficient compressions to maintain circulation.
Choice D: 90 compressions coordinated with 30 breaths per minute would result in an incorrect compression-to-vent
The factor indicative of an abnormal labour pattern on vaginal examination is
- A. The vagina is warm and moist
- B. Cervical canal is long and thick
- C. Cervical canal is short and thin
- D. The vagina is hot and dry
Correct Answer: C
Rationale: Step 1: In normal labor, the cervix undergoes effacement and dilation.
Step 2: A short and thin cervical canal indicates progression towards labor.
Step 3: Long and thick cervical canal suggests a delay in labor progress.
Step 4: Choice C, short and thin cervical canal, is indicative of abnormal labor.
Summary: A, B, and D do not reflect changes in the cervix seen in labor, making them incorrect choices.
The fetal head retracting against the perineum is a
- A. Gaskin sign
- B. Turtle sign
- C. Klumpke sign
- D. Chignon sign
Correct Answer: B
Rationale: The correct answer is B: Turtle sign. This sign refers to the fetal head retracting against the perineum during delivery. It indicates shoulder dystocia, a complication where the baby's shoulders get stuck after the head is delivered. This can lead to serious complications for both the baby and the mother if not managed promptly.
A: Gaskin sign is incorrect as it refers to a position where the mother is on her hands and knees during labor.
C: Klumpke sign is incorrect as it is a neurological condition affecting the lower arm and hand.
D: Chignon sign is incorrect as it is not a recognized medical term related to childbirth.
Neonatal injury to nerve roots C8 & T1 causes one of the following
- A. Klumpke’s palsy
- B. Erb’s palsy
- C. Phrenic injury
- D. Radial palsy
Correct Answer: A
Rationale: Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy due to damage to the lower brachial plexus. This results in weakness of the hand and forearm muscles. Erb's palsy is from injury to C5-C6 roots causing upper brachial plexus damage. Phrenic injury affects the diaphragm due to C3-C5 roots. Radial palsy involves the radial nerve, typically from injury at the spiral groove of the humerus. Therefore, the correct answer is A as it directly correlates with the specific nerve roots affected in Klumpke's palsy.