Nokea
Prior to taking a patient for an emergency cesarean section, it is MOST important to assess that:
- A. A signed informed consent has been given
- B. A Foley’s catheter has been inserted
- C. An intravenous line has been started
- D. The perineal area has been shaved adequately
Correct Answer: C
Rationale: The correct answer is C because establishing an intravenous line is essential for immediate access to administer fluids, medications, and blood products during the emergency cesarean section. This step ensures that the patient's vital signs can be supported, and any emergent interventions can be readily delivered.
A: While informed consent is important, in an emergency situation, the priority is to ensure the patient's immediate medical needs are met.
B: Inserting a Foley's catheter may be necessary during the procedure, but it is not the most critical assessment prior to the cesarean section.
D: Shaving the perineal area is not a priority in an emergency situation and may be done during the preparation for surgery.
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What is the role of the placenta in pregnancy?
- A. Produces hormones
- B. Provides nutrients and oxygen to the fetus
- C. Removes waste products from the fetus
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D because the placenta performs multiple crucial roles in pregnancy. Firstly, it produces hormones essential for maintaining the pregnancy. Secondly, it provides nutrients and oxygen to the fetus for growth and development. Lastly, it removes waste products from the fetus to ensure a healthy environment. Choices A, B, and C individually do not cover all the functions of the placenta, making them incorrect. Selecting option D acknowledges the comprehensive functions of the placenta during pregnancy.
K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that
- A. He will need endoscopy to evaluate the problem
- B. Chronic gastroparesis is a known complication of ulcer surgery
- C. Medication is unlikely to help, and he may need another surgery
- D. His symptoms occur in 5 to 10% of people after ulcer surgery
Correct Answer: C
Rationale: Rationale for Correct Answer (C):
1. The patient's symptoms of decreased capacity for intake and nausea after eating suggest gastroparesis, a common complication post-ulcer surgery.
2. Given the history of complicated peptic ulcer disease and prior surgery, medication may be ineffective, necessitating potential reoperation.
3. The AGACNP advises that another surgery may be needed, indicating that medication alone may not suffice to address the issue.
Summary of Incorrect Choices:
A: Endoscopy is not necessary at this point as the symptoms are likely indicative of a functional issue rather than a structural problem.
B: While gastroparesis can occur post-ulcer surgery, the patient's symptoms are more suggestive of gastroparesis rather than chronic gastroparesis as a known complication.
D: The frequency of occurrence of symptoms after ulcer surgery is not relevant to the current management of the patient's symptoms.
Causes of puerperal pyrexia are entirely obstetrically related.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: B
Rationale: Step 1: Puerperal pyrexia refers to fever occurring after childbirth.
Step 2: Causes can be obstetric (infection) or non-obstetric (e.g., urinary tract infection).
Step 3: Non-obstetric causes are also common postpartum.
Step 4: Therefore, puerperal pyrexia is not entirely obstetrically related.
Step 5: Hence, the correct answer is B (FALSE).
Three (3) complications of breech presentation:
- A. Prolonged labor, umbilical cord prolapse, shoulder dystocia
- B. Cesarean delivery, fetal distress, uterine rupture
- C. Preeclampsia, gestational diabetes, low birth weight
- D. All of the above
Correct Answer: A
Rationale: Rationale: Breech presentation increases risks during childbirth. Prolonged labor is common due to the position of the baby. Umbilical cord prolapse occurs when the cord slips through the cervix before the baby, leading to oxygen deprivation. Shoulder dystocia happens when the baby's shoulders get stuck during delivery. Choice A is correct as it directly relates to complications of breech presentation. Choices B, C, and D are incorrect as they do not specifically address the complications associated with breech presentation. Cesarean delivery is often recommended for breech presentation to avoid complications. Uterine rupture is a rare but severe complication that is not directly caused by breech presentation. Preeclampsia, gestational diabetes, and low birth weight are not commonly associated with breech presentation. Therefore, choice A is the correct answer.
A condition of trial of scar is
- A. Estimated fetal weight of less than 3600g
- B. Availability of a level one hospital nearby
- C. Not more than two previous caesarean section scars
- D. An adequate pelvis with true conjugate 10.5cm
Correct Answer: C
Rationale: Rationale for Correct Answer (C): A trial of scar is indicated when a woman has had no more than two previous caesarean sections. This is because the risk of uterine rupture increases with each subsequent caesarean section due to scar tissue weakening. Limiting the number of previous scars reduces this risk. Therefore, option C is correct.
Summary of Incorrect Choices:
A: Estimated fetal weight is not a determining factor for a trial of scar.
B: Availability of a level one hospital nearby is important for emergency situations but not a criteria for trial of scar.
D: Adequate pelvis with true conjugate 10.5cm is important for vaginal delivery but not a specific requirement for a trial of scar.