Nokea
Psychosis during puerperium mostly manifests as
- A. Mania
- B. Bipolar
- C. Depression
- D. Infection
Correct Answer: C
Rationale: The correct answer is C: Depression. Psychosis during puerperium commonly manifests as postpartum depression, characterized by feelings of extreme sadness, anxiety, and fatigue. This is due to hormonal changes and stress associated with childbirth. Mania (choice A) and bipolar disorder (choice B) are less common during this period. Infection (choice D) is not a typical manifestation of psychosis during puerperium. Overall, postpartum depression is the most prevalent and well-documented form of psychosis in the postpartum period.
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Extra-peritoneal uterine rupture: a) Define extra-peritoneal uterine rupture
- A. A tear in the uterus with no organ damage
- B. A tear involving the peritoneum
- C. A rupture of the uterine wall confined to the tissue
- D. Complete rupture of all uterine layers
Correct Answer: C
Rationale: The correct answer is C: A rupture of the uterine wall confined to the tissue. Extra-peritoneal uterine rupture refers to a rupture that does not breach the peritoneal cavity, keeping the damage confined to the uterine tissue only. This is distinct from intra-peritoneal rupture which involves the peritoneum (choice B) and complete rupture of all uterine layers (choice D). Choice A is incorrect as it does not specify the location of the tear, and it does not necessarily imply that there is no organ damage.
In obstructed labor, edema of the vulva presents early due to
- A. Prolonged effort of the mother to push the baby
- B. Pressure applied on cervix by the presenting part
- C. An ill-fitting presenting part pressing on the cervix
- D. Large presenting diameters stretching the vulva
Correct Answer: B
Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.
T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600L. The AGACNP suspects
- A. Dissecting aortic aneurysm
- B. Acute pancreatitis
- C. Perforated peptic ulcer
- D. Mallory-Weiss tear
Correct Answer: B
Rationale: The correct answer is B: Acute pancreatitis. The clinical presentation of sudden, severe upper abdominal pain not related to food intake, along with the patient's position (lying on right side with hips and knees flexed), and presence of involuntary guarding suggest acute pancreatitis. The elevated white blood cell count indicates an inflammatory process. Dissecting aortic aneurysm (A) typically presents with abrupt, severe chest or back pain radiating to the abdomen, with signs of shock. Perforated peptic ulcer (C) presents with sudden, severe abdominal pain often related to food intake, with signs of peritonitis. Mallory-Weiss tear (D) presents with hematemesis after forceful or prolonged vomiting.
Which one of the following fetal positions is associated with intense back pain during labor?
- A. Occipito-anterior
- B. Transverse position
- C. Occipito-posterior
- D. Occipito-lateral
Correct Answer: C
Rationale: The correct answer is C: Occipito-posterior. This position occurs when the baby's head is facing forward but towards the mother's spine. This position can cause intense back pain during labor because the baby's head puts pressure on the mother's lower back. Occipito-anterior (A) is the most common and ideal position for labor. Transverse position (B) is when the baby is lying sideways, which may cause prolonged labor but not necessarily intense back pain. Occipito-lateral (D) is a less common position where the baby's head is facing sideways, which may not specifically cause intense back pain.
Which of the following is an indication for forceps delivery?
- A. Cephalopelvic disproportion
- B. Occipito posterior position
- C. Breech presentation
- D. Placenta abruption
Correct Answer: B
Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery.
Incorrect choices:
A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis.
C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery.
D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.