Nokea
Sara S. is a 41-year-old patient who has just had a bone marrow transplant. The AGACNP knows that which medication will be used to decrease her risk of graft-versus-host reaction?
- A. Immune globulin
- B. Cyclosporine
- C. Prophylactic antibiotics
- D. Systemic corticosteroids
Correct Answer: A
Rationale: The correct answer is A: Immune globulin. Post bone marrow transplant, immune globulin is used to decrease the risk of graft-versus-host reaction by providing passive immunity. This helps in reducing the chances of the donor's immune cells attacking the recipient's tissues. Immune globulin does not suppress the immune system like cyclosporine (B) or systemic corticosteroids (D) do, which could increase the risk of infections post-transplant. Prophylactic antibiotics (C) are used to prevent infections but do not specifically target graft-versus-host reaction.
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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 are typically not honored for terminally ill patients with impaired cognition. Firstly, living wills require the patient to be of sound mind to make decisions. Secondly, in the case of a cognitively impaired patient, their ability to express their wishes and understand the implications may be compromised. Therefore, healthcare providers may not be able to honor the living will accurately. Choices A, B, and D are incorrect because A) competency can be determined by healthcare professionals, B) impaired cognition can lead to incompetence, and D) informed consent requires the patient to understand the decision-making process.
A patient with suspected Cushings syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate
- A. Low ACTH and low cortisol
- B. Low ACTH and high cortisol
- C. High ACTH and low cortisol
- D. High ACTH and high cortisol
Correct Answer: A
Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low.
Explanation for other choices:
B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome.
C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome.
D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.
Deep transverse arrest is
- A. Where flexion is always well maintained.
- B. Caused by strong uterine contractions throughout labor.
- C. Caused by a sacrum that is well curved.
- D. Where the level of the occiput and the sinciput is the same.
Correct Answer: D
Rationale: The correct answer is D because deep transverse arrest occurs when the level of the occiput and the sinciput is the same, leading to a failure of descent of the fetal head through the pelvis. This alignment issue hinders the progress of labor despite adequate contractions.
A: Incorrect. Flexion being well maintained is not a defining characteristic of deep transverse arrest.
B: Incorrect. While strong uterine contractions can contribute to labor challenges, deep transverse arrest is specifically related to the alignment of the fetal head.
C: Incorrect. The curvature of the sacrum is not directly related to deep transverse arrest.
Neonatal injury to nerve roots C8 & T1 causes one of the following
- A. Erb’s palsy
- B. Klumpke’s palsy
- C. Phrenic injury
- D. Radial palsy
Correct Answer: B
Rationale: The correct answer is B: Klumpke's palsy. Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy, characterized by paralysis of the lower arm and hand muscles. This occurs due to damage to the lower trunk of the brachial plexus. Erb's palsy (choice A) involves C5 & C6 nerve roots, causing weakness in the shoulder and upper arm. Phrenic injury (choice C) affects the diaphragm, leading to breathing difficulties. Radial palsy (choice D) results from damage to the radial nerve, causing wrist drop and weakness in forearm muscles. Klumpke's palsy specifically matches the description of injury to nerve roots C8 & T1.
Icterus gravis and hydrops fetalis are conditions highly associated with:
- A. Rhesus D incompatibility
- B. ABO incompatibility
- C. Physiological jaundice
- D. Instant perinatal death
Correct Answer: A
Rationale: The correct answer is A: Rhesus D incompatibility. Icterus gravis and hydrops fetalis are conditions associated with hemolytic disease of the newborn, caused by Rhesus D incompatibility between the mother and fetus. This occurs when the mother is Rh-negative and the baby is Rh-positive, leading to the production of antibodies by the mother that attack the baby's red blood cells. This can result in severe jaundice (icterus gravis) and excessive fluid accumulation in the fetus (hydrops fetalis).
Summary:
- Choice B (ABO incompatibility) is incorrect because it typically causes less severe jaundice and anemia compared to Rhesus D incompatibility.
- Choice C (Physiological jaundice) is incorrect as it is a common benign condition in newborns due to immature liver function.
- Choice D (Instant perinatal death) is incorrect as it does not specifically relate to the conditions mentioned.