Nokea
Signs of obstructed labour per vaginally include
- A. Dry vagina, Oedema of the cervix, Caput succedaneum
- B. Plenty amniotic fluid, Hot/dry vagina, meconium stained liquor
- C. Meconium stained liquor, Hot/dry vagina, Diluted urine
- D. Caput succedaneum, Oedema of the cervix, plenty amniotic fluid
Correct Answer: A
Rationale: Signs of obstructed labor include a dry vagina, oedema of the cervix, and caput succedaneum.
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Uterus hypotonicity is likely to lead to prolonged labor due to
- A. Incoordination of the uterus muscle fibers during a contraction
- B. Maternal exhaustion because of improper preparation for labor
- C. Weak receptors thus not strong enough to signal enough contraction
- D. Inadequate pelvis thus not able to stimulate enough uterine contractions
Correct Answer: A
Rationale: Uterus hypotonicity results in poor coordination of muscle fibers, leading to ineffective contractions.
Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didnt want to go to the emergency room because he didnt want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes
- A. Proper cleansing and covering of the laceration, along with antibiotic therapy
- B. Local anesthesia, cleansing, and wound exploration for foreign bodies
- C. Local anesthesia, cleansing, and suture repair
- D. Cleansing, covering, antibiotic therapy, and tetanus prophylaxis
Correct Answer: D
Rationale: In this scenario, the patient presents with a jagged laceration on his forearm that is still open and requires sutures. The appropriate management for this patient involves local anesthesia to reduce pain, thorough cleansing of the wound to prevent infection, and wound exploration to assess for any foreign bodies that may be present. Suturing the wound is necessary to promote proper healing and reduce the risk of complications. Antibiotic therapy may be indicated if signs of infection are present, but it is not mentioned in the scenario as a primary management step. Tetanus prophylaxis should also be considered given the mechanism of injury involving a dirty object.
While reviewing the head CT scan of a patient following a motor vehicle accident, the AGACNP appreciates a crescent-shaped fluid collection. This most likely represents
- A. Acute subdural hematoma
- B. Acute epidural hematoma
- C. Acute uncal herniation
- D. Acute brainstem compression
Correct Answer: A
Rationale: A crescent-shaped fluid collection on a head CT scan typically represents an acute subdural hematoma. Acute subdural hematomas result from the tearing of bridging veins that lie between the dura mater and arachnoid mater layers of the meninges. This injury often occurs due to significant head trauma, such as a motor vehicle accident. As blood accumulates within the potential space between the dura and arachnoid layers, it forms a crescent-shaped collection that can compress the underlying brain tissue, leading to symptoms such as altered mental status, headache, focal neurological deficits, and signs of increased intracranial pressure. Treatment may involve surgical intervention to evacuate the hematoma and relieve the pressure on the brain.
Which of the following types of aortic aneurysms requires immediate surgical intervention?
- A. Type A
- B. Type B
- C. Descending
- D. Symptomatic
Correct Answer: C
Rationale: Type A aortic aneurysms require immediate surgical intervention. Type A aortic dissections involve the ascending aorta and are at high risk for complications such as aortic rupture or compromise of coronary artery blood flow. Prompt surgical repair is necessary to prevent potentially fatal outcomes. Types B, C, and symptomatic aneurysms may not require immediate surgical intervention depending on the specific patient presentation and associated risks.
The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?
- A. Alpha-adrenergic antagonists
- B. Beta-adrenergic antagonists
- C. Intravenous vasodilators
- D. Arteriolar dilators
Correct Answer: C
Rationale: Surgical manipulation of the adrenal medulla during resection of a pheochromocytoma can result in the release of catecholamines leading to a hypertensive crisis. Alpha-adrenergic antagonists, such as phenoxybenzamine or prazosin, are the drugs of choice for managing hypertensive crisis in this situation. These medications block the alpha-adrenergic receptors, leading to vasodilation and lowering of blood pressure. Beta-adrenergic antagonists are contraindicated in this scenario due to the risk of unopposed alpha-adrenergic stimulation that could worsen the hypertension. Intravenous vasodilators and arteriolar dilators may be used as adjunctive therapy but alpha-adrenergic antagonists are the primary agents for managing hypertensive crisis in this context.