Varneys Midwifery 6th Edition Test Bank

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T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?

  • A. A temperature of 101.5°F
  • B. A leukocyte count of 18,000/µL
  • C. A palpable gallbladder
  • D. A positive Murphy’s sign
Correct Answer: A

Rationale: A leukocyte count of 18,000/µL suggests an elevated white blood cell count, which is indicative of an inflammatory or infectious process. In the context of biliary colic, an elevated white blood cell count could be a sign of complications such as cholecystitis (inflammation of the gallbladder) or choledocholithiasis (bile duct obstruction). These complications may require urgent surgical evaluation and intervention. The other options, although concerning, do not specifically suggest a complication that necessitates immediate surgical evaluation.

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The term persistent occipito-posterior position indicates that the occiput

  • A. Fails to rotate forward
  • B. Escapes under the symphysis pubis
  • C. Rotates forward always
  • D. Reaches the pelvic floor first
Correct Answer: A

Rationale: Persistent occipito-posterior position means the occiput fails to rotate forward.

Mr. Novello is an 81-year old male patient who presents with crampy abdominal pain in the hypogastrum and a vague history as to his last normal bowel movement. Physical examination reveals distention and high-pitched bowel sounds. The patient says he has never has this kind of problem before and denies any history of abdominal surgery. Abdominal radiographs reveal a frame pattern of colonic distention. The AGACNP considers

  • A. A stimulant laxative to relieve bowel contents
  • B. Carcinoma of the bowel as a leading diagnosis
  • C. Decompression of the colon with rectal tube
  • D. Angiography to rule out mesenteric ischemia
Correct Answer: B

Rationale: The most appropriate step for the AGACNP to take in this scenario is to decompress the colon with a rectal tube. The patient's presentation, including crampy abdominal pain, distention, lack of bowel movements, and a frame pattern of colonic distention on radiographs, are suggestive of acute colonic pseudo-obstruction, also known as Ogilvie's syndrome. This condition is characterized by colonic distention without a mechanical obstruction, which can lead to significant complications such as perforation.

Arrested active phase of labor in a multiparous woman denotes an abnormal labor pattern as characterized by

  • A. Cessation of cervical dilatation for more than 2 hours
  • B. Cessation of cervical dilatation for more than 4 hours
  • C. Duration of latent phase of labor lasting more than 8 hours
  • D. Cessation of descent of the presenting part for more than 1 hour
Correct Answer: B

Rationale: Arrested active phase is characterized by cessation of cervical dilatation for more than 4 hours.

Vaginal birth after caesarean section is known as

  • A. Spontaneous vaginal delivery
  • B. Trial of scar
  • C. Spontaneous vertex delivery
  • D. Trial of birth
Correct Answer: B

Rationale: Vaginal birth after cesarean is known as a trial of scar.

Vitamin K prevents hemorrhagic disease of the neonate by

  • A. Activating the white blood cells
  • B. Activating the dormant clotting factors
  • C. Adopting a fibrinogen sparing mechanism
  • D. Altering the red blood cells count
Correct Answer: B

Rationale: Vitamin K activates dormant clotting factors, preventing hemorrhagic disease in neonates.

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