Nokea
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: D
Rationale: Step-by-step rationale for why D is correct:
1. Arteriolar dilators such as sodium nitroprusside are used to manage hypertensive crisis by rapidly reducing blood pressure.
2. Pheochromocytoma surgery can result in catecholamine release, causing severe hypertension.
3. Arteriolar dilators act directly on blood vessels to lower blood pressure quickly.
4. Alpha-adrenergic antagonists (A) can worsen hypotension, beta-adrenergic antagonists (B) can lead to unopposed alpha-adrenergic effects, and intravenous vasodilators (C) may not act rapidly enough.
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A major predisposing factor to cardiac disease in pregnancy includes
- A. Rheumatic heart disease
- B. Notable peripheral oedema
- C. Easy fatiguability
- D. Basal crepitation
Correct Answer: A
Rationale: The correct answer is A: Rheumatic heart disease. This is because rheumatic heart disease is a known risk factor for cardiac complications during pregnancy due to the strain pregnancy places on the heart. Choice B, notable peripheral edema, is a symptom of heart failure but not a predisposing factor. Choice C, easy fatiguability, is a non-specific symptom and not a direct predisposing factor. Choice D, basal crepitation, is a sign of possible lung pathology and not directly related to cardiac disease in pregnancy. Therefore, the correct answer is A as it directly relates to an increased risk of cardiac issues during pregnancy.
Clinical features of intracranial injury include:
- A. Limpness, bruises, and hypothermia
- B. Irritability, hypoxia, and paralysis
- C. Hypothermia, limpness, and irritability
- D. Hypocalcemia, paralysis, and hypoxia
Correct Answer: B
Rationale: The correct answer is B: Irritability, hypoxia, and paralysis. Intracranial injury can lead to neurological symptoms such as irritability due to brain inflammation, hypoxia from impaired oxygen delivery, and paralysis from damage to the brain or spinal cord. Limpness, bruises, and hypothermia (Option A) are not specific to intracranial injury. Hypothermia, limpness, and irritability (Option C) do not encompass the key neurological symptoms associated with intracranial injury. Hypocalcemia, paralysis, and hypoxia (Option D) include incorrect factors not typically seen in intracranial injury.
Surgical induction of labor refers to the use of
- A. Cytotec and mechanical cervical dilatation
- B. Sweeping of membranes and amniotomy
- C. Mechanical cervical dilatation and buscopan
- D. Artificial rupture of membranes and syntocinon
Correct Answer: B
Rationale: The correct answer is B: Sweeping of membranes and amniotomy.
1. Sweeping of membranes involves manually separating the amniotic sac from the lower part of the uterus, stimulating the release of prostaglandins to induce labor.
2. Amniotomy is the artificial rupture of membranes, which can accelerate labor by releasing amniotic fluid and initiating contractions.
3. These methods are commonly used for surgical induction of labor due to their effectiveness and minimal invasiveness compared to other options.
Incorrect choices:
A: Cytotec is a medication used for labor induction, but mechanical cervical dilatation is not a standard surgical method.
C: Buscopan is used for relaxation of smooth muscle and not commonly used for labor induction.
D: Syntocinon is a synthetic form of oxytocin used to induce or augment labor, but it is not typically used in surgical induction methods.
A clinical feature that is suggestive of hypothermia neonatorum is
- A. Bradycardia
- B. Hyperglycemia
- C. Hypoventilation
- D. Hyperventilation
Correct Answer: A
Rationale: The correct answer is A: Bradycardia. Hypothermia neonatorum is characterized by low body temperature in newborns, which can lead to bradycardia as the heart rate decreases in response to the cold stress. Bradycardia is a common physiological response to hypothermia as the body tries to conserve energy and maintain vital functions. Hyperglycemia, hypoventilation, and hyperventilation are not specific clinical features of hypothermia neonatorum. Hyperglycemia is more commonly associated with conditions like diabetes, hypoventilation could be a sign of respiratory distress, and hyperventilation is usually seen in response to metabolic acidosis or anxiety.
The term used to describe a situation whereby the fetal lie keeps varying after 36 gestational weeks is
- A. Unstable lie
- B. Compound lie
- C. Multiple lie
- D. Transverse lie
Correct Answer: A
Rationale: The correct answer is A: Unstable lie. After 36 weeks of gestation, the fetal lie should typically be consistent. An unstable lie refers to a situation where the fetal lie keeps changing position, indicating a potential complication. This can lead to difficulties during labor and delivery.
Summary:
B: Compound lie - Refers to a situation where the fetus is in an abnormal position, such as breech or transverse, alongside another part of the body presenting first.
C: Multiple lie - Not a recognized medical term.
D: Transverse lie - Refers to a situation where the fetus is positioned horizontally across the uterus, which can complicate delivery.