Nokea
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal
- A. Increased MCV
- B. Increased Hgb
- C. Increased platelets
- D. Increased albumin
Correct Answer: B
Rationale: Step 1: Post-splenectomy, platelet count typically drops temporarily, leading to a risk of bleeding.
Step 2: To compensate, the body increases hemoglobin (Hgb) levels to maintain oxygen-carrying capacity.
Step 3: Therefore, on postoperative day 2, an increased Hgb level is expected.
Summary: A is incorrect because MCV is not typically affected in this scenario. C is incorrect because platelet count usually decreases post-splenectomy. D is incorrect as albumin levels are not directly impacted by splenectomy for ITP.
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For questions 91 & 92, match the following with the statements in column A by indicating the correct number
- A. Colicky uterus
- B. Constriction ring dystocia
- C. Precipitate labour
- D. Cervical dystocia
Correct Answer: C
Rationale: The correct answer is C: Precipitate labor. Precipitate labor refers to a rapid labor and delivery process. It is matched with the statement in column A because it is associated with a sudden and quick progression of labor, leading to a rapid delivery of the baby. The other choices are incorrect because:
A: Colicky uterus - This term is not related to rapid labor but rather refers to uterine contractions that are painful and intermittent.
B: Constriction ring dystocia - This term describes a condition where there is a tight band around the uterus, causing difficulty in the delivery process, which is different from the rapid progression seen in precipitate labor.
D: Cervical dystocia - This term refers to a condition where there are issues with the dilation or effacement of the cervix, not directly related to the speed of labor as in precipitate labor.
Mechanism of labor in left occipito-posterior position:
- A. Descent, engagement, flexion, internal rotation
- B. Extension, engagement, internal rotation, external rotation
- C. Flexion, descent, external rotation
- D. Descent, engagement, extension
Correct Answer: A
Rationale: The correct answer is A: Descent, engagement, flexion, internal rotation. In left occipito-posterior position, the fetus descends into the pelvis, engages in the maternal pelvis, undergoes flexion to fit through the birth canal, and internally rotates to align with the pelvis for delivery.
Choice B (Extension, engagement, internal rotation, external rotation) is incorrect because extension is not typically seen in occipito-posterior positions. Choice C (Flexion, descent, external rotation) is incorrect because external rotation is not part of the mechanism in this position. Choice D (Descent, engagement, extension) is incorrect because extension is not typically seen in this position.
Which one of the following clinical features indicates neonatal intracranial injury?
- A. An oedematous swelling on the newborn’s scalp that resolves in 48 hours
- B. Notable bleeding between the epicranial aponeurosis & the periosteum
- C. Evidence of excessive molding or abnormal stretching of the fetal head
- D. Peripheral cyanosis as noted by the midwife on the neonate’s peripheries
Correct Answer: C
Rationale: Rationale for choice C:
1. Excessive molding or abnormal stretching of the fetal head can indicate neonatal intracranial injury due to the trauma during birth.
2. This feature suggests possible compression or trauma to the baby's head during delivery.
3. It may lead to intracranial hemorrhage or other injuries, requiring close monitoring and medical intervention.
Summary of other choices:
A. An oedematous swelling resolving in 48 hours is likely a normal finding (cephalohematoma) and not specific to intracranial injury.
B. Notable bleeding between the epicranial aponeurosis & periosteum may indicate cephalohematoma or caput succedaneum, not necessarily intracranial injury.
D. Peripheral cyanosis is related to oxygenation and circulation, not specific to intracranial injury.
V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade IIVI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. The AGACNP knows that ongoing management for R. V. must include
- A. Annual or biannual serial echocardiography
- B. Modification of activity level
- C. Baseline cardiac catheterization
- D. Statin therapy
Correct Answer: C
Rationale: The correct answer is C: Baseline cardiac catheterization. Given the presence of a new onset grade IIVI crescendo-decrescendo cardiac murmur, a baseline cardiac catheterization is necessary to assess the severity and etiology of the murmur. This procedure will provide crucial information on the structure and function of the heart, helping to determine the appropriate management plan.
A: Annual or biannual serial echocardiography is not necessary as the patient is currently asymptomatic and echocardiography has already revealed mild aortic calcification.
B: Modification of activity level is not the immediate priority as the patient is very active physically and not reporting any limitations to daily activities.
D: Statin therapy is not indicated based solely on the presence of a new murmur without further assessment of cardiac function through cardiac catheterization.
The CORRECT statement with regards to face to pubis delivery is
- A. It results due to a 135˚ anterior rotation of the occiput
- B. It results due to a persistent occipito posterior position
- C. It results due to a 45˚ anterior rotation of the occiput
- D. It results due to a 45˚ anterior rotation of the sinciput
Correct Answer: C
Rationale: Rationale:
Face to pubis delivery occurs when the fetal face presents towards the mother's pubic bone during birth. Choice C is correct because a 45˚ anterior rotation of the occiput is needed for this positioning. This allows the fetal face to be directed towards the mother's pubis for a successful face to pubis delivery. Choices A and D are incorrect as they mention incorrect angles of rotation. Choice B is incorrect as a persistent occipito posterior position would result in a face to sacrum delivery, not face to pubis.