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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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During neonatal resuscitation, dry wiping is aimed at
- A. Preventing hypothermia and facilitating tactile stimulation
- B. Preventing hemorrhage and clearing of the airway
- C. Preventing infection and facilitating tactile stimulation
- D. Improving the appearance and preventing infection
Correct Answer: A
Rationale: The correct answer is A: Preventing hypothermia and facilitating tactile stimulation. Dry wiping during neonatal resuscitation helps prevent hypothermia by removing wetness from the baby's skin. It also facilitates tactile stimulation, which can help stimulate the baby's breathing.
Summary:
B: Preventing hemorrhage and clearing of the airway - Dry wiping does not prevent hemorrhage or clear the airway directly.
C: Preventing infection and facilitating tactile stimulation - While dry wiping can help prevent infection, its primary aim during neonatal resuscitation is to prevent hypothermia.
D: Improving the appearance and preventing infection - Dry wiping is not done for cosmetic reasons; its main purpose is to prevent hypothermia.
Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves
- A. Several days of oxygen by face mask
- B. Hyperbaric oxygen
- C. Surgical resection
- D. Treatment of underlying disease
Correct Answer: B
Rationale: The correct answer is B: Hyperbaric oxygen. Hyperbaric oxygen therapy is the most effective treatment for pneumatosis as it helps to reduce gas cysts by increasing oxygen levels in the tissues. This promotes healing and resolution of the condition.
A: Several days of oxygen by face mask - Regular oxygen therapy is not as effective as hyperbaric oxygen in treating pneumatosis.
C: Surgical resection - Surgical resection is not typically the first-line treatment for pneumatosis and is usually reserved for severe cases or complications.
D: Treatment of underlying disease - While treating the underlying disease is important, it may not directly address the gas cysts in the gastrointestinal tract. Hyperbaric oxygen therapy targets the gas cysts specifically.
Janet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows serum bilirubin approximately 2 gdL, albumin 3.1 gdL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to
- A. Cancel the transfer and keep her in the ICU
- B. Infuse albumin and fresh frozen plasma
- C. Repeat the labs the next day
- D. Prepare for reoperation
Correct Answer: D
Rationale: The correct answer is D: Prepare for reoperation. Given the patient's elevated AST and ALT levels after hepatic resection, along with abnormal prothrombin time and low albumin, there is concern for liver dysfunction. This indicates a potential complication post-surgery, such as hepatic insufficiency or failure, necessitating reoperation for further evaluation and management. Cancelling the transfer (A) would delay necessary intervention. Infusing albumin and fresh frozen plasma (B) would address only the symptoms but not the underlying cause. Repeating labs the next day (C) would not address the urgency of the situation.
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.
A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about
- A. Lactulose taken 20 g PO daily
- B. Spironolactone taken 100 mg PO daily
- C. Protein intake of 50 g daily
- D. Zolpidem taken 10 mg PO qhs.
Correct Answer: C
Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake helps decrease ammonia production. Excessive ammonia leads to neurological symptoms. Lactulose (choice A) is correct for hepatic encephalopathy as it helps eliminate ammonia through the gut. Spironolactone (choice B) is a diuretic and not indicated for hepatic encephalopathy. Zolpidem (choice D) is a sleep aid and not relevant to managing ammonia accumulation. In summary, choice C is correct because it directly targets the underlying issue of ammonia accumulation in hepatic encephalopathy, while the other choices do not address this specific concern.