Nokea
The MOST common type of breech presentation is
- A. Frank breech presentation
- B. Complete breech presentation
- C. Incomplete breech presentation
- D. Footling breech presentation
Correct Answer: A
Rationale: The correct answer is A: Frank breech presentation. This is because the frank breech presentation is the most common type of breech presentation, accounting for about 50-70% of all breech births. In a frank breech presentation, the baby's buttocks are presenting first with the legs extended up towards the head. This position is considered the most favorable for a vaginal delivery compared to the other types of breech presentations.
Summary of incorrect choices:
B: Complete breech presentation - This type of breech presentation occurs when the baby's buttocks are presenting first with the knees bent and the feet near the buttocks. It is less common than the frank breech presentation.
C: Incomplete breech presentation - In this type, one or both of the baby's legs are presenting first instead of the buttocks. It is less common than the frank breech presentation.
D: Footling breech presentation - This type occurs when one or both of the baby's feet
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On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection consists of
- A. Cyclosporine
- B. Azathioprine
- C. Methylprednisolone
- D. Sirolimus
Correct Answer: A
Rationale: The correct answer is A: Cyclosporine. Cyclosporine is a first-line treatment for acute rejection following hepatic transplant due to its immunosuppressive properties. It inhibits T-cell activation and cytokine production, suppressing the immune response against the transplanted liver. This helps in preventing further damage caused by rejection. Azathioprine (B) and Sirolimus (D) are also immunosuppressants, but Cyclosporine is preferred as the initial treatment. Methylprednisolone (C) is a corticosteroid that can be used in combination with Cyclosporine for acute rejection to provide a more potent immunosuppressive effect.
Five (5) major factors predisposed to uterine rupture:
- A. Previous C-section, uterine scars, fetal macrosomia, trauma, prolonged labor
- B. Malpresentation, premature rupture of membranes, obesity, malnutrition, anemia
- C. Uterine fibroids, excessive weight gain, smoking, poor prenatal care
- D. All of the above
Correct Answer: A
Rationale: Rationale for Correct Answer (A):
1. Previous C-section and uterine scars weaken the uterine wall.
2. Fetal macrosomia (large baby) increases pressure on the uterus.
3. Trauma can cause direct injury to the uterus.
4. Prolonged labor can lead to uterine overdistension and fatigue, increasing rupture risk.
Summary of Incorrect Choices:
B: Malpresentation, premature rupture of membranes, obesity, malnutrition, anemia are not direct factors for uterine rupture.
C: Uterine fibroids, excessive weight gain, smoking, poor prenatal care can contribute to complications but not primary causes of uterine rupture.
D: Not all factors in choices B and C are predisposing factors for uterine rupture, making this choice incorrect.
Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders
- A. Anteroposterior neck radiography
- B. CT scan of the neck
- C. White blood cell (WBC) differential
- D. Aspiration and culture of fluid
Correct Answer: D
Rationale: The correct answer is D: Aspiration and culture of fluid. Given Jasmine's history of injection drug use, neck pain, inability to turn her neck, elevated temperature, and foul breath, there is a high suspicion of a deep neck space infection. Aspiration and culture of fluid from the affected area will help identify the causative organism and guide appropriate antibiotic therapy. This procedure is essential for definitive diagnosis and management of deep neck infections.
A: Anteroposterior neck radiography is not the most appropriate initial diagnostic test for evaluating deep neck space infections as it may not provide detailed information on the extent or nature of the infection.
B: CT scan of the neck may provide valuable information regarding the extent of the infection, but aspiration and culture of fluid are crucial for identifying the causative organism.
C: White blood cell (WBC) differential may show signs of inflammation, but it does not provide specific information on the causative organism of the infection.
An oedematous swelling on the newborn’s scalp is indicative of
- A. Caput succedaneum
- B. Subgaleal hemorrhage
- C. Intracranial injury
- D. Neonatal cephalhematoma
Correct Answer: A
Rationale: The correct answer is A: Caput succedaneum. This swelling is a result of pressure during birth and typically resolves on its own. Subgaleal hemorrhage involves bleeding into the potential space between the periosteum and skull, presenting as a boggy mass. Intracranial injury refers to damage within the skull, often due to trauma. Neonatal cephalhematoma is a subperiosteal collection of blood, causing a localized swelling. Caput succedaneum is the most likely diagnosis based on the description provided.
The term used to describe the situation whereby there is the presence of more than one part of the fetus on the pelvic brim at the onset of labor is
- A. Unstable lie
- B. Fetal malpresentation
- C. Fetal malposition
- D. Compound presentation
Correct Answer: D
Rationale: The correct answer is D: Compound presentation. This term refers to the situation where there is more than one part of the fetus on the pelvic brim at the onset of labor. This can include a hand or arm alongside the head or another body part. The other choices are incorrect because: A: Unstable lie refers to the fetus being in a transverse position. B: Fetal malpresentation indicates an abnormal presentation of the fetus, such as breech or transverse. C: Fetal malposition refers to the fetus being in a suboptimal position, like occiput posterior. Thus, the best choice is D as it specifically describes the scenario of multiple fetal parts on the pelvic brim.