Nokea
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.
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Delivery of the head in a complete breech presentation is usually accomplished through
- A. Lovset maneuver
- B. Mauriceau-Smellie-Veit
- C. Burns Marshall method
- D. Gentle traction of the neck
Correct Answer: B
Rationale: The correct answer is B: Mauriceau-Smellie-Veit. This method involves flexing the hips, extending the thighs, and applying suprapubic pressure to deliver the head in a complete breech presentation. This technique helps to avoid hyperextension of the neck and potential spinal cord injury. The Lovset maneuver (A) is used for delivering the arms in a breech presentation. The Burns Marshall method (C) involves performing an episiotomy and delivering the baby by flexion and traction on the legs. Gentle traction of the neck (D) is not recommended as it can cause spinal cord injury. Mauriceau-Smellie-Veit is the preferred method for safe delivery of the head in a complete breech presentation.
What are the key signs of preeclampsia?
- A. High blood pressure
- B. Proteinuria
- C. Severe headaches
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D (All of the above) because preeclampsia is characterized by high blood pressure, proteinuria, and symptoms like severe headaches. High blood pressure is a hallmark sign, proteinuria indicates kidney damage, and severe headaches can be a symptom of worsening preeclampsia. Therefore, all three signs are crucial for diagnosing preeclampsia. Choices A, B, and C are incorrect individually because they do not encompass all the key signs necessary for diagnosing preeclampsia.
K. W. is a 50-year-old woman who presents for surgical resection of the liver for treatment of metastatic colon cancer. Preoperatively, the surgeon tells her that he is planning to remove 50 to 75 of her liver. The patient is concerned that she will not be able to recover normal liver function with that much removed. The AGACNP counsels her that
- A. Such a high-volume resection is utilized only in people with markedly compromised hepatic function
- B. Major regeneration occurs within 10 days, and the process is complete by 5 weeks
- C. Liver function will probably recover to 50% baseline, but that is enough for normal function
- D. Up to 95% of the liver can be removed without any apparent consequence to the patient
Correct Answer: A
Rationale: The correct answer is A because high-volume liver resection is typically performed in individuals with significantly compromised hepatic function to ensure adequate liver remnant. Removing 50 to 75% of the liver in a patient with metastatic colon cancer may be necessary for tumor clearance but carries risks due to potential impairment of liver function postoperatively. Choices B and C provide inaccurate information regarding the timeline and extent of liver regeneration following resection. Choice D is incorrect as removing up to 95% of the liver would lead to severe consequences, such as liver failure. Hence, option A is the most appropriate advice given the patient's situation.
A correct statement about shoulder dystocia is
- A. It is an impaction of the anterior shoulder after delivery of the head
- B. It is an impaction of the posterior shoulder after delivery of the head
- C. Shoulder dystocia occurs due to compound presentation of the fetus
- D. Shoulder dystocia is not an emergency and resolves on its own effort gradually
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Shoulder dystocia is an impaction of the anterior shoulder after delivery of the head because the anterior shoulder gets stuck behind the pubic symphysis during childbirth. This can lead to serious complications for both the mother and the baby if not managed promptly.
Summary of Incorrect Choices:
B: Impaction of the posterior shoulder is not referred to as shoulder dystocia; it is the impaction of the anterior shoulder that causes the complication.
C: Shoulder dystocia is not caused by a compound presentation of the fetus, which refers to a situation where more than one fetal part presents at the maternal pelvis simultaneously.
D: Shoulder dystocia is indeed an emergency that requires immediate intervention, as delays can lead to birth injuries and complications. It does not resolve on its own and needs medical assistance.
P. T. is a 58-year-old female who is admitted with chest pain and shortness of breath and is found to have a large pulmonary embolus. Her systolic blood pressure is falling, and a diagnosis of obstructive shock is made. Cardiac pressure would likely demonstrate
- A. Elevated atrial and decreased ventricular pressures
- B. Elevated right-sided and decreased left-sided pressures
- C. Elevated left ventricular pressure and decreased cardiac output
- D. Elevated left ventricular pressure and decreased systemic vascular resistance
Correct Answer: C
Rationale: The correct answer is C because in obstructive shock due to a large pulmonary embolus, there is increased resistance to blood flow out of the right ventricle, leading to elevated right ventricular pressure. This causes a backup of blood into the pulmonary circulation, increasing left ventricular pressure. The increased left ventricular pressure results in decreased cardiac output as the left ventricle struggles to pump against the increased resistance.
A: Elevated atrial and decreased ventricular pressures - This is incorrect as obstructive shock typically results in elevated ventricular pressures due to increased resistance.
B: Elevated right-sided and decreased left-sided pressures - This is partially true, but C is a more complete answer that explains the consequences of these pressures on cardiac output.
D: Elevated left ventricular pressure and decreased systemic vascular resistance - This is incorrect as obstructive shock leads to increased, not decreased, systemic vascular resistance due to the embolus obstructing blood flow.