Nokea
Trial of scar is likely to have an auspicious outcome if the
- A. Estimated fetal weight is below 3500 grams
- B. Maternal body mass index is estimated at 27.5
- C. Gestational age is approximately 42 weeks
- D. Maternal age is approximately 42 years
Correct Answer: A
Rationale: The correct answer is A because an estimated fetal weight below 3500 grams indicates a lower risk of complications during childbirth. Higher fetal weight increases the likelihood of shoulder dystocia and birth injuries. Maternal body mass index, gestational age, and maternal age do not directly impact the likelihood of a favorable outcome during a trial of scar.
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According to the American College of Surgeons (ACS) and the National Surgical Quality Improvement Program (NSQIP) guidelines for preoperative evaluation of the geriatric patient, the preoperative evaluation should include all of the following except
- A. Cognitive ability
- B. Functional status
- C. Competency assessment
- D. Frailty score
Correct Answer: A
Rationale: Step-by-step rationale:
1. Cognitive ability is important for decision-making during surgery.
2. Functional status helps assess the patient's ability to recover post-surgery.
3. Competency assessment ensures the patient can consent to surgery.
4. Frailty score predicts surgical outcomes in geriatric patients.
5. Cognitive ability is not typically assessed preoperatively in the ACS/NSQIP guidelines.
Summary:
- A: Cognitive ability is not typically part of preoperative evaluation.
- B: Functional status is important for post-surgery recovery.
- C: Competency assessment is crucial for informed consent.
- D: Frailty score helps predict surgical outcomes in geriatric patients.
Vaginal delivery is possible in
- A. Brow presentation
- B. Face presentation
- C. Shoulder presentation
- D. Unstable lie
Correct Answer: B
Rationale: The correct answer is B: Face presentation. Vaginal delivery is possible in face presentation as the baby's head is extended, allowing for descent through the birth canal. Brow presentation (A) and shoulder presentation (C) may require cesarean delivery due to the atypical presentation of the baby. Unstable lie (D) refers to the baby being in a transverse position, which also necessitates a cesarean section. Face presentation is the only option where vaginal delivery may be possible due to the extended position of the baby's head.
Lester R. is a 58-year-old male who is being evaluated for nocturia. He reports that he has to get up 2 to 3 times nightly to void. Additional assessment reveals urinary urgency and appreciable post-void dribbling. A digital rectal examination reveals a normal-sized prostate with no appreciable hypertrophy. The best approach to this patient includes
- A. Administration of the American Urological Association (AUA) Symptom Scale
- B. Laboratory assessment to include a PSA
- C. Ordering a prostate ultrasound
- D. Assessment of nonprostate causes of nocturia
Correct Answer: D
Rationale: The correct answer is D: Assessment of nonprostate causes of nocturia. In this case, the patient's symptoms of nocturia, urinary urgency, and post-void dribbling are not indicative of prostate enlargement. Given that the digital rectal examination revealed a normal-sized prostate with no hypertrophy, it is essential to explore other potential causes of nocturia in this patient. By assessing non-prostate causes of nocturia, such as diabetes, urinary tract infection, medication side effects, or sleep disorders, a more accurate diagnosis and appropriate treatment plan can be developed. This approach will lead to better patient outcomes compared to focusing solely on prostate-related evaluations.
Option A: Administration of the AUA Symptom Scale is not the best approach in this case because the patient's symptoms are not primarily related to prostate enlargement.
Option B: Laboratory assessment to include a PSA is not necessary since the digital rectal examination already indicated a normal-sized prostate with no appreciable hypertrophy.
Option C: Ordering a
The presenting diameters in face presentation are
- A. Submentovertival, bitemporal
- B. Submentobregmatic, bitemporal
- C. Submentobregmatic, biparietal
- D. Mentovertical, bitemporal
Correct Answer: A
Rationale: The correct answer is A: Submentovertival, bitemporal. In a face presentation, the presenting diameters are submentovertival (chin to vertex) and bitemporal (temple to temple). This is because the fetus is in a face-first position with the chin presenting first. Option B is incorrect because submentobregmatic is not a recognized presenting diameter in face presentation. Option C is incorrect as biparietal refers to the widest transverse diameter of the fetal head, not relevant in face presentation. Option D is incorrect as mentovertical is not a valid presenting diameter in face presentation.
Which one of the following therapies is the MOST incorporated in the management of clients with gestational diabetes?
- A. Therapeutic diet alone
- B. Long acting insulin
- C. Oral hypoglycaemics
- D. Short acting insulin
Correct Answer: D
Rationale: The correct answer is D: Short acting insulin. In gestational diabetes, short acting insulin is preferred as it provides immediate control over blood sugar levels after meals. This is crucial in managing the condition to prevent complications for both the mother and the baby. Therapeutic diet alone (choice A) may not be sufficient to control blood sugar levels, while long-acting insulin (choice B) may not provide the rapid response needed after meals. Oral hypoglycemics (choice C) are generally avoided in pregnancy due to potential risks to the fetus. Therefore, short acting insulin is the most appropriate therapy for managing gestational diabetes effectively.