Nokea
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.
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Cord presentation is when the
- A. Umbilical cord lies in front of the presenting part after the membranes have ruptured.
- B. Umbilical cord lies in front of the presenting part before membranes have ruptured
- C. Umbilical cord is tied around the fetal neck.
- D. Umbilical cord has prematurely been detached.
Correct Answer: A
Rationale: The correct answer is A because cord presentation occurs when the umbilical cord lies in front of the presenting part after the membranes have ruptured. This can lead to compression of the cord during labor, affecting fetal oxygenation. Option B is incorrect as it describes cord prolapse, where the cord lies in front of the presenting part before membrane rupture. Option C describes nuchal cord, where the cord is wrapped around the fetal neck. Option D describes cord abruption, where the cord detaches prematurely from the placenta.
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.
The presenting diameter in brow presentation is
- A. Submentobregmatic
- B. Suboccipitofrontal
- C. Occipitalfrontal
- D. Mentovertical
Correct Answer: A
Rationale: The presenting diameter in brow presentation is the submentobregmatic diameter. This is because in brow presentation, the fetal head is partially extended, causing the forehead (bregma) to be the presenting part. The submentobregmatic diameter is the distance between the chin (mentum) and the highest point of the forehead (bregma). This diameter is crucial for successful delivery in brow presentation as it is the smallest diameter that must pass through the maternal pelvis.
Summary of other choices:
B: Suboccipitofrontal - This diameter is not relevant in brow presentation as it involves the back of the head.
C: Occipitalfrontal - This diameter is the distance between the back of the head and the forehead, also not relevant in brow presentation.
D: Mentovertical - This diameter is the distance between the chin and the vertex of the head, not the forehead.
Which of the following is highly associated with preterm babies?
- A. Social habits
- B. Genetic factors
- C. Multiple gestation
- D. Chronic conditions
Correct Answer: C
Rationale: The correct answer is C: Multiple gestation. Preterm birth is more common in multiple gestation pregnancies due to the increased strain on the mother's uterus and cervix. This can lead to early labor and delivery. Social habits (choice A) and genetic factors (choice B) may play a role in preterm birth but are not highly associated. Chronic conditions (choice D) can also contribute to preterm birth, but multiple gestation is a stronger predictor.
Mr. Novello is an 81-year old male patient who presents with crampy abdominal pain in the hypogastrum and a vague history as to his last normal bowel movement. Physical examination reveals distention and high-pitched bowel sounds. The patient says he has never has this kind of problem before and denies any history of abdominal surgery. Abdominal radiographs reveal a frame pattern of colonic distention. The AGACNP considers
- A. A stimulant laxative to relieve bowel contents
- B. Carcinoma of the bowel as a leading diagnosis
- C. Decompression of the colon with rectal tube
- D. Angiography to rule out mesenteric ischemia
Correct Answer: C
Rationale: The correct answer is C: Decompression of the colon with rectal tube. This is the most appropriate intervention for a patient with acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome. In this condition, there is colonic distention without an actual mechanical obstruction, leading to symptoms like abdominal pain, distention, and high-pitched bowel sounds. Decompression with a rectal tube can help relieve the distention and prevent complications like perforation.
Choice A (stimulant laxative) is incorrect because ACPO is not due to simple constipation, so laxatives would not be effective. Choice B (carcinoma of the bowel) is unlikely given the acute onset and lack of risk factors. Choice D (angiography for mesenteric ischemia) is not indicated in this case as there are no signs of acute ischemia.
In summary, the correct choice is C because it directly addresses the underlying issue of colonic distention in