Nokea
Vasa praevia occurs when there is a
- A. Velamentous insertion of the cord
- B. Succenturiate insertion of the cord
- C. Tripartite cord
- D. Bipartite cord
Correct Answer: A
Rationale: Vasa praevia occurs with a velamentous insertion of the umbilical cord.
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A definitive indication for elective caesarean section includes
- A. Cord prolapse denoted in first stage
- B. Failure of first stage to progress
- C. Major degree of placenta praevia
- D. Fetal compromise denoted in first stage
Correct Answer: C
Rationale: A major degree of placenta praevia is a definitive indication for elective cesarean section.
What is the role of folic acid in pregnancy?
- A. Prevents gestational hypertension
- B. Supports placenta growth
- C. Prevents neural tube defects
- D. Reduces anemia
Correct Answer: C
Rationale: Folic acid is crucial for preventing neural tube defects.
The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kgday. The best approach to this patients management is to
- A. Continue the current regimen
- B. D/C the spironolactone and begin a loop diuretic
- C. Add a loop diuretic to the spironolactone
- D. Proceed to large-volume paracentesis Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?
Correct Answer: B
Rationale: The best approach to managing the patient with ascites who has responded to spironolactone with weight loss is to add a loop diuretic to the current regimen. Spironolactone is an aldosterone antagonist that primarily works on the distal convoluted tubule, while loop diuretics, such as furosemide, act on the thick ascending limb of the loop of Henle. Combining these two diuretics can result in a synergistic effect, increasing diuresis and reducing fluid retention in patients with ascites. This combination therapy is often used in patients who do not respond adequately to spironolactone alone, and it is considered a common strategy in the management of ascites due to cirrhosis. Therefore, adding a loop diuretic to the spironolactone regimen is the most appropriate next step to optimize diuresis and fluid management in this patient.
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: B
Rationale: The liver is known for its remarkable ability to regenerate. Major regeneration can occur within 10 days after partial hepatectomy (liver resection) as a compensatory mechanism. The process is typically complete within 5 weeks. This regenerative capacity allows for safe removal of a significant portion of the liver for procedures such as liver resection for cancer. The remaining liver tissue is able to rapidly proliferate and restore normal liver function. The patient should be reassured that even with 50 to 75% of her liver being removed, she can expect a significant amount of liver function recovery postoperatively.
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke most likely resulted from a subarachnoid hemorrhage when the patients family reports that the patient
- A. Has a history of atrial fibrillation
- B. Was unable to be aroused in the morning
- C. Had been complaining of a headache before losing consciousness
- D. Has had several brief episodes of mental confusion and right arm and leg weakness
Correct Answer: A
Rationale: The key clinical manifestation indicating a possible subarachnoid hemorrhage in this scenario is that the patient had been complaining of a headache before losing consciousness. Subarachnoid hemorrhage is a type of stroke that results from bleeding into the space between the arachnoid membrane and the pia mater surrounding the brain. Severe headache, often described as the worst headache of one's life, is a classic symptom of subarachnoid hemorrhage. The sudden onset of a severe headache before loss of consciousness raises the suspicion for this type of stroke. Other symptoms such as mental confusion and weakness may also be present, but the headache is a crucial indicator in this case.