Nokea
Wernicke’s encephalopathy and Mallory-Weiss syndrome are among the complications of
- A. Placenta praevia
- B. Hypertensive disorders
- C. Vitamin B deficiency
- D. Hyperemesis gravidarum
Correct Answer: D
Rationale: Step-by-step rationale for why D is correct:
1. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy.
2. Prolonged vomiting can lead to electrolyte imbalances and nutritional deficiencies.
3. Vitamin B deficiency, specifically thiamine, can result in Wernicke’s encephalopathy.
4. Mallory-Weiss syndrome can occur due to repeated retching and vomiting.
5. Therefore, hyperemesis gravidarum can lead to both Wernicke’s encephalopathy and Mallory-Weiss syndrome.
Summary:
A: Placenta praevia is related to abnormal placental placement, not vomiting.
B: Hypertensive disorders are associated with high blood pressure, not vomiting-related complications.
C: Vitamin B deficiency can lead to Wernicke’s encephalopathy but is not directly caused by hyperemesis gravidarum.
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A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?
- A. Isoproterenol 0.2 to 0.6 mg IV bolus
- B. External pacemaking
- C. Atropine 0.5 mg IV
- D. Epinephrine 1 mg IV
Correct Answer: A
Rationale: The correct answer is A: Isoproterenol 0.2 to 0.6 mg IV bolus. Isoproterenol is a non-selective beta-adrenergic agonist that can worsen graft rejection in heart transplant patients. The appropriate intervention for bradyarrhythmia in posttransplant patients is external pacemaking or pharmacological agents like atropine or epinephrine. Isoproterenol should be avoided due to its potential to stimulate the immune system and increase the risk of rejection. It is crucial to choose interventions that address the bradycardia without compromising the patient's transplant graft.
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?
- A. A temperature of 101.5°F
- B. A leukocyte count of 18,000/µL
- C. A palpable gallbladder
- D. A positive Murphy’s sign
Correct Answer: A
Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.
Complications of occipito-posterior position:
- A. Prolonged labor, fetal distress, back pain
- B. Postpartum hemorrhage, uterine rupture, fetal death
- C. Cesarean delivery, low birth weight, infection
- D. All of the above
Correct Answer: A
Rationale: The correct answer is A because occipito-posterior position can lead to prolonged labor due to poor fetal positioning, causing maternal back pain. This can result in fetal distress as the baby may have difficulty descending through the birth canal. Postpartum hemorrhage, uterine rupture, fetal death (choices B and C) are not typically associated with occipito-posterior position. Therefore, choice A is the most appropriate answer.
The commonest major cause of primary postpartum haemorrhage is
- A. Trauma of the genital tract
- B. Blood coagulation disorder
- C. Prolonged 3rd stage
- D. Atony of the uterus
Correct Answer: D
Rationale: Step 1: Atony of the uterus is the most common cause of primary postpartum hemorrhage due to inadequate uterine contractions.
Step 2: Trauma of the genital tract can lead to bleeding but is not as common as atony of the uterus in postpartum hemorrhage.
Step 3: Blood coagulation disorder can contribute to excessive bleeding but is not the primary cause of postpartum hemorrhage.
Step 4: Prolonged 3rd stage can result in postpartum hemorrhage but is typically secondary to uterine atony.
Clinical diagnosis of polyhydramnios is based on an excessive amount of amniotic fluid exceeding
- A. 1500 ml
- B. 2500 ml
- C. 1900 ml
- D. 3000 ml
Correct Answer: D
Rationale: The correct answer is D: 3000 ml. Polyhydramnios is diagnosed when the amniotic fluid volume exceeds 2000 to 3000 ml. This is because amniotic fluid serves important functions in protecting the fetus and aiding in fetal movements. Having an excessively high volume can lead to complications such as preterm labor, fetal malpresentation, and placental abruption. Choices A, B, and C are incorrect as they do not fall within the range typically used to diagnose polyhydramnios. A: 1500 ml and C: 1900 ml are below the threshold, while B: 2500 ml is at the lower end but still not exceeding the diagnostic range for polyhydramnios.