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What are the main causes of postpartum hemorrhage?
- A. Uterine atony
- B. Retained placenta
- C. Vaginal trauma
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D, "All of the above." Postpartum hemorrhage can be caused by uterine atony, which is the failure of the uterus to contract after delivery; retained placenta, where parts of the placenta remain in the uterus; and vaginal trauma, such as tears or lacerations during delivery. Each of these factors can contribute to excessive bleeding after childbirth. Therefore, selecting all the choices is necessary to encompass the main causes of postpartum hemorrhage.
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Why is it important to monitor blood pressure regularly in pregnant women?
- A. To prevent anemia
- B. To detect preeclampsia
- C. To avoid preterm labor
- D. To prevent gestational diabetes
Correct Answer: B
Rationale: It is important to monitor blood pressure in pregnant women to detect preeclampsia, a serious condition that can lead to complications for both the mother and the baby. Preeclampsia is characterized by high blood pressure and protein in the urine, and early detection is crucial for timely intervention. Regular monitoring allows healthcare providers to identify and manage preeclampsia promptly, reducing the risk of severe complications such as eclampsia and organ damage. Anemia, preterm labor, and gestational diabetes are important aspects of prenatal care but are not directly related to the need for regular blood pressure monitoring in pregnant women.
A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about
- A. Lactulose taken 20 g PO daily
- B. Spironolactone taken 100 mg PO daily
- C. Protein intake of 50 g daily
- D. Zolpidem taken 10 mg PO qhs.
Correct Answer: C
Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake helps decrease ammonia production. Excessive ammonia leads to neurological symptoms. Lactulose (choice A) is correct for hepatic encephalopathy as it helps eliminate ammonia through the gut. Spironolactone (choice B) is a diuretic and not indicated for hepatic encephalopathy. Zolpidem (choice D) is a sleep aid and not relevant to managing ammonia accumulation. In summary, choice C is correct because it directly targets the underlying issue of ammonia accumulation in hepatic encephalopathy, while the other choices do not address this specific concern.
In the preoperative assessment of a patient for the likelihood of postoperative risk, ascorbic acid deficiency, anemia, and volume contraction are all risk factors for
- A. Prolonged intubation
- B. Thromboembolism
- C. Delayed wound healing
- D. Atelectasis
Correct Answer: D
Rationale: Step-by-step rationale for why choice D (Atelectasis) is correct:
1. Ascorbic acid deficiency can lead to impaired lung function, increasing the risk of atelectasis.
2. Anemia can cause decreased oxygen-carrying capacity, contributing to atelectasis.
3. Volume contraction can lead to reduced lung expansion, further predisposing to atelectasis.
Summary:
- Choice A (Prolonged intubation): Intubation duration is more related to respiratory complications, not directly linked to the mentioned risk factors.
- Choice B (Thromboembolism): Risk factors like immobility and hypercoagulability are more relevant to thromboembolism.
- Choice C (Delayed wound healing): More associated with factors like malnutrition and impaired immune function rather than the mentioned risk factors.
The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNRthe patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here?
- A. Veracity and beneficence
- B. Beneficence and nonmalfeasance
- C. Autonomy and beneficence
- D. Justice and autonomy
Correct Answer: C
Rationale: The correct answer is C: Autonomy and beneficence. Autonomy refers to the patient's right to make their own decisions regarding their healthcare. In this case, the patient is refusing reintubation, exercising his autonomy. However, beneficence, the duty to act in the patient's best interest, also comes into play as the patient's refusal could lead to respiratory failure and death. The conflict arises from balancing the patient's autonomy with the healthcare provider's duty to provide beneficial care.
Choices A, B, and D are incorrect because they do not accurately capture the ethical conflict present in the scenario. Veracity (A) refers to truthfulness, which is not the primary issue here. Nonmalfeasance (B) is the duty to do no harm, which is not directly relevant to the conflict between the patient's autonomy and the need for beneficial care. Justice (D) relates to fairness in resource allocation and is not the primary issue in this case.
Vaginal birth after caesarean section is known as
- A. Spontaneous vaginal delivery
- B. Trial of scar
- C. Spontaneous vertex delivery
- D. Trial of birth
Correct Answer: B
Rationale: The correct answer is B: Trial of scar. This term specifically refers to the process of attempting a vaginal birth after a previous caesarean section. It involves monitoring the previous cesarean scar for any signs of complications during labor.
A: Spontaneous vaginal delivery refers to giving birth vaginally without any previous cesarean section.
C: Spontaneous vertex delivery simply describes the position of the baby's head during birth.
D: Trial of birth is not a commonly used term in obstetrics and does not specifically relate to VBAC.