Nokea
What role does the placenta play in managing fetal waste products?
- A. Filters toxins
- B. Facilitates nutrient absorption
- C. Removes carbon dioxide
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D because the placenta performs multiple functions in managing fetal waste products. It filters toxins, facilitates nutrient absorption, and removes carbon dioxide. The placenta acts as a barrier between the mother and the fetus, allowing for the exchange of nutrients and waste products. Therefore, all of the above choices are correct in describing the role of the placenta in managing fetal waste products. The other choices are incorrect because they do not encompass all the functions that the placenta serves in this context.
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While participating in sports, it is not uncommon for people to be subjected to sudden rotational injuries that result in the abrupt rotation of the cerebral cortex around the more fixed midbrain structures. This can interrupt input and outflow from the reticular activating system and result in what clinical phenomenon?
- A. Epidural hematoma
- B. Uncal herniation
- C. Concussion
- D. Contrecoup injury
Correct Answer: A
Rationale: The correct answer is A: Epidural hematoma.
1. Sudden rotational injuries can cause tearing of the middle meningeal artery, leading to an epidural hematoma.
2. The hematoma can compress the brain, disrupting the reticular activating system, causing altered consciousness.
3. Uncal herniation (B) involves herniation of the uncus, not rotation-related.
4. Concussion (C) is a mild traumatic brain injury, not directly related to rotational injuries.
5. Contrecoup injury (D) is when the brain impacts the opposite side of the skull due to sudden deceleration, not rotation-induced.
Which one of the following is a characteristic of fetal post-maturity syndrome?
- A. Closed eyes, unusually alert
- B. Long, frail finger nails
- C. Wrinkled, peeling skin
- D. Excess vernix caseosa
Correct Answer: C
Rationale: The correct answer is C: Wrinkled, peeling skin. Post-maturity syndrome occurs when a pregnancy extends beyond 42 weeks, causing the baby to lose the protective layer of vernix caseosa, leading to dry, peeling skin. Closed eyes and being unusually alert (A) are not specific to post-maturity syndrome. Long, frail fingernails (B) are not a typical characteristic of post-maturity. Excess vernix caseosa (D) is actually a characteristic of a premature baby, not a post-mature one.
Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifers evaluation and management should include
- A. No further care, because the chest radiograph is negative
- B. Quantiferon serum assay for exposure
- C. Consideration of prophylactic therapy
- D. Beginning therapy for pulmonary TB pending sputum cultures
Correct Answer: A
Rationale: The correct answer is A: No further care, because the chest radiograph is negative. In this scenario, Jennifer has a positive PPD test with a 12-mm induration but a negative chest radiograph, indicating latent TB infection. The negative chest radiograph rules out active TB disease. As a result, Jennifer does not require further evaluation or treatment for active TB. The positive PPD alone does not warrant further investigations such as Quantiferon assay (B) or prophylactic therapy (C) as these are not indicated for latent TB infection without active disease. Beginning therapy for pulmonary TB (D) is unnecessary and potentially harmful as Jennifer does not have active TB. Thus, the correct course of action is to provide no further care based on the negative chest radiograph.
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 is crucial to prevent ammonia accumulation. Protein breakdown in the body leads to ammonia production, which worsens encephalopathy symptoms. Limiting protein intake to 50g daily helps decrease ammonia formation. Lactulose (choice A) is used to reduce ammonia absorption in the gut. Spironolactone (choice B) is a diuretic used to treat fluid retention in liver disease. Zolpidem (choice D) is a sedative and not related to managing ammonia accumulation in hepatic encephalopathy. Therefore, choices A, B, and D are incorrect for long-term management of ammonia accumulation in hepatic encephalopathy.
Janet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows serum bilirubin approximately 2 gdL, albumin 3.1 gdL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to
- A. Cancel the transfer and keep her in the ICU
- B. Infuse albumin and fresh frozen plasma
- C. Repeat the labs the next day
- D. Prepare for reoperation
Correct Answer: B
Rationale: The correct answer is B: Infuse albumin and fresh frozen plasma. Given Janet's post-hepatic resection status and abnormal lab values indicating liver dysfunction (elevated bilirubin, low albumin, prolonged prothrombin time, elevated AST and ALT), she is at risk for coagulopathy and hypoalbuminemia. Infusing albumin can help improve her oncotic pressure and fluid balance, while fresh frozen plasma can replenish clotting factors to address the prolonged prothrombin time. This intervention aims to stabilize her condition before transferring to the general medical floor.
Canceling the transfer (Choice A) is not necessary if appropriate interventions can be taken. Repeating labs the next day (Choice C) delays potentially needed treatments. Preparing for reoperation (Choice D) is not indicated based on the information provided.