Nokea
Which one of the following is a prerequisite for forceps delivery?
- A. Intact membranes
- B. Ruptured membranes
- C. Cephalic presentation
- D. Full urinary bladder
Correct Answer: B
Rationale: Ruptured membranes are a prerequisite for forceps delivery to avoid injury to the membranes.
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The term persistent occipito-posterior position indicates that the occiput
- A. Fails to rotate forward
- B. Escapes under the symphysis pubis
- C. Rotates forward always
- D. Reaches the pelvic floor first
Correct Answer: A
Rationale: Persistent occipito-posterior position means the occiput fails to rotate forward.
Total loss of polarity and fundal dominance leads to
- A. Precipitate labour
- B. Colicky uterus
- C. Spontaneous labour
- D. Cervical dystocia
Correct Answer: A
Rationale: Loss of polarity and fundal dominance can lead to precipitate labor.
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: Vaginal birth after cesarean is known as a trial of scar.
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: B
Rationale: The most appropriate step for the AGACNP to take in this scenario is to decompress the colon with a rectal tube. The patient's presentation, including crampy abdominal pain, distention, lack of bowel movements, and a frame pattern of colonic distention on radiographs, are suggestive of acute colonic pseudo-obstruction, also known as Ogilvie's syndrome. This condition is characterized by colonic distention without a mechanical obstruction, which can lead to significant complications such as perforation.
R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention. The AGACNP knows that which of the following is contraindicated in this circumstance?
- A. Digital prostate examination
- B. Urinary catheterization
- C. Fluoroquinolone antibiotics
- D. Drainage of prostate abscess
Correct Answer: D
Rationale: In a patient with suspected prostatic abscess and urinary retention, urinary catheterization is contraindicated due to the risk of spreading infection and causing potential complications such as septicemia or worsening of the abscess. The introduction of a catheter can disrupt the abscess capsule, leading to dissemination of the infection. Therefore, other methods of decompression and treatment should be considered, such as drainage of the abscess or other appropriate interventions guided by a healthcare provider.