Varneys Midwifery Test Bank

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While reviewing the head CT scan of a patient following a motor vehicle accident, the AGACNP appreciates a crescent-shaped fluid collection. This most likely represents

  • A. Acute subdural hematoma
  • B. Acute epidural hematoma
  • C. Acute uncal herniation
  • D. Acute brainstem compression
Correct Answer: A

Rationale: A crescent-shaped fluid collection on a head CT scan typically represents an acute subdural hematoma. Acute subdural hematomas result from the tearing of bridging veins that lie between the dura mater and arachnoid mater layers of the meninges. This injury often occurs due to significant head trauma, such as a motor vehicle accident. As blood accumulates within the potential space between the dura and arachnoid layers, it forms a crescent-shaped collection that can compress the underlying brain tissue, leading to symptoms such as altered mental status, headache, focal neurological deficits, and signs of increased intracranial pressure. Treatment may involve surgical intervention to evacuate the hematoma and relieve the pressure on the brain.

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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.

The presenting diameter in face presentation is

  • A. Submento-vertical
  • B. Mento-vertical
  • C. Suboccipito-bregmatic
  • D. Submento-bregmatic
Correct Answer: A

Rationale: In face presentation, the presenting diameter is submento-vertical.

The appropriate time to perform external cephalic version in a breech presentation is at

  • A. 36 gestational weeks
  • B. 38 gestational weeks
  • C. 40 gestational weeks
  • D. 42 gestational weeks
Correct Answer: A

Rationale: External cephalic version is most successful when performed between 36 and 37 weeks.

On vaginal examination, the findings characteristic of brow presentation include

  • A. Presenting diameter is submento-vertical 11.5cm, head partially extended
  • B. Back difficult to palpate, fetal heart heard on the same side as the limbs
  • C. Presenting diameter is mento-vertical 13.5cm, head partially extended
  • D. Presenting diameter is mento-vertical 13.5cm, head completely extended
Correct Answer: A

Rationale: The characteristic presenting diameter in brow presentation is submento-vertical, with the head partially extended.

The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?

  • A. Pyuria
  • B. Fever
  • C. CVA tenderness
  • D. Gross hematuria
Correct Answer: D

Rationale: While pyuria, fever, and CVA tenderness are common features of acute pyelonephritis, gross hematuria is less commonly associated with this condition. In acute pyelonephritis, the inflammatory process primarily affects the renal parenchyma and pelvis, leading to symptoms such as fever, chills, flank pain, pyuria (presence of pus in the urine), and CVA tenderness (tenderness over the costovertebral angle). Hematuria in acute pyelonephritis is more likely to be microscopic rather than gross.

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