Nokea
Why is adequate prenatal care crucial for reducing maternal mortality?
- A. Early detection of complications
- B. Encourages healthy behaviors
- C. Reduces the likelihood of preterm birth
- D. All of the above
Correct Answer: D
Rationale: Prenatal care helps detect complications, promotes healthy behaviors, and reduces preterm birth risk.
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Priority nursing diagnoses for Mrs. Q (Breech presentation):
- A. Risk of uterine rupture, risk of fetal distress, pain
- B. Risk of infection, risk of fetal distress, risk of preterm birth
- C. Risk of hemorrhage, risk of cord prolapse, pain
- D. Risk of fetal malpresentation, impaired maternal coping
Correct Answer: A
Rationale: Nursing diagnoses include risks of uterine rupture, fetal distress, and pain management.
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.
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: A leukocyte count of 18,000/µL suggests an elevated white blood cell count, which is indicative of an inflammatory or infectious process. In the context of biliary colic, an elevated white blood cell count could be a sign of complications such as cholecystitis (inflammation of the gallbladder) or choledocholithiasis (bile duct obstruction). These complications may require urgent surgical evaluation and intervention. The other options, although concerning, do not specifically suggest a complication that necessitates immediate surgical evaluation.
Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is really wrong. She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?
- A. Abdominal radiographs
- B. CT scan of the abdomen with contrast
- C. Right upper quadrant ultrasound
- D. A HIDA scan
Correct Answer: A
Rationale: Given Janice's presentation of significant abdominal pain localized to the right upper quadrant with tenderness on deep palpation, the most appropriate initial imaging study to investigate the likely cause is a right upper quadrant ultrasound. This imaging modality is commonly used to evaluate the liver, gallbladder, bile ducts, and adjacent structures. It can help identify common causes of right upper quadrant pain such as gallstones, cholecystitis, or biliary duct obstruction. The non-invasive nature of ultrasound and its ability to provide real-time imaging make it a valuable tool in the initial assessment of patients with abdominal pain. Depending on the findings of the ultrasound, further imaging studies or interventions may be pursued. Abdominal radiographs may not provide sufficient detail of the biliary system, while a CT scan with contrast or a HIDA scan may be reserved for further evaluation if needed based on the ultrasound findings.
Which of the following is associated with diazygotic twinning?
- A. Conjoined twins
- B. Polyhydramnious
- C. Superfecundation
- D. Foetus compressus
Correct Answer: C
Rationale: Superfecundation can occur with dizygotic twinning, leading to multiple paternity.