Based upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma?

Correct Answer: A

Rationale: The correct answer is A: Hypogastrinemia and acid hyposecretion. Gastrinoma is a tumor that secretes excessive gastrin, leading to hypergastrinemia and increased acid secretion. However, due to a negative feedback mechanism, chronic exposure to high gastrin levels can cause downregulation of gastrin receptors on parietal cells, leading to decreased acid secretion. Therefore, in gastrinoma, despite high gastrin levels, acid secretion may be reduced due to this negative feedback loop. Choices B, C, and D are incorrect because they do not align with the expected relationship between gastrin levels and acid secretion in gastrinoma.

Correct Answer: D

Rationale: The correct answer is D because deep transverse arrest refers to a situation where the fetal head fails to rotate and descend in the pelvis due to the occiput and sinciput being at the same level. This leads to a prolonged labor. Choice A is incorrect because flexion can be inadequate in deep transverse arrest. Choice B is incorrect because it is not solely caused by uterine contractions but rather fetal malposition. Choice C is incorrect because a well-curved sacrum is not a defining factor in deep transverse arrest.

Correct Answer: C

Rationale: The correct answer is C because establishing an intravenous line is essential for immediate access to administer fluids, medications, and blood products during the emergency cesarean section. This step ensures that the patient's vital signs can be supported, and any emergent interventions can be readily delivered. A: While informed consent is important, in an emergency situation, the priority is to ensure the patient's immediate medical needs are met. B: Inserting a Foley's catheter may be necessary during the procedure, but it is not the most critical assessment prior to the cesarean section. D: Shaving the perineal area is not a priority in an emergency situation and may be done during the preparation for surgery.

Correct Answer: A

Rationale: Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy due to damage to the lower brachial plexus. This results in weakness of the hand and forearm muscles. Erb's palsy is from injury to C5-C6 roots causing upper brachial plexus damage. Phrenic injury affects the diaphragm due to C3-C5 roots. Radial palsy involves the radial nerve, typically from injury at the spiral groove of the humerus. Therefore, the correct answer is A as it directly correlates with the specific nerve roots affected in Klumpke's palsy.

Correct Answer: B

Rationale: Congenital retraction of the prepuce, leading to permanent glans exposure, describes paraphimosis. This condition occurs when the foreskin is pulled back and cannot return to its normal position, causing pain and swelling. Phimosis (A) is the inability to retract the foreskin over the glans. Hypospadias (C) is a urethral opening on the underside of the penis. Hermaphroditism (D) is a rare condition of having both male and female reproductive organs. Paraphimosis (B) is the specific term for the given scenario.

Correct Answer: D

Rationale: The correct answer is D because skin-to-skin contact after birth offers multiple benefits. Firstly, it helps stabilize the baby's temperature by utilizing the parent's body heat. Secondly, it promotes bonding between the parent and baby through physical closeness and touch. Finally, it can regulate the baby's heartbeat by providing a calming and reassuring environment. Therefore, all of the above choices are correct in highlighting the significance of skin-to-skin contact after birth.

Correct Answer: B

Rationale: The correct answer is B: Klumpke's palsy. Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy, characterized by paralysis of the lower arm and hand muscles. This occurs due to damage to the lower trunk of the brachial plexus. Erb's palsy (choice A) involves C5 & C6 nerve roots, causing weakness in the shoulder and upper arm. Phrenic injury (choice C) affects the diaphragm, leading to breathing difficulties. Radial palsy (choice D) results from damage to the radial nerve, causing wrist drop and weakness in forearm muscles. Klumpke's palsy specifically matches the description of injury to nerve roots C8 & T1.

Correct Answer: C

Rationale: The correct answer is C: Fever. The first clinical manifestation of physiologic stress ulcer is often a fever due to the body's response to stress. This is because stress can trigger an inflammatory response, leading to an increase in body temperature. Epigastric pain (choice A) is more commonly associated with peptic ulcers. Change in mental status (choice B) is not a typical early symptom of physiologic stress ulcer. Hemorrhage (choice D) is a severe complication that can occur later in the course of the disease, but it is not typically the first clinical manifestation.

Correct Answer: C

Rationale: The correct answer is C. In myelodysplastic syndromes, splenectomy is indicated for sustained leukocyte elevation above 30,000 cells/µL to manage symptomatic splenomegaly and cytopenias. This is because an enlarged spleen can sequester and destroy blood cells, leading to low blood cell counts. Choices A, B, and D are incorrect as splenectomy is not typically indicated for major hemolysis unresponsive to medical management, severe symptoms of massive splenomegaly, or portal hypertension in the context of myelodysplastic syndromes.