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: B

Rationale: The correct answer is B: Rotational injury. Flexion-distraction injuries of the thoracolumbar spine are often caused by rotational forces that occur during accidents such as motor vehicle collisions or falls. These forces lead to the spine being twisted, causing separation of the vertebrae. Blunt trauma (A) can cause various spinal injuries but is not specific to flexion-distraction injuries. Seat belts (C) are designed to prevent spinal injuries by restraining the body during a collision. Gunshot wounds (D) can cause spinal cord injuries but are not commonly associated with flexion-distraction injuries of the thoracolumbar spine.

Correct Answer: D

Rationale: The correct answer is D - All of the above. Braxton Hicks contractions can be differentiated from true labor by timing, intensity, and duration. Timing refers to the regularity of contractions, intensity relates to the strength of contractions, and duration indicates how long contractions last. By considering all three factors together, one can determine whether contractions are Braxton Hicks (practice contractions) or true labor contractions. Choices A, B, and C alone provide only partial information, which may lead to misinterpretation. Therefore, choosing all three factors collectively (D) is essential for accurate differentiation.

Correct Answer: B

Rationale: Step 1: Feminizing adrenal tumors are not always carcinomas, so A is incorrect. Step 2: Virilizing tumors in women can originate from adrenal or extra-adrenal sites, so C is incorrect. Step 3: Virilizing adrenal tumors are usually benign, especially in children, so D is incorrect. Step 4: B is correct as feminizing adrenal tumors are rare but are the most common type of adrenal tumor causing gender symptoms.

Correct Answer: A

Rationale: Rationale: Breech presentation increases risks during childbirth. Prolonged labor is common due to the position of the baby. Umbilical cord prolapse occurs when the cord slips through the cervix before the baby, leading to oxygen deprivation. Shoulder dystocia happens when the baby's shoulders get stuck during delivery. Choice A is correct as it directly relates to complications of breech presentation. Choices B, C, and D are incorrect as they do not specifically address the complications associated with breech presentation. Cesarean delivery is often recommended for breech presentation to avoid complications. Uterine rupture is a rare but severe complication that is not directly caused by breech presentation. Preeclampsia, gestational diabetes, and low birth weight are not commonly associated with breech presentation. Therefore, choice A is the correct answer.

Correct Answer: D

Rationale: The correct answer is D. TB in pregnancy can lead to premature labor due to the fever experienced. Fever increases the risk of premature labor by triggering uterine contractions. Poor maternal appetite (A) and severe anemia (B) may impact the mother's health but are not directly linked to premature labor. Adverse reactions of anti-TB drugs (C) could potentially affect the mother's health but are not a direct cause of premature labor.

Correct Answer: A

Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low. Explanation for other choices: B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome. C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome. D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.

Correct Answer: B

Rationale: The correct answer is B: Very severe anaemia. Productive cough, dyspnoea at rest, and generalized oedema are classic symptoms of very severe anaemia due to decreased oxygen-carrying capacity of the blood. Anemia leads to tissue hypoxia, causing shortness of breath and fluid retention. Folate deficiency (A) typically presents with megaloblastic anemia, not generalized edema. Mild iron deficiency (C) may lead to fatigue and weakness but not the severe symptoms described. Severe anemia (D) is too broad; very severe anemia specifically refers to the severity of the condition.

Correct Answer: C

Rationale: The correct answer is C: Importance of early ambulation. After a cesarean section, early ambulation is crucial to prevent complications like blood clots and promote circulation. It helps prevent post-operative complications. Choice A is important for respiratory health but not the priority right after surgery. Choice B focuses on perineal care which is important but not the immediate priority. Choice D is important, but recognizing signs of infection can wait until the client is more stable. Early ambulation is key to preventing complications and aiding in recovery.