Delivery of breech with an extended head is accomplished through

Correct Answer: C

Rationale: The correct answer is C: Mauriceau-Smellie-Veit maneuver for delivery of breech with an extended head. This maneuver involves flexing the head while still in the vagina to allow for easier delivery. The Burns Marshall maneuver (A) is for impacted fetal shoulders, Lovset maneuver (B) is for shoulder dystocia, and McRobert's maneuver (D) is for shoulder dystocia as well. The Mauriceau-Smellie-Veit maneuver is specifically designed for delivering a breech with an extended head, making it the correct choice in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Autonomy and beneficence. Autonomy refers to the patient's right to make their own decisions regarding their healthcare. In this case, the patient is refusing reintubation, exercising his autonomy. However, beneficence, the duty to act in the patient's best interest, also comes into play as the patient's refusal could lead to respiratory failure and death. The conflict arises from balancing the patient's autonomy with the healthcare provider's duty to provide beneficial care. Choices A, B, and D are incorrect because they do not accurately capture the ethical conflict present in the scenario. Veracity (A) refers to truthfulness, which is not the primary issue here. Nonmalfeasance (B) is the duty to do no harm, which is not directly relevant to the conflict between the patient's autonomy and the need for beneficial care. Justice (D) relates to fairness in resource allocation and is not the primary issue in this case.

Correct Answer: A

Rationale: The correct answer is A: Descent, engagement, flexion, internal rotation. In left occipito-posterior position, the fetus descends into the pelvis, engages in the maternal pelvis, undergoes flexion to fit through the birth canal, and internally rotates to align with the pelvis for delivery. Choice B (Extension, engagement, internal rotation, external rotation) is incorrect because extension is not typically seen in occipito-posterior positions. Choice C (Flexion, descent, external rotation) is incorrect because external rotation is not part of the mechanism in this position. Choice D (Descent, engagement, extension) is incorrect because extension is not typically seen in this position.

Correct Answer: B

Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery. Incorrect choices: A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis. C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery. D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.

Correct Answer: D

Rationale: The correct answer is D: Prepare for reoperation. Given the patient's elevated AST and ALT levels after hepatic resection, along with abnormal prothrombin time and low albumin, there is concern for liver dysfunction. This indicates a potential complication post-surgery, such as hepatic insufficiency or failure, necessitating reoperation for further evaluation and management. Cancelling the transfer (A) would delay necessary intervention. Infusing albumin and fresh frozen plasma (B) would address only the symptoms but not the underlying cause. Repeating labs the next day (C) would not address the urgency of the situation.

Correct Answer: D

Rationale: The correct answer is D: All of the above. Multiple gestations are at higher risk for complications such as premature labor, where contractions start before 37 weeks, leading to preterm birth. Twin-to-twin transfusion syndrome can occur in identical twins sharing a placenta, causing unequal blood flow. Preeclampsia, characterized by high blood pressure and organ damage, is more common in multiple pregnancies. Therefore, all choices A, B, and C are correct as they are common complications associated with multiple gestations.

Correct Answer: C

Rationale: The correct answer is C: Oligohydramnios. Shoulder presentation occurs when the baby presents shoulder-first rather than head-first during birth. Oligohydramnios, a condition characterized by low levels of amniotic fluid, can lead to decreased uterine space, increasing the chances of abnormal fetal positioning. Macerated fetus (A) is associated with fetal decomposition, not shoulder presentation. Postdates pregnancy (B) is linked to increased risk of macrosomia but not shoulder presentation. Placenta abruption (D) is a separation of the placenta from the uterus, not a direct cause of shoulder presentation.

Correct Answer: C

Rationale: The correct answer is C: Precipitate labor. Precipitate labor refers to a rapid labor and delivery process. It is matched with the statement in column A because it is associated with a sudden and quick progression of labor, leading to a rapid delivery of the baby. The other choices are incorrect because: A: Colicky uterus - This term is not related to rapid labor but rather refers to uterine contractions that are painful and intermittent. B: Constriction ring dystocia - This term describes a condition where there is a tight band around the uterus, causing difficulty in the delivery process, which is different from the rapid progression seen in precipitate labor. D: Cervical dystocia - This term refers to a condition where there are issues with the dilation or effacement of the cervix, not directly related to the speed of labor as in precipitate labor.

Correct Answer: B

Rationale: The correct answer is B: Hyperextension casting. The AGACNP knows that this treatment is appropriate for a condition that requires immobilization and support while allowing controlled movement. Hyperextension casting provides stability and support while promoting healing. Observation (A) would not provide adequate treatment for a condition requiring immobilization. Jewett brace (C) is typically used for spinal fractures, not for conditions that require hyperextension casting. Surgical intervention (D) would be considered if conservative measures like casting have failed.