enna is a 41-year-old female who presents to the emergency room complaining of sudden hearing loss. She is generally very healthyshe denies any significant medical history, and her only daily medication is a combined oral contraceptive. She does admit that she is just getting over a head cold, but other than that she offers no relevant history. A comprehensive history and physical examination results in a diagnosis of sudden sensorineural hearing loss (SSHL) of unknown origin. The AGACNP knows that the next step in the patients management should include

Correct Answer: A

Rationale: The correct answer is A: Acyclovir. The rationale is that sudden sensorineural hearing loss (SSHL) can sometimes be associated with viral infections, such as herpes simplex virus. Acyclovir is an antiviral medication that can potentially help treat the underlying viral infection causing SSHL. It is important to address the potential viral etiology before considering other treatments. Summary of other choices: B: Furosemide is a diuretic used to treat conditions like high blood pressure and edema, not SSHL. C: Warfarin is an anticoagulant used to prevent blood clots, not indicated for SSHL. D: Hyperbaric oxygen therapy is sometimes used for SSHL, but addressing any potential viral infection with Acyclovir would be a more appropriate initial step.

Correct Answer: C

Rationale: The correct answer is C: Oligohydramnios. Oligohydramnios, which is low levels of amniotic fluid, can lead to reduced cushioning in the uterus, allowing the fetus to assume abnormal positions like shoulder presentation. Macerated fetus (choice A) is related to prolonged fetal death, not shoulder presentation. Postdates pregnancy (choice B) may increase the risk of complications but is not a direct cause of shoulder presentation. Placenta abruption (choice D) is the premature separation of the placenta, which can lead to fetal distress but is not specifically linked to shoulder presentation.

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: Hyperbaric oxygen. Hyperbaric oxygen therapy is the most effective treatment for pneumatosis as it helps to reduce gas cysts by increasing oxygen levels in the tissues. This promotes healing and resolution of the condition. A: Several days of oxygen by face mask - Regular oxygen therapy is not as effective as hyperbaric oxygen in treating pneumatosis. C: Surgical resection - Surgical resection is not typically the first-line treatment for pneumatosis and is usually reserved for severe cases or complications. D: Treatment of underlying disease - While treating the underlying disease is important, it may not directly address the gas cysts in the gastrointestinal tract. Hyperbaric oxygen therapy targets the gas cysts specifically.

Correct Answer: C

Rationale: The correct answer is C: Transmural myocardial infarction. Subtotal plaque disruption leads to vasoconstriction, platelet activation, and embolization, causing complete occlusion of a coronary artery. This results in ischemia of the entire thickness of the myocardial wall, leading to transmural myocardial infarction. Endothelial cell dysfunction (A) is an early event in atherosclerosis but does not directly result from subtotal plaque disruption. Prinzmetal's angina (B) is caused by transient coronary artery spasm rather than plaque disruption. Non-ST elevation myocardial infarction (D) involves incomplete blockage of a coronary artery and typically does not result from subtotal plaque disruption.

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: B

Rationale: Step 1: Post-splenectomy, platelet count typically drops temporarily, leading to a risk of bleeding. Step 2: To compensate, the body increases hemoglobin (Hgb) levels to maintain oxygen-carrying capacity. Step 3: Therefore, on postoperative day 2, an increased Hgb level is expected. Summary: A is incorrect because MCV is not typically affected in this scenario. C is incorrect because platelet count usually decreases post-splenectomy. D is incorrect as albumin levels are not directly impacted by splenectomy for ITP.

Correct Answer: C

Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake helps decrease ammonia production. Excessive ammonia leads to neurological symptoms. Lactulose (choice A) is correct for hepatic encephalopathy as it helps eliminate ammonia through the gut. Spironolactone (choice B) is a diuretic and not indicated for hepatic encephalopathy. Zolpidem (choice D) is a sleep aid and not relevant to managing ammonia accumulation. In summary, choice C is correct because it directly targets the underlying issue of ammonia accumulation in hepatic encephalopathy, while the other choices do not address this specific concern.

Correct Answer: C

Rationale: The correct answer is C because radiation and substances of abuse are known teratogenic causes of congenital abnormalities. Radiation exposure can lead to genetic mutations and developmental issues in the fetus. Substances of abuse like alcohol, tobacco, and illicit drugs can also negatively impact fetal development. A: Medical conditions and pesticides may have negative effects on pregnancy outcomes, but they are not typically classified as teratogenic causes of congenital abnormalities. B: Prescription drugs can be teratogenic in some cases, but not all prescription drugs have harmful effects on fetal development. Chromosomes are not typically considered teratogenic causes. D: Disordered genes can lead to congenital abnormalities, but they are not classified as teratogenic causes. Medical conditions are not universally teratogenic.