He has had 1 L of NSS infused by emergency medical services. His vital signs reveal a pulse of 128 bpm and a blood pressure of 8860 mm Hg. With respect to his hypotension, the AGACNP recognizes that

Correct Answer: C

Rationale: The correct answer is C: His blood pressure is likely a physiologic response to traumatic head injury. Rationale: 1. Physiologic response: Traumatic head injury can lead to autonomic dysregulation, causing increased sympathetic activity and elevated blood pressure to maintain cerebral perfusion. 2. Compensation mechanism: The body may increase blood pressure in response to hypotension to ensure vital organs receive adequate blood flow. 3. Treatment consideration: Understanding that elevated blood pressure can be a compensatory mechanism helps guide appropriate management strategies for traumatic head injury patients. Summary: A: Vasopressors can be used in traumatic head injury depending on the specific situation, and they are not always contraindicated. B: While hypotension can worsen outcomes in traumatic head injury, this choice overstates the risk without providing context. D: Identifying the cause of hypotension is crucial in managing traumatic head injury patients and should not be disregarded in favor of stabilizing the head injury.

Correct Answer: C

Rationale: The correct answer is C: His blood pressure is likely a physiologic response to traumatic head injury. Rationale: 1. Physiologic response: Traumatic head injury can lead to autonomic dysregulation, causing increased sympathetic activity and elevated blood pressure to maintain cerebral perfusion. 2. Compensation mechanism: The body may increase blood pressure in response to hypotension to ensure vital organs receive adequate blood flow. 3. Treatment consideration: Understanding that elevated blood pressure can be a compensatory mechanism helps guide appropriate management strategies for traumatic head injury patients. Summary: A: Vasopressors can be used in traumatic head injury depending on the specific situation, and they are not always contraindicated. B: While hypotension can worsen outcomes in traumatic head injury, this choice overstates the risk without providing context. D: Identifying the cause of hypotension is crucial in managing traumatic head injury patients and should not be disregarded in favor of stabilizing the head injury.

Correct Answer: C

Rationale: The correct answer is C: Multiple gestation. Preterm birth is more common in multiple gestation pregnancies due to the increased strain on the mother's uterus and cervix. This can lead to early labor and delivery. Social habits (choice A) and genetic factors (choice B) may play a role in preterm birth but are not highly associated. Chronic conditions (choice D) can also contribute to preterm birth, but multiple gestation is a stronger predictor.

Correct Answer: B

Rationale: The correct answer is B: Within the first week of birth. Classical vitamin K deficiency bleeding typically occurs within the first week of birth due to low levels of vitamin K in newborns. During this time, infants are at a higher risk of bleeding complications if not supplemented with vitamin K. Choice A is incorrect because bleeding usually occurs after the first 24 hours. Choice C is incorrect as it does not specify a specific time frame within the neonatal stage. Choice D is incorrect as classical vitamin K deficiency bleeding is typically seen within the first week, not necessarily during the entire infancy stage.

Correct Answer: B

Rationale: The correct answer is B: Myelomeningocele. McEwen sign refers to the characteristic scalloping of the frontal bones due to pressure from the expanding brain in individuals with myelomeningocele. This sign is specific to myelomeningocele and is not associated with hydrocephalus (A), microcephaly (C), or encephalocele (D), which have different clinical manifestations and imaging findings. Myelomeningocele is a neural tube defect where the spinal cord and its coverings protrude through an opening in the spine, leading to neurological deficits and associated signs like McEwen sign.

Correct Answer: D

Rationale: Step 1: Atony of the uterus is the most common cause of primary postpartum hemorrhage due to inadequate uterine contractions. Step 2: Trauma of the genital tract can lead to bleeding but is not as common as atony of the uterus in postpartum hemorrhage. Step 3: Blood coagulation disorder can contribute to excessive bleeding but is not the primary cause of postpartum hemorrhage. Step 4: Prolonged 3rd stage can result in postpartum hemorrhage but is typically secondary to uterine atony.

Correct Answer: A

Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.

Correct Answer: A

Rationale: The correct answer is A: Acute mitral valve regurgitation. The presence of a grade VVI systolic murmur that radiates to the midaxillary line suggests mitral valve involvement. Mitral regurgitation leads to acute onset of symptoms such as dyspnea and pulmonary congestion, indicated by coarse rales on auscultation. The murmur is loudest at the point of maximal impulse due to eccentric regurgitation jet. Acute aortic valve regurgitation (B) typically presents with a diastolic murmur. Acute cardiac tamponade (C) would present with Beck's triad and pulsus paradoxus. Acute pulmonary embolus (D) would present with sudden onset dyspnea and pleuritic chest pain.

Correct Answer: C

Rationale: The correct answer is C: 4 hours. This is based on the definition of prolonged second stage in nulliparous women, which is labor lasting more than 4 hours. This duration is considered abnormal and may lead to increased risk of maternal and fetal complications. Choice A (1 hour) is too short and does not meet the criteria for prolonged second stage. Choice B (2 hours) is also insufficient based on the established timeframe. Choice D (8 hours) exceeds the duration for prolonged second stage, indicating a more advanced stage of labor. Therefore, the most appropriate and accurate timeframe for prolonged second stage in nulliparous women is 4 hours.