Melanie is a 31-year-old patient who is being evaluated following a routine urinalysis that revealed microscopic hematuria. She was between menses and has no other identifiable explanation for hematuria. She has no significant medical history and otherwise is without complaint. The AGACNP knows that workup for Melanie should include

Correct Answer: B

Rationale: The correct answer is B: CT urogram. This is the appropriate next step in the workup for Melanie's microscopic hematuria. A CT urogram can provide detailed imaging of the urinary tract to identify any structural abnormalities or causes of hematuria. A urology consultation (choice A) may be necessary after the imaging results. Upper urinary imaging (choice C) is not specific enough and may not provide a comprehensive evaluation. Cystoscopy (choice D) is invasive and typically reserved for cases where lower urinary tract issues are suspected, which is not indicated in Melanie's case without further evaluation.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. Pregnancy can lead to severe anaemia due to increased demand for iron and folate. 2. Pregnancy-induced physiological changes can exacerbate malaria-related anaemia. 3. Severe jaundice may occur in pregnant women with malaria due to liver dysfunction. 4. These effects are common during pregnancy and can worsen with malaria infection. Summary of why other choices are incorrect: - Choice B: Blood smear positivity is not always guaranteed in malaria, and severe anaemia is not the only effect. - Choice C: Therapy limitations can occur, but the presence of few parasites in severe cases is not a defining feature. - Choice D: Loss of pregnancy can happen, but it is not a universal effect of malaria during pregnancy, and severity is not based on parasite count alone.

Correct Answer: C

Rationale: The correct answer is C: Placing client on Trendelenburg position. This helps prevent compression of the cord by moving the presenting part off the cord. Placing the client on all fours (choice A) may worsen cord compression. Application of fundal pressure (choice B) is contraindicated as it can further compress the cord. Labor augmentation with oxytocin (choice D) is not indicated in cord prolapse management as it does not address the immediate risk to the fetus. Trendelenburg position is the recommended intervention to alleviate cord compression and improve fetal oxygenation.

Correct Answer: D

Rationale: The correct answer is D: Placental insufficiency. A bipartite placenta and succenturiate lobe are structural abnormalities that can lead to placental insufficiency. This is because these conditions can interfere with proper blood flow and nutrient exchange between the mother and fetus, resulting in decreased oxygen and nutrients reaching the fetus, leading to placental insufficiency. Placental abruption (choice A), placental calcification (choice B), and placenta previa (choice C) are not directly associated with bipartite placenta or succenturiate lobe and do not specifically cause placental insufficiency.

Correct Answer: A

Rationale: The correct answer is A (Low ACTH and low cortisol) because in patients with an adrenal tumor causing Cushing's syndrome, the tumor autonomously produces cortisol, leading to suppression of ACTH secretion from the pituitary. This results in low ACTH levels and high cortisol levels. Choices B, C, and D are incorrect because they do not reflect the characteristic hormone levels seen in patients with an adrenal tumor causing Cushing's syndrome.

Correct Answer: A

Rationale: The correct answer is A (36 weeks gestation) because at this stage, the fetal lie should stabilize into a consistent position, typically longitudinal. Before 36 weeks, fetal movement and position can vary frequently. Choices B, C, and D are incorrect as they are past the point where fetal lie should have stabilized. At 42 weeks gestation (Choice B), the baby is considered post-term, and fetal lie should have already been established. Similarly, Choices C (38 weeks) and D (40 weeks) fall within the expected range for fetal lie stabilization.

Correct Answer: B

Rationale: The correct answer is B: Tonic. During the tonic stage of eclampsia, the muscles go into a prolonged contraction leading to an arched back and tightly clenched teeth. This is due to sustained muscle rigidity. In contrast, the clonic stage involves rhythmic muscle contractions and relaxations, not sustained rigidity. The premonitory stage is characterized by warning signs like headaches and visual disturbances, not specific physical postures. Coma is a severe stage of unconsciousness, not associated with specific physical postures or muscle rigidity seen in the tonic stage of eclampsia.

Correct Answer: B

Rationale: Uterine apoplexy is the sudden rupture of blood vessels in the uterus, leading to severe hemorrhage. Placental abruption is the most likely cause due to the separation of the placenta from the uterine wall, resulting in bleeding. Incidental hemorrhage is not sudden or severe. Multiple pregnancy may increase the risk but doesn't directly cause uterine apoplexy. Placenta previa involves the placenta covering the cervix, leading to bleeding but not necessarily uterine rupture. Therefore, the correct answer is B.

Correct Answer: A

Rationale: Rationale for Correct Answer (A): 1. Previous C-section and uterine scars weaken the uterine wall. 2. Fetal macrosomia (large baby) increases pressure on the uterus. 3. Trauma can cause direct injury to the uterus. 4. Prolonged labor can lead to uterine overdistension and fatigue, increasing rupture risk. Summary of Incorrect Choices: B: Malpresentation, premature rupture of membranes, obesity, malnutrition, anemia are not direct factors for uterine rupture. C: Uterine fibroids, excessive weight gain, smoking, poor prenatal care can contribute to complications but not primary causes of uterine rupture. D: Not all factors in choices B and C are predisposing factors for uterine rupture, making this choice incorrect.