Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1 packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows temperature 99.1F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 13784 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal?

Correct Answer: A

Rationale: The correct answer is A: A complete blood count and RBC differential. In this case, Mr. Jefferson presents with severe abdominal pain, which could indicate various conditions like pancreatitis, a possible complication of his heavy drinking. A complete blood count (CBC) with RBC differential can help assess for signs of inflammation or infection, which may be elevated in conditions like pancreatitis. The RBC differential can also provide insights into potential causes of abdominal pain, such as anemia or other blood disorders. Summary: - B: Liver function enzymes may be affected in conditions like alcoholic liver disease, but in this case, the focus should be on investigating acute abdominal pain. - C: Serum amylase, lipase, and glucose are typically checked in cases of suspected pancreatitis, but a CBC with RBC differential would provide a more comprehensive initial assessment. - D: A basic metabolic panel may not directly address the underlying cause of the acute abdominal pain and is not the most appropriate test to anticipate

Correct Answer: D

Rationale: Step-by-step rationale for why D is correct: 1. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy. 2. Prolonged vomiting can lead to electrolyte imbalances and nutritional deficiencies. 3. Vitamin B deficiency, specifically thiamine, can result in Wernicke’s encephalopathy. 4. Mallory-Weiss syndrome can occur due to repeated retching and vomiting. 5. Therefore, hyperemesis gravidarum can lead to both Wernicke’s encephalopathy and Mallory-Weiss syndrome. Summary: A: Placenta praevia is related to abnormal placental placement, not vomiting. B: Hypertensive disorders are associated with high blood pressure, not vomiting-related complications. C: Vitamin B deficiency can lead to Wernicke’s encephalopathy but is not directly caused by hyperemesis gravidarum.

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.

Correct Answer: B

Rationale: The correct answer is B: FALSE. In mild preeclampsia, the mother may have symptoms such as mild hypertension, proteinuria, and swelling. This contradicts the statement that the mother has no complaints. Choice A is incorrect because it inaccurately states that the mother has no complaints. Choices C and D are not applicable as they do not provide any relevant information to address the question.

Correct Answer: A

Rationale: The presenting diameter in brow presentation is Submentobregmatic (choice A) because it refers to the distance from the submentum (chin) to the bregma (anterior fontanelle). This is the appropriate measurement for the brow presentation as the brow is the prominent part between the forehead and the chin. Choice B (Suboccipitofrontal) is incorrect because it refers to the distance from the subocciput to the frontal bone, which is not relevant to brow presentation. Choice C (Occipitalfrontal) is incorrect because it describes the distance from the occiput to the frontal bone, which again is not specific to brow presentation. Choice D (Mentovertical) is incorrect as it denotes the distance from the chin to the vertex, which is not the relevant measurement for brow presentation.

Correct Answer: A

Rationale: The correct answer is A because intraperitoneal uterine rupture involves a tear that goes through all layers of the uterus - endometrium, myometrium, and peritoneum. This type of rupture extends beyond the muscular layer of the uterus and into the peritoneal cavity. Choices B, C, and D are incorrect as they do not include the peritoneum, which is a key component of intraperitoneal uterine rupture. Therefore, choice A is the correct answer as it accurately describes the layers involved in this type of rupture.

Correct Answer: D

Rationale: Non-infective mastitis is associated with adenitis because it refers to inflammation of breast tissue without an infection. Adenitis specifically involves inflammation of the lymph nodes, which can be a common cause of non-infective mastitis. Cellulitis (A) is an infection of the skin and tissues beneath the skin, not specific to mastitis. Flat (B) and bifid (C) nipples are anatomical variations that do not directly relate to the inflammation of breast tissue.

Correct Answer: C

Rationale: The correct answer is C: Majority are classified as secondary face presentation. In face presentation, the fetal head is hyperextended, presenting the face to the birth canal. Primary face presentation is rare. The bi-parietal diameter is not the presenting diameter in face presentation, as it is in vertex presentation. Locating the anterior fontanelle is not diagnostic of face presentation, as the fontanelles can be difficult to palpate during labor. Therefore, the correct statement is that the majority of face presentations are classified as secondary face presentation.

Correct Answer: D

Rationale: The correct answer is D (All of the above) because during pregnancy, UTI symptoms include painful urination, increased frequency of urination, and lower abdominal pain. Painful urination is a common symptom due to inflammation of the urinary tract. Increased frequency of urination is caused by the pressure of the growing uterus on the bladder. Lower abdominal pain can also occur due to the infection. Therefore, all these symptoms are indicative of a UTI during pregnancy. Other choices are incorrect as they do not encompass the comprehensive range of symptoms typically seen in a UTI during pregnancy.