Mr. Nelson is a 65-year-old male who has been advised that he is a candidate for coronary artery bypass grafting. He has been doing some internet research and is asking about whether or not he should have a beating heart bypass. Regarding off-pump coronary bypass grafting, the AGACNP advises Mr. Nelson that

Correct Answer: A

Rationale: The correct answer is A: There is a slightly higher risk of neurologic complications. Rationale: 1. Off-pump bypass grafting involves performing surgery on a beating heart without the use of a heart-lung machine. 2. The lack of cardiopulmonary bypass during off-pump surgery can lead to reduced blood flow to the brain, increasing the risk of neurologic complications. 3. This is why the AGACNP advises Mr. Nelson about the slightly higher risk of neurologic complications associated with off-pump bypass. 4. Choice B is incorrect as long-term results actually suggest similar or better patency rates for grafts in off-pump surgery. 5. Choice C is incorrect as the statement about the incidence increasing significantly in the last 10 years is not relevant to the risks of off-pump surgery. 6. Choice D is incorrect as off-pump surgery is not considerably more expensive and the correlation with better long-term outcomes is debatable.

Correct Answer: C

Rationale: The correct answer is C: Local anesthesia, cleansing, and suture repair. 1. Local anesthesia is needed to minimize pain during the procedure. 2. Cleansing is crucial to remove contaminants and reduce the risk of infection. 3. Suture repair is necessary for a jagged laceration of this size to promote proper wound healing and minimize scarring. Summary of other choices: A: Antibiotic therapy is not routinely needed for clean lacerations, and covering alone may not provide adequate wound closure. B: While wound exploration for foreign bodies is important, it is not the immediate priority for this patient with an open, flapping laceration. D: While cleansing, covering, and tetanus prophylaxis are important, antibiotic therapy is not routinely needed for clean lacerations.

Correct Answer: A

Rationale: Placenta praevia is more common in women with a history of multiple pregnancies (Grandmultiparity), as repeated stretching of the uterine wall can lead to abnormal placental implantation. Preeclampsia is a separate condition associated with hypertension in pregnancy. Placenta fenestrate and placenta increta are specific placental abnormalities but do not directly cause placenta praevia.

Correct Answer: D

Rationale: The correct answer is D: Fistula formation. Fistula formation is the most severe type of urinary tract trauma as it involves an abnormal connection between the urinary tract and another organ or the skin. This condition can lead to severe complications such as recurrent infections, incontinence, and even sepsis. Retention of urine (A) is a symptom of urinary tract obstruction, not necessarily the most severe type of trauma. Stress incontinence (B) is a common condition but is not indicative of severe trauma. Scalding sensation (C) can be a symptom of a urinary tract infection but does not necessarily indicate severe trauma like fistula formation.

Correct Answer: A

Rationale: Step 1: Sulfadoxine Pyrimethamine is recommended for pregnant women in malaria endemic areas due to its safety and efficacy in preventing malaria during pregnancy. Step 2: Pregnant women are at higher risk of severe complications from malaria, making prophylaxis crucial. Step 3: The World Health Organization recommends intermittent preventive treatment with Sulfadoxine Pyrimethamine for pregnant women in malaria-endemic areas. Step 4: Option A aligns with these guidelines, making it the correct choice. Summary: Option B is incorrect because pregnant women are considered at risk regardless of testing. Option C is incorrect as the timing of administration is not based on quickening. Option D is incorrect as the recommended number of doses may vary based on guidelines.

Correct Answer: D

Rationale: The correct answer is D: Aspiration and culture of fluid. Given Jasmine's history of injection drug use, neck pain, inability to turn her neck, elevated temperature, and foul breath, there is a high suspicion of a deep neck space infection. Aspiration and culture of fluid from the affected area will help identify the causative organism and guide appropriate antibiotic therapy. This procedure is essential for definitive diagnosis and management of deep neck infections. A: Anteroposterior neck radiography is not the most appropriate initial diagnostic test for evaluating deep neck space infections as it may not provide detailed information on the extent or nature of the infection. B: CT scan of the neck may provide valuable information regarding the extent of the infection, but aspiration and culture of fluid are crucial for identifying the causative organism. C: White blood cell (WBC) differential may show signs of inflammation, but it does not provide specific information on the causative organism of the infection.

Correct Answer: C

Rationale: The correct answer is C: Secondary postpartum haemorrhage. This term refers to excessive bleeding from the genital tract after the first 24 hours but within the puerperium period (6 weeks postpartum). A: Primary postpartum haemorrhage occurs within the first 24 hours after delivery. B: Tertiary postpartum haemorrhage occurs more than 6 weeks postpartum. D: Incidental postpartum haemorrhage is not a recognized medical term for postpartum bleeding.

Correct Answer: B

Rationale: The correct answer is B: Iron and folic acid. Diamorphic anemia is characterized by the presence of both microcytic and macrocytic red blood cells, which can be caused by a deficiency in both iron and folic acid. Iron deficiency leads to microcytic anemia, while folic acid deficiency results in macrocytic anemia. Thiamine deficiency (Choice A) primarily affects the nervous system and does not directly cause diamorphic anemia. Liver enzymes deficiency (Choice D) does not directly lead to diamorphic anemia. Folic acid and thiamine deficiency (Choice C) can cause individual types of anemia but not diamorphic anemia.

Correct Answer: A

Rationale: The correct answer is A because in cases of anteriorly situated placenta praevia, where the placenta partially or completely covers the cervix, a classical caesarean section is indicated to prevent severe bleeding during delivery. For choice B, a posteriorly situated placenta praevia does not necessitate a classical caesarean section. Choice C, gestation of more than 32 weeks, does not specifically indicate the need for a classical caesarean section. Choice D, aesthetic purpose on maternal request, is not a valid medical indication for a classical caesarean section.