Ms. OReilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?

Correct Answer: D

Rationale: Correct Answer: D Rationale: 1. Metformin should be held if the morning blood sugar is < 200 mg/dL to reduce the risk of lactic acidosis postoperatively. 2. Warfarin should be held 5 days before surgery to prevent excessive bleeding during the procedure. 3. Beta blocker (metoprolol) can be continued on the day of surgery to prevent rebound hypertension. 4. Vitamin E can be continued as it does not have significant interactions or adverse effects in this scenario. Summary: - Choice A is incorrect as it does not address the need to hold metformin and warfarin appropriately. - Choice B is incorrect as it discontinues medications too early and does not address metformin management. - Choice C is incorrect as it only addresses warfarin and does not consider metformin or other medications. - Choice D is the most appropriate approach as it addresses the specific considerations for each medication based on their effects and interactions.

Correct Answer: C

Rationale: Rationale for choice C: 1. Excessive molding or abnormal stretching of the fetal head can indicate neonatal intracranial injury due to the trauma during birth. 2. This feature suggests possible compression or trauma to the baby's head during delivery. 3. It may lead to intracranial hemorrhage or other injuries, requiring close monitoring and medical intervention. Summary of other choices: A. An oedematous swelling resolving in 48 hours is likely a normal finding (cephalohematoma) and not specific to intracranial injury. B. Notable bleeding between the epicranial aponeurosis & periosteum may indicate cephalohematoma or caput succedaneum, not necessarily intracranial injury. D. Peripheral cyanosis is related to oxygenation and circulation, not specific to intracranial injury.

Correct Answer: B

Rationale: The correct answer is B: Hyperextension casting. The AGACNP knows that this treatment is appropriate for a condition that requires immobilization and support while allowing controlled movement. Hyperextension casting provides stability and support while promoting healing. Observation (A) would not provide adequate treatment for a condition requiring immobilization. Jewett brace (C) is typically used for spinal fractures, not for conditions that require hyperextension casting. Surgical intervention (D) would be considered if conservative measures like casting have failed.

Correct Answer: C

Rationale: The correct answer is C: Oligohydramnios. Shoulder presentation occurs when the baby presents shoulder-first rather than head-first during birth. Oligohydramnios, a condition characterized by low levels of amniotic fluid, can lead to decreased uterine space, increasing the chances of abnormal fetal positioning. Macerated fetus (A) is associated with fetal decomposition, not shoulder presentation. Postdates pregnancy (B) is linked to increased risk of macrosomia but not shoulder presentation. Placenta abruption (D) is a separation of the placenta from the uterus, not a direct cause of shoulder presentation.

Correct Answer: D

Rationale: Rationale: 1. Hypoplastic left heart syndrome involves underdevelopment of the left ventricle, aortic valve, and aortic arch. 2. The left ventricle is essential for pumping oxygenated blood to the body. 3. Aortic valve controls blood flow from the left ventricle to the aorta. 4. Aortic arch connects the ascending and descending aorta. Summary: A - Incorrect, as it includes pulmonary veins not related to hypoplastic left heart syndrome. B - Incorrect, as it includes structures not primarily affected in this condition. C - Incorrect, as it does not involve structures related to the left side of the heart.

Correct Answer: C

Rationale: The correct answer is C: Precipitate labor. Precipitate labor refers to a rapid labor and delivery process. It is matched with the statement in column A because it is associated with a sudden and quick progression of labor, leading to a rapid delivery of the baby. The other choices are incorrect because: A: Colicky uterus - This term is not related to rapid labor but rather refers to uterine contractions that are painful and intermittent. B: Constriction ring dystocia - This term describes a condition where there is a tight band around the uterus, causing difficulty in the delivery process, which is different from the rapid progression seen in precipitate labor. D: Cervical dystocia - This term refers to a condition where there are issues with the dilation or effacement of the cervix, not directly related to the speed of labor as in precipitate labor.

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: D

Rationale: The correct answer is D because the main aims of an exchange transfusion procedure are to control haemolysis (process of breaking down red blood cells) and restore hemoglobin levels. This procedure involves removing the baby's blood and replacing it with donor blood to prevent complications from severe jaundice or other conditions. Choice A is incorrect because exchange transfusion does not necessarily cure haemolysis, but it helps control it. Choice B is incorrect as the procedure focuses on managing specific issues rather than removing all toxic materials. Choice C is incorrect because it does not directly address the primary goals of an exchange transfusion.

Correct Answer: C

Rationale: Rationale: Face to pubis delivery occurs when the fetal face presents towards the mother's pubic bone during birth. Choice C is correct because a 45˚ anterior rotation of the occiput is needed for this positioning. This allows the fetal face to be directed towards the mother's pubis for a successful face to pubis delivery. Choices A and D are incorrect as they mention incorrect angles of rotation. Choice B is incorrect as a persistent occipito posterior position would result in a face to sacrum delivery, not face to pubis.