Stuvia.com - The Marketplace to Buy and Sell your Study Material T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600L. The AGACNP suspects

Correct Answer: B

Rationale: The correct answer is B: Acute pancreatitis. The patient's sudden, severe upper abdominal pain, unaffected by food intake, along with guarding and elevated white blood cell count, are indicative of acute pancreatitis. The patient's positioning (knees to chest) suggests relief from pain, which is characteristic of pancreatitis. A dissecting aortic aneurysm (choice A) typically presents with tearing chest or back pain. Perforated peptic ulcer (choice C) would present with a history of chronic ulcer symptoms. Mallory-Weiss tear (choice D) presents with a history of recent vomiting. Therefore, based on the patient's presentation and findings, acute pancreatitis is the most likely diagnosis.

Correct Answer: C

Rationale: The correct answer is C: Compound. When a hand or foot lies alongside the presenting part during childbirth, it is called a compound presentation. This can be a complication as it increases the risk of the presenting part not fitting through the birth canal properly. A: Footling presentation occurs when the baby's foot or feet are the first to emerge from the birth canal. B: Transverse presentation is when the baby is lying sideways in the uterus. D: Cephalic presentation is the ideal position for vaginal delivery, with the baby's head down and ready to be born.

Correct Answer: A

Rationale: The correct answer is A: Bradycardia. Hypothermia neonatorum is characterized by low body temperature in newborns, which can lead to bradycardia as the heart rate decreases in response to the cold stress. Bradycardia is a common physiological response to hypothermia as the body tries to conserve energy and maintain vital functions. Hyperglycemia, hypoventilation, and hyperventilation are not specific clinical features of hypothermia neonatorum. Hyperglycemia is more commonly associated with conditions like diabetes, hypoventilation could be a sign of respiratory distress, and hyperventilation is usually seen in response to metabolic acidosis or anxiety.

Correct Answer: A

Rationale: The correct answer is A: Moderate anaemia. Haematinics, dietary advice, and close surveillance are appropriate management plans for moderate anaemia to improve iron levels and overall health. For mild anaemia, dietary changes alone may be sufficient. Severe anaemia often requires more aggressive treatments like blood transfusions. Anaemia prevention focuses on strategies to avoid developing anaemia rather than managing an existing case.

Correct Answer: B

Rationale: The correct answer is B: reduce serum sodium concentration by infusing a 0.45% sodium chloride solution. In hyponatremic hyperosmolality, the primary goal is to correct the low serum sodium levels. A 0.45% sodium chloride solution is hypotonic, which helps to slowly correct the serum sodium concentration without causing rapid shifts in osmolality. Infusing a hypotonic solution will gradually increase the serum sodium levels, addressing the underlying issue. Choices A, C, and D are incorrect because they do not directly address the low serum sodium levels, which is essential in treating hyponatremic hyperosmolality. Infusing a 5% dextrose in 0.2% sodium chloride solution (Choice A) or a 5% dextrose in water solution (Choice D) would not correct the low sodium levels. Replenishing volume with a 0.9% sodium chloride solution (Choice C) would not directly

Correct Answer: A

Rationale: The correct statement about shoulder dystocia is A: It’s an impaction of the anterior shoulder after delivery of the head. This is accurate as shoulder dystocia occurs when the anterior shoulder becomes impacted behind the maternal pubic symphysis. This can lead to difficulty delivering the shoulders after the head is delivered. B is incorrect as shoulder dystocia involves the anterior shoulder, not the posterior. C is incorrect as shoulder dystocia is not related to compound presentation. D is incorrect as shoulder dystocia is an obstetric emergency that requires prompt intervention to prevent complications for both the mother and the baby.

Correct Answer: D

Rationale: The correct answer is D: His symptoms occur in 5 to 10% of people after ulcer surgery. This is the correct answer because the patient's symptoms of decreased capacity for intake and nausea after eating are common post-operative complications following ulcer surgery. By stating this fact to the patient, the AGACNP is providing reassurance that these symptoms are not unusual. Explanation for why the other choices are incorrect: A: Endoscopy is not necessary at this point since the symptoms described by the patient are known post-operative complications and do not indicate an urgent need for endoscopy. B: While gastroparesis can be a complication of ulcer surgery, there is no information in the case to suggest that the patient has chronic gastroparesis. C: Jumping to the conclusion that medication is unlikely to help and another surgery may be needed is premature and not supported by the information provided in the case.

Correct Answer: C

Rationale: The correct answer is C: Seat belts. Flexion-distraction injuries of the thoracolumbar spine are commonly caused by seat belts due to the mechanism of injury during a motor vehicle accident. When a sudden deceleration occurs, the body is restrained by the seat belt while the spine continues to move forward, leading to hyperflexion of the spine. This results in distraction forces at the thoracolumbar junction, causing injury. Blunt trauma (choice A) can cause various types of spinal injuries but is not specifically associated with flexion-distraction injuries. Rotational injury (choice B) typically leads to injuries such as fractures or dislocations, not flexion-distraction injuries. Gunshot wounds (choice D) can cause direct spinal damage, but they do not typically result in flexion-distraction injuries.

Correct Answer: C

Rationale: The correct answer is C: Fever. Physiologic stress ulcers are often associated with systemic stress response, leading to an increase in body temperature. Fever is an early sign of stress-related ulcers before other symptoms like epigastric pain or hemorrhage manifest. Change in mental status is more indicative of neurological issues rather than stress ulcers. Epigastric pain typically occurs after the ulcer has progressed, and hemorrhage is a severe complication of untreated stress ulcers.