ATI RN
Varneys Midwifery 6th Edition Test Bank Questions
Question 1 of 5
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?
Correct Answer: A
Rationale: A leukocyte count of 18,000/µL suggests an elevated white blood cell count, which is indicative of an inflammatory or infectious process. In the context of biliary colic, an elevated white blood cell count could be a sign of complications such as cholecystitis (inflammation of the gallbladder) or choledocholithiasis (bile duct obstruction). These complications may require urgent surgical evaluation and intervention. The other options, although concerning, do not specifically suggest a complication that necessitates immediate surgical evaluation.
Question 2 of 5
When counseling a patient about his surgical options for an ulcer that has been refractory to medical therapy, the AGACNP advises the patient that he will need
Correct Answer: C
Rationale: When counseling a patient about surgical options for an ulcer that has been refractory to medical therapy, advising the patient that he will need some form of vagotomy is important. Vagotomy is a surgical procedure in which the vagus nerve is partially or completely severed. This procedure is commonly performed for patients with ulcers that have not responded to medical treatment. Vagotomy reduces the acid secretion in the stomach, which can help in the healing of the ulcer and prevent recurrence. It is an effective option for treating ulcers that have not responded to conservative medical management.
Question 3 of 5
When evaluating a patient with acute pancreatitis, which of the following physical or diagnostic findings is an ominous finding that indicates a seriously illpotentially moribund patient?
Correct Answer: C
Rationale: The Grey Turner sign is characterized by bruising in the flanks and is a rare finding associated with acute pancreatitis. It indicates retroperitoneal bleeding and is considered an ominous finding that suggests a severe and potentially moribund state in patients with acute pancreatitis. The presence of the Grey Turner sign should prompt immediate intervention and close monitoring in a hospital setting. The other options, severe epigastric pain with radiation to the back, abdominal guarding and rigidity, and obturator sign, are indicative of pancreatitis but do not carry the same ominous implication as the Grey Turner sign.
Question 4 of 5
He has had 1 L of NSS infused by emergency medical services. His vital signs reveal a pulse of 128 bpm and a blood pressure of 8860 mm Hg. With respect to his hypotension, the AGACNP recognizes that
Correct Answer: D
Rationale: In this scenario, the patient's low blood pressure is likely a physiologic response to traumatic head injury. Hypotension can occur as a compensatory mechanism in traumatic brain injury to maintain cerebral perfusion. The body may reduce blood pressure to decrease the risk of further brain injury or bleeding. It is important for the AGACNP to recognize that in traumatic brain injury, hypotension may not necessarily require immediate intervention with vasopressors, as it may be a protective response. Monitoring and managing the patient's condition closely, including neurologic status and trends in blood pressure, is crucial in this situation.
Question 5 of 5
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patients mental status from the day before. Vital signs and hemodynamic parameters are as follows BP 8854 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93 on a 50 mask Systemic vascular resistance (SVR) 1600 dynes seccm5 Cardiac index 1.3 Lmin Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state?
Correct Answer: B
Rationale: The patient's presentation with low blood pressure, tachycardia, tachypnea, decreased oxygen saturation, and altered mental status is most consistent with distributive shock. Distributive shock is characterized by systemic vasodilation and decreased systemic vascular resistance (SVR), leading to inadequate perfusion of tissues and organs despite normal or high cardiac output. In this case, the low SVR (1600 dynes ∙ sec/cm5) and low blood pressure indicate vasodilation. The patient's pulmonary capillary wedge pressure (PCWP) of 8 mm Hg is not consistent with cardiogenic shock, where elevated PCWP would be expected. Additionally, there are no signs of obstructive shock, such as a history of pulmonary embolism but rather clinical findings that suggest distributive shock. Hypovolemic shock would typically present with signs of volume depletion and would be less likely in this patient with stable mental status initially.