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 clinical presentation of sudden, severe upper abdominal pain not related to food intake, along with the patient's position (lying on right side with hips and knees flexed), and presence of involuntary guarding suggest acute pancreatitis. The elevated white blood cell count indicates an inflammatory process. Dissecting aortic aneurysm (A) typically presents with abrupt, severe chest or back pain radiating to the abdomen, with signs of shock. Perforated peptic ulcer (C) presents with sudden, severe abdominal pain often related to food intake, with signs of peritonitis. Mallory-Weiss tear (D) presents with hematemesis after forceful or prolonged vomiting.

Correct Answer: D

Rationale: The correct answer is D: Prepare for reoperation. Given the patient's elevated AST and ALT levels after hepatic resection, along with abnormal prothrombin time and low albumin, there is concern for liver dysfunction. This indicates a potential complication post-surgery, such as hepatic insufficiency or failure, necessitating reoperation for further evaluation and management. Cancelling the transfer (A) would delay necessary intervention. Infusing albumin and fresh frozen plasma (B) would address only the symptoms but not the underlying cause. Repeating labs the next day (C) would not address the urgency of the situation.

Correct Answer: A

Rationale: The correct answer is A because secondary postpartum hemorrhage typically occurs between the 8th-14th day postpartum and can extend up to 6 weeks after delivery. This timeframe aligns with the physiological changes and healing process after childbirth. Choice B is incorrect because it contradicts the established timeframe for secondary postpartum hemorrhage. Choice C is incorrect as secondary postpartum hemorrhage is not rare but rather a recognized complication that can occur after childbirth. Choice D is incorrect as secondary postpartum hemorrhage does not happen sporadically, but rather follows a defined timeframe based on postpartum physiological changes.

Correct Answer: D

Rationale: The correct answer is D: Elective lymph node dissection. This is because elective lymph node dissection helps to remove potentially cancerous lymph nodes, aiding in staging and ensuring complete tumor removal, thus improving the chances of curative surgery. En bloc resection (A) is important but may not always be feasible in fixed tumors. Adjuvant therapies (B) are used after surgery, not as the primary approach. Neoadjuvant therapies (C) are given before surgery to shrink tumors, not specifically for fixed tumors.

Correct Answer: A

Rationale: The correct answer is A: Acyclovir. The rationale is that sudden sensorineural hearing loss (SSHL) can sometimes be associated with viral infections, such as herpes simplex virus. Acyclovir is an antiviral medication that can potentially help treat the underlying viral infection causing SSHL. It is important to address the potential viral etiology before considering other treatments. Summary of other choices: B: Furosemide is a diuretic used to treat conditions like high blood pressure and edema, not SSHL. C: Warfarin is an anticoagulant used to prevent blood clots, not indicated for SSHL. D: Hyperbaric oxygen therapy is sometimes used for SSHL, but addressing any potential viral infection with Acyclovir would be a more appropriate initial step.

Correct Answer: C

Rationale: The correct answer is C: Couvelaire uterus. This condition refers to the bruised and edematous appearance of the uterus associated with placental abruption. Placental abruption occurs when the placenta separates from the uterine wall prematurely, leading to bleeding and a compromised blood supply to the uterus. The bruised appearance is due to blood infiltrating the myometrium. Explanation for other choices: A: Wernicke’s encephalopathy - This is a neurological disorder caused by thiamine deficiency, not related to uterine issues. B: Uterine prolapse - This is the descent or herniation of the uterus into or beyond the vaginal canal, not related to placental abruption. D: Asherman’s syndrome - This is characterized by intrauterine adhesions or scar tissue, typically a result of uterine surgery, not associated with placental abruption.

Correct Answer: A

Rationale: The correct answer is A: Descent, engagement, flexion, internal rotation. In left occipito-posterior position, the fetus descends into the pelvis, engages in the maternal pelvis, undergoes flexion to fit through the birth canal, and internally rotates to align with the pelvis for delivery. Choice B (Extension, engagement, internal rotation, external rotation) is incorrect because extension is not typically seen in occipito-posterior positions. Choice C (Flexion, descent, external rotation) is incorrect because external rotation is not part of the mechanism in this position. Choice D (Descent, engagement, extension) is incorrect because extension is not typically seen in this position.

Correct Answer: C

Rationale: The correct answer is C: Baseline cardiac catheterization. Given the presence of a new onset grade IIVI crescendo-decrescendo cardiac murmur, a baseline cardiac catheterization is necessary to assess the severity and etiology of the murmur. This procedure will provide crucial information on the structure and function of the heart, helping to determine the appropriate management plan. A: Annual or biannual serial echocardiography is not necessary as the patient is currently asymptomatic and echocardiography has already revealed mild aortic calcification. B: Modification of activity level is not the immediate priority as the patient is very active physically and not reporting any limitations to daily activities. D: Statin therapy is not indicated based solely on the presence of a new murmur without further assessment of cardiac function through cardiac catheterization.

Correct Answer: B

Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery. Incorrect choices: A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis. C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery. D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.