The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?

Correct Answer: D

Rationale: Step-by-step rationale for why D is correct: 1. Arteriolar dilators such as sodium nitroprusside are used to manage hypertensive crisis by rapidly reducing blood pressure. 2. Pheochromocytoma surgery can result in catecholamine release, causing severe hypertension. 3. Arteriolar dilators act directly on blood vessels to lower blood pressure quickly. 4. Alpha-adrenergic antagonists (A) can worsen hypotension, beta-adrenergic antagonists (B) can lead to unopposed alpha-adrenergic effects, and intravenous vasodilators (C) may not act rapidly enough.

Correct Answer: A

Rationale: The correct answer is A because immediate cesarean is crucial to prevent further complications and ensure the safety of the mother and baby. Monitoring for signs of shock is essential to detect any deterioration in the mother's condition. Fluid resuscitation helps stabilize the mother's hemodynamic status. Option B is incorrect as observation alone may delay necessary interventions. Option C is partially correct as immediate cesarean is necessary but does not address monitoring for shock and fluid resuscitation. Option D is incorrect as continuous monitoring alone is insufficient to manage incomplete uterine rupture.

Correct Answer: C

Rationale: The correct answer is C because living wills typically are not always honored for cognitively impaired patients. Step-by-step rationale: A) Incorrect - A court can declare a patient incompetent if they are unable to make decisions. B) Incorrect - Impaired cognition can indeed make a person incompetent. D) Incorrect - A patient must have the capacity to understand information and make decisions to give informed consent.

Correct Answer: C

Rationale: The correct answer is C: Place the client in knee-chest position. This helps relieve pressure on the cord and prevents further compression, ensuring adequate blood flow to the fetus. Pushing the cord back in (A) can worsen the situation. Covering the cord (B) does not address the urgent need to relieve pressure. Immediate vaginal delivery (D) may not be possible or safe at 32 weeks. Placing the client in the knee-chest position is the most immediate and effective action to manage cord prolapse.

Correct Answer: B

Rationale: The correct answer is B: Delay in second stage of labor. Forceps delivery is indicated when there is a delay in the second stage of labor to expedite delivery and prevent maternal and fetal complications. This could be due to factors such as maternal exhaustion, fetal distress, or ineffective pushing. Inadequate pelvis size (A) may necessitate a C-section, unsuccessful vacuum extraction (C) may require alternative interventions, and fetal distress in the first stage of labor (D) may not necessarily indicate the need for forceps delivery immediately.

Correct Answer: B

Rationale: The correct answer is B: Sweeping of membranes and amniotomy. 1. Sweeping of membranes involves manually separating the amniotic sac from the lower part of the uterus, stimulating the release of prostaglandins to induce labor. 2. Amniotomy is the artificial rupture of membranes, which can accelerate labor by releasing amniotic fluid and initiating contractions. 3. These methods are commonly used for surgical induction of labor due to their effectiveness and minimal invasiveness compared to other options. Incorrect choices: A: Cytotec is a medication used for labor induction, but mechanical cervical dilatation is not a standard surgical method. C: Buscopan is used for relaxation of smooth muscle and not commonly used for labor induction. D: Syntocinon is a synthetic form of oxytocin used to induce or augment labor, but it is not typically used in surgical induction methods.

Correct Answer: B

Rationale: The correct answer is B: Placental bed. Malaria parasites hide in the placental bed during pregnancy to avoid detection by the immune system. This location provides a safe haven for the parasites to survive and replicate without being cleared by the mother's immune response. The placental bed offers a rich blood supply and a favorable environment for the parasites to thrive. Incorrect choices: A: Bone marrow - Malaria parasites do not typically hide in the bone marrow during pregnancy. C: Fetal circulation - Malaria parasites do not hide in the fetal circulation; they primarily reside in the placental bed. D: Uterine muscle - Malaria parasites do not hide in the uterine muscle; the placental bed is the main site of sequestration during pregnancy.

Correct Answer: C

Rationale: The correct answer is C: Truncus arteriosus. In this condition, there is a single large vessel arising from the heart that gives rise to the systemic, pulmonary, and coronary arteries. This results in mixing of oxygenated and deoxygenated blood, leading to severe cyanosis and inadequate oxygenation of the body, causing immediate death after birth. A: Pulmonary stenosis and B: Aortic coarctation typically do not cause immediate death after birth. D: Ductus arteriosus is a normal fetal structure that closes shortly after birth and its presence would not directly cause immediate death.

Correct Answer: A

Rationale: The correct answer is A: Entonox. Entonox, a mixture of nitrous oxide and oxygen, is commonly used for inhalational analgesia during labor due to its fast-acting and safe properties. Nitrous oxide provides pain relief without affecting the baby's heart rate or causing sedation. Trilene (B) is not commonly used during labor due to potential side effects on the baby. Oxygen (C) is not an analgesic but is often used in conjunction with Entonox. Nitrous oxide (D) is the active component in Entonox and is the primary analgesic agent in this mixture.