The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal

Correct Answer: A

Rationale: The correct answer is A: Increased MCV. Following splenectomy, there is a compensatory increase in red blood cell production, leading to an increase in Mean Corpuscular Volume (MCV) due to the release of larger, younger red blood cells into circulation. This is known as stress erythropoiesis. Summary: B: Increased Hgb - Hgb levels may not necessarily increase post-splenectomy as it depends on factors such as bleeding or hydration status. C: Increased platelets - Platelet count is not expected to increase immediately post-splenectomy. D: Increased albumin - Albumin levels are not directly influenced by splenectomy for idiopathic thrombocytopenia purpura.

Correct Answer: C

Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake is crucial to prevent ammonia accumulation. Protein breakdown in the body leads to ammonia production, which worsens encephalopathy symptoms. Limiting protein intake to 50g daily helps decrease ammonia formation. Lactulose (choice A) is used to reduce ammonia absorption in the gut. Spironolactone (choice B) is a diuretic used to treat fluid retention in liver disease. Zolpidem (choice D) is a sedative and not related to managing ammonia accumulation in hepatic encephalopathy. Therefore, choices A, B, and D are incorrect for long-term management of ammonia accumulation in hepatic encephalopathy.

Correct Answer: B

Rationale: The correct answer is B: Hypoglycaemia. Neonates born to diabetic mothers are at risk of hypoglycaemia due to high insulin levels in utero. Feeding the newborn within the first 15 minutes helps maintain blood glucose levels. Hypocalcaemia, hyponatraemia, and hypokalaemia are not typically immediate concerns in neonates born to diabetic mothers.

Correct Answer: D

Rationale: The correct answer is D: Fetal macrosomia. Fetal macrosomia, which refers to a baby being significantly larger than average, is an inorganic risk factor for birth injuries because it can lead to difficult delivery and increase the risk of birth trauma such as shoulder dystocia. Maternal short stature (A) is a biological risk factor, not inorganic. Prenatal oligohydramnios (B) refers to low levels of amniotic fluid and is a maternal condition, not an inorganic factor. External cephalic version (C) is a procedure to turn a breech baby and is not a risk factor for birth injuries.

Correct Answer: B

Rationale: The correct answer is B: Fetal exsanguination. This term accurately describes the process of pure fetal blood loss following a ruptured vasa praevia. Exsanguination refers to severe blood loss leading to death. In this context, it specifically denotes the loss of fetal blood due to the rupture of vasa praevia, which can be fatal for the fetus. A: Fetal extra-versation is not a recognized medical term and does not accurately describe the scenario presented in the question. C: Velamentous bleeding refers to a condition where fetal blood vessels are unprotected by the umbilical cord and run through the amniotic membranes, not specifically related to ruptured vasa praevia. D: Fetal hemorrhage is a general term for fetal blood loss and does not specifically address the situation of pure fetal blood loss following a ruptured vasa praevia.

Correct Answer: A

Rationale: The correct answer is A because Bishop's score assesses the readiness of the cervix for labor by evaluating descent (station of the fetal head), presentation (fetal position), and cervical dilatation, which are key indicators of cervical ripening and effacement. Descent shows the progress of the fetus through the birth canal, presentation indicates the fetal position for delivery, and cervical dilatation reflects the opening of the cervix for labor. Choices B, C, and D are incorrect as they do not encompass all the essential components of Bishop's score, which focuses on descent, presentation, and cervical dilatation.

Correct Answer: A

Rationale: The correct answer is A: Uterine rupture. This is the most significant risk associated with VBAC, where the scar from the previous cesarean section may tear during labor. This can lead to severe complications for both the mother and baby. Postpartum hemorrhage (B) and placenta previa (C) are potential risks in any pregnancy but are not specifically increased in VBAC. Therefore, the correct answer is A, as it directly relates to the unique risk of VBAC.

Correct Answer: B

Rationale: The correct answer is B: Conduction. Conduction is the transfer of heat through direct contact. By keeping the neonatal unit warm and wrapping neonates in warm blankets, heat loss through direct contact with surfaces is minimized. Convection involves heat transfer through air or fluid movement, not relevant in this scenario. Evaporation is the process of heat loss through moisture evaporation from the skin, not applicable here. Radiation is heat transfer through electromagnetic waves, which can be prevented by warm wrapping but not the primary focus in this context.

Correct Answer: B

Rationale: The correct answer is B: Placental insufficiency. Prolonged pregnancy can lead to decreased placental function, resulting in inadequate oxygen and nutrients for the fetus. This can lead to complications such as intra-uterine growth restriction and fetal distress. Option A (Intra-uterine oligohydramnios) is a consequence of decreased amniotic fluid levels but not directly associated with prolonged pregnancy. Option C (Fetal post-maturity syndrome) refers to the complications seen in a post-term newborn, not maternal risks. Option D (Large for gestational age baby) is a consequence of prolonged pregnancy but does not directly impact maternal health.