The AGACNP knows that treatment for this likely will include

Correct Answer: B

Rationale: The correct answer is B: Hyperextension casting. The AGACNP knows that this treatment is appropriate for a condition that requires immobilization and support while allowing controlled movement. Hyperextension casting provides stability and support while promoting healing. Observation (A) would not provide adequate treatment for a condition requiring immobilization. Jewett brace (C) is typically used for spinal fractures, not for conditions that require hyperextension casting. Surgical intervention (D) would be considered if conservative measures like casting have failed.

Correct Answer: B

Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.

Correct Answer: D

Rationale: The correct answer is D, "All of the above." Postpartum hemorrhage can be caused by uterine atony, which is the failure of the uterus to contract after delivery; retained placenta, where parts of the placenta remain in the uterus; and vaginal trauma, such as tears or lacerations during delivery. Each of these factors can contribute to excessive bleeding after childbirth. Therefore, selecting all the choices is necessary to encompass the main causes of postpartum hemorrhage.

Correct Answer: D

Rationale: The correct answer is D: All of the above. Multiple gestations are at higher risk for complications such as premature labor, where contractions start before 37 weeks, leading to preterm birth. Twin-to-twin transfusion syndrome can occur in identical twins sharing a placenta, causing unequal blood flow. Preeclampsia, characterized by high blood pressure and organ damage, is more common in multiple pregnancies. Therefore, all choices A, B, and C are correct as they are common complications associated with multiple gestations.

Correct Answer: A

Rationale: The correct answer is A: Prevent alveoli of the lungs from collapsing. Surfactant reduces surface tension in the alveoli, preventing them from collapsing during exhalation and maintaining lung compliance. B, C, and D are incorrect because surfactant primarily affects lung mechanics, not the initiation of breathing, maturity of the respiratory center, or immediate regulation of breathing upon birth.

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: 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: A

Rationale: The correct answer is A: Prescribe anti-nausea medication. This is the most appropriate choice to manage hyperemesis gravidarum, a severe form of morning sickness. Anti-nausea medication can help alleviate symptoms and prevent dehydration. Choice B (Recommend bed rest) may not directly address the nausea and vomiting associated with hyperemesis gravidarum. Choice C (Suggest a high-protein diet) and D (Advise on exercise) may not be effective in managing the condition or providing immediate relief from symptoms. Anti-nausea medication is the most evidence-based approach to support a woman with hyperemesis gravidarum.

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.