The commonest causative organism of pyelonephritis is

Correct Answer: D

Rationale: The correct answer is D: Escherichia coli. E. coli is the most common causative organism of pyelonephritis due to its prevalence in the gastrointestinal tract. It has specific virulence factors that enable it to ascend the urinary tract and cause infection. Streptococcus faecalis, Proteus vulgaris, and Staphylococcus pyogene are less commonly associated with pyelonephritis compared to E. coli.

Correct Answer: D

Rationale: The correct answer is D: A HIDA scan. A HIDA scan is the most appropriate imaging study for investigating the likely cause in this case because the patient's symptoms (abdominal pain centered on the right side just under the ribcage, tenderness in the right upper quadrant) are suggestive of a possible gallbladder issue, such as cholecystitis or biliary colic. A HIDA scan is specifically used to evaluate the gallbladder and biliary system. A: Abdominal radiographs would not provide detailed information about the gallbladder or biliary system, and are not the best choice in this scenario. B: A CT scan of the abdomen with contrast can be helpful in some situations, but it may not provide the specific information needed to evaluate the gallbladder and biliary system. C: Right upper quadrant ultrasound is a good initial imaging study for evaluating gallbladder disease, but a HIDA scan is more specific for functional assessment of

Correct Answer: D

Rationale: Step 1: The presence of bile in vomitus suggests that the vomit originated from the small intestine or stomach, indicating an obstruction in the pyloric region. Step 2: Pyloric stenosis is a condition characterized by narrowing of the opening from the stomach to the small intestine, leading to projectile vomiting with bile. Step 3: Therefore, the presence of bile in vomitus suggests pyloric stenosis, making option D the correct answer. Summary: Option A is incorrect because vomiting preceding pain does not necessarily indicate a surgical abdomen. Option B is incorrect as the severity of symptoms is not solely based on age. Option C is incorrect as some surgical abdomens can present with vomiting as a primary symptom.

Correct Answer: D

Rationale: The correct answer is D: Check the neonate’s vital signs every 2-4 hourly. This is the priority action because neonates undergoing phototherapy are at risk for dehydration and temperature instability. Monitoring vital signs regularly helps to detect any signs of dehydration, such as decreased urine output or increased heart rate, and ensures timely intervention. Explanation for other choices: A: Turning the neonate every six hours routinely is important for preventing pressure ulcers but is not the priority when compared to monitoring vital signs for potential complications. B: Encouraging the mother to discontinue breastfeeding is incorrect as breastmilk provides essential nutrients and hydration, which are important for neonates, even during phototherapy. C: Notifying the physician if the skin turns bronze-colored is important to address a potential adverse reaction to phototherapy but does not take precedence over monitoring vital signs for immediate concerns.

Correct Answer: D

Rationale: The correct answer is D: 3000 ml. Polyhydramnios is diagnosed when the amniotic fluid volume exceeds 2000 to 3000 ml. This is because amniotic fluid serves important functions in protecting the fetus and aiding in fetal movements. Having an excessively high volume can lead to complications such as preterm labor, fetal malpresentation, and placental abruption. Choices A, B, and C are incorrect as they do not fall within the range typically used to diagnose polyhydramnios. A: 1500 ml and C: 1900 ml are below the threshold, while B: 2500 ml is at the lower end but still not exceeding the diagnostic range for polyhydramnios.

Correct Answer: C

Rationale: Correct Answer: C - Fine needle aspiration does not allow grading of tumors. Rationale: 1. Fine needle aspiration (FNA) collects cells for cytology evaluation, not tissue for grading. 2. Grading requires evaluation of tissue architecture, which is not possible with FNA. 3. FNA is useful for diagnosis but not for determining tumor grade. Summary: A: Incorrect - Excisional biopsy is preferred over incisional biopsy to obtain the entire tumor for diagnosis and grading. B: Incorrect - Core needle biopsy has a lower false positive rate compared to fine needle aspiration. D: Incorrect - Core needle and incisional biopsies differ in the amount of tissue sampled and potential for false results.

Correct Answer: D

Rationale: The correct answer is D: Provide counseling to the patient regarding her options. The AGACNP's initial action should prioritize the patient's well-being and autonomy. Counseling allows the patient to understand her options, including legal, medical, and emotional support. Reporting to law enforcement (A) without the patient's consent violates her autonomy. Having the patient sign a release to go home with her husband (B) disregards the potential danger and trauma she may face. Consulting psychiatry for a psych hold (C) may not address the immediate emotional and physical needs of the patient.

Correct Answer: A

Rationale: The correct answer is A because cord presentation occurs when the umbilical cord lies in front of the presenting part after the membranes have ruptured. This can lead to compression of the cord during labor, affecting fetal oxygenation. Option B is incorrect as it describes cord prolapse, where the cord lies in front of the presenting part before membrane rupture. Option C describes nuchal cord, where the cord is wrapped around the fetal neck. Option D describes cord abruption, where the cord detaches prematurely from the placenta.

Correct Answer: T

Rationale: Step-by-step rationale: 1. Puerperal psychosis is a severe mental health condition occurring postpartum. 2. Psychosocial adversities, such as stress or lack of social support, can trigger or exacerbate mental health issues. 3. Therefore, psychosocial adversities can be predisposing factors for puerperal psychosis. 4. Option A (TRUE) is correct as it aligns with the established relationship between psychosocial factors and mental health. Summary: Option A is correct because psychosocial adversities can indeed contribute to the development of puerperal psychosis, making it a relevant predisposing factor. Options B, C, and D are incorrect as they do not provide any rationale or evidence to support their validity.