The MOST common type of breech presentation is

Question 1 of 5

A. Frank breech presentation B. Complete breech presentation C. Incomplete breech presentation D. Footling breech presentation

Correct Answer: A

Rationale: Frank breech, where the buttocks are presenting with the legs extended, is the most common type of breech presentation.

Question 2 of 5

Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is really wrong. She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?

A. Abdominal radiographs B. CT scan of the abdomen with contrast C. Right upper quadrant ultrasound D. A HIDA scan

Correct Answer: A

Rationale: Given Janice's presentation of significant abdominal pain localized to the right upper quadrant with tenderness on deep palpation, the most appropriate initial imaging study to investigate the likely cause is a right upper quadrant ultrasound. This imaging modality is commonly used to evaluate the liver, gallbladder, bile ducts, and adjacent structures. It can help identify common causes of right upper quadrant pain such as gallstones, cholecystitis, or biliary duct obstruction. The non-invasive nature of ultrasound and its ability to provide real-time imaging make it a valuable tool in the initial assessment of patients with abdominal pain. Depending on the findings of the ultrasound, further imaging studies or interventions may be pursued. Abdominal radiographs may not provide sufficient detail of the biliary system, while a CT scan with contrast or a HIDA scan may be reserved for further evaluation if needed based on the ultrasound findings.

Question 3 of 5

What are the signs of uterine rupture during labor?

A. Sudden abdominal pain B. Loss of fetal heart tones C. Vaginal bleeding D. All of the above

Correct Answer: D

Rationale: Uterine rupture is life-threatening and has multiple warning signs.

Question 4 of 5

R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?

A. CT scan with IV, oral, and rectal contrast B. CBC with WBC differential C. Colonoscopy D. Barium enema

Correct Answer: B

Rationale: In a 71-year-old female presenting with left lower quadrant pain and a history of constipation, the most likely differential diagnosis to consider is diverticulitis. A CT scan with IV, oral, and rectal contrast is the diagnostic test of choice for confirming suspected diverticulitis. It is considered the gold standard imaging modality for evaluating acute abdominal pain and can help identify diverticula, inflammation, abscesses, and complications such as perforation or obstruction.

Question 5 of 5

Lester R. is a 58-year-old male who is being evaluated for nocturia. He reports that he has to get up 2 to 3 times nightly to void. Additional assessment reveals urinary urgency and appreciable post-void dribbling. A digital rectal examination reveals a normal-sized prostate with no appreciable hypertrophy. The best approach to this patient includes

A. Administration of the American Urological Association (AUA) Symptom Scale B. Laboratory assessment to include a PSA C. Ordering a prostate ultrasound D. Assessment of nonprostate causes of nocturia

Correct Answer: C

Rationale: In this case, the best approach to the patient includes assessment of nonprostate causes of nocturia. Despite the lack of significant prostate hypertrophy on digital rectal examination, the patient is experiencing bothersome lower urinary tract symptoms such as nocturia, urinary urgency, and post-void dribbling. These symptoms suggest the need to consider alternative causes beyond prostate enlargement. Factors such as overactive bladder, urinary tract infections, diabetes, sleep apnea, medications, or other systemic conditions could be contributing to the patient's symptoms. Therefore, a comprehensive evaluation to identify potential nonprostate causes of the patient's nocturia is warranted before considering more invasive prostate-specific tests like PSA, ultrasound, or symptom scales.