A client in her first trimester of pregnancy is scheduled for an ultrasound.
Which of the following would not be a reason for an ultrasound at this stage?
Determine fetal position.
Detect multiple gestations.
Detect maternal abnormalities.
Confirm pregnancy.
The Correct Answer is A
Choice A rationale:
Fetal position during the first trimester is not definitively determined through ultrasound. While the gestational sac and fetal pole can be visualized, the fetus is still quite small and has ample space to move within the amniotic sac. This makes it challenging to accurately ascertain its position.
Reliable assessment of fetal position typically occurs later in pregnancy, usually between 34 and 36 weeks gestation. At this point, the fetus is larger and less mobile, allowing for a clearer assessment of its position through ultrasound.
The early determination of fetal position in the first trimester is not a primary goal of ultrasound. It is more focused on establishing pregnancy viability, gestational age, and detecting any potential abnormalities.
Choice B rationale:
Ultrasound in the first trimester can reliably detect multiple gestations. It can visualize the presence of multiple gestational sacs or fetal poles, clearly indicating whether a woman is carrying twins, triplets, or more.
Early identification of multiple gestations is crucial for optimal pregnancy management. It allows healthcare providers to tailor prenatal care, monitor for potential complications associated with multiple pregnancies, and plan for appropriate delivery. Choice C rationale:
Ultrasound in the first trimester can assist in detecting certain maternal abnormalities that could impact pregnancy. These may include:
Uterine abnormalities, such as fibroids or structural defects
Ovarian cysts
Ectopic pregnancies (where the embryo implants outside the uterus)
Gestational trophoblastic disease (abnormal growth of tissue inside the uterus)
Early identification of these maternal abnormalities allows for timely intervention and management, ensuring the best possible outcomes for both mother and fetus.
Choice D rationale:
Confirming pregnancy is a primary reason for ultrasound in the first trimester. It can visualize the gestational sac, which contains the developing embryo and confirms the presence of a pregnancy.
Ultrasound can also detect the fetal heartbeat, which typically becomes visible between 6 and 8 weeks gestation. This provides further confirmation of a viable pregnancy.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Infertility is a common issue for women with endometriosis. The endometrial tissue that grows outside the uterus can cause scarring and inflammation, which can block fallopian tubes and prevent eggs from being released or fertilized. Studies have shown that 30-50% of women with endometriosis experience infertility.
It is important to address this potential issue with the patient and discuss options for fertility preservation if desired.
Choice B rationale:
There is no evidence to suggest that women with endometriosis are more likely to have multiples. The likelihood of having multiples is primarily influenced by factors such as genetics, maternal age, and the use of fertility treatments.
Choice C rationale:
Acetaminophen may not be effective for pain relief in women with endometriosis. The pain associated with endometriosis is often severe and can be unresponsive to over-the-counter pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are often more effective in managing endometriosis-related pain.
In some cases, stronger pain medications such as opioids may be necessary.
Choice D rationale:
Oral contraceptives can be helpful for women with endometriosis by:
Suppressing ovulation, which can reduce the amount of endometrial tissue that grows and bleeds each month.
Thinning the uterine lining, which can also reduce pain and bleeding.
Slowing the growth of endometrial tissue.
Oral contraceptives are not a cure for endometriosis, but they can help to manage symptoms and improve quality of life.
Correct Answer is ["B","C","E","F"]
Explanation
The correct answers are B, C, E, and F.
Rationale for each choice:
- Albuterol
Mechanism of action: Albuterol is a beta-2 agonist that stimulates beta-2 receptors in the cell membranes of skeletal muscle, liver, and adipose tissue. This stimulation causes an increase in intracellular cyclic AMP (cAMP), which activates protein kinase A (PKA). PKA then phosphorylates a number of proteins, including the sodium-potassium ATPase pump. This pump is responsible for transporting potassium ions into cells and out of the bloodstream. By increasing the activity of this pump, albuterol can help to lower serum potassium levels.
Onset of action: Albuterol has a rapid onset of action, typically within 30 minutes.
Duration of action: The duration of action of albuterol is relatively short, usually 4-6 hours.
Dosage: The dosage of albuterol for hyperkalemia is typically 10-20 mg nebulized every 4-6 hours.
Additional considerations: Albuterol can cause tachycardia and tremors. It should be used cautiously in patients with heart disease or hyperthyroidism.
- Kayexalate
Mechanism of action: Kayexalate is a cation exchange resin that binds to potassium ions in the gastrointestinal tract. This prevents the potassium from being absorbed into the bloodstream.
Onset of action: Kayexalate has a relatively slow onset of action, usually 1-2 hours.
Duration of action: The duration of action of Kayexalate is relatively long, usually 4-6 hours.
Dosage: The dosage of Kayexalate for hyperkalemia is typically 15-30 grams orally or rectally every 6 hours.
Additional considerations: Kayexalate can cause constipation and hypocalcemia. It should be used cautiously in patients with bowel obstruction or kidney disease.
- Insulin & dextrose
Mechanism of action: Insulin promotes the movement of potassium into cells, thus lowering serum potassium levels. Dextrose is given along with insulin to prevent hypoglycemia.
Onset of action: Insulin has a rapid onset of action, typically within 30 minutes.
Duration of action: The duration of action of insulin is relatively short, usually 4-6 hours.
Dosage: The dosage of insulin for hyperkalemia is typically 10 units of regular insulin IV push, followed by an infusion of 5-10 units per hour. The dosage of dextrose is typically 50 grams IV push, followed by an infusion of 10% dextrose at 100 mL/hour.
Additional considerations: Insulin can cause hypoglycemia. It should be used cautiously in patients with diabetes mellitus.
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