Although the physician could convince the patients family to persuade her to

Although the physician could convince the patients

This preview shows page 91 - 93 out of 128 pages.

Although the physician could convince the patient's family to persuade her to change her mind, it would be better to respect her autonomy. A 19-year-old woman is admitted to the obstetrics ward for potential labor. She reports that she is at 32-weeks gestation by her last menstrual period. About 2 hours ago, she began having dull low back pain and menstrual-like cramps. She is now experiencing regular contractions every 2 minutes. After obtaining a history, the most immediate course of action you should take is to A. administer magnesium sulfate B. palpate the abdomen to determine the frequency of contractions C. perform a fetal non-stress test D. perform a pelvic examination to evaluate the cervix E. perform ultrasonography of the pelvis to confirm pregnancy dating Explanation: The correct answer is B. The patient is presenting with low back pain and regular menstrual-like cramping, which are both signs of preterm labor. The first thing the physician should do is determine the contraction frequency by palpating the abdomen. There should be 4 contractions in 20 minutes or 8 contractions in 60 minutes, each lasting at least 30 seconds. Contractions may also be counted with an electronic tocodynometer, which is not to be confused with the electronic non-stress test monitor used to measure fetal heart rate. Magnesium sulfate (choice A) is a final step in the management of preterm labor. The initial step should be to confirm the diagnosis of preterm labor by palpating the abdomen and determining contraction frequency. It is important to document fetal well-being during preterm labor with a non-
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stress test (choice C) , but the initial step should be to confirm the diagnosis of preterm labor by palpating the abdomen and determining contraction frequency. A pelvic examination (choice D) to evaluate the cervix should be performed after confirming the diagnosis of preterm labor by determining the frequency of contractions. Cervical examination involves ruling out premature rupture of the membranes as well as documenting dilatation, position, and station. The first step should be to confirm the diagnosis of preterm labor by determining the frequency of contractions. Ultrasonography (choice E) can and should be done later during the management of preterm labor. Ultrasonography is useful in estimating gestational age, as well as in evaluation for placental abruption or placenta previa. A 50-year-old woman comes to the office for a periodic health maintenance examination. She had her first screening mammogram performed 2 weeks ago and is here for the results. She has no past medical history and no family history of breast cancer. The mammogram demonstrates multiple rounded densities of differing sizes scattered throughout both breasts. There is no architectural distortion and no microcalcifications. The patient has no pain in her breasts and has not noticed any nipple discharge. The most appropriate management for this patient is to A. arrange surgical consult for biopsy B. order an MRI of the breasts C. order screening mammogram 1 year from now
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