Nokea
A patient presents with a 2-day history of abdominal pain, fever, vomiting, and diarrhea. A surgical abdomen is ruled out, and radiography demonstrates inflammation of the small bowel and colon. Microscopy supports a diagnosis of Campylobacter jejuni, and the patient is prepared for discharge from the emergency room. Important patient education includes advising her that
- A. The bacteria may be spread for as long as she has diarrhea
- B. The disorder should resolve on its own; recurrence is rare but represents a much more serious condition
- C. She will need to take a 10-day course of antibiotics
- D. There is no readily identified food source of this bacteria
Correct Answer: B
Rationale: Campylobacter jejuni is a common bacterial cause of gastroenteritis, typically transmitted through contaminated food, water, or contact with infected animals. Patient education regarding Campylobacter jejuni infection should include advising the patient that the bacteria may be spread for as long as she has diarrhea. It is important for the patient to practice good hand hygiene and take precautions to prevent spreading the infection to others. While most cases of Campylobacter infection are self-limiting and resolve on their own without the need for antibiotics, proper hygiene practices help prevent the spread of the bacteria to others.
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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.
The AGACNP is counseling a patient about various methods of tumor biopsy. Which of the following is not an accurate statement?
- A. Incisional biopsy is preferred to excisional biopsy when possible
- B. Core needle biopsy has a higher rate of false positive than does fine needle aspiration
- C. Fine needle aspiration does not allow grading of tumors
- D. Core needle and incisional biopsies are virtually identical in terms of false results
Correct Answer: C
Rationale: Typically, excisional biopsy is preferred over incisional biopsy whenever feasible because it provides a more accurate representation of the tumor since the entire mass is removed. This benefits both the patient (by potentially preventing the need for a second procedure) and the medical team (by ensuring a more comprehensive evaluation of the tumor). It is important to remove the entire lesion during excisional biopsy to make an accurate diagnosis. Incisional biopsy, on the other hand, involves taking only a portion of the tumor for examination, which may lead to potential sampling error and inadequate representation of the tumor.
Fetal position and occipito-posterior position: a) Define fetal position
- A. Orientation of the fetus in the uterus relative to the mother
- B. Orientation of the fetus' head and limbs
- C. Fetal movements during labor
- D. None of the above
Correct Answer: A
Rationale: Fetal position refers to the alignment of the fetus during pregnancy and labor.
A Para 3+0 client who was scheduled for the fourth cesarean section comes in active labor. The MAIN complication of concern in this case is
- A. Placenta abruption
- B. Rupture of the uterus
- C. Prolonged labor
- D. Precipitate labor
Correct Answer: B
Rationale: The main concern for a woman with multiple previous cesarean sections is uterine rupture.
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patients mental status from the day before. Vital signs and hemodynamic parameters are as follows BP 8854 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93 on a 50 mask Systemic vascular resistance (SVR) 1600 dynes seccm5 Cardiac index 1.3 Lmin Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state?
- A. Hypovolemic
- B. Cardiogenic
- C. Distributive
- D. Obstructive
Correct Answer: B
Rationale: The patient's presentation with low blood pressure, tachycardia, tachypnea, decreased oxygen saturation, and altered mental status is most consistent with distributive shock. Distributive shock is characterized by systemic vasodilation and decreased systemic vascular resistance (SVR), leading to inadequate perfusion of tissues and organs despite normal or high cardiac output. In this case, the low SVR (1600 dynes ∙ sec/cm5) and low blood pressure indicate vasodilation. The patient's pulmonary capillary wedge pressure (PCWP) of 8 mm Hg is not consistent with cardiogenic shock, where elevated PCWP would be expected. Additionally, there are no signs of obstructive shock, such as a history of pulmonary embolism but rather clinical findings that suggest distributive shock. Hypovolemic shock would typically present with signs of volume depletion and would be less likely in this patient with stable mental status initially.