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P. T. is a 58-year-old female who is admitted with chest pain and shortness of breath and is found to have a large pulmonary embolus. Her systolic blood pressure is falling, and a diagnosis of obstructive shock is made. Cardiac pressure would likely demonstrate
- A. Elevated atrial and decreased ventricular pressures
- B. Elevated right-sided and decreased left-sided pressures
- C. Elevated left ventricular pressure and decreased cardiac output
- D. Elevated left ventricular pressure and decreased systemic vascular resistance
Correct Answer: B
Rationale: Obstructive shock, such as in this case of a large pulmonary embolus causing obstructive shock, results in a sudden increase in right ventricular afterload due to obstruction of blood flow. This leads to right heart failure and decreased left ventricular preload, ultimately resulting in decreased cardiac output. The elevated right-sided pressures will be reflected by elevated right atrial and ventricular pressures, while the left ventricular pressures will be decreased due to decreased preload. This commonly leads to a situation known as acute cor pulmonale, where the right heart becomes dilated and dysfunctional in response to the increased afterload.
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Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isnt hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 9460 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects
- A. Irritable bowel syndrome
- B. Inflammatory bowel disease
- C. Diverticulitis
- D. Appendicitis
Correct Answer: C
Rationale: Mrs. Maroldo's presentation with left lower quadrant pain, fever, elevated heart rate, history of previous episodes of similar pain that improved with antibiotics, and recent diarrhea are all concerning for diverticulitis. Diverticulitis is an infection or inflammation of small pouches that can form in the wall of the colon, known as diverticula. The symptoms typically include localized abdominal pain, fever, elevated heart rate, and changes in bowel habits such as diarrhea or constipation. The discomfort to deep palpation in the left lower quadrant indicates inflammation in that area. The presence of fever, elevated heart rate, and low blood pressure suggests an infectious process requiring urgent evaluation and treatment. Further diagnostic tests such as a CT scan may be ordered to confirm the diagnosis and assess the extent of the inflammation. Appendicitis can also present with abdominal pain, but the location of the pain in the left lower quadrant makes diverticul
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke most likely resulted from a subarachnoid hemorrhage when the patients family reports that the patient
- A. Has a history of atrial fibrillation
- B. Was unable to be aroused in the morning
- C. Had been complaining of a headache before losing consciousness
- D. Has had several brief episodes of mental confusion and right arm and leg weakness
Correct Answer: A
Rationale: The key clinical manifestation indicating a possible subarachnoid hemorrhage in this scenario is that the patient had been complaining of a headache before losing consciousness. Subarachnoid hemorrhage is a type of stroke that results from bleeding into the space between the arachnoid membrane and the pia mater surrounding the brain. Severe headache, often described as the worst headache of one's life, is a classic symptom of subarachnoid hemorrhage. The sudden onset of a severe headache before loss of consciousness raises the suspicion for this type of stroke. Other symptoms such as mental confusion and weakness may also be present, but the headache is a crucial indicator in this case.
A client is declared fit for vaginal birth after cesarean section if
- A. Her previous C/S was due to cephalopelvic disproportion
- B. The current pregnancy is confirmed as a multiple pregnancy
- C. Previous delivery was via cesarean section
- D. Previous delivery was via spontaneous vertex delivery
Correct Answer: D
Rationale: Vaginal birth after cesarean section is possible if the previous delivery was via spontaneous vertex delivery
Puerperal pyrexia is characterized by any episode of fever during the entire puerperium.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: B
Rationale: Puerperal pyrexia is defined by persistent fever, not any episode during puerperium.
Melanie is a 31-year-old patient who is being evaluated following a routine urinalysis that revealed microscopic hematuria. She was between menses and has no other identifiable explanation for hematuria. She has no significant medical history and otherwise is without complaint. The AGACNP knows that workup for Melanie should include
- A. A urology consultation
- B. CT urogram
- C. Upper urinary imaging
- D. Cystoscopy
Correct Answer: D
Rationale: Upper urinary imaging is the appropriate next step in the workup for Melanie based on the presentation of microscopic hematuria with no other identifiable explanation. Upper urinary imaging, such as an ultrasound or CT scan, can help evaluate the upper urinary tract, including the kidneys and ureters, to investigate potential causes of hematuria. This step is commonly recommended before proceeding to invasive procedures like cystoscopy or consultation with a urologist. It allows for a non-invasive assessment of the upper urinary system to identify any potential abnormalities that may be causing the hematuria in the patient.