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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.
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On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection consists of
- A. Cyclosporine
- B. Azathioprine
- C. Methylprednisolone
- D. Sirolimus
Correct Answer: D
Rationale: The first-line treatment for acute rejection following hepatic transplant is high-dose corticosteroids, such as methylprednisolone. This is because corticosteroids have potent anti-inflammatory and immunosuppressive effects that can help suppress the immune response causing rejection. Cyclosporine, azathioprine, and sirolimus are also commonly used immunosuppressive medications in transplant patients, but in this case of acute rejection, the immediate treatment of choice is methylprednisolone.
The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?
- A. Pyuria
- B. Fever
- C. CVA tenderness
- D. Gross hematuria
Correct Answer: D
Rationale: While pyuria, fever, and CVA tenderness are common features of acute pyelonephritis, gross hematuria is less commonly associated with this condition. In acute pyelonephritis, the inflammatory process primarily affects the renal parenchyma and pelvis, leading to symptoms such as fever, chills, flank pain, pyuria (presence of pus in the urine), and CVA tenderness (tenderness over the costovertebral angle). Hematuria in acute pyelonephritis is more likely to be microscopic rather than gross.
Achalasia is a risk factor for
- A. Squamous cell carcinoma
- B. Gastroesophageal reflux disease
- C. Esophageal atrophy
- D. Malabsorption syndromes
Correct Answer: A
Rationale: Achalasia is a motility disorder characterized by the inability of the lower esophageal sphincter to relax, resulting in difficulty swallowing and impaired movement of food from the esophagus into the stomach. Patients with achalasia have an increased risk of developing squamous cell carcinoma of the esophagus. This risk is due to chronic inflammation, stasis of food in the esophagus, and increased exposure of esophageal mucosa to irritants, all of which can contribute to the development of cancer over time. Gastroesophageal reflux disease (Choice B) is less likely to be associated with achalasia because the impaired esophageal motility in achalasia results in decreased, rather than increased, reflux of stomach contents into the esophagus. Esophageal atrophy (Choice C) and malabsorption syndromes (Choice D) are not directly related to achalasia.
Signs of obstructed labour per vaginally include
- A. Dry vagina, Oedema of the cervix, Caput succedaneum
- B. Plenty amniotic fluid, Hot/dry vagina, meconium stained liquor
- C. Meconium stained liquor, Hot/dry vagina, Diluted urine
- D. Caput succedaneum, Oedema of the cervix, plenty amniotic fluid
Correct Answer: A
Rationale: Signs of obstructed labor include a dry vagina, oedema of the cervix, and caput succedaneum.
K. W. is a 50-year-old woman who presents for surgical resection of the liver for treatment of metastatic colon cancer. Preoperatively, the surgeon tells her that he is planning to remove 50 to 75 of her liver. The patient is concerned that she will not be able to recover normal liver function with that much removed. The AGACNP counsels her that
- A. Such a high-volume resection is utilized only in people with markedly compromised hepatic function
- B. Major regeneration occurs within 10 days, and the process is complete by 5 weeks
- C. Liver function will probably recover to 50% baseline, but that is enough for normal function
- D. Up to 95% of the liver can be removed without any apparent consequence to the patient
Correct Answer: B
Rationale: The liver is known for its remarkable ability to regenerate. Major regeneration can occur within 10 days after partial hepatectomy (liver resection) as a compensatory mechanism. The process is typically complete within 5 weeks. This regenerative capacity allows for safe removal of a significant portion of the liver for procedures such as liver resection for cancer. The remaining liver tissue is able to rapidly proliferate and restore normal liver function. The patient should be reassured that even with 50 to 75% of her liver being removed, she can expect a significant amount of liver function recovery postoperatively.