Nokea
When counseling a patient about his surgical options for an ulcer that has been refractory to medical therapy, the AGACNP advises the patient that he will need
- A. Lifelong vitamin D replacement
- B. Excision of the ulcer, which produces an 80% cure rate
- C. To eat much smaller, more frequent meals
- D. Some form of vagotomy
Correct Answer: D
Rationale: Correct Answer: D. Some form of vagotomy
Rationale:
1. Vagotomy is a surgical procedure that involves cutting the vagus nerve to reduce acid production in the stomach, which can help in treating ulcers.
2. Vagotomy is often recommended when ulcers are refractory to medical therapy, making it an appropriate surgical option.
3. Lifelong vitamin D replacement (A) is not typically necessary for ulcer treatment. Excision of the ulcer (B) is not a common treatment and does not address the underlying cause. Eating smaller meals (C) may help manage symptoms but is not a surgical option for refractory ulcers.
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R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention. The AGACNP knows that which of the following is contraindicated in this circumstance?
- A. Digital prostate examination
- B. Urinary catheterization
- C. Fluoroquinolone antibiotics
- D. Drainage of prostate abscess
Correct Answer: C
Rationale: The correct answer is C: Fluoroquinolone antibiotics. In this case, the patient presents with signs of sepsis and urinary retention, which are indicative of a possible prostatic abscess. Administering fluoroquinolone antibiotics could potentially mask the symptoms and delay further evaluation and treatment of the abscess. This can lead to worsening infection and sepsis. Therefore, the AGACNP should avoid prescribing fluoroquinolones until further evaluation is done to confirm or rule out a prostatic abscess.
Incorrect choices:
A: Digital prostate examination - This could help in assessing the prostate for abscess or other abnormalities.
B: Urinary catheterization - Necessary to relieve bladder distention and assess urine output.
D: Drainage of prostate abscess - If confirmed, drainage would be the appropriate intervention to address the abscess.
Which one of the following statements is correct with regards to face presentation?
- A. Majority are classified as primary face presentation
- B. The presenting transverse diameter is the bi-parietal diameter
- C. Majority are classified as secondary face presentation
- D. Locating the anterior fontanelle is diagnostic of the presentation
Correct Answer: C
Rationale: The correct answer is C: Majority are classified as secondary face presentation. In face presentation, the fetal head is hyperextended, presenting the face to the birth canal. Primary face presentation is rare. The bi-parietal diameter is not the presenting diameter in face presentation, as it is in vertex presentation. Locating the anterior fontanelle is not diagnostic of face presentation, as the fontanelles can be difficult to palpate during labor. Therefore, the correct statement is that the majority of face presentations are classified as secondary face presentation.
Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is really wrong. She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?
- A. Abdominal radiographs
- B. CT scan of the abdomen with contrast
- C. Right upper quadrant ultrasound
- D. A HIDA scan
Correct Answer: D
Rationale: The correct answer is D: A HIDA scan. A HIDA scan is the most appropriate imaging study for investigating the likely cause in this case because the patient's symptoms (abdominal pain centered on the right side just under the ribcage, tenderness in the right upper quadrant) are suggestive of a possible gallbladder issue, such as cholecystitis or biliary colic. A HIDA scan is specifically used to evaluate the gallbladder and biliary system.
A: Abdominal radiographs would not provide detailed information about the gallbladder or biliary system, and are not the best choice in this scenario.
B: A CT scan of the abdomen with contrast can be helpful in some situations, but it may not provide the specific information needed to evaluate the gallbladder and biliary system.
C: Right upper quadrant ultrasound is a good initial imaging study for evaluating gallbladder disease, but a HIDA scan is more specific for functional assessment of
A pregnant woman with acute pyelonephritis is advised on a high fluid intake so as to
- A. Promote enough rest
- B. Correct dehydration
- C. Relief irritability
- D. Increase urine output
Correct Answer: B
Rationale: The correct answer is B: Correct dehydration. Acute pyelonephritis can lead to dehydration due to fever, vomiting, and decreased fluid intake. High fluid intake helps correct dehydration by maintaining adequate fluid balance and preventing further complications. Increasing urine output (choice D) is a consequence of correcting dehydration. Promoting enough rest (choice A) is important but not the primary reason for advising high fluid intake. Relief of irritability (choice C) is not directly related to the management of acute pyelonephritis.
Vaginal delivery is possible in
- A. Brow presentation
- B. Face presentation
- C. Shoulder presentation
- D. Unstable lie
Correct Answer: B
Rationale: The correct answer is B: Face presentation. Vaginal delivery is possible in face presentation as the baby's head is extended, allowing for descent through the birth canal. Brow presentation (A) and shoulder presentation (C) may require cesarean delivery due to the atypical presentation of the baby. Unstable lie (D) refers to the baby being in a transverse position, which also necessitates a cesarean section. Face presentation is the only option where vaginal delivery may be possible due to the extended position of the baby's head.