Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1 packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows temperature 99.1F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 13784 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal?

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Question 1 of 5

Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1 packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows temperature 99.1F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 13784 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal?

Correct Answer: A

Rationale: The correct answer is A: A complete blood count and RBC differential. In this case, Mr. Jefferson presents with severe abdominal pain, which could indicate various conditions like pancreatitis, a possible complication of his heavy drinking. A complete blood count (CBC) with RBC differential can help assess for signs of inflammation or infection, which may be elevated in conditions like pancreatitis. The RBC differential can also provide insights into potential causes of abdominal pain, such as anemia or other blood disorders. Summary: - B: Liver function enzymes may be affected in conditions like alcoholic liver disease, but in this case, the focus should be on investigating acute abdominal pain. - C: Serum amylase, lipase, and glucose are typically checked in cases of suspected pancreatitis, but a CBC with RBC differential would provide a more comprehensive initial assessment. - D: A basic metabolic panel may not directly address the underlying cause of the acute abdominal pain and is not the most appropriate test to anticipate

Question 2 of 5

Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade VVI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes

Correct Answer: A

Rationale: The correct answer is A: Acute mitral valve regurgitation. The presence of a grade VVI systolic murmur that radiates to the midaxillary line suggests mitral valve involvement. Mitral regurgitation leads to acute onset of symptoms such as dyspnea and pulmonary congestion, indicated by coarse rales on auscultation. The murmur is loudest at the point of maximal impulse due to eccentric regurgitation jet. Acute aortic valve regurgitation (B) typically presents with a diastolic murmur. Acute cardiac tamponade (C) would present with Beck's triad and pulsus paradoxus. Acute pulmonary embolus (D) would present with sudden onset dyspnea and pleuritic chest pain.

Question 3 of 5

According to the American College of Surgeons (ACS) and the National Surgical Quality Improvement Program (NSQIP) guidelines for preoperative evaluation of the geriatric patient, the preoperative evaluation should include all of the following except

Correct Answer: A

Rationale: Step-by-step rationale: 1. Cognitive ability is important for decision-making during surgery. 2. Functional status helps assess the patient's ability to recover post-surgery. 3. Competency assessment ensures the patient can consent to surgery. 4. Frailty score predicts surgical outcomes in geriatric patients. 5. Cognitive ability is not typically assessed preoperatively in the ACS/NSQIP guidelines. Summary: - A: Cognitive ability is not typically part of preoperative evaluation. - B: Functional status is important for post-surgery recovery. - C: Competency assessment is crucial for informed consent. - D: Frailty score helps predict surgical outcomes in geriatric patients.

Question 4 of 5

Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifers evaluation and management should include

Correct Answer: C

Rationale: The correct answer is C: Consideration of prophylactic therapy. A 12-mm induration in a healthcare worker is considered positive for PPD. In the absence of active TB on chest radiograph, the next step is to consider prophylactic therapy to prevent the development of active TB. This is based on the guidelines for the management of latent TB infection. Choice A is incorrect as a positive PPD warrants further evaluation regardless of the chest radiograph result. Choice B, the Quantiferon assay, is not the next step after a positive PPD and negative chest radiograph. Choice D, beginning therapy for pulmonary TB pending sputum cultures, is not indicated in this scenario as there is no evidence of active TB.

Question 5 of 5

A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?

Correct Answer: A

Rationale: The correct answer is A: Isoproterenol 0.2 to 0.6 mg IV bolus. Isoproterenol is a non-selective beta-adrenergic agonist that can worsen graft rejection in heart transplant patients. The appropriate intervention for bradyarrhythmia in posttransplant patients is external pacemaking or pharmacological agents like atropine or epinephrine. Isoproterenol should be avoided due to its potential to stimulate the immune system and increase the risk of rejection. It is crucial to choose interventions that address the bradycardia without compromising the patient's transplant graft.

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