Mrs. Jenner is a 41-year-old female who is being evaluated for persistent nausea. She had an abdominal CT scan that reported three hepatic hemangiomas ranging from 3 to 5 cm. The AGACNP knows that the appropriate response to this report is to

Correct Answer: A

Rationale: Rationale: A needle biopsy is appropriate for definitive diagnosis of hepatic hemangiomas, ruling out other liver lesions. It helps determine if they are benign or malignant. This will guide further management decisions. Summary: B: Annual ultrasound is unnecessary for benign hemangiomas. C: Surgery is not indicated for asymptomatic hepatic hemangiomas. D: Documenting the finding is important but not the appropriate next step in management.

Correct Answer: A

Rationale: Rationale for choice A: Calcium channel antagonists are the treatment of choice for achalasia as they help relax the lower esophageal sphincter, improving swallowing. This is a non-invasive option that can provide symptom relief for many patients. Summary for other choices: B: Intrasphincter botulinum injection is a temporary solution and not considered the treatment of choice. C: Pneumatic dilation is another option for achalasia but is typically used if calcium channel antagonists are ineffective. D: Myotomy and partial fundoplication is a more invasive surgical option and usually considered if other treatments fail.

Correct Answer: B

Rationale: Step-by-step rationale for why choice B is correct: 1. The ACCF/AHA recommends cardiac consultation before an operation for patients on antiplatelet therapy to assess the risk of bleeding versus thrombotic events. 2. Cardiac consultation helps determine the necessity of continuing, modifying, or stopping antiplatelet therapy. 3. This individualized approach ensures optimal perioperative management based on the patient's cardiovascular risk profile. 4. Choice A is incorrect as stopping antiplatelet therapy for 10 days can increase the risk of thrombotic events. 5. Choice C is incorrect as it oversimplifies the decision-making process without considering the patient's specific risks. 6. Choice D is incorrect because initiating antiplatelet therapy in all high-risk cardiac procedures may not be necessary for every patient.

Correct Answer: A

Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low. Explanation for other choices: B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome. C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome. D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.

Correct Answer: C

Rationale: Rationale for Correct Answer (C): 1. The patient's symptoms of decreased capacity for intake and nausea after eating suggest gastroparesis, a common complication post-ulcer surgery. 2. Given the history of complicated peptic ulcer disease and prior surgery, medication may be ineffective, necessitating potential reoperation. 3. The AGACNP advises that another surgery may be needed, indicating that medication alone may not suffice to address the issue. Summary of Incorrect Choices: A: Endoscopy is not necessary at this point as the symptoms are likely indicative of a functional issue rather than a structural problem. B: While gastroparesis can occur post-ulcer surgery, the patient's symptoms are more suggestive of gastroparesis rather than chronic gastroparesis as a known complication. D: The frequency of occurrence of symptoms after ulcer surgery is not relevant to the current management of the patient's symptoms.