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?

Correct Answer: D

Rationale: In a patient with suspected prostatic abscess and urinary retention, urinary catheterization is contraindicated due to the risk of spreading infection and causing potential complications such as septicemia or worsening of the abscess. The introduction of a catheter can disrupt the abscess capsule, leading to dissemination of the infection. Therefore, other methods of decompression and treatment should be considered, such as drainage of the abscess or other appropriate interventions guided by a healthcare provider.

Correct Answer: C

Rationale: In this case, the best approach to the patient includes assessment of nonprostate causes of nocturia. Despite the lack of significant prostate hypertrophy on digital rectal examination, the patient is experiencing bothersome lower urinary tract symptoms such as nocturia, urinary urgency, and post-void dribbling. These symptoms suggest the need to consider alternative causes beyond prostate enlargement. Factors such as overactive bladder, urinary tract infections, diabetes, sleep apnea, medications, or other systemic conditions could be contributing to the patient's symptoms. Therefore, a comprehensive evaluation to identify potential nonprostate causes of the patient's nocturia is warranted before considering more invasive prostate-specific tests like PSA, ultrasound, or symptom scales.

Correct Answer: C

Rationale: When counseling a patient about surgical options for an ulcer that has been refractory to medical therapy, advising the patient that he will need some form of vagotomy is important. Vagotomy is a surgical procedure in which the vagus nerve is partially or completely severed. This procedure is commonly performed for patients with ulcers that have not responded to medical treatment. Vagotomy reduces the acid secretion in the stomach, which can help in the healing of the ulcer and prevent recurrence. It is an effective option for treating ulcers that have not responded to conservative medical management.

Correct Answer: C

Rationale: The Grey Turner sign is characterized by bruising in the flanks and is a rare finding associated with acute pancreatitis. It indicates retroperitoneal bleeding and is considered an ominous finding that suggests a severe and potentially moribund state in patients with acute pancreatitis. The presence of the Grey Turner sign should prompt immediate intervention and close monitoring in a hospital setting. The other options, severe epigastric pain with radiation to the back, abdominal guarding and rigidity, and obturator sign, are indicative of pancreatitis but do not carry the same ominous implication as the Grey Turner sign.

Correct Answer: D

Rationale: In this scenario, the patient's low blood pressure is likely a physiologic response to traumatic head injury. Hypotension can occur as a compensatory mechanism in traumatic brain injury to maintain cerebral perfusion. The body may reduce blood pressure to decrease the risk of further brain injury or bleeding. It is important for the AGACNP to recognize that in traumatic brain injury, hypotension may not necessarily require immediate intervention with vasopressors, as it may be a protective response. Monitoring and managing the patient's condition closely, including neurologic status and trends in blood pressure, is crucial in this situation.