The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kgday. The best approach to this patients management is to

Correct Answer: B

Rationale: The best approach to managing the patient with ascites who has responded to spironolactone with weight loss is to add a loop diuretic to the current regimen. Spironolactone is an aldosterone antagonist that primarily works on the distal convoluted tubule, while loop diuretics, such as furosemide, act on the thick ascending limb of the loop of Henle. Combining these two diuretics can result in a synergistic effect, increasing diuresis and reducing fluid retention in patients with ascites. This combination therapy is often used in patients who do not respond adequately to spironolactone alone, and it is considered a common strategy in the management of ascites due to cirrhosis. Therefore, adding a loop diuretic to the spironolactone regimen is the most appropriate next step to optimize diuresis and fluid management in this patient.

Correct Answer: C

Rationale: Mrs. Maroldo's presentation with left lower quadrant pain, fever, elevated heart rate, history of previous episodes of similar pain that improved with antibiotics, and recent diarrhea are all concerning for diverticulitis. Diverticulitis is an infection or inflammation of small pouches that can form in the wall of the colon, known as diverticula. The symptoms typically include localized abdominal pain, fever, elevated heart rate, and changes in bowel habits such as diarrhea or constipation. The discomfort to deep palpation in the left lower quadrant indicates inflammation in that area. The presence of fever, elevated heart rate, and low blood pressure suggests an infectious process requiring urgent evaluation and treatment. Further diagnostic tests such as a CT scan may be ordered to confirm the diagnosis and assess the extent of the inflammation. Appendicitis can also present with abdominal pain, but the location of the pain in the left lower quadrant makes diverticul

Correct Answer: C

Rationale: Abdominal pain in pregnancy can be caused by various conditions, but spontaneous hepatic rupture is a rare but life-threatening cause that must be ruled out. Spontaneous hepatic rupture, also known as liver rupture, can occur in pregnancy, though it is extremely rare. It is associated with severe abdominal pain, hypovolemic shock, and can lead to significant maternal and fetal morbidity and mortality. Therefore, the AGACNP should evaluate this possibility when assessing a pregnant patient with abdominal pain to provide timely and appropriate management.HELLP syndrome, placental abruption, and preterm labor are important considerations in the differential diagnosis of abdominal pain in pregnancy but are not specific to the life-threatening nature of spontaneous hepatic rupture.

Correct Answer: C

Rationale: Type A aortic aneurysms require immediate surgical intervention. Type A aortic dissections involve the ascending aorta and are at high risk for complications such as aortic rupture or compromise of coronary artery blood flow. Prompt surgical repair is necessary to prevent potentially fatal outcomes. Types B, C, and symptomatic aneurysms may not require immediate surgical intervention depending on the specific patient presentation and associated risks.

Correct Answer: C

Rationale: Ultrasonography is considered essential in all cases of acute abdomen because it is a valuable tool in evaluating various abdominal organs non-invasively. It can quickly identify common causes of acute abdomen such as cholecystitis, pancreatitis, appendicitis, and other intra-abdominal pathologies. Ultrasonography also has the advantage of being radiation-free and can be performed rapidly at the bedside, making it a preferred initial diagnostic modality in the evaluation of acute abdominal pain. Abdominal radiograph, contrast radiography, and chest radiography may have limited utility in the evaluation of acute abdomen compared to ultrasonography.