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

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.

Correct Answer: C

Rationale: The correct answer is C: Decompression of the colon with rectal tube. This is the most appropriate intervention for a patient with acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome. In this condition, there is colonic distention without an actual mechanical obstruction, leading to symptoms like abdominal pain, distention, and high-pitched bowel sounds. Decompression with a rectal tube can help relieve the distention and prevent complications like perforation. Choice A (stimulant laxative) is incorrect because ACPO is not due to simple constipation, so laxatives would not be effective. Choice B (carcinoma of the bowel) is unlikely given the acute onset and lack of risk factors. Choice D (angiography for mesenteric ischemia) is not indicated in this case as there are no signs of acute ischemia. In summary, the correct choice is C because it directly addresses the underlying issue of colonic distention in

Correct Answer: D

Rationale: The correct answer is D: Assessment of nonprostate causes of nocturia. In this case, the patient's symptoms of nocturia, urinary urgency, and post-void dribbling are not indicative of prostate enlargement. Given that the digital rectal examination revealed a normal-sized prostate with no hypertrophy, it is essential to explore other potential causes of nocturia in this patient. By assessing non-prostate causes of nocturia, such as diabetes, urinary tract infection, medication side effects, or sleep disorders, a more accurate diagnosis and appropriate treatment plan can be developed. This approach will lead to better patient outcomes compared to focusing solely on prostate-related evaluations. Option A: Administration of the AUA Symptom Scale is not the best approach in this case because the patient's symptoms are not primarily related to prostate enlargement. Option B: Laboratory assessment to include a PSA is not necessary since the digital rectal examination already indicated a normal-sized prostate with no appreciable hypertrophy. Option C: Ordering a

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.

Correct Answer: A

Rationale: The correct answer is A: Immediate caesarean section. In obstructed labor, prompt delivery is crucial to prevent harm to both the mother and the baby. A caesarean section is the most effective and timely intervention to safely deliver the baby and avoid complications such as fetal distress, maternal infection, and uterine rupture. Observation with pain relief (B) may delay necessary intervention, and manual repositioning of the fetus (C) is not sufficient in cases of obstructed labor. Choice D is incorrect because not all options are appropriate in this specific scenario.

Correct Answer: D

Rationale: The correct answer is D: Escherichia coli. E. coli is the most common causative organism of pyelonephritis due to its prevalence in the gastrointestinal tract. It has specific virulence factors that enable it to ascend the urinary tract and cause infection. Streptococcus faecalis, Proteus vulgaris, and Staphylococcus pyogene are less commonly associated with pyelonephritis compared to E. coli.

Correct Answer: C

Rationale: The presenting diameter in brow presentation is the suboccipitofrontal diameter. This is because in brow presentation, the fetal head is in a deflexed position, with the largest diameter being from the subocciput (back of the head) to the frontal bone (forehead). This allows the head to enter the pelvis in the transverse diameter. A: Mentovertical - This refers to the chin to the top of the head, not the correct diameter for brow presentation. B: Submentobregmatic - This refers to the chin to the bregma, not the correct diameter for brow presentation. D: Occipitalfrontal - This refers to the back of the head to the forehead, not the correct diameter for brow presentation.

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.

Correct Answer: A

Rationale: The correct answer is A: Symptom are absent and abnormal specific laboratory results. Chemical diabetes mellitus refers to a condition where there are abnormal specific laboratory results indicating diabetes without the presence of any symptoms. This classification is based on objective data from laboratory tests rather than subjective symptoms. Choices B, C, and D are incorrect as they do not align with the definition of chemical diabetes mellitus, which focuses on laboratory results rather than symptoms, congenital abnormalities, or pregnancy outcomes.