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: 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: D

Rationale: The correct answer is D: Obturator sign. This finding indicates irritation of the peritoneum and is associated with a ruptured appendix, not acute pancreatitis. A: Severe epigastric pain with radiation to the back is a common presentation of acute pancreatitis, but not necessarily indicative of a seriously ill patient. B: Abdominal guarding and rigidity may suggest peritonitis but are not specific to acute pancreatitis. C: Grey Turner sign, bruising of the flanks, is associated with severe pancreatitis but does not necessarily indicate a seriously ill patient.

Correct Answer: A

Rationale: The correct answer is A: Submentovertival, bitemporal. In a face presentation, the presenting diameters are submentovertival (chin to vertex) and bitemporal (temple to temple). This is because the fetus is in a face-first position with the chin presenting first. Option B is incorrect because submentobregmatic is not a recognized presenting diameter in face presentation. Option C is incorrect as biparietal refers to the widest transverse diameter of the fetal head, not relevant in face presentation. Option D is incorrect as mentovertical is not a valid presenting diameter in face presentation.

Correct Answer: D

Rationale: Step 1: Campylobacter jejuni is a bacteria commonly associated with foodborne illness, often found in undercooked poultry and unpasteurized milk. Step 2: The patient's symptoms and microbiological findings are consistent with Campylobacter infection. Step 3: Advising the patient that there is no readily identified food source of this bacteria is important for preventing future exposure and potential reinfection. Step 4: Choices A, B, and C are incorrect as they do not address the specific educational need related to food safety and prevention of Campylobacter infection.

Correct Answer: B

Rationale: Complete uterine rupture involves a full-thickness disruption of all uterine layers, including the serosa, myometrium, and endometrium. This leads to a complete separation of the uterine wall, potentially resulting in severe bleeding and fetal distress. Choice A is incorrect as it only involves the outermost layer of the uterus. Choice C is incorrect as uterine contractions are usually present during uterine rupture. Choice D is incorrect as the correct definition of complete uterine rupture involves the entire uterine layers being affected.

Correct Answer: D

Rationale: The correct answer is D: A HIDA scan. A HIDA scan is the most appropriate imaging study for investigating the likely cause in this case because the patient's symptoms (abdominal pain centered on the right side just under the ribcage, tenderness in the right upper quadrant) are suggestive of a possible gallbladder issue, such as cholecystitis or biliary colic. A HIDA scan is specifically used to evaluate the gallbladder and biliary system. A: Abdominal radiographs would not provide detailed information about the gallbladder or biliary system, and are not the best choice in this scenario. B: A CT scan of the abdomen with contrast can be helpful in some situations, but it may not provide the specific information needed to evaluate the gallbladder and biliary system. C: Right upper quadrant ultrasound is a good initial imaging study for evaluating gallbladder disease, but a HIDA scan is more specific for functional assessment of

Correct Answer: D

Rationale: The correct answer is D because placenta praevia can lead to life-threatening bleeding during labor due to the placenta partially or completely covering the cervix. This condition poses a high risk of morbidity and mortality to both the mother and the baby. A: Incorrect. Bleeding in placenta praevia is not related to the segment preparing for labor. B: Incorrect. While bleeding is due to placental issues, it is specifically due to the placenta's abnormal positioning, not a pathological process. C: Incorrect. Bleeding can occur before 37 weeks in cases of placenta praevia, and the timing of bleeding is not linked to gestational age.

Correct Answer: B

Rationale: The correct answer is B: Within the first week of birth. Classical vitamin K deficiency bleeding typically occurs within the first week of birth due to low levels of vitamin K in newborns. During this time, infants are at a higher risk of bleeding complications if not supplemented with vitamin K. Choice A is incorrect because bleeding usually occurs after the first 24 hours. Choice C is incorrect as it does not specify a specific time frame within the neonatal stage. Choice D is incorrect as classical vitamin K deficiency bleeding is typically seen within the first week, not necessarily during the entire infancy stage.