Mrs. Van Doern is being examined on postop day 3 following surgical resection

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Question 58

Mrs. Van Doern is

being examined on postop day 3 following surgical resection following a bowel obstruction. The postoperative course been unremarkable. Upon removal of the dressing, the incision is dry with staples intact. There is an approximately 0.5 cm erythema around the incision. There is no exudate. The patient demonstrates some discomfort on palpation of the site. The most appropriate approach to this patient includes:

A.Leaving the wound open to air and medicating for pain        B. Ordering a topical antibiotic, replacing the dressing with a nonadherent dressing, and following up in 2 days                                 C. Beginning systemic antibiotics to cover skin flora                                                              D.Obtaining a white blood cell differential, redress the wound and reassess in the a.m.

 
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K.T. is a 38-year-old female with a BMI of 39 kg/m2

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Question 59

K.T. is a

38-year-old female with a BMI of 39 kg/m2 who needs surgical reduction of a hiatal hernia. She is asking about the recovery process and says that she has read about something called the obesity paradox. She wants to know what that means with respect to her healing. The AGACNP explains that the paradox refers to the fact that:

A. Obesity correlates with poor outcomes for some surgical procedures but not others.                     B. There is an inverse relationship between weight and surgical outcomes.                                          C. Underweight patients have more surgical complications than obese patients.                                 D. Planned weight loss preoperatively is indicated only when the BMI is > 40 kg/m2 .

 
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Esophageal motility

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Question 60

Esophageal motility

disorders are sometimes a consequence of systemic diseases such as scleroderma, Raynaud’s disease, and systemic lupus erythematosus. When patients with these diseases have gastroparesis, which medication should be added to the regimen?

A. A proton pump inhibitor      B. A histamine 2 receptor antagonist       C. A calcium channel antagonist        D. A promotility agent

 
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S. is a 46-year-old

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Question 61

S. is a 46-year-old

female with metastatic breast cancer. She is currently off cycle for chemotherapy and generally is feeling well. Today, however, she presents feeling acutely unwell. She says that she has had coldlike symptoms over the last few days, including cough, nasal congestion, headache, and a hoarse voice in the mornings. Today she became acutely concerned because she feels as though her face and even shoulders look swollen and a bit discolored—bluish. She denies any nausea or vomiting but admits to feeling generally fatigued; she attribute it to her cancer. Recognizing the likely diagnosis, the AGACNP knows that treatment will likely include:

A.Radiation     B. Surgery      C. Fibrinolytics      D. Expansile stents

 
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