T. is a 39-year-old male who presents to the hospital emergency room

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T. is a 39-year-old male who presents to the hospital emergency room with a

chief complaint of profound substernal chest pain. Results of the 12-lead ECG and cardiac enzymes test are normal. Vital signs are as follows: temperature 101.9°F, pulse 129 bpm, respirations 26 breaths per minute, and blood pressure 90/60 mm Hg. The patient is pale and clearly unwell, and physical examination reveals a systolic pericardial crunching sound. Which of the following additional pieces of history would make the AGACNP suspect acute mediastinitis?

A.A 48 pack year smoke history

B. A 2-day history of vomiting

C. Aortic valve regurgitation

D.Cardiac tamponade

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

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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 who needs surgical

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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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Kelly T. is a 49-year-old female who is being admitted for aortic valve

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Kelly T. is a 49-year-old female who is being admitted for aortic valve

replacement. Her preoperative evaluation revealed an ascending thoracic aneurysm of 4.8 cm in diameter. Kelly has not had any aneurysm symptoms and is generally considered a very strong surgical candidate. The AGACNP knows that the standard of care dictates:

A. Postponing her valve surgery due to the aneurysm

B. Annual imaging of the aneurysm after her valve replacement

C. Surgical repair of the aneurysm at the same time as valve replacement

D. Surgical repair of the aneurysm after successful recovery from valve replacement

 
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