S. is a 59-year-old female who has been followed for several years for aortic
regurgitation. Serial echocardiography has demonstrated normal ventricular
function, but the patient was lost to follow-up for the last 16 months and now
presents complaining of activity intolerance and weight gain. Physical examination
reveals a grade IV/VI diastolic aortic murmur and 2+ lower extremity edema to the
midcalf. The AGACNP considers which of the following as the most appropriate
management strategy?
A. Serial echocardiography every 6 months
B. Begin a calcium channel antagonist
C. Begin an angiotensin converting enzyme (ACE) inhibitor
D. Surgical consultation and intervention
The patient is having grade 6 diastolic aortic murmur. The murmur is not
accompanied by any serious complications because there is a 2+ lower extremity
edema to the midcalf. Angiotensin converting enzyme (ACE) inhibitor lowers the
blood pressure. High blood pressure often worsens the underlying conditions that
cause heart murmurs. Beginning an angiotensin converting enzyme (ACE)
inhibitor will help in the management of diastolic aortic murmur by dealing with
the conditions that cause heart murmurs. A surgery would be used only when the
valves are damaged or leaky
Question 2
, An ascending thoracic aneurysm of > 5.5 cm is universally considered an
indication for surgical repair, given the poor outcomes with sudden rupture.
Regardless of the aneurysm’s size, all of the following are additional indications
for immediate operation except:
A. Comorbid Marfan’s syndrome
B. Enlargement of > 1 cm since diagnosis
C. Crushing chest pain
D. History of giant cell arteritis
Prophylactic surgery is recommended when the aorta reaches a diameter of 5.5 cm, when the patient falls
under the Marfan syndrome bicuspid aortic valve category, when the enlargement is greater than 0.5 cm, and
when the patient has a history of fast growing cell arteritis. Marfan syndrome is a connective tissue condition
that involves the respiratory, skeletal, cardiovascular and ocular systems. It is one of the most serious
complication of aortic valve regurgitations and needs an immediate surgery. For this reason, a crushing
chest pain is the odd one out
Question 3
Jasmine is a 31-year-old female who presents with neck pain. She has a long
history of injection drug use and admits to injecting opiates into her neck. Physical
examination reveals diffuse tracking and scarring. Today Jasmine has a distinct
inability to turn her neck without pain, throat pain, and a temperature of 102.1°F.
She appears ill and has foul breath. In order to evaluate for a deep neck space
infection, the AGACNP orders:
A. Anteroposterior neck radiography
B. CT scan of the neck
C. White blood cell (WBC) differential
D. Aspiration and culture of fluid
Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway
obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess.
In the evaluation of these infections, ultrasonography is the gold standard:
1. to differentiate abscesses from cellulitis
, 2. for the diagnosis of lymphadenitis
However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation
of superficial lesions and to image-guided aspiration or drainage.
Computed tomography (CT) combines fast image acquisition and precise anatomical information without
field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and
multi-compartment lesions
Question 4
Mr. Draper is a 39-year-old male recovering from an extended abdominal
procedure. As a result of a serious motor vehicle accident, he has had repair of a
small bowel perforation, splenectomy, and repair of a hepatic laceration. He will be
on total parenteral nutrition postoperatively. The AGACNP recognizes that the
most common complications of parenteral nutrition are a consequence of:
A. Poorly calculated solution
B. Resultant diarrhea and volume contraction
C. The central venous line used for infusion
D. Bowel disuse and hypomotility
Total parenteral nutrition is the administration of nutritional components via the venous system rather than the enteral
route/gastrointestinal tract. It can be total or partial where just a selected number of nutrients are given
This type of nutrient administration comes with a myriad of challenges as a result of the many complications
associated with it. Among the complications the most common is infection which commonly results from the central
venous line used. The contamination of the blood stream is with normal skin flora around the cannulation site,
commonly staphylococcus organisms
The other complications include:
1. Dehydration and electrolyte Imbalances due to inadequate intake
2. Venous thrombosis
3. Hyperglycemia (high blood sugars)
4. Hypoglycemia (low blood sugars)
5. Micro-nutrient deficiencies (vitamin and minerals)
Question 5
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller WALDENEXAMS. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $18.49. You're not tied to anything after your purchase.
