A 19-year-old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis?

Correct Answer: C

Rationale: The correct answer is C. Meningitis typically presents with neck stiffness due to meningeal irritation. In choice C, the patient has a tender neck to palpation and is unable to perform range of motion, indicating meningeal inflammation. Choices A, B, and D all describe a normal head and fundi exam, which is not consistent with meningitis. Choice B mentions muscle spasm and limited range of motion to the right, but this is more suggestive of a musculoskeletal issue rather than meningitis. Choice D describes a normal neck exam, which is not in line with the presentation of meningitis.

Correct Answer: C

Rationale: Step 1: Identify the characteristics of the lesion described - dome-shaped, in dermis, benign, closed sac attached to epidermis. Step 2: A cutaneous cyst fits all these characteristics - it is a benign closed sac in the dermis with attachment to the epidermis. Step 3: Keloid (A) is an overgrowth of scar tissue, not a closed sac lesion. Tophi (B) are deposits of uric acid crystals, not a sac. Chondrodermatitis (D) is inflammation of cartilage and skin, not a closed sac lesion. Summary: A cutaneous cyst is the correct choice as it matches all the characteristics given, while the other options do not fit the description provided.

Correct Answer: D

Rationale: The correct answer is D: 32 cm. At 32 weeks gestation, fundal height should typically correspond to the number of weeks of gestation. This is known as the McDonald's rule. The NP would suspect fetal growth if the fundal height is not within a range of +/- 2 cm from the expected measurement. In this case, 32 cm aligns with the expected fundal height for a pregnancy at 32 weeks gestation. Therefore, it indicates appropriate fetal growth. Choices A, B, and C are incorrect as they do not match the expected fundal height for a pregnancy at 32 weeks gestation, suggesting possible issues with fetal growth.

Correct Answer: D

Rationale: The correct answer is D: Dry and rough. In hypothyroidism, there is reduced secretion of sweat and oils, leading to dry skin. The lack of hydration causes the skin to become rough. This correlates with the clinical presentation of fatigue, weight gain, and hair loss, which are common symptoms of hypothyroidism. Choices A and B are incorrect because moisture is reduced in hypothyroidism, resulting in dry skin. Choice C is incorrect because the lack of oils in hypothyroidism leads to rough skin texture, not smooth.

Correct Answer: C

Rationale: The correct answer is C because Certified Nursing Assistants (CNAs) typically provide the majority of direct patient care in nursing homes. CNAs assist with activities of daily living, monitoring patients' health, and providing emotional support. This is true in most nursing homes as they play a crucial role in patient care. Rationale: - A: Most nurses in nursing homes are not necessarily Registered Nurses (RNs), as there are also Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs) who provide care. - B: LPNs or LVNs may assist with the patient care plan under the supervision of an RN, but they do not typically develop the plan themselves. - D: Staff turnover is a major issue in nursing homes due to various factors such as workload, stress, and burnout among healthcare workers.

Correct Answer: C

Rationale: The correct answer is C: Stop aspirin and begin apixaban 5 mg twice a day. The rationale is that for stroke risk reduction in nonvalvular atrial fibrillation, anticoagulation therapy with direct oral anticoagulants (DOACs) like apixaban is preferred over antiplatelet therapy like aspirin. DOACs have been shown to be more effective in reducing stroke risk with a lower bleeding risk compared to warfarin. Choice A is incorrect as aspirin alone is not sufficient for stroke prevention in atrial fibrillation. Choice B is incorrect as warfarin has more monitoring requirements and potential drug interactions compared to DOACs like apixaban. Choice D is incorrect as aspirin and apixaban together are not recommended due to increased bleeding risk.

Correct Answer: B

Rationale: The correct answer is B: Present illness. The statement "I feel really tired" falls under the present illness category because it describes the current health concern the individual is experiencing. This section focuses on the details of the current symptoms, their duration, severity, and any associated factors. It helps in understanding the progression and impact of the current health issue. A: Chief complaint typically refers to the main reason for seeking medical help, usually a symptom or problem that brought the individual to the healthcare provider. C: Personal and social history covers information about the individual's lifestyle, habits, and social support system. D: Review of systems involves systematically asking about symptoms related to different body systems, which is not the case in the given statement.

Correct Answer: A

Rationale: The correct answer is A: A palpable "notch" along its edge. This supports an enlarged kidney over the spleen because the kidney has a concave shape with a notch where the renal vessels enter. This notch is palpable in an enlarged kidney. Choice B is incorrect because the inability to push fingers between the mass and the costal margin is indicative of a spleen, which is a solid organ located close to the ribs. Choice C is incorrect as normal tympany over the area suggests gas-filled structures like the stomach or intestines, not a solid organ like the kidney or spleen. Choice D is incorrect as the ability to push fingers medial and deep to the mass would be more typical of an enlarged spleen, which can displace other organs medially due to its size.

Correct Answer: C

Rationale: The correct answer is C because cultural humility emphasizes recognizing power imbalances and fostering interpersonal sensitivity through partnerships with and learning from patients. This approach encourages self-awareness, openness, and willingness to engage in respectful dialogues. Option A is incorrect because cultural humility is not solely achieved through professional development courses. Option B is incorrect as anyone, regardless of their background, can practice cultural humility. Option D is incorrect as cultural humility does consider the impacts of structural factors on health disparities, including biological, socioeconomic, and racial influences.