A 22-year-old architecture major comes to your office, complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive. She has had no pregnancies or surgeries. She reports one new partner within the last month. She does not smoke but does drink occasionally. Her parents are both in good health. On examination you see a young woman appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative. Which disorder of the vulva is most likely in this case?

Correct Answer: A

Rationale: The correct answer is A: Genital herpes. The clinical presentation of severe burning with urination, fever, aching all over, lymphadenopathy, and multiple shallow ulcers along the vulva is highly suggestive of genital herpes. The history of a new sexual partner and the absence of upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms further support this diagnosis. The presence of white blood cells in the urine is consistent with the systemic inflammatory response seen in genital herpes. The negative urine pregnancy test rules out pregnancy-related complications. Condylomata acuminata (choice B) presents as warty growths, not ulcers. Syphilitic chancre (choice C) typically presents as a painless ulcer with regional lymphadenopathy. Epidermoid cyst (choice D) does not typically cause symptoms like severe burning with urination and fever.

Correct Answer: C

Rationale: The correct answer is C: Dissecting aortic aneurysm. The patient's presentation is consistent with aortic dissection due to severe chest pain radiating to the back, asymmetric blood pressure in both arms, and asymmetric pulses. Aortic dissection is a life-threatening emergency requiring immediate intervention. Angina pectoris typically does not present with asymmetric blood pressure or pulses. Pericarditis usually presents with chest pain that worsens with deep breathing and is relieved by sitting up. Pleural pain is typically localized and not associated with asymmetric blood pressure or pulses.

Correct Answer: A

Rationale: The correct answer is A: Perform a complete mental status examination. This is the best course of action as memory loss following a fall can be indicative of a serious condition such as a concussion or traumatic brain injury. A complete mental status examination will help assess various cognitive functions such as memory, orientation, attention, and reasoning abilities. This will provide a comprehensive evaluation of the husband's mental health and cognitive functioning, helping to identify any underlying issues that may require further intervention or treatment. Choice B is incorrect because a psychometrician typically focuses on administering and interpreting psychological tests, which may not address the immediate concerns related to memory loss after a fall. Choice C is not the best course of action as integrating the mental status examination into the history and physical examination may not provide a thorough assessment of the husband's cognitive abilities. Choice D is incorrect as memory loss after a physical shock should not be dismissed without a proper evaluation, as it could be a symptom of a more serious condition.

Correct Answer: C

Rationale: The correct answer is C because the man whose wife has just been diagnosed with lung cancer is emotionally distressed, which can impact his ability to accurately interpret the message. This emotional state may lead to misinterpretations due to heightened stress and distraction. A: Well-adjusted adolescent - Unlikely to misinterpret as they are in a stable emotional state. B: Recovering alcoholic - Unlikely to misinterpret unless under the influence, which is not specified. D: Man with a hearing impairment - Unlikely to misinterpret with the presence of an interpreter for accurate communication.

Correct Answer: B

Rationale: The correct answer is B: Inspection. When performing a physical assessment, inspection is always the first technique used as it provides an overall view of the patient's appearance and any obvious abnormalities. This includes observing skin color, posture, gait, facial expressions, and any visible signs of distress. Inspection helps the nurse gather initial information before proceeding to palpation, percussion, and auscultation. Palpation (A) involves using touch to assess areas such as texture, temperature, and tenderness. Percussion (C) is tapping on the body to produce sounds that indicate the location, size, and density of underlying structures. Auscultation (D) is listening to sounds produced by the body using a stethoscope. These techniques are important in a comprehensive physical assessment but come after inspection.