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 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 patient's symptoms of severe burning with urination, fever, lymphadenopathy, and multiple shallow ulcers along the vulva are classic for genital herpes. The new sexual partner and absence of red blood cells or bacteria in the urine support a sexually transmitted infection. The presence of white blood cells in urine and absence of other systemic symptoms help differentiate it from other choices. Condylomata acuminata (choice B) present as warty lesions and do not cause the systemic symptoms described. Syphilitic chancre (choice C) would typically present as a single painless ulcer and is unlikely given the multiple shallow ulcers described. Epidermoid cyst (choice D) does not match the clinical presentation of fever, burning with urination, and lymphadenopathy.

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: A

Rationale: The correct answer is A: The fovea. The fovea is the central focal point for incoming images because it contains a high concentration of cones, which are responsible for detailed central vision. Cones are essential for color vision and visual acuity. The macula, while important for central vision, refers to the area surrounding the fovea. The optic disk is where the optic nerve exits the eye, and it does not receive incoming images. The physiologic cup is a normal depression in the optic nerve head and is not involved in image reception. In conclusion, the fovea is the correct answer as it is the area with the highest visual acuity due to the dense concentration of cones.

Correct Answer: A

Rationale: The correct answer is A: Provide positive pressure ventilation with supplemental oxygen. This is the most appropriate action as the patient is cyanotic, responsive to painful stimuli, and exhibiting stridorous respirations, indicating potential airway compromise. Providing positive pressure ventilation with supplemental oxygen can help improve oxygenation and support the patient's breathing. Summary of other choices: B: Obtaining vital signs is important, but in this urgent situation, addressing the airway and breathing takes precedence. C: Contacting medical direction may delay essential treatment. Immediate intervention is crucial in this scenario. D: Applying a pulse oximeter can provide valuable information, but administering oxygen and ensuring adequate ventilation should be the priority in a patient with compromised breathing.

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: B

Rationale: The correct answer is B: Chest pain and pleuritic breathing. This indicates possible complications like pleurisy or pleural effusion, requiring further evaluation. A: Persistent cough with sputum production is common in pneumonia. C: Shortness of breath is a typical symptom of pneumonia. D: Fever and chills are also common in pneumonia. However, chest pain and pleuritic breathing are more indicative of potential complications that may require immediate attention.

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: Hyperkalemia is associated with diminished renal function because the kidneys play a crucial role in regulating potassium levels in the body. When renal function is impaired, the kidneys may not be able to excrete excess potassium effectively, leading to elevated potassium levels in the blood. - Choice A (Increase BP) is incorrect because hyperkalemia is not directly associated with increased blood pressure. - Choice B (Alpha-blockers) is incorrect as alpha-blockers are not typically linked to hyperkalemia. - Choice D (Loop diuretics) is incorrect as loop diuretics can actually lower potassium levels, not cause hyperkalemia.

Correct Answer: D

Rationale: The correct answer is D because asking the patient to describe what happened will provide crucial information about the onset, nature, and potential cause of the knee pain. This open-ended question allows the patient to share their experience freely, aiding in accurate diagnosis and appropriate treatment planning. Option A focuses solely on pain intensity, which is important but not as comprehensive as understanding the context of the pain (D). Options B and C are more specific to past injuries and onset time, respectively, which are relevant but not as immediate and all-encompassing as asking the patient to describe the current issue (D).