A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?

Correct Answer: C

Rationale: A stage 3 pressure ulcer involves full-thickness skin loss with damage and necrosis of the subcutaneous tissue, but the underlying muscle is not affected. In this case, the description of the full-thickness skin loss with involvement of the subcutaneous tissue but not the muscle corresponds to a stage 3 pressure ulcer. Stage 1 involves intact skin with non-blanchable redness, stage 2 involves partial-thickness skin loss with a shallow open ulcer, and stage 4 involves full-thickness tissue loss with the involvement of muscle, bone, or supporting structures.

Correct Answer: B

Rationale: The patient's presentation with an enlarged chest diameter, decreased breath sounds throughout all lobes, and the presence of rhonchi over all lung fields is suggestive of a chronic condition that affects the entire respiratory system. These findings are classic for COPD, a progressive lung disease characterized by airflow limitation. The breath sounds are decreased due to airflow obstruction, and the presence of rhonchi indicates mucus production and airway inflammation commonly seen in COPD. In contrast, a spontaneous pneumothorax would typically present with sudden chest pain and shortness of breath, often in a younger patient with risk factors such as smoking. Asthma would present with wheezing, shortness of breath, and possibly a history of atopy or allergies. Pneumonia would typically present with fever, cough, and focal findings on chest examination, such as crackles or bronchial breath sounds over a consolidated area. In

Correct Answer: B

Rationale: The repeated scenario of finding a positive test result that does not correlate with the suspected disease indicates a lack of specificity for the test in question. In such cases, it is important to use the test when there is a higher suspicion for a specific condition that is known to correlate with the finding. By using the test selectively in situations where it is more likely to provide accurate information, its utility can be maximized and unnecessary further workup can be avoided. This approach allows for a more targeted and efficient use of resources in the diagnostic process.

Correct Answer: A

Rationale: The symptom described - sharp, aching chest pain that increases with breathing - is typically associated with musculoskeletal issues. The pain worsening with breathing suggests a connection to the movements of the chest wall, which could involve the muscles, bones, or joints in that area. Conditions such as costochondritis (inflammation of the cartilage that connects a rib to the breastbone) or muscle strains in the chest wall are common causes of chest pain that worsens with breathing. This localization to the musculoskeletal system is based on the characteristics of the pain and how it is affected by breathing, helping to narrow down the differential diagnosis.

Correct Answer: A

Rationale: A tender, painful swelling of the scrotum is a common symptom of acute epididymitis, which is the inflammation of the epididymis. The epididymis is a tube located at the back of the testicle that stores and transports sperm. In acute epididymitis, the swelling is usually accompanied by pain, tenderness, redness, and warmth in the affected area. Other symptoms may include fever, chills, and discharge from the penis. Prompt medical evaluation and treatment are necessary to prevent complications such as abscess formation or chronic epididymitis. Strangulated inguinal hernia and torsion of the spermatic cord may present with severe pain and swelling in the scrotum, but they have distinct mechanisms and require different management approaches.

Correct Answer: B

Rationale: While it is important to ask about recent sexual activity and whether it included sexual intercourse, using the term "intimate physical contact" is not specific enough. This question could potentially lead to misinterpretation or confusion regarding what types of activities are being referred to. It is more appropriate to directly ask about sexual intercourse when obtaining a sexual history. The other options are all appropriate questions to elicit information about the patient's sexual history.

Correct Answer: D

Rationale: The changes in Jenny's appearance and behavior, such as wearing old jeans, lack of makeup, and avoiding eye contact, are suggestive of potential signs of depression. When a person is feeling depressed, they may lose interest in their appearance, have changes in sleep patterns leading to fatigue, and exhibit avoidance behaviors like avoiding eye contact. It is essential to approach Jenny with empathy and offer support as depression can significantly impact one's well-being and daily functioning. It would be beneficial for Jenny to seek professional help and guidance to address any underlying issues causing her to feel this way.

Correct Answer: D

Rationale: To hear a soft murmur or bruit clearly, it is important to minimize any background noise or distractions that may interfere with your ability to auscultate effectively. Therefore, asking the patient to hold her breath (choice A) can help reduce noise caused by the patient's respiration. Asking the patient in the next bed to turn down the TV (choice B) can also help eliminate external noise that may disrupt your ability to hear subtle sounds. Checking your stethoscope for air leaks (choice C) is crucial to ensure that you are hearing sounds accurately and not being affected by any equipment issues. By combining these strategies, you can create an optimal environment for listening to soft murmurs or bruits.

Correct Answer: B

Rationale: Urge incontinence, also known as overactive bladder, is characterized by a sudden and strong urge to urinate which is difficult to control. In this case, Mrs. LaFarge is unable to get to the bathroom quickly enough when she senses the need to urinate, which indicates a lack of control over the urge to urinate. This is typically caused by involuntary contractions of the bladder muscle. Stress incontinence, on the other hand, is leakage of urine during activities that increase intra-abdominal pressure, such as coughing or exercising. Overflow incontinence is characterized by urinary retention and constant dribbling of urine due to the bladder being unable to empty properly. Functional incontinence occurs when a person has normal bladder control but is unable to reach the bathroom in time due to physical or cognitive impairments. Since Mrs. LaFarge is experiencing a sudden and strong urge to urinate that she cannot