A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?

Correct Answer: D

Rationale: The correct answer is D: Obtain an ultrasound of the liver. This is the most appropriate next step to assess the patient's enlarged liver in the context of COPD. Ultrasound can provide detailed images of the liver to identify potential causes of enlargement, such as fatty liver disease or liver cirrhosis. Percussing the lower border (Choice A) or measuring the span of the liver (Choice B) may provide some information but are less specific and may not identify the underlying cause. Ordering a hepatitis panel (Choice C) would focus only on viral hepatitis as a potential cause, while an ultrasound can provide a broader evaluation of liver structure and function.

Correct Answer: A

Rationale: The correct answer is A because dopamine, serotonin, and norepinephrine are neurotransmitters commonly associated with mood regulation. Medications that affect these neurotransmitters can lead to symptoms of depression as a side effect. B: Gabapentin is not primarily associated with mood regulation. C: Milnacipran is an SNRI used to treat depression, not cause it. D: Cortisol is a stress hormone, not a neurotransmitter directly linked to depression symptoms.

Correct Answer: B

Rationale: The correct answer is B: Betamethasone dipropionate 0.05% (Betanate). When managing an acute flare of atopic dermatitis unresponsive to emollient therapy, topical corticosteroids like betamethasone are often the first-line treatment due to their anti-inflammatory properties. Betamethasone is a potent corticosteroid that can help reduce inflammation, itching, and redness associated with atopic dermatitis. Oral corticosteroids (Choice A) are generally reserved for severe cases due to potential systemic side effects. Desonide (Choice C) is a milder topical corticosteroid suitable for maintenance therapy but may not be potent enough for acute flares. Pimecrolimus (Choice D) is a calcineurin inhibitor used for moderate to severe atopic dermatitis and is generally not the first choice for initial treatment of acute flares.

Correct Answer: A

Rationale: Rationale: The correct answer is A: Supraspinatus. This muscle is responsible for initiating abduction movement at the shoulder joint. It is located on the top of the shoulder blade and assists in lifting the arm away from the body. The other choices, B: Infraspinatus, C: Levator scapulae muscle, and D: Subscapularis, are not involved in initiating abduction movement at the shoulder. Infraspinatus is responsible for external rotation, Levator scapulae muscle elevates the scapula, and Subscapularis assists in internal rotation of the shoulder joint.

Correct Answer: B

Rationale: The correct answer is B because decreased tactile fremitus suggests fluid or air in the pleural space, which can occur in conditions like pleural effusion or pneumothorax. This decrease in tactile fremitus is due to the transmission of vibrations from the vocal cords being impeded by the presence of fluid or air between the lung and chest wall. Choices A, C, and D are incorrect because decreased tactile fremitus is not typically associated with increased lung density, normal lung function, or lung tumors.

Correct Answer: C

Rationale: The correct answer is C: Advise them to file an advanced directive. An advanced directive is a legal document that allows individuals to specify their healthcare preferences in advance, including who they want to make medical decisions for them if they are unable to do so. In this scenario, since the patient and her partner are not married, it is important for her to have an advanced directive in place to ensure that her partner is legally recognized as the decision-maker. This documentation will help ensure her goals of care are followed in case she becomes incapacitated. Choice A (Advise them to complete a POLST) is incorrect because a POLST (Physician Orders for Life-Sustaining Treatment) form is used to specify a patient's wishes for end-of-life care, not for designating a medical decision-maker. Choice B (Advise them that they have adequate documentation to be recognized legally) is incorrect because without an advanced directive, there may be legal challenges to the partner's authority to make medical decisions

Correct Answer: A

Rationale: The correct answer is A: Extrapyramidal symptoms. Selective serotonin reuptake inhibitors (SSRIs) are not known to cause extrapyramidal symptoms, which are more commonly associated with antipsychotic medications. SSRIs can cause gastrointestinal bleeding, irritation, and hyponatremia in older adults due to their effects on serotonin levels and platelet function. Extrapyramidal symptoms involve movement disorders like tremors and muscle rigidity, which are not typically seen with SSRIs. Therefore, A is the correct answer.

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: B

Rationale: The correct answer is B: Streptococcus pneumoniae. This bacterium is the most common cause of community-acquired pneumonia in adults due to its prevalence and ability to cause infections in the lungs. It accounts for a significant portion of pneumonia cases worldwide. Staphylococcus aureus (A) is more commonly associated with healthcare-associated pneumonia. Mycoplasma pneumoniae (C) typically causes atypical pneumonia, which tends to be milder and more common in younger individuals. Pseudomonas aeruginosa (D) is more commonly seen in individuals with underlying health conditions or compromised immune systems, rather than in healthy adults with community-acquired pneumonia.