Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders

Correct Answer: D

Rationale: The correct answer is D: Aspiration and culture of fluid. Given Jasmine's history of injection drug use, neck pain, inability to turn her neck, elevated temperature, and foul breath, there is a high suspicion of a deep neck space infection. Aspiration and culture of fluid from the affected area will help identify the causative organism and guide appropriate antibiotic therapy. This procedure is essential for definitive diagnosis and management of deep neck infections. A: Anteroposterior neck radiography is not the most appropriate initial diagnostic test for evaluating deep neck space infections as it may not provide detailed information on the extent or nature of the infection. B: CT scan of the neck may provide valuable information regarding the extent of the infection, but aspiration and culture of fluid are crucial for identifying the causative organism. C: White blood cell (WBC) differential may show signs of inflammation, but it does not provide specific information on the causative organism of the infection.

Correct Answer: A

Rationale: The correct answer is A: There is a slightly higher risk of neurologic complications. Rationale: 1. Off-pump bypass grafting involves performing surgery on a beating heart without the use of a heart-lung machine. 2. The lack of cardiopulmonary bypass during off-pump surgery can lead to reduced blood flow to the brain, increasing the risk of neurologic complications. 3. This is why the AGACNP advises Mr. Nelson about the slightly higher risk of neurologic complications associated with off-pump bypass. 4. Choice B is incorrect as long-term results actually suggest similar or better patency rates for grafts in off-pump surgery. 5. Choice C is incorrect as the statement about the incidence increasing significantly in the last 10 years is not relevant to the risks of off-pump surgery. 6. Choice D is incorrect as off-pump surgery is not considerably more expensive and the correlation with better long-term outcomes is debatable.

Correct Answer: A

Rationale: The correct answer is A: Temperature > 102°F. A high fever in the context of right lower quadrant colicky pain raises concern for ureteral colic, which is often caused by kidney stones. Fever may indicate infection or obstruction, requiring urgent medical attention. Choices B, C, and D are incorrect because they are common findings in cases of ureteral colic but are not as specific to raise the index of suspicion. White blood cell count elevation and hematuria are common with kidney stones, while vomiting is a common symptom due to severe pain. However, fever is a more concerning sign that necessitates prompt evaluation.

Correct Answer: B

Rationale: The correct answer is B: CT urogram. This is the appropriate next step in the workup for Melanie's microscopic hematuria. A CT urogram can provide detailed imaging of the urinary tract to identify any structural abnormalities or causes of hematuria. A urology consultation (choice A) may be necessary after the imaging results. Upper urinary imaging (choice C) is not specific enough and may not provide a comprehensive evaluation. Cystoscopy (choice D) is invasive and typically reserved for cases where lower urinary tract issues are suspected, which is not indicated in Melanie's case without further evaluation.

Correct Answer: A

Rationale: The correct answer is A: TRUE. Uterine atony is the most common cause of immediate postpartum hemorrhage due to inadequate uterine contraction to control bleeding. This is supported by research and clinical evidence. Trauma to the genital tract is a less common cause and usually leads to delayed hemorrhage. Choice B is incorrect as uterine atony is a well-documented primary cause. Choice C is incorrect as uterine atony is consistently the leading cause. Choice D is incorrect as the cause of immediate postpartum hemorrhage is clear, with uterine atony being the most common culprit.

Correct Answer: B

Rationale: The correct answer is B (500-1500 gm) because very low birth weight babies typically weigh less than 1500 grams at birth. This range encompasses the common weight range for these babies. Option A (1000-500 gm) is too narrow and excludes babies weighing below 500 grams. Option C (1001-1500 gm) is incorrect as it includes babies weighing over 1500 grams. Option D (1500-2000 gm) is incorrect as it includes babies above the typical weight range for very low birth weight babies.

Correct Answer: B

Rationale: The correct answer is B: His procedure has put him at significant risk for B12 absorption problems. Rationale: 1. Jejunum is primarily responsible for nutrient absorption, including B12. 2. Resection of a large portion of the jejunum can lead to malabsorption of B12. 3. B12 is essential for neurological function and red blood cell production. 4. Patients with significant jejunum resection are at high risk for B12 deficiency. 5. Monitoring B12 levels and potentially requiring supplementation is crucial for patients like Jake. Summary of other choices: A: Incorrect. Lifetime issues with diarrhea are not necessarily expected following jejunum resection. C: Incorrect. The ileum may assume some functions of the jejunum but cannot fully compensate. D: Incorrect. Enteral nutrition should not be delayed for months as it is essential for Jake's recovery and nutritional needs.

Correct Answer: B

Rationale: Uterine apoplexy is the sudden rupture of blood vessels in the uterus, leading to severe hemorrhage. Placental abruption is the most likely cause due to the separation of the placenta from the uterine wall, resulting in bleeding. Incidental hemorrhage is not sudden or severe. Multiple pregnancy may increase the risk but doesn't directly cause uterine apoplexy. Placenta previa involves the placenta covering the cervix, leading to bleeding but not necessarily uterine rupture. Therefore, the correct answer is B.

Correct Answer: B

Rationale: The correct answer is B: Iron and folic acid. Diamorphic anemia is characterized by the presence of both microcytic and macrocytic red blood cells, which can be caused by a deficiency in both iron and folic acid. Iron deficiency leads to microcytic anemia, while folic acid deficiency results in macrocytic anemia. Thiamine deficiency (Choice A) primarily affects the nervous system and does not directly cause diamorphic anemia. Liver enzymes deficiency (Choice D) does not directly lead to diamorphic anemia. Folic acid and thiamine deficiency (Choice C) can cause individual types of anemia but not diamorphic anemia.