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: D

Rationale: The correct answer is D: Placental insufficiency. A bipartite placenta and succenturiate lobe are structural abnormalities that can lead to placental insufficiency. This is because these conditions can interfere with proper blood flow and nutrient exchange between the mother and fetus, resulting in decreased oxygen and nutrients reaching the fetus, leading to placental insufficiency. Placental abruption (choice A), placental calcification (choice B), and placenta previa (choice C) are not directly associated with bipartite placenta or succenturiate lobe and do not specifically cause placental insufficiency.

Correct Answer: B

Rationale: The correct answer is B: Facilitation of weight gain. A thermal controlled environment for a low birth weight baby helps in maintaining the baby's body temperature, reducing energy expenditure, and promoting weight gain. This is crucial for the baby's growth and development. Incorrect choices: A: Prevention of infection - While a thermal controlled environment can indirectly help prevent infections by maintaining the baby's health, it is not the primary aim. C: Provision of quality care - Quality care involves multiple aspects beyond just thermal control, so this is not the primary aim. D: Provision of nutrition - Nutrition is important for weight gain, but the thermal controlled environment specifically focuses on regulating the baby's body temperature to support weight gain.

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: Placenta praevia is more common in women with a history of multiple pregnancies (Grandmultiparity), as repeated stretching of the uterine wall can lead to abnormal placental implantation. Preeclampsia is a separate condition associated with hypertension in pregnancy. Placenta fenestrate and placenta increta are specific placental abnormalities but do not directly cause placenta praevia.

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: 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: C

Rationale: The correct answer is C: Choanal atresia. The congenital abnormality of the respiratory tract with abnormal apical position is typically associated with choanal atresia, which is a blockage or narrowing of the back of the nasal passage. This condition can lead to respiratory distress in newborns due to difficulty breathing through the nose. Explanation: 1. Laryngeal stridor (Choice A) is a high-pitched noise during breathing and is not typically associated with abnormal apical position. 2. Diaphragmatic hernia (Choice B) is a defect in the diaphragm that allows abdominal organs to move into the chest cavity, but it is not related to abnormal apical position. 3. Tracheo-bronchi fistula (Choice D) is an abnormal connection between the trachea and bronchi, which is not associated with abnormal apical position. In summary, choanal atresia is the correct answer because it fits the description of

Correct Answer: A

Rationale: The correct answer is A (36 weeks gestation) because at this point in pregnancy, the fetus has reached a stable lie position. Before 36 weeks, fetal lie can vary due to the ample space in the uterus. After 36 weeks, the fetus tends to settle into a consistent head-down or breech position, making the lie stable. Choices B, C, and D are incorrect as they are past the point where the lie typically stabilizes, leading to less variability in fetal positioning.