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: Type A aortic aneurysm. Type A involves the ascending aorta, which is more critical due to proximity to the heart. Immediate surgical intervention is necessary to prevent catastrophic complications like aortic dissection or rupture. Choice B, Type B, usually involves the descending aorta and can often be managed through medical therapy initially. Choice C, Descending aneurysm, may not require immediate surgery unless symptomatic or rapidly expanding. Choice D, Symptomatic aneurysm, could refer to any type and would need further evaluation to determine the urgency of surgical intervention.

Correct Answer: A

Rationale: The correct answer is A (Low ACTH and low cortisol) because in patients with an adrenal tumor causing Cushing's syndrome, the tumor autonomously produces cortisol, leading to suppression of ACTH secretion from the pituitary. This results in low ACTH levels and high cortisol levels. Choices B, C, and D are incorrect because they do not reflect the characteristic hormone levels seen in patients with an adrenal tumor causing Cushing's syndrome.

Correct Answer: B

Rationale: The correct answer is B: Tonic. During the tonic stage of eclampsia, the muscles go into a prolonged contraction leading to an arched back and tightly clenched teeth. This is due to sustained muscle rigidity. In contrast, the clonic stage involves rhythmic muscle contractions and relaxations, not sustained rigidity. The premonitory stage is characterized by warning signs like headaches and visual disturbances, not specific physical postures. Coma is a severe stage of unconsciousness, not associated with specific physical postures or muscle rigidity seen in the tonic stage of eclampsia.

Correct Answer: D

Rationale: The correct answer is D: All neonates need vitamin K for activation of thrombokinase. Vitamin K is essential for the synthesis of clotting factors in the liver, including thrombokinase, which plays a crucial role in blood clotting. In neonates, there is a deficiency of vitamin K due to limited transfer across the placenta and low levels in breast milk. Administering vitamin K at birth helps prevent hemorrhagic disease of the newborn. Choices A, B, and C are incorrect because vitamin K does not directly impact immunity, prevent jaundice, or promote normal gut bacteria growth in neonates.

Correct Answer: C

Rationale: The correct answer is C: Placing client on Trendelenburg position. This helps prevent compression of the cord by moving the presenting part off the cord. Placing the client on all fours (choice A) may worsen cord compression. Application of fundal pressure (choice B) is contraindicated as it can further compress the cord. Labor augmentation with oxytocin (choice D) is not indicated in cord prolapse management as it does not address the immediate risk to the fetus. Trendelenburg position is the recommended intervention to alleviate cord compression and improve fetal oxygenation.

Correct Answer: B

Rationale: The correct answer is B: Gastroesophageal reflux disease (GERD). Achalasia is a motility disorder characterized by impaired esophageal peristalsis and lower esophageal sphincter relaxation. This dysfunction can lead to stagnant food in the esophagus, causing regurgitation and increased intra-esophageal pressure, which can trigger GERD. Squamous cell carcinoma (choice A) is not directly linked to achalasia. Esophageal atrophy (choice C) is not a typical consequence of achalasia. Malabsorption syndromes (choice D) are not directly associated with achalasia.

Correct Answer: A

Rationale: The correct answer is A: Pyuria. Pyuria is a common feature in acute pyelonephritis, as it indicates the presence of white blood cells in the urine due to the infection. Fever, CVA tenderness, and gross hematuria are all common features of acute pyelonephritis. Fever is a systemic response to infection, CVA tenderness indicates inflammation of the kidney, and gross hematuria is often seen due to inflammation and damage to the kidney tissue. Therefore, the absence of pyuria would be unexpected in a patient with suspected acute pyelonephritis.

Correct Answer: D

Rationale: The correct answer is D. A ruptured uterus can lead to fetal distress and necessitate a cesarean section. Failure of the cervix to dilate is indicative of a potential uterine rupture, as the uterus may not be able to contract effectively due to the rupture. Maternal dehydration (A), pyrexia (B), and oliguria (C) are not specific signs of a ruptured uterus and may be present in various other conditions. Therefore, failure of the cervix to dilate is the most relevant early sign in this scenario.