Which of the following is true of a grade 4-intensity murmur?

Correct Answer: A

Rationale: The correct answer is A: It is moderately loud. A grade 4-intensity murmur indicates a moderately loud murmur that is readily heard with the stethoscope lightly on the chest. This intensity suggests a significant level of turbulence in blood flow, typically indicating a more pronounced cardiac abnormality. Explanation for why other choices are incorrect: B: It can be heard with the stethoscope off the chest - This is incorrect because a murmur would not be audible without the stethoscope. C: It can be heard with the stethoscope partially off the chest - This is incorrect as a murmur would still require direct contact with the chest for auscultation. D: It is associated with a "thrill" - This is incorrect as a thrill is a palpable vibration indicating turbulent blood flow and is not directly related to murmur intensity.

Correct Answer: D

Rationale: The correct answer is D, cardiomyopathy. Cardiomyopathy is a disease of the heart muscle that can lead to an increase in the size and strength of the heart muscle, resulting in an increased amplitude of the apical impulse. This is due to the heart working harder to pump blood effectively. Hypothyroidism (choice A) typically does not cause an increase in the amplitude of the apical impulse. Aortic stenosis (choice B) and mitral stenosis (choice C) both result in pressure or volume overload on specific chambers of the heart, but they do not directly lead to diffuse and increased amplitude of the apical impulse like cardiomyopathy does. In summary, an increase in the amplitude of the apical impulse is more likely to be caused by cardiomyopathy due to the increased workload on the heart muscle, compared to the other conditions provided in the choices.

Correct Answer: C

Rationale: The correct answer is C: Suggest that you discuss this further after getting to know the patient and family a little better. This response allows the healthcare provider to gather more information about the patient's beliefs, values, and preferences before making a decision. It demonstrates respect for the autonomy of the patient and involves a collaborative approach with the family. It also allows time to assess the patient's emotional and psychological readiness to receive the diagnosis. Incorrect answers: A: This answer disregards the patient's autonomy and does not consider the emotional impact of delivering such news without proper assessment. B: While respecting the son's wishes is important, prioritizing the patient's well-being and autonomy should come first. D: Relying solely on the family's perspective without considering the patient's own wishes and understanding may lead to ethical issues and potential harm to the patient.

Correct Answer: A

Rationale: The correct answer is A because in an older adult with an indwelling urinary catheter, a fever >100°F can be a sign of urinary tract infection (UTI) or urosepsis. Given her acute decline in mental status and fever, empiric antibiotic therapy is warranted to treat a potential infection. Choice B is incorrect because older adults with indwelling catheters are at increased risk for UTIs and bloodstream infections. Choice C is incorrect as obtaining a urine culture is important to confirm the diagnosis and guide appropriate antibiotic therapy. Choice D is incorrect as the duration of antibiotic treatment for a UTI is typically longer than 3 days.

Correct Answer: A

Rationale: The correct answer is A: It is not effective during an acute asthma attack. Salmeterol is a long-acting beta agonist used for maintenance therapy, not for acute attacks. It does not provide immediate relief. Choices B and C are incorrect because salmeterol's onset of action is not immediate, and it may take days to weeks to achieve full effect. Choice D is incorrect because salmeterol should not be used in children under 12 years old.

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.

Correct Answer: C

Rationale: The correct answer is C because cultural humility emphasizes recognizing power imbalances and fostering interpersonal sensitivity through partnerships with and learning from patients. This approach encourages self-awareness, openness, and willingness to engage in respectful dialogues. Option A is incorrect because cultural humility is not solely achieved through professional development courses. Option B is incorrect as anyone, regardless of their background, can practice cultural humility. Option D is incorrect as cultural humility does consider the impacts of structural factors on health disparities, including biological, socioeconomic, and racial influences.

Correct Answer: A

Rationale: Rationale: 1. Cefuroxime and nitrofurantoin are safe for use in pregnancy and effective against UTIs. 2. Cefuroxime is a cephalosporin antibiotic, considered safe in pregnancy. 3. Nitrofurantoin is a first-line agent for UTIs in pregnancy due to its safety profile. 4. Ciprofloxacin and tetracycline are contraindicated in pregnancy due to potential harm to the fetus. 5. Amoxicillin is considered safe in pregnancy but not as effective as nitrofurantoin for UTIs.

Correct Answer: D

Rationale: The correct answer is D: Dry and rough. In hypothyroidism, there is reduced secretion of sweat and oils, leading to dry skin. The lack of hydration causes the skin to become rough. This correlates with the clinical presentation of fatigue, weight gain, and hair loss, which are common symptoms of hypothyroidism. Choices A and B are incorrect because moisture is reduced in hypothyroidism, resulting in dry skin. Choice C is incorrect because the lack of oils in hypothyroidism leads to rough skin texture, not smooth.