jarvis physical examination and health assessment 9th edition test bank

jarvis physical examination and health assessment 9th edition test bank Related

Review jarvis physical examination and health assessment 9th edition test bank related questions and content

An 82-year-old woman receives oral amoxicillin-clavulanate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management?

  • A. Metronidazole is the treatment of choice for C. difficile infection.
  • B. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin.
  • C. Fecal transplantation is the treatment of choice for C. difficile infection.
  • D. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
Correct Answer: D

Rationale: The correct answer is D: Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.

1. Choice A is incorrect because metronidazole is no longer recommended as first-line treatment due to increasing resistance.
2. Choice B is incorrect because there is no evidence suggesting older adults require a longer duration of treatment with vancomycin for their first episode.
3. Choice C is incorrect because while fecal transplantation can be used in refractory cases, it is not typically the first-line treatment.
4. The rationale for D being correct is that both vancomycin and fidaxomicin are recommended as first-line treatments for the initial episode of C. difficile infection based on current guidelines. This allows for flexibility in selecting the appropriate antibiotic based on individual patient factors.

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During the breast examination of a perimenopausal woman, the NP detects a bloody spontaneous discharge from the right nipple. This indicates further evaluation:

  • A. Fibroadenoma
  • B. Polycystic breast disease
  • C. An intraductal papilloma
  • D. Pituitary prolactinoma
Correct Answer: C

Rationale: The correct answer is C: An intraductal papilloma. Bloody spontaneous discharge from the nipple in a perimenopausal woman is concerning for an intraductal papilloma, which is a benign growth in the milk ducts. Further evaluation with imaging studies and possibly a biopsy is necessary to rule out malignancy.

Choice A: Fibroadenoma is a common benign breast tumor but does not typically present with bloody discharge.

Choice B: Polycystic breast disease is not associated with bloody discharge and is characterized by multiple fluid-filled cysts in the breast tissue.

Choice D: Pituitary prolactinoma is a benign tumor of the pituitary gland that can cause elevated prolactin levels leading to nipple discharge, but it is not typically bloody and would not present with spontaneous discharge from the nipple.

Where should the uterine fundus be palpable at 12 weeks?

  • A. At the level of the umbilicus
  • B. At the level of the symphysis pubis
  • C. Midway between the symphysis and umbilicus
  • D. Below the symphysis pubis
Correct Answer: B

Rationale: At 12 weeks of gestation, the uterine fundus should be palpable at the level of the symphysis pubis. This is because the uterus rises approximately 1 cm above the symphysis pubis each week during the first trimester. By 12 weeks, it should be palpable at this level.

Choice A (At the level of the umbilicus) is incorrect because the fundus is not expected to reach the level of the umbilicus until around 20 weeks.

Choice C (Midway between the symphysis and umbilicus) is incorrect as this would typically occur around 16-18 weeks.

Choice D (Below the symphysis pubis) is also incorrect because by 12 weeks, the fundus should have risen above the symphysis pubis.

An 84-year-old male with prostatic hypertrophy is at increased risk of:

  • A. Constipation
  • B. Fecal incontinence
  • C. Urinary tract infections
  • D. Prostate cancer
Correct Answer: C

Rationale: The correct answer is C: Urinary tract infections. Prostatic hypertrophy can cause obstruction of the urinary tract, leading to urinary retention and stasis, which increases the risk of urinary tract infections. Constipation (choice A) and fecal incontinence (choice B) are more related to issues with the gastrointestinal system rather than prostatic hypertrophy. Prostate cancer (choice D) is a separate condition that is not directly linked to prostatic hypertrophy. Therefore, the increased risk for an 84-year-old male with prostatic hypertrophy is urinary tract infections due to urinary obstruction.

A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?

  • A. Pityriasis rosea
  • B. Tinea versicolor
  • C. Psoriasis
  • D. Atopic eczema
Correct Answer: A

Rationale: The correct answer is A: Pityriasis rosea. The key features that point towards this diagnosis include the sudden eruption of lesions in a Christmas tree pattern on the back and torso, along with itching. Pityriasis rosea commonly presents with a single large patch followed by smaller lesions in a distinct pattern. Other choices can be ruled out based on the description provided. Tinea versicolor typically presents with hypo- or hyperpigmented patches, not the erythematous papules and macules described. Psoriasis usually presents with thick, silvery scales, not erythematous lesions in a Christmas tree pattern. Atopic eczema may present with erythematous papules, but the Christmas tree pattern and acute onset described are not typical.

Which lesion is dark, raised, and asymmetric with an irregular border?

  • A. Nevus
  • B. Actinic keratosis
  • C. Keratoacanthoma
  • D. Melanoma
Correct Answer: D

Rationale: The correct answer is D, Melanoma. Melanoma is a type of skin cancer that typically presents as a dark, raised lesion with an irregular border and asymmetry. This is due to the abnormal growth of melanocytes, the pigment-producing cells in the skin. Nevus (A) is a common mole that is usually symmetrical and has a regular border. Actinic keratosis (B) is a precancerous lesion that is typically rough and scaly, not dark or raised. Keratoacanthoma (C) is a low-grade skin cancer that often appears as a dome-shaped lesion with a central crater, not necessarily dark or asymmetric.

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