Download MSN 612 Final EXAM LATEST 2024/2025 COMPLETE QUESTION AND ANSWER (100% GUARANTEED PASS) and more Exams Nursing in PDF only on Docsity!
MSN 612 Final EXAM LATEST 2024/2025 COMPLETE QUESTION AND
ANSWER (100% GUARANTEED PASS)
A 16-year-old male presents with lethargy, fatigue, and occasional mucosal bleeding. The patient also reports weight loss in the past 5 months. Laboratory analysis reveals a white blood cell count of 32,000 cells/microL. On examination, hepatosplenomegaly is noted. Further evaluation shows findings suggestive of acute lymphocytic leukemia. What is the most likely cause of the patient's mucosal bleeding? Decreased platelet count A 16-year-old female presents with complaints of fever, lethargy, and night sweats. The patient also reports a 6-kilogram (13.2 pound) weight loss in the past 3 months. On examination, painless, enlarged cervical and supraclavicular lymph nodes are palpated. A fine-needle aspiration biopsy of one of the lymph nodes is shown in the image. The patient's findings are most suggestive of which of the following? (see photo) Hodgkin lymphoma A 16-year-old male presents with fatigue, easy bruisability, and weight loss. On examination, hepatosplenomegaly is noted. After a detailed evaluation, the patient is diagnosed with acute lymphocytic leukemia. Which of the following is used in the management of this patient's condition L-asparaginase A 57-year-old patient with lymphoma complains of nausea after starting morphine. Which of the following is most accurate regarding nausea and vomiting due to opioids? After starting opioids, nausea, often improves within a few days A 43-year-old man presents to the clinic for evaluation after abnormalities noted on a routine set of labs. CBC with differential demonstrated hemoglobin 14 g/dL, WBC count 26,000/microL, lymphocytes 21,000/microL, neutrophils 4500/microL, and platelets 260,000/microL. The basic
metabolic panel demonstrates normal electrolytes and renal function. LFTs show total bilirubin 1.2 mg/dL and normal liver enzymes. On examination in office, his examination is normal, with no palpable lymph nodes or hepatosplenomegaly. He denies any B symptoms. Peripheral smear shows lymphocytosis with many small lymphocytes and smudge cells. Which of the following is the next best step in the management of this patient? Observation and close follow up A 65-year-old woman presents with an 8-month history of recurrent low-grade fevers, a 3- month history of abdominal fullness, and more recently, fatigue and moderately reduced exercise tolerance. Before this, she was in good health with no major medical conditions. Upon examination, she appeared to be stable and in no acute distress. She has a heart rate of 95 bpm and blood pressure of 128/60 mmHg. She had several palpable cervical and axillary lymph nodes (1-2 cm) that were non-tender and freely mobile. She also had palpable splenomegaly. No other abdominal masses/hepatomegaly appreciated on examination. Her complete blood count showed a leukocyte count of 32,000/mm3, hemoglobin of 9.8 g/dL, platelet count of 145,000/mm3, neutrophil count 1,900/mm3, lymphocyte count 30,000/mm3, elevated LDH, and elevated reticulocyte count. Peripheral blood smear showed an increasing number of mature lymphocytes, spherocytes, and pol Autoimmune hemolytic anemia A 67-year-old female with a performance status of 0, is brought to the clinic with symptomatic anemia and has required several transfusions over the past 2 to 3 months. Currently, her hemoglobin is 7.5 g/dL, absolute neutrophil count 1500/microL and platelet count is 119,000/microL. She had a bone marrow biopsy performed that reveals myelodysplastic syndrome (MDS) with 6% blasts and cytogenetics positive for 5q deletion. She did not have any mutations or other cytogenetic abnormalities. Which of the following is the best initial course of treatment? A thalidomide derivative A 36-year-old woman with a past medical history significant for menorrhagia from uterine fibroids presents with exertional dyspnea and fatigue. Examination shows conjunctival pallor. Laboratory tests reveal a hemoglobin of 6.2 grams/dL, mean corpuscular volume (MCV) 60 fl (normal: 80-100 fl), and normal liver function tests. What is the most likely diagnosis? Iron deficiency anemia
A 67-year-old female presents with a history of high fevers and productive cough with green sputum for the last three days. The patient received the influenza vaccine this year. Her past medical history is unremarkable. She has a smoking history of 25 pack years. She does not drink alcohol or use illicit drugs. Temperature is 102F, blood pressure is 115/70mmHg, the pulse is 101/min, and respirations are 23/min. Her oxygen saturation is 91% on room air. On examination, her anterior cervical lymph nodes are enlarged and nontender. Chest auscultation reveals crackles in the left lower lobe. Hepatosplenomegaly is present. A chest x-ray shows a developing left lower lobe consolidation. Labs show a WBC count of 45000, with lymphocytes being 85%. Empirical pharmacotherapy is initiated, and blood cultures are sent to the lab. Which of the following is the most appropriate step next? Flow cytometry of blood A 49-year-old male with fatigue and easy bruising is found to have terminal deoxynucleotidyl transferase (TdT) positive cells in the blood. He may have which of the following conditions Acute lymphoblastic leukemia Which of the following is associated with the CD10 antigen? Acute lymphocytic leukemia A 16-year-old patient presents because she believes she was bitten by a tick while hiking in the woods a few days ago. She mentions swelling in her right ear and general malaise. On exam, she has a 1 x 2 cm bluish-red nodule on the right ear lobe. What is the next best step in management for this patient? lyme serology A 26-year-old male comes to the emergency department complaining of fatigue, dyspnea, chest pain, and syncope, especially when playing soccer. This has been going on for the past 2 weeks. He has no significant past medical history. He denies smoking, caffeine intake, tinnitus, vomiting, or coughing. He has been taking NSAIDs regularly for the past year due to headaches that he attributes to "being stressed out from my new job." On examination, BP: 120/81 mmHg, HR: 55 bpm, RR: 18/min, and O2: 99% on room air. Skin examination: no rashes, abdominal examination: mild epigastric tenderness but no organomegaly, chest examination: equal air entry bilaterally with no abnormal sounds. ECG shows P waves and QRS complexes that are
independent of each other. Blood tests show antibodies to the organism in the picture. Which of the following is the most appropriate treatment for this patient's case? (see photo) Hospitalization for close monitoring with telemetry and IV ceftriaxone An adolescent presents to you with sore throat, fever, lymphadenopathy, and splenomegaly. He also complains of headache but has been previously well. Which should be done? Treat symptomatically A healthy 17-year-old male presents with three days of worsening fatigue, rhinorrhea, nasal congestion, myalgias, and subjective fever. He is severely allergic to eggs and therefore does not receive the annual influenza vaccine. His blood pressure is 125/75 mmHg, pulse 100 beats per minute, temperature 100 F (37.7 C), and respiratory rate 18 breaths per minute. Examination demonstrates conjunctivitis, oropharyngeal erythema, and clear breath sounds. Given the likely diagnosis, what is the most appropriate treatment? Symptomatic treatment only A 33-year-old inmate is brought to the clinic for a routine annual checkup. The patient says that he has been in good health and does not have any medical problems. He, however, does complain of disturbed sleep, constipation, and weight loss. A review of systems is negative for cough, shortness of breath, burning urination, abdominal discomfort, or weakness. Examination shows normal vitals, a soft, nontender abdomen with no organomegaly, normal S1 and S2 with no added sounds, and normal bronchial breathing bilaterally. A purified protein derivative test shows an induration of 11 mm. What is the next best step in the management of this patient? Chest x-ray A 16-year-old patient presents to the hospital with fever, fatigue, lymphadenopathy, and sore throat. Exudative pharyngitis is noted on the throat examination. However, rapid strep testing is negative. His blood pressure is 135/85 mmHg, the pulse rate is 92/min regular, and his respiratory rate is 16/min. Past medical history is positive for asthma, and his father had leukemia. Social history is notable for being involved in multiple school sporting activities. What is the most appropriate piece of advice for this patient? Avoid contact sports for a minimum of 6 weeks
A 17-year-old female presents with a severe sore throat. She has been sick with a fever for four days. The patient's voice is muffled, and she prefers not to speak secondary to pain. She has not been able to eat solids for 2 days and has refused to drink for 1 day. Vital signs show a temperature of 39.8 C, heart rate 140 beats/min, respiratory rate 20, and blood pressure 110/70 mmHg. The exam shows the tonsils to be four-plus enlarged with partial airway obstruction and grey-white exudates. It is associated with cervical lymphadenopathy and splenomegaly. A rapid strep screen is negative. A CBC shows atypical lymphocytes. What is the most appropriate management? Admission for hydration and corticosteroids A 16-year-old boy with a low-grade fever and a cough is seen in the ER. The clinician sends blood work for the measurement of heterophile antibodies because they suspect which of the following? Infectious mononucleosis A 40-year-old woman from the New England area of the United States presents with complaints of malaise, headache, rash, and fever. She went hiking in a local park with her family 7 days ago. She has a history of depression and hypothyroidism, for which she takes paroxetine and levothyroxine. She was an occasional smoker but quit 5 years ago. On examination, her temperature is 99 F (37.2 C), heart rate is 80 bpm, respiratory rate is 16 breaths/min, and blood pressure is 125/75 mmHg. A rash is noted on her right upper extremity (see image). The rest of her physical exam is unremarkable. What is the recommended treatment for this patient's condition? (see photo) 10 - day course of doxycycline A 17-year-old presents with tonsil hypertrophy, new-onset snoring, bilateral cervical lymphadenopathy, low-grade fever, and general malaise. Two days ago, the patient developed severe abdominal pain and anorexia, unaffected by eating or drinking. He has had a recent bowel movement. Which of the following is the gold standard test in diagnosing his condition? Heterophil antibody test A healthy patient is administered a subcutaneous injection of purified protein derivative (PPD) on the anterior aspect of the forearm. At 48 hours, 15 mm of induration develops. What is the diagnosis?
Exposure to TB A client is diagnosed with pulmonary tuberculosis. Which of the following is the most common diagnostic histopathological hallmark of the client's condition? Caseating granuloma A 39-year-old woman is brought to the emergency department with complaints of fever, headache, severe body aches, dry cough, dyspnea, and coryza for the last 2 days. She has had rheumatoid arthritis for the last 5 years, and she is on oral prednisone therapy. History reveals that she is a school teacher, and many of her students have been sick with similar symptoms. Physical examination shows scattered crackles in both lung fields. Laboratory findings indicate a white blood cell (WBC) count of 12,000 cells/mm3 with 67% lymphocytes. Chest x-ray (CXR) detects bilateral increased interstitial markings. Which of the following treatment is most likely to be given to this patient? Oseltamivir 75 mg orally 2 times daily A 39-year-old woman is brought to the emergency department with 2 days history of fever, headache, severe myalgias, dry cough, breathlessness, and coryza. She is a school teacher, and many students in her class have been reported sick with "the flu." Physical examination reveals scattered crackles in both lung fields. Blood tests indicate a white blood cell count of 12, cells/microL with 69% lymphocytes. Chest x-ray shows increased interstitial markings on both sides. She has had rheumatoid arthritis, and she takes prednisone. Which of the following tests is most likely to confirm the diagnosis in this patient? Rapid influenza diagnostic test from a throat swab A 35-year-old male is seen in the outpatient department with complaints of cough and low- grade fever for the past 3 months. The patient developed fever 3 months back, which was low grade and associated with night sweats. He also has had a troublesome cough. He had an episode of hemoptysis, which prompted the visit. His history is significant for HIV infection 8 years ago, for which he has never taken treatment. Examination reveals a temperature of 99 F, a pulse of 90 beats per minute, a blood pressure of 110/70 mmHg, and a respiratory rate of 22 breaths per minute. His general physical examination reveals the presence of oropharyngeal thrush and mild pallor. Chest examination reveals coarse crackles and bronchial breathing in the left upper lobe. His investigations reveal a WBC count of 3,000 per microL, hemoglobin of 10
loose, watery stools per day. His heart rate is 66 beats per minute, blood pressure 138/ mmHg, respiratory rate 14 breaths per minute, and temperature 101.4 F (38.6 C). He denies taking any medication and denies any known food intolerances. His most likely condition is associated with which of the following changes? Decreased extracellular fluid volume and unchanged intracellular fluid volume A 34-year-old Asian woman reported a history of losing weight and cough over a period of 5 months. On examination, she was anemic and on auscultation left apical crackles were noted. Her chest x-ray revealed left apical shadowing with cavitation. What is the next stage in her management? Tuberculin skin test and sputum culture A female presents with progressive confusion over weeks with memory loss. She has a slight fever at 100.4 F. Prior to cognitive changes, she had been complaining of arthralgias. History is otherwise unremarkable except for the fact she is an avid camper. Which of the following is the initial diagnostic test that should be ordered? Serology A 50-year-old woman with metastatic ovarian cancer requires at least 12 hours of active nursing care because of a worsening condition. What is the best description for this patient's level of hospice service under the Medical Hospice Benefit? Continuous home hospice care A 37-year-old woman presents to her clinic with complaints of aching pain in the breast for six months which is worse before her periods. She is apprehensive as her mother-in-law has been recently diagnosed with breast cancer. On examination, the breasts feel lumpy with greenish discharge from the right nipple. Ultrasound reveals focal areas of thickening of the parenchyma and multiple small cysts. Core biopsy reveals cystically dilated ducts, with a few ducts showing atypical epithelial hyperplasia surrounded by dense fibrosis. Which of the following best estimates the patient's risk of breast cancer? 1 to 2 times the normal population
A 24-year-old woman presents to the office for evaluation of a tender breast swelling. The patient states she noticed the swelling last week while taking a shower. She is sexually active and uses oral contraceptive pills regularly. The patient is concerned as her mother died from metastatic breast cancer 2 years ago. On examination, a 2x1 cm size lump is present in the upper lateral quadrant of the right breast. The lump is rubbery in texture and is mobile. A biopsy is performed, and the histopathology findings are shown in the figure. What is the most likely diagnosis? (see photo) Fibroadenosis with dystrophic calcifications A 65-year-old woman with a past medical history of hypertension, well-controlled diabetes mellitus, and transient ischemic attacks presents to the clinic for abdominal bloating for the last four months. Abdominal distension is noted on examination. Further evaluation by a CT scan abdomen shows liver lesions, ascites, and pleural effusion with lung lesions. The biopsy of the lesions is consistent with primary ovarian cancer. CA-125 is elevated. She is negative for BRCA 1 and BRCA 2. Which of the following is the most appropriate first-line therapy for this patient? Carboplatin with paclitaxel A 36-year-old woman presents to the clinic for her annual visit. She is sexually active, has no children, and her medications include oral contraceptive pills and a daily multivitamin. Her menses are regular, with mild cramps. She does not smoke tobacco or drink alcohol. Her family history is significant for a mother diagnosed at 45 years of age with ovarian cancer. Physical exam, including bimanual exam, is normal. She asks the clinician about ovarian cancer screening. Which of the following best describes this screening? Ovarian cancer screening may be offered to women at high risk A 31-year-old female attends the clinics with a complaint of being unable to conceive. She has been having regular unprotected intercourse for the last 18 months but still unable to conceive. Her periods are regular every 28 days which last for 4-5 days. She has a history of lower abdominal pain starting a day before her menstruation. She has been taking paracetamol and mefenamic acid with minimal relief. She has no other relevant history, and she is a teetotaler and denies smoking. On examination, her blood pressure is 123/76 mmHg, and her pulse is 81 bpm, her body mass index is 29 kg/m2. On bimanual pelvic examination, there is tenderness on the left side for her abdomen. What the most appropriate next step in management? Pelvic ultrasound
breast cancer in the paternal grandmother and ovarian cancer in the mother. She is up to date with her screenings and vaccinations. After her family history, which of the following is the most important risk factor for the development of ovarian cancer in this patient? nulliparity A 25-year-old G0P0 female presents with intermittent abdominal pain. She states that the pain starts before her period, is "crampy" in nature, and lasts for a few days after, and has been occurring intermittently since menarche. Her periods have been regular, with no spotting or pain in between periods. Her last period was a week ago. She has no other health issues and takes no medications. She has had no previous surgeries in the past. She is currently sexually active with her husband and is interested in starting a family shortly. What is the first line of treatment for this patient? NSAIDS A 65-year-old woman with a BMI of 32 kg/m2 comes to the clinician with a complaint of two episodes of vaginal bleeding in the past 40 days. She has a past medical history of hypertension and diabetes mellitus type 2. On both occasions, light spotting lasted for three days. She experienced menopause at the age of 56 years. Currently, she is afebrile and hemodynamically stable with an unremarkable physical examination. She takes metformin and lisinopril. What is the first-line imaging study to evaluate a patient with this complaint? Transvaginal ultrasound An 18-year-old white female presents for a wellness examination. After some questioning, she admits to heavy menstrual cycles that are 28 days apart and last 7-8 days. She reports the passage of clots and on her heaviest days, having to change her pads every 1-2 hours. She is not sexually active and denies any significant past medical history. She does admit to an episode of heavy bleeding after tooth extraction for braces when she was 13 years old. The physical examination is unremarkable except for scattered ecchymoses on her bilateral shins. Which of the following is the most appropriate step in the diagnosis of this patient? Coagulopathy studies A 51-year-old female presents with a chief complaint of irregular, heavy menstrual bleeding for the past six months. She reports previously regular cycles every 30 days, lasting 4 to 6 days, with medium flow. She reports her cycles are now occurring every 30 to 45 days, lasting anywhere
from 5 to 12 days, with heavy flow and the occasional passing of clots. On exam, her BMI is 30.2, and her vitals are within normal limits. Along with a pelvic examination, what is the next most appropriate step in evaluating this patient? Endometrial sampling A 65-year-old nulligravid woman presents to the clinic with complaints of vaginal bleeding and vague abdominal pain. She says she has not been feeling well for the past three months. She denies any weight loss and has not seen a healthcare provider for the past five years. She smokes one pack of cigarettes per day, and her BMI is 29 kg/m2. She has a history of multiple sexual partners and was diagnosed with endometriosis when she was 20 years old. She is on no medications and denies any allergies. The physical exam is unremarkable except for the presence of blood clots at the cervical os. Which of the following risk factors would raise suspicion of her condition? obesity A 41-year-old female patient presented to the clinician for contraception. She had 3 children, all born through standard vaginal delivery. She stated that her family was complete, and was sure that she does not want another child. Her blood pressure was 150/90, and her pulse was at 89 beats/minute. She smoked half a pack of cigarettes daily. What would be an ideal contraceptive in this case? Intrauterine device A 65-year-old female presents to the clinic with complaints of vaginal bleeding, vague abdominal pain, and nausea. She says she has not been feeling well for the past few months. She has class 2 obesity and denies any weight loss and has not seen a healthcare provider for at least five years. She has a 3 0 - pack-year history of smoking and drinks three to four alcoholic beverages daily. She is on no medications and denies any allergies. A physical exam is unremarkable except for the presence of blood clots at the cervical os. Which of the following risk factors would raise the suspicion of uterine cancer? obesity A 48-year-old woman presents with a swelling on the left side of her vulva. The patient says she noticed this swelling one week ago. She denies any pain, or history of weight loss. She reports having regular menstrual cycles and being sexually active with her husband. She has no past
Primary ovarian insufficiency A 20-year-old woman presents for extremely painful menstrual periods and associated abdominal bloating over the last 6 months. The symptoms are most severe on the first day of her period, and she is concerned because it is causing her to miss work. Her menstrual history reveals regular menstrual periods every 28 days that last for 5 days. She denies excessive menstrual blood loss. She is otherwise fit and healthy. She takes no medication and denies smoking tobacco or using illicit drugs. She drinks alcohol occasionally. She admits that she is trying to conceive and does not use any method of contraception. Her BMI is 25 kg/m2. Which of the following is the best initial treatment for this patient? naproxen A 49-year-old female (G2 P2) with a history of fibrocystic breast disease presented with a left breast mass that she found a month ago on self-examination. The patient faithfully had obtained routine mammograms since age 40. This year, after reporting the mass and with spot films obtained as recommended by the radiologist, a new cluster of microcalcifications was identified on the report: "spot compression" assessment identified a 3-cm mass and noted "s/p breast augmentation." The radiologist interpreted the spot films to be benign. His report stated that "15% of breast cancers are not detected by a mammogram, and breast self-exam is recommended monthly from 40 years of age." The provider recommended a 6-month follow- up. When the patient complied, the radiologist's report again noted calcifications believed to be nonmalignant. Six months later, the patient presented with bloody nipple discharge from her left breast w Paget disease A 30-year-old female presents to her provider complaining of a swelling on the left side of her vulva. She reports that this is the third time she develops a recurrence of this problem. She asks what is her diagnosis and she wonders what should be the best treatment to be done for her to prevent this swelling from recurring again and again? Bartholian's gland abscess, marsupialization A 25-year-old woman presents to the clinic with nausea, pelvic pain, and vaginal discharge. The client is sexually active and has multiple sexual partners. Her blood pressure is 110/70 mmHg, her pulse rate is 110/min, and her temperature is 102 F (38.8 C). On examination, adnexal
tenderness is noted. Which of the following complications is most likely to occur if this client's condition is left untreated? infertility A 25-year-old woman with no previous history of abnormal Pap tests is being evaluated. Which of the following is the most appropriate Pap test frequency for this patient? Every three years A 17-year-old female presents to the clinic with a 1-week history of low-grade fever and abdominal pain. She has presented multiple times in the last year with urinary tract infections. The patient says she has had multiple sexual partners over the last year and uses barrier protection inconsistently. On examination, the patient has diffuse lower abdominal tenderness with no guarding or rigidity. She also has cervical motion tenderness and mucopurulent vaginal discharge on pelvic examination. Culture and gram staining are negative for any organism. What is the organism most likely responsible for the patient's presentation? chlamydia A 67-year-old woman presents with new-onset vaginal bleeding. She reports first sexual intercourse at age 14, smoking 1/2 pack of cigarettes for the last 35 years, and a history of vaginal intraepithelial neoplasia treated with laser ablation. On pelvic exam, a lesion is seen by separating both labia minora without having to place a speculum. Which lymphatic chain is the suspected malignancy most likely to spread to first? Inguinal lymph nodes A 15-year-old female presents to the hospital with a complaint of intermenstrual bleeding that started four months ago. She also complains of dyspareunia and vaginal discharge. On further questioning, she gives a history of lower abdominal pain and fever. Her vital signs show blood pressure 120/70 mmHg, respiratory rate 14/min, heart rate 84/min, and temperature 101 F (38.8 C). A pelvic examination performed shows cervical motion tenderness and uterine tenderness. A blood test was ordered, which showed a white cell count of 18,000 per microliter of blood. What other conditions are in the primary differential diagnosis? Ectopic pregnancy, appendicitis, and pyelonephritis
A 17-year-old female presents with lower abdominal pain and vaginal bleeding. She states that she just missed her period and has been sexually active. She has a past medical history of gonorrhea and trichomonas, which have been treated successfully. She is allergic to penicillin. The physical exam reveals mild tenderness to palpation in the right lower quadrant. The pelvic exam reveals the presence of blood, but no masses are felt. Her urinary human chorionic gonadotropin (hCG) is positive. Blood hCG level is 1,000 IU. The patient remains stable while waiting for an ultrasound. If this is an ectopic pregnancy, what blood hCG level will be seen in 48 hours? Less than 2,000 IU A 17-year-old female presents with fever and low abdominal pain. The patient admits to unprotected sexual intercourse. There are cervical motion tenderness and an adnexal mass. Select the most likely diagnosis. Tubo-ovarian abscess A 24-year-old female has a sudden onset of low abdominal pain. She passes a clot per vagina and collapses. She is brought to the emergency department where fluid resuscitation is initiated. The abdomen is slightly distended and the left adnexa shows a tender soft mass. Ultrasound only is remarkable for fluid in the pouch of Douglas. The clot is examined and only shows decidua and coagulated blood without trophoblastic tissue or chorionic villi. What is the most probable diagnosis? Ruptured ectopic pregnancy A patient past her reproductive years has carcinoma in situ of the cervix with cone biopsy showing squamous cell carcinoma with invasion 1 mm beyond the basement membrane. There is no lymphovascular space invasion. What is the next best step? Simple hysterectomy A 23-year-old female presents to the hospital with a complaint of mucopurulent vaginal discharge that started a month ago. She also complains of fever and intermenstrual bleeding. On further questioning, she gives a history of mild and continuous lower abdominal pain. A detailed medical history reveals that she was treated for a similar condition last year. Her vital signs show blood pressure 100/60 mmHg, respiratory rate 18/min, heart rate 96/min, and temperature 101 F (38.8C). A pelvic examination performed shows cervical motion tenderness
and uterine tenderness. A blood test was ordered, which shows a white cell count of 17,000 per microliter of blood. What is the most likely initial complication of her condition? Pelvic abscess A 26-year-old woman presents with sudden onset severe right lower quadrant abdominal pain. Examination reveals extreme tenderness on palpation. She has no history of smoking, alcohol consumption, or illicit drug use. She has a medical history of 2 previous elective abortions followed by a D & C. Her menstrual cycle started this morning and reports it was ten days before it was due. She states that this is unusual for her. A urine pregnancy test is positive. Blood pressure is 86/60 mmHg, pulse rate is 100/min, and the respiratory rate is 16/min. Two large- bore needles are placed on each arm, and IV fluids are begun. Which of the following is the most appropriate next step in the management of this patient? Transvaginal ultrasound A 17-year-old female sex worker presents to the hospital with a complaint of vaginal discharge that started two months ago. She also complains of intermenstrual bleeding and lower abdominal pain. On further questioning, she reveals that she has been active with multiple partners lately. Her vital signs show blood pressure 100/80 mmHg, respiratory rate 18 breaths/min, heart rate 88 beats/min, and temperature 101 F (38.3 C). A pelvic examination shows cervical discharge, cervical motion tenderness, and uterine tenderness. A blood test is ordered, which shows a white cell count of 17,500 per microliter of blood. What is the most likely mechanism leading to the spread of the causative organism? Thinning of cervical mucus A 22-year-old woman presents with severe lower abdominal pain, nausea, and vomiting that started two hours ago. She also reports fever, dyspareunia, and mucopurulent vaginal discharge for the last five days. Her blood pressure is 100/70 mmHg, respiratory rate 20 breaths/min, temperature 101 F (38.3 C), and heart rate 96 beats/min. Pelvic examination is consistent with severe pelvic inflammatory disease. What is the most appropriate initial treatment for this patient? Ceftriaxone plus doxycycline plus metronidazole A 16-year-old female patient presents to the hospital with a complaint of vaginal pain and dyspareunia that started two weeks ago. She also complains of mild lower abdominal pain. A
