jarvis physical examination and health assessment test bank

Correct Answer: D

Rationale: The correct answer is D: Take it with food. Glucocorticosteroids can irritate the stomach lining, leading to gastritis or ulcers. Taking them with food helps reduce stomach irritation and the risk of gastrointestinal side effects. Crushing it in applesauce (A) or chewing it prior to a high-fat meal (B) can exacerbate stomach irritation. Taking it on an empty stomach (C) can increase the risk of stomach upset and decrease absorption. Therefore, taking it with food (D) is the best option to minimize stomach irritation and improve medication effectiveness.

Correct Answer: C

Rationale: The correct answer is C: Stop aspirin and begin apixaban 5 mg twice a day. The rationale is that for stroke risk reduction in nonvalvular atrial fibrillation, anticoagulation therapy with direct oral anticoagulants (DOACs) like apixaban is preferred over antiplatelet therapy like aspirin. DOACs have been shown to be more effective in reducing stroke risk with a lower bleeding risk compared to warfarin. Choice A is incorrect as aspirin alone is not sufficient for stroke prevention in atrial fibrillation. Choice B is incorrect as warfarin has more monitoring requirements and potential drug interactions compared to DOACs like apixaban. Choice D is incorrect as aspirin and apixaban together are not recommended due to increased bleeding risk.

Correct Answer: B

Rationale: The correct answer is B because decreased tactile fremitus suggests fluid or air in the pleural space, which can occur in conditions like pleural effusion or pneumothorax. This decrease in tactile fremitus is due to the transmission of vibrations from the vocal cords being impeded by the presence of fluid or air between the lung and chest wall. Choices A, C, and D are incorrect because decreased tactile fremitus is not typically associated with increased lung density, normal lung function, or lung tumors.

Correct Answer: A

Rationale: The correct answer is A: A palpable "notch" along its edge. This supports an enlarged kidney over the spleen because the kidney has a concave shape with a notch where the renal vessels enter. This notch is palpable in an enlarged kidney. Choice B is incorrect because the inability to push fingers between the mass and the costal margin is indicative of a spleen, which is a solid organ located close to the ribs. Choice C is incorrect as normal tympany over the area suggests gas-filled structures like the stomach or intestines, not a solid organ like the kidney or spleen. Choice D is incorrect as the ability to push fingers medial and deep to the mass would be more typical of an enlarged spleen, which can displace other organs medially due to its size.

Correct Answer: C

Rationale: The correct answer is C: Advise them to file an advanced directive. An advanced directive is a legal document that allows individuals to specify their healthcare preferences in advance, including who they want to make medical decisions for them if they are unable to do so. In this scenario, since the patient and her partner are not married, it is important for her to have an advanced directive in place to ensure that her partner is legally recognized as the decision-maker. This documentation will help ensure her goals of care are followed in case she becomes incapacitated. Choice A (Advise them to complete a POLST) is incorrect because a POLST (Physician Orders for Life-Sustaining Treatment) form is used to specify a patient's wishes for end-of-life care, not for designating a medical decision-maker. Choice B (Advise them that they have adequate documentation to be recognized legally) is incorrect because without an advanced directive, there may be legal challenges to the partner's authority to make medical decisions