Vital Signs Assessment

Vital Signs Assessment Related

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A 60-year-old man presents with difficulty swallowing. He reports that the difficulty has been present for several months and is associated with weight loss. He has a history of smoking and heavy alcohol use. On examination, he has a palpable mass in the upper abdomen. Which of the following is the most likely cause of his symptoms?

  • A. Esophageal cancer
  • B. Achalasia
  • C. Gastroesophageal reflux disease
  • D. Peptic ulcer disease
Correct Answer: A

Rationale: The most likely cause of the man's symptoms is esophageal cancer (Choice A) due to his age, symptoms of dysphagia and weight loss, history of smoking and heavy alcohol use, and the presence of a palpable mass in the upper abdomen on examination. Esophageal cancer commonly presents with difficulty swallowing, weight loss, and risk factors such as smoking and alcohol use. The palpable mass indicates a more advanced disease stage.

Choice B (Achalasia) is less likely due to the presence of a palpable mass, which is not typical of achalasia. Choice C (Gastroesophageal reflux disease) typically presents with heartburn and regurgitation rather than dysphagia and weight loss. Choice D (Peptic ulcer disease) is less likely as it does not typically cause a palpable mass or significant weight loss.

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A 25-year-old accountant presents with intermittent lower right-sided chest pain for several days. The pain is knifelike, lasts 3-5 seconds, worsens with deep breathing, and improves when lying on the affected side.

  • A. Pericarditis
  • B. Chest wall pain
  • C. Pleural pain
  • D. Angina pectoralis
Correct Answer: C

Rationale: The correct answer is C: Pleural pain. The key features here are the sharp, knifelike pain that worsens with deep breathing, which is typical of pleuritic pain due to inflammation of the pleura. This pain pattern is distinct from pericarditis (A) which typically worsens with lying flat and improves when sitting up. Chest wall pain (B) is usually reproducible with palpation, and angina pectoris (D) is typically described as a pressure or squeezing sensation, often triggered by exertion. Therefore, based on the pain characteristics described by the patient, pleural pain is the most likely diagnosis.

When auscultating over a patient's femoral arteries, the nurse notices the presence of a bruit on the left side. The nurse knows that bruits:

  • A. Are often associated with venous disease.
  • B. Occur in the presence of lymphadenopathy.
  • C. In the femoral arteries are caused by hypermetabolic states.
  • D. Occur with turbulent blood flow, indicating partial occlusion.
Correct Answer: D

Rationale: The correct answer is D. When a bruit is heard over the femoral arteries, it indicates turbulent blood flow, which is often a result of partial occlusion in the artery. This turbulent flow causes vibrations that can be heard as a bruit. This finding suggests that there may be a narrowing or blockage in the femoral artery, which can lead to decreased blood flow to the lower extremities. Choices A, B, and C are incorrect because bruits are not typically associated with venous disease, lymphadenopathy, or hypermetabolic states in the context of femoral artery auscultation.

The nurse is auscultating the chest in an adult. Which technique is correct?

  • A. Instructing the patient to take deep, rapid breaths.
  • B. Instructing the patient to breathe in and out through his or her nose.
  • C. Firmly holding the diaphragm of the stethoscope against the chest.
  • D. Lightly holding the bell of the stethoscope against the chest to avoid friction.
Correct Answer: C

Rationale: The correct technique for auscultating the chest in an adult is to firmly hold the diaphragm of the stethoscope against the chest. This allows for optimal transmission of sound and better detection of abnormal lung or heart sounds. Instructing the patient to take deep, rapid breaths (Choice A) may interfere with accurate auscultation. Breathing through the nose (Choice B) does not impact the technique. Lightly holding the bell of the stethoscope (Choice D) may lead to poor sound transmission and decreased sensitivity in detecting faint sounds.

Which joint is most commonly dislocated among pediatric patients?

  • A. Shoulder
  • B. Hip
  • C. Elbow
  • D. Proximal interphalangeal (PIP) joint
Correct Answer: C

Rationale: The correct answer is C: Elbow. Pediatric patients commonly dislocate their elbows due to falls on outstretched hands. The elbow joint is inherently unstable in children due to the immature musculature and ligamentous structures. This vulnerability increases the likelihood of dislocation. Shoulder dislocations are more common in adults due to trauma or overuse. Hip dislocations are rare in pediatric patients. Proximal interphalangeal (PIP) joint dislocations are also uncommon compared to elbow dislocations in children. Therefore, the elbow joint is the most commonly dislocated joint among pediatric patients due to its unique anatomy and susceptibility to injury.

During a neurological assessment, the nurse tests cranial nerve VII. What is the primary function of this nerve?

  • A. Hearing and balance.
  • B. Facial movements and expression.
  • C. Swallowing and speech.
  • D. Eye movement.
Correct Answer: B

Rationale: The correct answer is B: Facial movements and expression. Cranial nerve VII, also known as the facial nerve, primarily controls facial muscles responsible for facial expressions, such as smiling and frowning. It also innervates the muscles involved in closing the eyes and controlling the forehead and mouth movements. Other choices are incorrect because cranial nerve VII is not primarily responsible for hearing and balance (A), swallowing and speech (C), or eye movement (D). The key function of cranial nerve VII lies in its role in facial movements and expressions.