Nokea
Variations in body temperature can be caused by...
- A. Recent Exercising
- B. Gender
- C. Drinking cold fluids
- D. All of the above
Correct Answer: D
Rationale: Body temperature varies with exercise increasing it via metabolism, gender with slight differences (e.g., women post-ovulation), and cold fluids potentially lowering oral readings. All are factors. Choice D is correct, as nursing recognizes these influencesexercise raises heat production, gender affects baseline, and fluids alter local readingsrequiring context in temperature assessment to ensure accurate interpretation and care planning.
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A young man is concerned about a hard mass he has just noticed in the midline of his palate. On examination, it is indeed hard and in the midline. There are no mucosal abnormalities associated with this lesion. He is experiencing no other symptoms. What will you tell him is the most likely diagnosis?
- A. Leukoplakia
- B. Torus palatinus
- C. Thrush (candidiasis)
- D. Kaposi's sarcoma
Correct Answer: B
Rationale: The most likely diagnosis for a hard mass in the midline of the palate with no associated mucosal abnormalities is Torus palatinus (Choice B). This is a benign bony growth that typically occurs in the midline of the hard palate. The absence of mucosal abnormalities and the hard nature of the mass are indicative of a bony growth rather than a soft tissue lesion like leukoplakia (Choice A), thrush (Choice C), or Kaposi's sarcoma (Choice D). Leukoplakia is a white patch that cannot be scraped off, thrush is a fungal infection causing creamy white lesions, and Kaposi's sarcoma usually presents as purplish lesions in immunocompromised individuals. In this case, the hard midline mass without mucosal changes points towards Torus palatinus as the most likely diagnosis.
The nurse is preparing to assess the dorsalis pedis artery. Where is the correct location for palpation?
- A. Behind the knee
- B. Over the lateral malleolus
- C. In the groove behind the medial malleolus
- D. Lateral to the extensor tendon of the great toe
Correct Answer: D
Rationale: The correct location for palpating the dorsalis pedis artery is lateral to the extensor tendon of the great toe. This is because the dorsalis pedis artery is located on the dorsum of the foot, slightly lateral to the midline, and can be palpated just lateral to the extensor hallucis longus tendon. This location allows for accurate assessment of the pulse. Choices A, B, and C are incorrect as they do not correspond to the correct anatomical location of the dorsalis pedis artery.
What is the expected moisture and texture of the skin of a patient with hypothyroidism?
- A. Moist and smooth
- B. Moist and rough
- C. Dry and smooth
- D. Dry and rough
Correct Answer: D
Rationale: The correct answer is D, dry and rough. In hypothyroidism, there is a decrease in thyroid hormone production, leading to reduced metabolic activity. This results in decreased oil and sweat gland function, leading to dry skin. Additionally, the reduced metabolic rate can cause a buildup of dead skin cells, contributing to rough texture. Choices A and B are incorrect because moisture levels are decreased in hypothyroidism. Choice C is incorrect as dryness is a key characteristic of hypothyroidism, and smooth skin is less likely due to the rough texture caused by decreased cell turnover.
A 25-year-old woman presents with a complaint of dizziness and fainting. On examination, her blood pressure is 90/60 mm Hg. Which of the following is the most likely cause of her symptoms?
- A. Postural hypotension
- B. Acute myocardial infarction
- C. Arrhythmia
- D. Hyperthyroidism
Correct Answer: A
Rationale: The correct answer is A: Postural hypotension. This condition typically presents with symptoms of dizziness and fainting upon standing due to a drop in blood pressure. In this case, the blood pressure of 90/60 mm Hg indicates hypotension, which is exacerbated by changes in position. Acute myocardial infarction (B) presents with chest pain and ECG changes, not dizziness. Arrhythmia (C) can cause palpitations but not necessarily dizziness. Hyperthyroidism (D) can cause palpitations and weight loss but not typically dizziness and fainting.
A patient presents in the clinic with dizziness and fatigue. The nursing assistant reports a very slow radial pulse of 44. What is your priority intervention?
- A. Request that the nursing assistant repeat the pulse check
- B. Call for a stat electrocardiogram (ECG)
- C. Assess the patient's apical pulse and evidence of a pulse deficit
- D. Prepare to administer cardiac-stimulating medications
Correct Answer: C
Rationale: Bradycardia (pulse 44) with dizziness/fatigue requires apical pulse assessment to confirm rate and check for deficit, indicating cardiac output issues. Repeating radial delays RN evaluation. Stat ECG is secondary. Meds are premature. Choice C is correct, per nursing priority to verify and assess symptomatic bradycardia directly.