Nokea
What clinical finding in a funduscopic examination is indicative of increased intracranial pressure?
- A. Pulsating veins
- B. Indistinct disk edge
- C. Clear disk edge
- D. Normal retinal appearance
Correct Answer: B
Rationale: The correct answer is B: Indistinct disk edge. Increased intracranial pressure causes papilledema, resulting in swelling and elevation of the optic disk. This leads to a blurred or indistinct disk edge. Pulsating veins (choice A) are seen in conditions like arteriovenous malformations, not specifically indicative of increased intracranial pressure. Clear disk edge (choice C) and normal retinal appearance (choice D) are not consistent with the findings associated with increased intracranial pressure.
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You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem?
- A. Optic nerve damage on the right
- B. Optic nerve damage on the left
- C. Efferent nerve damage on the right
- D. Efferent nerve damage on the left
Correct Answer: C
Rationale: The correct answer is C: Efferent nerve damage on the right. When both pupils dilate but only the right pupil constricts briskly in response to light, it indicates a problem with the efferent pathway controlling the right eye's pupillary constriction. This suggests damage to the parasympathetic fibers of the oculomotor nerve (CN III) that innervate the pupillary sphincter muscle. Choices A and B (optic nerve damage) do not involve pupil constriction. Choice D (efferent nerve damage on the left) would not explain the brisk constriction in the right eye.
Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
- A. Sigmoid mass
- B. Tumor in the abdominal wall
- C. Hernia
- D. Enlarged bladder
Correct Answer: D
Rationale: Rationale for D (Enlarged bladder): The presentation of a smooth lower abdominal mass that is minimally tender and associated with dullness to percussion above the symphysis pubis suggests an enlarged bladder. This is a common finding in elderly individuals due to various reasons such as urinary retention or bladder outlet obstruction. The location and characteristics of the mass align with an enlarged bladder.
Summary of other choices:
A: Sigmoid mass - Unlikely as sigmoid mass typically presents with different characteristics such as irregular shape and may not cause dullness to percussion above the symphysis pubis.
B: Tumor in the abdominal wall - Less likely as tumors in the abdominal wall would have a different presentation and wouldn't be associated with urinary symptoms.
C: Hernia - Less likely as hernias typically manifest with a bulge that can be reduced and may not cause dullness to percussion above the symphysis pubis.
The nurse is caring for a client with dementia. Which intervention is most likely to reduce agitation in this client?
- A. Provide a calm environment with minimal stimulation.
- B. Increase social activities to promote interaction.
- C. Encourage frequent visitors to engage with the client.
- D. Provide a variety of activities to keep the client busy.
Correct Answer: A
Rationale: The correct answer is A: Provide a calm environment with minimal stimulation. This intervention is most likely to reduce agitation in a client with dementia because excessive stimulation can overwhelm and confuse them, leading to increased agitation. By creating a calm environment with minimal stimuli, the client can feel more relaxed and less agitated.
Summary:
B: Increasing social activities may actually worsen agitation as it can be overwhelming for a client with dementia.
C: While social engagement is important, too many visitors can increase agitation.
D: Providing a variety of activities may lead to confusion and frustration instead of reducing agitation.
A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency?
- A. Pallor of the foot when raised to 60 degrees for one minute
- B. Return of color to the skin within 5 seconds of allowing legs to dangle
- C. Filling of the veins of the ankles within 10 seconds of allowing the legs to dangle
- D. Hyperpigmentation of the skin
Correct Answer: A
Rationale: The correct answer is A. Pallor of the foot when raised to 60 degrees for one minute is consistent with chronic arterial insufficiency. When the foot is raised, blood flow decreases, leading to decreased oxygenation and pallor in the presence of arterial insufficiency. This is known as the dependent rubor test, and the delayed return of color is indicative of impaired blood flow.
Choice B is incorrect because a quick return of color within 5 seconds suggests normal vascular perfusion. Choice C is incorrect as filling of veins within 10 seconds indicates venous insufficiency rather than arterial insufficiency. Choice D, hyperpigmentation of the skin, is not a typical finding in chronic arterial insufficiency.
A 50-year-old male has a non-tender, enlarged scrotum. The nurse practitioner suspects which of the following conditions:
- A. Orchitis
- B. Epididymitis
- C. Hydrocele
- D. Prostatitis
Correct Answer: C
Rationale: The correct answer is C: Hydrocele. A hydrocele is a fluid-filled sac surrounding the testicle, causing scrotal enlargement without tenderness. Orchitis (A) is inflammation of the testicle, presenting with pain and tenderness. Epididymitis (B) is inflammation of the epididymis, also causing tenderness. Prostatitis (D) involves inflammation of the prostate gland, not related to scrotal enlargement. In this case, the lack of tenderness and presence of scrotal enlargement point towards a hydrocele as the likely condition.