Question 1 of 5

A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because she is concerned about his weight loss. He has a history of smoking 3 packs of cigarettes a day for 30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years, which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at that time his weight was 140 pounds. Today, his weight is 110 pounds. Which one of the following questions would be the most important to ask if you suspect that he has lung cancer?

A. Have you tried to force yourself to vomit after eating a meal? B. Do you have heartburn/indigestion and diarrhea? C. Do you have enough food to eat? D. Have you tried to lose weight?

Correct Answer: D

Rationale: The most important question to ask in this scenario would be if the patient has tried to lose weight. Given the patient's significant unintentional weight loss (from 140 to 110 pounds in a year), especially in the context of a chronic cough and a long history of smoking, lung cancer becomes a top concern. Unintentional weight loss is a common symptom seen in patients with lung cancer.
Therefore, understanding if the weight loss was intentional or unintentional can provide crucial information in the diagnostic evaluation for possible lung cancer.

Question 2 of 5

Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next?

A. Check an ultrasound of the liver B. Obtain a hepatitis panel C. Determine liver span by percussion D. Adopt a "watchful waiting" approach

Correct Answer: A

Rationale: Mr. Patel's case involves an enlarged liver, which warrants further investigation to determine the underlying cause. An ultrasound of the liver would provide valuable information regarding the size, shape, and texture of the liver, helping to identify any potential abnormalities such as liver cirrhosis, fatty liver disease, or liver tumors. This imaging study can also help differentiate between different conditions that may be causing the liver enlargement, guiding subsequent diagnostic and treatment decisions.
Therefore, obtaining an ultrasound of the liver is the most appropriate next step in evaluating Mr. Patel's condition.

Question 3 of 5

Which of the following conditions would produce a hyperresonant percussion note?

A. Large pneumothorax B. Lobar pneumonia C. Pleural effusion D. Empyema

Correct Answer: A

Rationale: A hyperresonant percussion note is a more intense and booming sound heard during percussion of the thorax. This can occur when there is an increased amount of air present in the chest cavity. In the case of a large pneumothorax, which is the presence of air in the pleural space causing partial or complete collapse of the lung, the percussion note would be hyperresonant due to the increased air content in the thoracic cavity. Lobar pneumonia, pleural effusion, and empyema would typically produce dull or flat percussion notes due to the presence of fluid or solid material in the pleural space.

Question 4 of 5

Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it "would be better if he were not here." What would you do next?

A. Tell him that he has a very promising career in anything he chooses and soon he will feel better. B. Tell him that he needs an antidepressant and it will take about 4 weeks to work. C. Speak with his mother about getting him together more with his friends. D. Assess his suicide risk.

Correct Answer: D

Rationale: It is crucial to assess Adam's suicide risk immediately due to the statements he made about it being better if he were not here. This indicates possible suicidal ideation, which requires urgent attention and intervention. Asking directly about suicidal thoughts and intentions can help determine the level of risk and ensure that appropriate support and resources are provided to Adam. It is important to take any mention of suicide seriously and prioritize the safety and well-being of the individual in such situations.

Question 5 of 5

How should you determine whether a murmur is systolic or diastolic?

A. Palpate the carotid pulse. B. Palpate the radial pulse. C. Judge the relative length of systole and diastole by auscultation. D. Correlate the murmur with a bedside heart monitor.

Correct Answer: C

Rationale:
To determine whether a murmur is systolic or diastolic, you should judge the relative length of systole and diastole by auscultation. Systolic murmurs occur during systole, which is the phase of the cardiac cycle when the heart is contracting and pushing blood out of the chambers. Diastolic murmurs occur during diastole, which is the phase when the heart is relaxing and filling with blood. By carefully listening to the timing of the murmur in relation to the cardiac cycle, you can determine if it is systolic or diastolic. Palpating the carotid pulse (
Choice
A) or radial pulse (
Choice
B) can help assess the pulse characteristics, but it does not directly determine whether a murmur is systolic or diastolic. Correlating the murmur with a bedside heart monitor (
Choice
D) may provide additional information about heart rate or rhythm, but it does not specifically indicate

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Nurselytic

ATI RN