A 23-year-old waitress comes to your clinic complaining of severe pelvic pain radiating to her right side. The pain began yesterday and is getting much worse. She has had no burning with urination and denies any recent sexual activity. She has no nausea, vomiting, constipation, diarrhea, fever, or vaginal discharge. Her last period was 3 to 4 weeks ago. Her past medical history consists of severe acne, depression, and mild obesity. She has had no surgeries. She broke up with her boyfriend 6 months ago and denies dating anyone else. She smokes one pack of cigarettes a day, drinks three to four beers two to three times a week, and denies any illegal drug use. Her mother is diabetic and her father has coronary artery disease. On examination you see a mildly obese female in moderate distress. Her blood pressure is 130/80 and her pulse is 90. She is afebrile. On auscultation she has active bowel sounds. She has no rebound or guarding in any abdominal quadrant. Speculum examination shows no lesions on the cervix and no discharge or bleeding from the os. During the bimanual examination she has no cervical motion tenderness, but her right adnexal area is swollen and tender. A urine analysis is normal and the urine pregnancy test is pending. What disorder of the adnexa is most likely the diagnosis?

Correct Answer: A

Rationale: Ovarian cysts often occur just before the onset of menses. They are also common in a disease known as polycystic ovarian syndrome. Other symptoms of this disorder are acne, hirsutism (increased hair growth), irregular periods, obesity. This disorder runs in families and later manifestations include diabetes, high blood pressure, and coronary artery disease. Single cysts on the right side can mimic the symptoms of appendicitis.

Correct Answer: D

Rationale: The correct answer is D) Strike the pleximeter over the distal inter-phalangeal joint. This is consistent with good percussion technique because striking the pleximeter over the distal inter-phalangeal joint allows for better control and precision in eliciting different sounds during percussion. By using this specific area of the finger, the nurse can accurately assess the underlying tissues and organs. Option A) Allow all of the fingers to touch the chest while performing percussion is incorrect because using all fingers can dampen the sound produced and make it difficult to differentiate between sounds. Option B) Maintain a stiff wrist and hand is incorrect because a stiff wrist and hand can lead to inconsistent force and impact during percussion, affecting the accuracy of the assessment. Option C) Leave the plexor finger on the pleximeter after each strike is incorrect because this can also dampen the sound produced and disrupt the accuracy of the assessment by not allowing for proper evaluation of the resulting sound. In an educational context, understanding proper percussion technique is crucial for healthcare providers to accurately assess patients' health conditions. By mastering the correct technique, nurses and other healthcare professionals can gather essential information about a patient's underlying health status through the sounds produced during percussion. This skill is vital in conducting comprehensive physical assessments and diagnosing various medical conditions accurately.

Correct Answer: B

Rationale: In a mental status assessment, asking a person about their future plans, as in option B, "Tell me what you plan to do once you are discharged from the hospital," is the best question to assess judgment. This question evaluates the individual's ability to think ahead, set goals, and make plans, which are all components of sound judgment. Option A, asking about paranoid delusions, assesses for potential psychosis or paranoia, not specifically judgment. Option C tests the person's interpretation of a proverb, which mainly evaluates abstract thinking. Option D, about finding an envelope, assesses problem-solving skills but not judgment specifically. Educationally, understanding the rationale behind each question helps students grasp the nuances of mental status assessment and the specific cognitive functions each question targets. It also highlights the importance of asking open-ended questions to assess various cognitive domains accurately.

Correct Answer: A

Rationale: The best response for the nurse to give in this situation is option A) Be silent, and allow him to continue when he is ready. This response is the most appropriate because the patient's pauses and expectant looks indicate that he may need time to gather his thoughts or express himself. Being silent and giving the patient space allows him to feel heard and respected, facilitating better communication. Option B is incorrect because although it aims to reassure the patient, it may also come off as dismissive or patronizing, potentially shutting down the patient's communication. Option C is wrong as it may make the patient feel self-conscious about his behavior, potentially hindering open and honest communication. Option D is not the best response because it assumes the patient is uncomfortable without any clear indication of this. It may prematurely end the conversation and potentially miss important information the patient wants to share. In an educational context, it's crucial for healthcare professionals to understand the importance of active listening and nonverbal communication in patient interactions. Pauses and expectant looks can be cues for deeper emotions or thoughts that the patient may be struggling to articulate. By allowing the patient time and space to express themselves, nurses can build trust, gather more accurate information, and provide better patient-centered care.

Correct Answer: A

Rationale: In the context of vital signs and pain assessment, understanding the correct use of a stethoscope is crucial for accurate patient assessment. The diaphragm of the stethoscope is designed to detect high-pitched sounds, such as normal heart sounds, lung sounds, and bowel sounds. Therefore, option A, stating that the diaphragm is used to listen for high-pitched sounds, is the correct answer. Option B is incorrect because low-pitched sounds, like heart murmurs and extra heart sounds, are best heard through the bell of the stethoscope, not the diaphragm. Option C is also incorrect as pressing the diaphragm lightly against the skin would actually enhance the transmission of low-pitched sounds rather than block them out. Option D is incorrect as well since listening for extra heart sounds and murmurs would require using the bell part of the stethoscope. Educationally, this question highlights the importance of proper stethoscope technique in clinical practice. Nurses must understand the functionalities of the different parts of the stethoscope to accurately assess and monitor patients' vital signs, respiratory sounds, and heart sounds. Mastering this skill ensures that healthcare providers can make informed clinical decisions based on accurate auscultation findings.