A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He says that it does seem to help when people speak louder or if he turns up the volume of a television or radio. The most likely cause of his hearing loss is:

Correct Answer: A

Rationale: The correct answer is A: Otosclerosis. Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically the stapes bone. This abnormal bone growth can lead to conductive hearing loss, which may result in the patient experiencing progressive hearing loss. In this case, the patient's symptoms of hearing improvement with louder sounds or increased volume suggest a conductive hearing loss, which is common in otosclerosis. Choice B: Presbycusis, is age-related hearing loss and typically presents as a gradual decline in hearing over time, not necessarily with a sudden progressive loss as described in the scenario. Choice C: Trauma to the bones would likely result in a more sudden onset of hearing loss, not a progressive loss as described in the scenario. Choice D: Frequent ear infections may lead to temporary hearing loss due to fluid buildup or damage to the ear structures, but the symptoms described in the scenario are more indicative of a chronic condition like otosclerosis.

Correct Answer: C

Rationale: The correct answer is C: Perform an otoscopic examination of the left nares. This is the correct next step to further assess the purulent drainage with a foul odor. By performing an otoscopic examination, the nurse can visualize the nasal passage and identify any underlying issues such as a possible foreign body, infection, or inflammation. It is important to rule out any potential serious conditions that may require medical intervention. Choice A is incorrect because antibiotics should not be prescribed without a proper assessment and diagnosis. Choice B is incorrect as waiting for a week can potentially lead to worsening of the condition. Choice D is incorrect as purulent drainage with a foul odor is not normal and should be further investigated.

Correct Answer: B

Rationale: Rationale for Correct Answer (B): The apices of the lungs extend 3 to 4 cm above the inner third of the clavicles. This is because the lungs extend superiorly in the thoracic cavity, reaching above the clavicles at their highest points. This anatomical fact is essential to understand the complete lung anatomy. Summary of Incorrect Choices: A: Incorrect. The apices of the lungs are not at the level of the second rib anteriorly. They extend higher in the thoracic cavity. C: Incorrect. The apices of the lungs are not located at the sixth rib anteriorly and the eighth rib laterally. They are positioned higher in the thoracic cavity. D: Incorrect. The apices of the lungs do not rest on the diaphragm at the fifth intercostal space in the midclavicular line. They extend above this point towards the clavicles.

Correct Answer: A

Rationale: The correct answer is A: Wheezes. In severe asthma, narrowed bronchioles cause turbulent airflow, producing high-pitched wheezing sounds during expiration. These sounds are continuous, musical, and often heard without a stethoscope. Bronchial sounds (B) are normal breath sounds heard over the trachea, not indicative of asthma. Bronchophony (C) refers to increased vocal resonance and is not associated with bronchoconstriction. Whispered pectoriloquy (D) is a technique used to assess for consolidation in the lungs, not characteristic of asthma.

Correct Answer: B

Rationale: Answer B is correct because assessing the girl's weight and BMI is important to determine if early breast budding is related to precocious puberty, which can be influenced by weight. Option A is not appropriate as periods starting is not directly relevant to early breast development. Option C focuses on the mother's history, not the current girl's situation. Option D is incorrect as further evaluation is needed to rule out any underlying health issues.