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

Questions 45

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Question 1 of 9

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

Correct Answer: A

Rationale: The correct answer is A: otosclerosis. Otosclerosis is a condition where abnormal bone growth in the middle ear causes hearing loss. In this case, the patient's symptoms of progressive hearing loss improving with louder sounds suggest conductive hearing loss, which is commonly seen in otosclerosis. Other choices are incorrect because presbycusis is age-related hearing loss, trauma to the bones would typically result in sudden hearing loss, and frequent ear infections are more likely to cause temporary hearing loss rather than progressive loss.

Question 2 of 9

Which of the following assessment findings is most consistent with clubbing of the fingernails?

Correct Answer: D

Rationale: Clubbing of the fingernails is characterized by an increased angle between the nail base and the nail plate (usually 180 degrees or greater) and a spongy texture at the nail base. This is due to underlying tissue changes associated with conditions like lung disease. Choice D is correct as it accurately describes the characteristic findings of clubbing. Choices A, B, and C do not align with clubbing features. Choice A describes tenderness and firmness, not sponginess and increased angle. Choice B mentions a convex profile and ridges, which are not specific to clubbing. Choice C includes an angle of 150 degrees, which is less than the typical angle seen in clubbing.

Question 3 of 9

During an assessment, a patient says that she was diagnosed with open-angle glaucoma 2 years ago. There are various types of glaucoma, such as open-angle glaucoma and closed-angle glaucoma. Which of the following are characteristics of open-angle glaucoma? (Select all that apply.)

Correct Answer: B

Rationale: The correct answer is B: It is the most common type of glaucoma. Open-angle glaucoma is indeed the most common type, accounting for about 90% of all glaucoma cases. In open-angle glaucoma, the drainage angle of the eye remains open, but the trabecular meshwork becomes blocked over time. This leads to increased intraocular pressure, which can damage the optic nerve and result in vision loss. A, C, and D are incorrect: A: The symptoms mentioned (sensitivity to light, nausea, halos around lights) are more commonly associated with acute angle-closure glaucoma, not open-angle glaucoma. C: Immediate treatment is not necessarily needed for open-angle glaucoma as it progresses slowly, and treatment can vary based on the severity of the condition. D: Vision loss in open-angle glaucoma typically starts with the loss of peripheral vision, not central vision.

Question 4 of 9

A 32-year-old woman is at the clinic for a checkup, and she states,"I have little white bumps in my mouth." During the assessment, the nurse notes that she has a 5-cm white, nontender papule under her tongue and one on the mucosa of her right cheek. Which of the following would the nurse tell the patient?

Correct Answer: D

Rationale: The correct answer is D because Fordyce's granules are small, yellow-white or flesh-colored spots that are sebaceous glands and commonly found on the oral mucosa. They are benign and do not require treatment. In this case, the patient's description matches the characteristics of Fordyce's granules. Option A is incorrect because strep throat typically presents with other symptoms like sore throat and fever, not white bumps in the mouth. Option B is incorrect as there is no indication of a serious lesion based on the description given. Option C is incorrect as leukoplakia is a condition associated with chronic irritation, not Fordyce's granules.

Question 5 of 9

A mother brings her 4-month-old to the clinic with concerns about a small padlike growth on the mid- upper lip that has been present since the baby was 1 month old. The infant has no health problems. On physical examination, the nurse notes a 5-cm, fleshy, elevated area on the mid-upper lip. There is no evidence of inflammation or drainage. What would the nurse tell this mother?

Correct Answer: D

Rationale: The correct answer is D because a sucking tubercle is a normal finding in infants caused by friction during breastfeeding or bottle feeding. The growth is typically painless, noninflammatory, and resolves on its own over time. This explanation reassures the mother that the condition is harmless and does not require any specific treatment. Choice A is incorrect because teething does not cause a sucking tubercle. Choice B is incorrect as there is no indication of abnormality that warrants specialist evaluation. Choice C is incorrect because chronic drooling does not typically result in a sucking tubercle.

Question 6 of 9

The papule on the nose of a 52-year-old woman has rounded, pearly borders and a central red ulcer. She tells the nurse that it has been present for several months and is slowly growing larger. Which of the following conditions does the nurse suspect?

Correct Answer: B

Rationale: The correct answer is B: Basal cell carcinoma. The clinical presentation of a papule with rounded, pearly borders, central red ulcer, slow growth, and location on the nose is highly indicative of basal cell carcinoma. Basal cell carcinoma commonly presents with these characteristics and is the most common type of skin cancer. It is locally invasive but rarely metastasizes. A: Acne is a common skin condition characterized by comedones, papules, and pustules, not typically presenting with the described features. C: Malignant melanoma usually presents as an asymmetric, irregularly bordered, multicolored lesion with rapid growth and potential for metastasis. D: Squamous cell carcinoma typically presents as a scaly, crusted lesion with potential for metastasis, not showing the described features.

Question 7 of 9

A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding:

Correct Answer: C

Rationale: The correct answer is C because pain in the ear when people speak loudly can be a sign of a middle ear infection. This is due to increased pressure in the middle ear caused by inflammation or fluid buildup. Recruitment (B) is a phenomenon related to hearing loss, not ear pain. Cerumen impaction (D) would not typically cause pain in response to loud sounds. It is not normal for a person of that age to experience ear pain when people speak loudly (A).

Question 8 of 9

In using the ophthalmoscope to assess a patient's eyes, the nurse notes a red glow in the patient's pupils. On the basis of this finding, the nurse would:

Correct Answer: C

Rationale: Rationale for Correct Answer (C): 1. Red glow in pupils indicates a normal reflection off the inner retina known as the red reflex. 2. The red reflex helps to visualize the internal structures of the eye, including the retina. 3. This finding is expected during an ophthalmoscopic examination. 4. No abnormality is suggested by the presence of a red glow in the pupils. Summary of Other Choices: A: Incorrect. Red glow does not indicate an opacity in the lens or cornea. B: Incorrect. Checking the light source is unnecessary as red glow is a normal finding. D: Incorrect. Referral is not needed as red reflex is a normal part of an ophthalmoscopic exam.

Question 9 of 9

A 52-year-old patient complains of seeing occasional"floaters or spots" in front of his eyes. The nurse should:

Correct Answer: D

Rationale: The correct answer is D because floaters are a common and typically benign phenomenon caused by condensed vitreous fibers in the eye. A nurse should educate the patient that floaters are usually not significant and do not require immediate intervention. Option A is incorrect because counting the number of floaters is unnecessary. Option B is incorrect because presuming glaucoma without proper assessment is inappropriate. Option C is incorrect because seeing occasional floaters is a common and normal occurrence in many individuals.

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