A 40-year-old man presents with a complaint of fatigue, weight loss, and night sweats. He has a history of smoking and a chronic cough. Chest X-ray reveals a mass in the left upper lobe. What is the most likely diagnosis?

Correct Answer: C

Rationale: The most likely diagnosis for the 40-year-old man with fatigue, weight loss, chronic cough, and a mass in the left upper lobe on chest X-ray is lung cancer (Choice C). 1. Symptoms: Fatigue, weight loss, night sweats are common in lung cancer due to systemic effects. 2. History: Smoking and chronic cough are major risk factors for lung cancer. 3. Imaging: Presence of a mass in the left upper lobe on chest X-ray is highly suggestive of lung cancer. 4. Exclusion: Pneumonia (Choice A) typically presents with fever and productive cough, not weight loss. Tuberculosis (Choice B) may show upper lobe involvement but is less common in non-endemic areas without known exposure. Chronic obstructive pulmonary disease (Choice D) does not typically present with weight loss or night sweats.

Correct Answer: A

Rationale: The correct answer is A: Postural hypotension. This is likely the cause of the man's symptoms because his blood pressure drops when standing, causing dizziness and fainting. Postural hypotension is a decrease in blood pressure upon standing, leading to inadequate blood flow to the brain. Arrhythmia (B) can cause similar symptoms but is less likely without other associated signs. Anemia (C) can cause fatigue and weakness but is less likely to result in dizziness and fainting solely based on blood pressure. Hyperthyroidism (D) can cause palpitations and weight loss, but is less likely to cause postural hypotension as the primary symptom.

Correct Answer: B

Rationale: The correct answer is B: Heart murmur. The soft, blowing sound heard over the left upper sternal border indicates the presence of turbulent blood flow within the heart, which is characteristic of a heart murmur. This finding suggests abnormal flow patterns, such as valve dysfunction or structural abnormalities. Heart failure (C) typically presents with other symptoms like edema and shortness of breath. Normal heart sounds (A) do not include blowing sounds. Aortic stenosis (D) would present with a harsh systolic ejection murmur, not a soft blowing sound.

Correct Answer: A

Rationale: The correct next step in assessing a limited range of motion in the shoulder is to palpate the shoulder for tenderness. This is important to identify any underlying causes of the limited range of motion, such as inflammation or injury. Palpation helps the nurse determine if there is any pain or tenderness in the shoulder joint, which can provide valuable information for further assessment and treatment planning. Performing passive range of motion (choice B) would be inappropriate without first assessing for tenderness. Auscultation for crepitus (choice C) is not typically indicated for assessing limited range of motion in the shoulder. Measuring the angle of motion (choice D) is not as relevant in this context as assessing for tenderness.

Correct Answer: A

Rationale: The correct answer is A: Fine crackles on auscultation. In ARDS, the alveoli become filled with fluid, leading to the crackling sound. Fine crackles indicate the presence of fluid in the small airways, which is a hallmark of ARDS. Wheezing (B) is more commonly associated with asthma or chronic obstructive pulmonary disease. Decreased tactile fremitus (C) may suggest pleural effusion or pneumothorax, not ARDS. Dullness on percussion (D) is seen in conditions like pneumonia or pleural effusion, not specifically ARDS. Therefore, the presence of fine crackles on auscultation is the most consistent finding with ARDS.