A 40-year-old man presents with shortness of breath and a dry cough. He has a history of frequent sinus infections. His chest X-ray shows bilateral hilar lymphadenopathy. Which of the following is the most likely diagnosis?

Correct Answer: A

Rationale: In this scenario, the most likely diagnosis for the 40-year-old man with bilateral hilar lymphadenopathy, shortness of breath, and a dry cough is A) Sarcoidosis. Sarcoidosis is a systemic inflammatory disease characterized by the formation of granulomas in various organs, including the lungs. Bilateral hilar lymphadenopathy is a classic finding in sarcoidosis, making it the most likely diagnosis in this case. Option B) Lung cancer is less likely in this patient as bilateral hilar lymphadenopathy is not a typical feature of lung cancer unless it has metastasized to the lymph nodes. Additionally, the patient's age and history of sinus infections do not strongly point towards lung cancer. Option C) Pneumonia is less likely since the presentation of bilateral hilar lymphadenopathy, shortness of breath, and a dry cough is not characteristic of pneumonia. Pneumonia typically presents with focal consolidation on chest X-ray and may have associated symptoms like fever and productive cough. Option D) Chronic obstructive pulmonary disease (COPD) is less likely given the patient's age and the presence of bilateral hilar lymphadenopathy, which is not a typical feature of COPD. COPD is more commonly associated with a history of smoking and progressive dyspnea. Educationally, understanding the clinical manifestations and diagnostic features of different respiratory conditions is crucial for healthcare providers to make accurate assessments and provide appropriate care. Recognizing the specific findings of sarcoidosis in this case highlights the importance of considering a broad range of differential diagnoses based on clinical presentation and diagnostic tests.

Correct Answer: A

Rationale: In this scenario, the correct next step in the assessment after observing a patient walking with a limp is to choose option A) Assess for pain in the affected leg. The rationale for this choice is that a limp can often be indicative of pain or discomfort in the affected leg. By assessing for pain, the nurse can gather important information about the potential cause of the abnormal gait. Pain assessment is crucial in identifying underlying issues and determining appropriate interventions for the patient. Option B) asking the patient to walk faster is not the correct next step as it does not address the underlying reason for the limp and may even exacerbate any pain or discomfort the patient is experiencing. Option C) documenting the abnormal gait is important for the patient's medical record but does not address the immediate need to assess for pain and determine the cause of the limp. Option D) performing a neurological exam may be necessary depending on the findings of the pain assessment, but assessing for pain should be the initial step in this situation. In an educational context, this question highlights the importance of thorough assessment and critical thinking in nursing practice. Understanding the significance of abnormal findings such as a limp and knowing the appropriate steps to take in the assessment process are essential skills for nurses to provide quality patient care.

Correct Answer: B

Rationale: In this scenario, the most likely diagnosis for the 45-year-old man with joint pain, particularly in his knees and fingers, worsened in the morning and improved with activity, along with a history of psoriasis, is psoriatic arthritis (Option B). Psoriatic arthritis is a type of inflammatory arthritis that occurs in some people with psoriasis, a chronic skin condition. The joint pain associated with psoriatic arthritis often presents as asymmetric oligoarthritis affecting the larger joints like knees, ankles, and fingers. The fact that the pain improves with activity is characteristic of inflammatory arthritis, which is seen in psoriatic arthritis due to increased blood flow to the joints during movement. Rheumatoid arthritis (Option A) typically presents with symmetrical polyarthritis, mostly affecting the small joints like those in the hands and wrists. Osteoarthritis (Option C) is more common in older individuals and usually presents with joint pain that worsens with activity. Gout (Option D) usually affects the big toe joint initially and is associated with sudden, severe pain attacks. Educationally, understanding the clinical presentation and key features of different types of arthritis is crucial for healthcare providers to make accurate diagnoses and provide appropriate treatment. Recognizing the specific patterns of joint involvement and associated symptoms can help differentiate between various types of arthritis and guide the management plan for patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Cranial nerve XI (spinal accessory nerve). The nurse is testing the patient's ability to shrug both shoulders against resistance, which assesses the function of the spinal accessory nerve. This nerve innervates the trapezius and sternocleidomastoid muscles responsible for shoulder shrugging and head rotation. Option A) Cranial nerve III (oculomotor nerve) is responsible for eye movements, pupil constriction, and eyelid elevation, not shoulder shrugging. Option B) Cranial nerve VII (facial nerve) controls facial expressions, taste sensation on the anterior two-thirds of the tongue, and salivary gland secretion, not shoulder movements. Option C) Cranial nerve IX (glossopharyngeal nerve) is involved in taste sensation on the posterior one-third of the tongue, swallowing, and salivation, not shoulder shrugging. Educationally, understanding the functions of different cranial nerves is crucial for nurses to accurately assess patients' neurological status and detect any abnormalities. Testing specific actions associated with each cranial nerve helps in pinpointing the exact nerve affected in case of injury or disease, guiding appropriate intervention and care.

Correct Answer: B

Rationale: The correct answer is B) Cranial nerve VII (facial nerve). When the nurse asks the patient to close their eyes and smile, they are testing the function of the facial nerve, which controls the muscles of facial expression. By closing the eyes and smiling, the nurse is assessing the patient's ability to perform these facial movements controlled by cranial nerve VII. Option A) Cranial nerve V (trigeminal nerve) is responsible for sensory innervation of the face, but it does not control facial movements like closing the eyes and smiling. Option C) Cranial nerve IX (glossopharyngeal nerve) is involved in swallowing and taste sensation, not facial movements. Option D) Cranial nerve X (vagus nerve) is responsible for autonomic functions like heart rate and digestion, not facial movements. Understanding the function of each cranial nerve is crucial for healthcare professionals, especially nurses, as it helps in accurate assessment and diagnosis of various neurological conditions. Testing cranial nerve function provides valuable information about the patient's overall neurological status and helps in determining appropriate interventions.