A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable. Which risk factor of her personal and family history most puts her in danger of getting breast cancer?

Correct Answer: A

Rationale: The correct answer is A: First-degree relative with premenopausal breast cancer. This is the most significant risk factor for the patient because her sister had unilateral breast cancer at a young age of 38, which indicates a potential genetic predisposition. Having a first-degree relative with premenopausal breast cancer significantly increases the patient's risk due to shared genetic factors. The other choices are less significant: B: Age at menarche of less than 12 is a risk factor, but not as significant as a family history of breast cancer. C: First live birth between the ages of 25 and 29 is actually a protective factor against breast cancer, as early pregnancies can reduce the risk. D: First-degree relative with postmenopausal breast cancer is a risk factor, but premenopausal breast cancer in a first-degree relative is a stronger indicator of genetic risk. In summary, the patient's highest risk factor for developing breast cancer is having a first-degree relative with

Correct Answer: A

Rationale: The correct answer is A: Plan to defer the rest of the mental status examination. Given the patient's dysarthric speech and lethargy, it is essential to prioritize the patient's physical well-being and safety over completing the mental status examination. Dysarthric speech may indicate a potential neurological issue that needs immediate attention. Deferring the examination allows for a more thorough assessment once the patient's physical condition stabilizes. Choice B is incorrect because skipping the language portion and proceeding to mood and affect assessment neglects the importance of addressing the potential underlying medical issue causing the dysarthric speech. Choice C is incorrect because conducting an in-depth speech evaluation and deferring the mental status examination may delay necessary medical intervention for the patient's condition. Choice D is incorrect because assuming dysarthria is always associated with severe depression and jumping to assess for suicidal thoughts without addressing the immediate physical concerns is premature and may lead to overlooking critical medical issues.

Correct Answer: A

Rationale: The correct answer is A. Note-taking may impede the nurse's observation of the patient's nonverbal behaviors because when the nurse is focused on writing notes, they may miss important nonverbal cues such as body language, facial expressions, and gestures. These nonverbal behaviors can provide valuable information about the patient's emotional state and overall well-being. By focusing on note-taking, the nurse may not fully engage in active listening or empathetic communication, which can hinder the therapeutic relationship. Choices B, C, and D are incorrect because note-taking does not necessarily allow the patient to continue at their own pace, shift attention away from the patient, or break eye contact to increase comfort level. In fact, effective communication involves active listening, maintaining eye contact, and being fully present with the patient. Note-taking should be done discreetly and minimally to avoid disrupting the interaction and compromising the quality of care.

Correct Answer: B

Rationale: Step 1: The correct answer is B: Dorsal surface of the hand; the skin is thinner on this surface than on the palms. Step 2: The dorsal surface of the hand has thinner skin, allowing for better sensitivity to temperature changes. Step 3: Thinner skin on the dorsal surface allows for more accurate assessment of subtle temperature variations. Step 4: Fingertips (choice A) are more sensitive to texture, not temperature. Ulnar portion (choice C) does not have enhanced temperature sensitivity. Palmar surface (choice D) is not the most sensitive to temperature variations. Summary: Choice B is correct because the dorsal surface of the hand offers better temperature sensitivity due to its thinner skin compared to other parts of the hand. Choices A, C, and D are incorrect as they do not provide the optimal location for assessing skin temperature.

Correct Answer: C

Rationale: Rationale for choice C: Starting with less distressing areas such as the abdomen is recommended when performing a physical exam on an infant. This approach helps build rapport and trust with the infant, allowing them to feel more comfortable during the exam. It also helps prevent unnecessary stress and agitation, leading to a smoother and more successful examination process. By starting with non-invasive areas, the nurse can gradually progress to more sensitive areas without causing undue distress to the infant. Summary of why other choices are incorrect: A: Conducting the exam in a head-to-toe manner may overwhelm the infant and increase stress levels. B: Beginning with invasive procedures like ear examination can cause discomfort and lead to resistance from the infant. D: Waiting for the infant to wake up before starting the exam is not practical as the nurse should take advantage of the infant's calm state during sleep to perform the exam efficiently.