A 50-year-old woman presents with a complaint of severe headaches that occur in the morning and are associated with nausea and vomiting. She also reports blurred vision. Neurological examination reveals papilledema. Which of the following is the most likely diagnosis?

Correct Answer: D

Rationale: The correct answer is D, Intracranial hypertension. This condition is characterized by increased pressure within the skull, leading to symptoms such as morning headaches, nausea, vomiting, blurred vision, and papilledema. The patient's presentation of severe morning headaches with associated symptoms and papilledema is classic for intracranial hypertension. Migraine (A) typically presents with pulsating headaches without neurological signs. Cluster headache (B) is characterized by severe unilateral headaches with autonomic features but not typically associated with papilledema. Tension-type headache (C) is usually bilateral, mild to moderate in intensity, and not associated with papilledema. In summary, the patient's symptoms and signs are most consistent with intracranial hypertension due to the presence of morning headaches, nausea, vomiting, blurred vision, and papilledema.

Correct Answer: B

Rationale: The correct answer is B: Hypertensive emergency. The patient's symptoms of persistent headache, blurred vision, and high blood pressure indicate a hypertensive emergency, a severe increase in blood pressure requiring immediate medical attention to prevent organ damage. Primary hypertension (A) is chronic high blood pressure without acute symptoms. Cluster headache (C) is characterized by severe, unilateral head pain with associated symptoms, not necessarily elevated blood pressure. Migraine (D) is a recurrent headache disorder with specific features, not typically associated with such high blood pressure levels.

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.