A 60-year-old baker presents with increasing shortness of breath and nonproductive cough over the last month. She has to sleep upright in her recliner. On examination, she has distant air sounds and late inspiratory crackles in both lower lobes.

Correct Answer: D

Rationale: The correct answer is D, left-sided heart failure. The patient's symptoms of shortness of breath, nonproductive cough, orthopnea, distant air sounds, and crackles in both lower lobes are indicative of congestive heart failure (CHF). In CHF, the heart is unable to pump effectively, causing fluid buildup in the lungs (pulmonary edema) leading to symptoms like orthopnea and crackles on auscultation. This is known as cardiogenic pulmonary edema. The absence of fever or sputum production makes pneumonia less likely (choice A). While COPD (choice B) can present with similar symptoms, the absence of a history of smoking or exposure to risk factors makes it less likely. Pleural pain (choice C) is typically associated with sharp chest pain worsened by breathing or coughing, which is not described in this case.

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.

Correct Answer: C

Rationale: Certainly! The correct answer is C: Diurnal cycle. Body temperature follows a circadian rhythm, peaking in the late afternoon and reaching its lowest point in the early morning. This cycle is influenced by the body's internal clock and is independent of external factors. A: Constipation does not directly influence body temperature. B: While emotions can affect body temperature temporarily, they are not a consistent factor influencing overall body temperature. D: Nocturnal cycle refers to nighttime activities and does not specifically impact body temperature regulation.