Correct Answer: C

Rationale: The correct answer is C: drooping of the upper eyelid. Ptosis refers to the drooping of the upper eyelid, which may occur due to weakened eyelid muscles or nerve damage. In this case, the nurse suspects ptosis in the 60-year-old man, which is likely due to age-related muscle weakness. Choice A, a cloudy cornea, is incorrect as it refers to a different eye condition. Choice B, an unequal red reflex, is incorrect as it is related to abnormalities in the retina. Choice D, protruding and bulging eyes, is incorrect as it indicates exophthalmos, a condition typically seen in thyroid eye disease.

Correct Answer: A

Rationale: The correct answer is A because drooling is a common sign of teething in infants. The nurse's response should validate the mother's observation to build trust and rapport. Choice B is incorrect because teething can start as early as 3 months. Choice C is incorrect as drooling is a normal developmental milestone in infants. Choice D is incorrect as infants do not consciously control saliva production.

Correct Answer: A

Rationale: The correct answer is A: this is most likely serous otitis media. In a child with chronic ear infections, amber-yellow tympanic membrane color and air bubbles suggest fluid accumulation behind the eardrum, characteristic of serous otitis media. The occasional hearing loss and popping sound with swallowing are also common symptoms. Serous otitis media is a non-infectious condition caused by Eustachian tube dysfunction. Choice B: Acute purulent otitis media presents with more severe symptoms like fever and severe ear pain, which are not mentioned in the case. Choice C: Cholesteatoma is a more serious condition characterized by a cyst-like growth in the middle ear, not just fluid accumulation as seen in this case. Choice D: Perforation typically presents with a visible hole in the eardrum and is not consistent with the findings of fluid and air bubbles in this case.

Correct Answer: C

Rationale: Rationale for Correct Answer (C): 1. Red glow in pupils indicates a normal reflection off the inner retina known as the red reflex. 2. The red reflex helps to visualize the internal structures of the eye, including the retina. 3. This finding is expected during an ophthalmoscopic examination. 4. No abnormality is suggested by the presence of a red glow in the pupils. Summary of Other Choices: A: Incorrect. Red glow does not indicate an opacity in the lens or cornea. B: Incorrect. Checking the light source is unnecessary as red glow is a normal finding. D: Incorrect. Referral is not needed as red reflex is a normal part of an ophthalmoscopic exam.

Correct Answer: A

Rationale: The correct answer is A: "Are you aware of having any allergies?" This question is appropriate because the patient's symptoms of pale, grey, and swollen nasal mucosa suggest an allergic reaction. By asking about allergies, the nurse can gather important information to determine the cause of the symptoms. B: "Do you have an elevated temperature?" - This question is not directly related to the patient's nasal symptoms and does not address the likely allergic reaction. C: "Have you had any symptoms of a cold?" - While cold symptoms may present similarly to allergies, the patient's specific symptoms of pale, grey, and swollen nasal mucosa are more indicative of an allergic reaction. D: "Have you been having frequent nosebleeds?" - This question does not directly address the patient's current symptoms and is not likely related to the nasal mucosa appearance described.