A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that:

Correct Answer: A

Rationale: The correct answer is A: she may have macular degeneration. Macular degeneration is characterized by loss of central vision while peripheral vision remains intact. In this case, the woman's difficulty with tasks that require central vision, such as reading and recognizing faces, points towards macular degeneration. The other choices are incorrect because: B: Her symptoms indicate a specific vision problem, not just age-related changes. C: Cataracts typically cause blurred vision, not loss of central vision. D: Glaucoma typically affects peripheral vision first before progressing to central vision loss.

Correct Answer: B

Rationale: The correct answer is B. When using an otoscope to assess the nasal cavity, it is crucial to avoid touching the nasal septum with the speculum to prevent discomfort or injury to the patient. Touching the nasal septum can cause pain and potential damage. Incorrect Choices: A: Inserting the speculum at least 3 cm into the vestibule is not necessary and may cause discomfort or injury to the patient. C: Displacing the nose to the side being examined is not required and may not provide any additional benefit during the assessment. D: Keeping the speculum tip medial to avoid touching the floor of the nares is not as critical as avoiding contact with the nasal septum, which is more sensitive and can be easily injured.

Correct Answer: B

Rationale: The correct answer is B because people of African descent commonly have a pigmented layer near the outer canthus of the lower lid called the "plica semilunaris." This is a normal anatomical variation in this population. Yellow fatty deposits over the cornea (choice A) are not typical findings in this demographic. Yellow color of the sclera extending up to the iris (choice C) is not a characteristic feature. The presence of small brown macules on the sclera (choice D) is also not a common finding in individuals of African descent.

Correct Answer: C

Rationale: The correct answer is C: turbinates. Turbinates are bony projections in the nasal cavity that increase the surface area for the warming, humidifying, and filtering of inhaled air. Meatus (A) refers to the passages in the nasal cavity, not the projections. Septum (B) is the partition between the nostrils, not the projections. Kiesselbach's plexus (D) is a collection of blood vessels in the nasal septum, not the projections that increase surface area.

Correct Answer: D

Rationale: The signs and symptoms - severe headache, high fever, and neck stiffness - in a young adult point towards meningeal inflammation. The combination of these symptoms is indicative of a potential infection or inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. The presence of fever and neck stiffness, in addition to the severe headache, raises concern for meningitis, an infection of the meninges. This is a medical emergency that requires prompt evaluation and treatment. Other choices are incorrect because: A: Head injury usually presents with a history of trauma, which is not mentioned in the scenario. B: Cluster headaches typically do not present with fever and neck stiffness. C: Migraine headaches do not typically cause such high fever and neck stiffness.

Correct Answer: A

Rationale: The correct answer is A: tinea capitis. Tinea capitis is a fungal infection of the scalp that can cause hair loss, scaling, and breakage of hair. In this case, the patient's symptoms of hair loss, patchy hair breakage, and scaling on the scalp are consistent with tinea capitis. The nurse should suspect tinea capitis based on the presentation of these specific symptoms in the patient. Summary: - B: tinea corporis is a fungal infection of the skin, not the scalp, so it is not the most likely cause of the patient's symptoms. - C: toxic alopecia refers to hair loss due to exposure to toxins, which is unlikely in this case based on the symptoms described. - D: seborrheic dermatitis is a common skin condition that causes redness, scaly patches, and dandruff on the scalp, but it does not typically cause hair loss in the same way as tinea capitis

Correct Answer: B

Rationale: The correct answer is B: not palpable. In healthy adults, most lymph nodes are not palpable as they are typically small and not easily detectable through touch. This indicates normal lymphatic function and absence of significant inflammation or infection. Choices A, C, and D describe characteristics of abnormal lymph nodes, such as being shotty, large/firm/fixed, or rubbery/discrete/mobile, respectively, which are indicative of pathological conditions like infection, malignancy, or inflammation. Therefore, the absence of palpable lymph nodes in a healthy individual is the expected norm.

Correct Answer: D

Rationale: The correct answer is D: Enlarged regional lymph nodes. In otitis externa, there may be regional lymphadenopathy due to inflammation and infection. Rhinorrhea (A) is associated with upper respiratory infections, not otitis externa. Periorbital edema (B) is seen in conditions like periorbital cellulitis. Pain over the maxillary sinuses (C) is indicative of sinusitis, not otitis externa.

Correct Answer: D

Rationale: The correct answer is D because over-the-counter nasal sprays, especially those containing decongestants, can lead to rebound swelling when used for an extended period. Rebound swelling occurs when the nasal passages become more congested after the effects of the medication wear off. This can result in a cycle of dependency on the nasal spray to alleviate symptoms, leading to worsening congestion over time. It is important for the nurse to educate the patient about this potential risk and suggest alternative treatment options to address her allergies effectively without causing rebound swelling. Choices A, B, and C are incorrect because: A: Incorrect, as not all over-the-counter nasal sprays carry a risk of addiction. B: Incorrect, as switching to another brand may not address the underlying issue of rebound swelling. C: Incorrect, as continuous use of the nasal spray without addressing rebound swelling can exacerbate the problem.