A 79-year-old client is admitted with pneumonia. Which symptom would most likely indicate the need for further evaluation?

Correct Answer: B

Rationale: The correct answer is B: Chest pain and pleuritic breathing. This indicates possible complications like pleurisy or pleural effusion, requiring further evaluation. A: Persistent cough with sputum production is common in pneumonia. C: Shortness of breath is a typical symptom of pneumonia. D: Fever and chills are also common in pneumonia. However, chest pain and pleuritic breathing are more indicative of potential complications that may require immediate attention.

Correct Answer: D

Rationale: The correct answer is D: A bone marrow examination. Acute lymphocytic leukemia is a type of blood cancer that affects the bone marrow's ability to produce normal blood cells. A bone marrow examination is necessary to confirm the diagnosis by analyzing the bone marrow cells for abnormality. A complete blood count (choice A) can show abnormalities in blood cell counts but cannot confirm leukemia. Magnetic resonance imaging (choice B) and nuclear bone scan (choice C) are imaging tests that can show bone abnormalities but are not specific for diagnosing leukemia.

Correct Answer: A

Rationale: The correct answer is A: Fingertips. Fingertips are the most sensitive part of the hand, allowing for accurate temperature assessment. They provide better tactile discrimination and are more sensitive to changes in temperature compared to other parts of the hand. Palms have thicker skin and are less sensitive, making them less ideal for temperature assessment. Backs of fingers and ulnar aspect of the hand are also less sensitive than fingertips and lack the precision needed for accurate temperature detection.

Correct Answer: B

Rationale: The correct answer is B: Provide thickened liquids and soft foods. This intervention helps prevent aspiration by reducing the risk of food or liquids entering the airway. Thickened liquids are easier to control while swallowing, decreasing the chance of aspiration. Soft foods are also easier to chew and swallow, further reducing the risk. Choice A is incorrect because eating quickly can increase the risk of choking and aspiration. Choice C is incorrect as lying down after meals can actually increase the risk of aspiration. Choice D is incorrect as large meals can increase the likelihood of swallowing difficulties and aspiration.

Correct Answer: B

Rationale: The correct answer is B: Potential congenital deformity. This observation suggests a condition called "low-set ears," which can be a sign of certain congenital anomalies affecting the development of the head and neck structures during fetal growth. It is important to investigate further to rule out any associated syndromes or genetic disorders. Choice A: Normal anatomical variation is incorrect because this positioning is not commonly considered a normal variation in the general population. Choice C: Increased risk of hearing loss is incorrect as the position of the ears alone does not directly correlate with hearing loss. Choice D: No clinical significance is incorrect because this observation warrants further evaluation to assess for potential underlying issues.

Correct Answer: C

Rationale: The correct answer is C: Voluntary stopping of eating and drinking. This is legal throughout the United States because it is considered a patient's right to refuse food and water, even if it may lead to death. This decision is based on the principle of patient autonomy and respects the patient's wishes. Euthanasia (A) involves actively causing death, which is illegal in the United States. Palliative sedation (B) is providing medication to relieve suffering, but not with the intention of hastening death. Physician-assisted death (D) involves a physician providing medication for a patient to self-administer to end their life, which is not legal in all states.

Correct Answer: C

Rationale: The correct answer is C. The patient's age (36 years) and chronic smoking are the main reasons why a combined hormonal contraceptive would be contraindicated. Age over 35 and tobacco use increase the risk of cardiovascular complications with hormonal contraceptives. Obesity (choice A), type 2 diabetes (choice B), and a sedentary lifestyle (choice D) are also risk factors, but they are not the primary reasons for contraindicating combined hormonal contraceptives in this case.

Correct Answer: C

Rationale: Step 1: Identify the characteristics of the lesion described - dome-shaped, in dermis, benign, closed sac attached to epidermis. Step 2: A cutaneous cyst fits all these characteristics - it is a benign closed sac in the dermis with attachment to the epidermis. Step 3: Keloid (A) is an overgrowth of scar tissue, not a closed sac lesion. Tophi (B) are deposits of uric acid crystals, not a sac. Chondrodermatitis (D) is inflammation of cartilage and skin, not a closed sac lesion. Summary: A cutaneous cyst is the correct choice as it matches all the characteristics given, while the other options do not fit the description provided.

Correct Answer: A

Rationale: The correct answer is A: Papilledema. Diabetic retinopathy is a microvascular complication of diabetes that primarily affects the retina's blood vessels. Papilledema, which is optic disc swelling due to increased intracranial pressure, is not a typical finding in diabetic retinopathy. Dot and blot hemorrhages, microaneurysms, and cotton wool spots are commonly seen in diabetic retinopathy due to retinal vessel damage and ischemia. Papilledema is more associated with conditions like intracranial hypertension or optic neuritis.