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: B

Rationale: The correct answer is B: Vomiting and pain. Small bowel obstruction typically leads to vomiting due to the blockage preventing food from passing through. Pain occurs as the intestine tries to push against the obstruction. Nausea and diarrhea (choice A) are more common in large bowel obstructions. Hematemesis and bloody stool (choice C) suggest bleeding in the upper gastrointestinal tract. Indigestion and anorexia (choice D) are not specific to small bowel obstruction. Therefore, the combination of vomiting and pain is indicative of small bowel obstruction.

Correct Answer: B

Rationale: The correct answer is B: Funnel chest (pectus excavatum). Pectus excavatum is characterized by a depressed or sunken appearance of the sternum, which matches the description provided in the case. In this condition, the chest wall is abnormally shaped inward. This can be a congenital condition or develop during growth spurts in adolescence. The lack of symptoms such as shortness of breath, chest pain, or lightheadedness on exertion is consistent with pectus excavatum, as these symptoms are not typically associated with this condition. The other choices (A: Barrel chest, C: Pigeon chest, D: Thoracic kyphoscoliosis) do not match the specific findings described in the case and are not associated with the characteristic sternal depression seen in pectus excavatum.

Correct Answer: B

Rationale: The correct answer is B: Haloperidol. Haloperidol is a first-line antipsychotic commonly used to manage agitation in delirium due to its rapid onset and minimal sedative effects. It acts by blocking dopamine receptors in the brain, which helps to reduce agitation and combativeness. Melatonin (A) is not effective for acute agitation. Diazepam (C) can worsen confusion in elderly patients and is not recommended for delirium. Gabapentin (D) is not indicated for managing agitation in delirium and may not be effective in this scenario.

Correct Answer: A

Rationale: The correct answer is A: Diuretics. In older adults, diuretics are considered the most appropriate first-line therapy for hypertension due to their effectiveness in reducing blood pressure and preventing complications such as heart failure. Diuretics are well-tolerated, have a long history of use, and are cost-effective. They are especially beneficial in older adults with volume overload or fluid retention. Beta-blockers (B) may be less effective in older adults and can have more side effects. ACE inhibitors (C) are commonly used but may pose risks of hyperkalemia and renal dysfunction in older adults. Calcium channel blockers (D) are effective but may increase the risk of falls and fractures in older adults.

Correct Answer: C

Rationale: The correct answer is C. During the secondary stage of syphilis, a rash marked by red or reddish-brown, penny-sized lesions over the palms and soles is a common clinical manifestation. This rash, known as a syphilitic rash, is a hallmark symptom of secondary syphilis. The rash can also appear on other parts of the body. It is important to note that syphilis progresses through distinct stages, and the secondary stage typically occurs a few weeks to a few months after the initial infection. Now, let's analyze why the other choices are incorrect: A: Absence of symptoms - This is incorrect as syphilis does present symptoms, especially during the secondary stage. B: Single painless lesion, chancre on the genital area - This is characteristic of the primary stage of syphilis, not the secondary stage. D: Poor muscle coordination - This symptom is associated with the late or tertiary stage of syphilis, not the secondary stage

Correct Answer: A

Rationale: The correct answer is A: A palpable "notch" along its edge. This supports an enlarged kidney over the spleen because the kidney has a concave shape with a notch where the renal vessels enter. This notch is palpable in an enlarged kidney. Choice B is incorrect because the inability to push fingers between the mass and the costal margin is indicative of a spleen, which is a solid organ located close to the ribs. Choice C is incorrect as normal tympany over the area suggests gas-filled structures like the stomach or intestines, not a solid organ like the kidney or spleen. Choice D is incorrect as the ability to push fingers medial and deep to the mass would be more typical of an enlarged spleen, which can displace other organs medially due to its size.

Correct Answer: B

Rationale: The correct answer is B: Metabolic problems. The patient's inability to maintain sustained upward hand posture indicates asterixis, a sign of metabolic encephalopathy commonly seen in patients with liver failure due to alcoholism. This is caused by metabolic disturbances affecting the brain's function, leading to confusion and motor abnormalities. It is not indicative of a stroke (A), carpal tunnel syndrome (C), or severe fatigue and weakness (D), as they do not typically present with asterixis or the described palm movements.

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.