Correct Answer: A

Rationale: The correct answer is A. Long-term laxative use can lead to the bowel becoming less responsive to stimuli, resulting in constipation. This is due to the body becoming dependent on laxatives to stimulate bowel movements. Choice B is incorrect as laxatives typically do not cause trauma or scarring to the intestinal lining. Choice C is incorrect because while emollient laxatives can be helpful for constipation, long-term use is not recommended due to potential side effects. Choice D is incorrect because laxatives do not directly cause malnourishment or prevent waste production.

Correct Answer: B

Rationale: The correct answer is B because the patient's inability to count fingers indicates severe visual impairment. Testing hand motion perception is a more appropriate initial assessment for patients with such significant visual losses. This method can differentiate between light perception and no light perception, providing valuable information about the patient's visual acuity. The other choices are incorrect because assessing vision using a Snellen chart (A) requires more visual acuity than just being able to see hand motion. Performing a detailed examination of external eye structures (C) and palpating periocular regions (D) are not relevant for assessing visual acuity and do not provide information on the patient's ability to perceive hand motion.

Correct Answer: C

Rationale: Rationale: Ganciclovir is the correct answer for the acute stage of CMV retinitis in AIDS patients. It is an antiviral drug that specifically targets CMV. Ganciclovir works by inhibiting viral DNA synthesis, effectively controlling CMV replication in the eye. Pilocarpine (A) is a miotic used for glaucoma, not for CMV retinitis. Penicillin (B) is an antibiotic effective against bacterial infections, not viral infections like CMV. Gentamicin (D) is an antibiotic used to treat bacterial infections, not viral infections like CMV.

Correct Answer: A

Rationale: The correct order for the massage is to start around the feces (4), then work downwards (1), followed by moving towards the sides (5), then back to the top (2), continuing to the sides again (3), and finally finishing at the top (6). This sequence ensures a thorough and effective massage process. Other choices have different orders that do not follow the logical flow of massaging around the feces and working down as specified in the question.

Correct Answer: D

Rationale: The correct answer is D: Discuss a referral for hospice care. Hospice care provides specialized care for patients with terminal illnesses, focusing on comfort and quality of life. This option aligns with the patient's wish to die at home and ensures his care needs are met. Hospice care also provides emotional and spiritual support for both the patient and family. A: Discuss a referral for rehabilitation hospital - This option focuses on rehabilitation, which is not suitable for a patient with a terminal illness like extensive stage small-cell lung cancer. B: Panel the patient for a personal care home - Personal care homes may not provide the level of specialized care needed for a terminally ill patient. C: Discuss a referral for acute care - Acute care is more focused on treating acute illnesses and injuries, not providing end-of-life care for a patient with a terminal illness.