A patient presents with ear pain. She is an avid swimmer. The history includes pain and drainage from the left ear. On examination, she has pain when the ear is manipulated, including manipulation of the tragus. The canal is narrowed and erythematous, with some white debris in the canal. The rest of the examination is normal. What diagnosis would you assign this patient?

Correct Answer: B

Rationale: The correct diagnosis for this patient is external otitis (choice B). The key findings that support this diagnosis include pain on manipulation of the ear, especially the tragus, narrowed and erythematous ear canal, drainage, and white debris in the canal. These are classic signs of external otitis, also known as swimmer's ear, which is an infection of the ear canal. Otitis media (choice A) typically presents with middle ear inflammation and fluid accumulation, but this patient's symptoms are more consistent with an external ear infection. Perforation of the tympanum (choice C) would present with different symptoms, such as hearing loss, ear discharge, and possible pain, but the examination findings described do not suggest a perforation. Cholesteatoma (choice D) is a benign growth in the middle ear and does not typically present with the external ear canal findings described in the patient.

Correct Answer: A

Rationale: The correct answer is A: Palpation. Palpation involves using the hands to feel for abnormalities such as crepitus (crackling or grating sensation), swelling, and pulsations. It allows the nurse to assess textures, temperatures, and tenderness. Inspection (B) involves visual examination, which may not detect subtle abnormalities like crepitus. Percussion (C) is tapping on the body to assess underlying structures and is not used for detecting crepitus, swelling, or pulsations. Auscultation (D) involves listening with a stethoscope and is used for assessing sounds like heartbeats or breath sounds, not the physical characteristics mentioned in the question.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Increased ICP can lead to cerebral edema and worsen neurological outcomes. 2. Promoting carbon dioxide elimination helps reduce cerebral blood flow and intracranial pressure. 3. Hyperventilation decreases PaCO2, causing vasoconstriction and reducing ICP. 4. Preventing respiratory alkalosis (A) and lowering arterial pH (B) are incorrect as they can worsen cerebral vasoconstriction. 5. Maintaining PaO2 above 80 mm Hg (D) is important but not the primary goal in managing increased ICP.

Correct Answer: D

Rationale: The correct answer is D because a new onset of chest pain during a cardiovascular assessment could indicate a serious cardiac issue like a heart attack requiring immediate intervention. Chest pain can be a symptom of myocardial infarction, which is a medical emergency. Choices A, B, and C are not immediate concerns. A capillary refill of 3 seconds is within normal limits (2 seconds or less is normal). Blood pressure of 130/80 mmHg is within the normal range, and a heart rate of 110 beats per minute may be elevated but not necessarily an immediate concern without additional context.

Correct Answer: B

Rationale: The correct answer is B: Reflex hammer. This tool is specifically designed to assess deep tendon reflexes by eliciting a quick stretch reflex response. The pointed end of the reflex hammer is used to strike the tendon, causing a quick tap that triggers the reflex. The other choices are incorrect: A tuning fork is used for testing auditory sensations, a penlight is used for assessing pupillary responses and examining the eyes, and an otoscope is used for visualizing the ear canal and eardrum. Therefore, the reflex hammer is the most appropriate tool for assessing deep tendon reflexes due to its specific design and function.