A patient presents with multiple, flesh-colored, papular lesions with a central dell on the face and trunk. The lesions have a tendency to bleed upon minor trauma and have been increasing in number over time. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: The description of multiple flesh-colored papular lesions with a central dell that tend to bleed upon minor trauma and have been increasing in number over time is characteristic of basal cell carcinoma. Basal cell carcinoma is the most common type of skin cancer and typically presents as pearly or flesh-colored papules with telangiectasias (tiny blood vessels) and a characteristic central dell or ulceration. This type of skin cancer often occurs on sun-exposed areas like the face and trunk and can manifest as slow-growing lesions that may bleed easily with minor trauma. In contrast, squamous cell carcinoma typically presents as a scaly or crusted lesion, seborrheic keratosis is a benign skin growth with a waxy, stuck-on appearance, and actinic keratosis is a precancerous lesion characterized by rough, scaly patches on sun-exposed areas.

Correct Answer: A

Rationale: Showing positive interpersonal relationships is the best evidence of a family coping well when their family coping index on therapeutic competence is rated as coping well. Positive interpersonal relationships indicate that family members are effectively communicating, supporting each other, and resolving conflicts in a healthy manner. This reflects strong family dynamics, emotional resilience, and adaptability which are important aspects of effective coping. While the other options (B, C, D) are beneficial activities or behaviors, positive interpersonal relationships directly demonstrate the family's ability to cope well together, making it the most relevant evidence for a high therapeutic competence rating.

Correct Answer: C

Rationale: Clients undergoing nasogastric suctioning are at highest risk for developing metabolic imbalances, specifically metabolic acidosis. Nasogastric suctioning can lead to the loss of gastric acid, which in turn can cause metabolic acidosis due to a decrease in bicarbonate levels in the body. This disruption in the acid-base balance can result in symptoms such as confusion, headache, and overall malaise. It is crucial for the nurse to monitor the client's acid-base status closely and provide appropriate interventions to prevent or correct metabolic acidosis.

Correct Answer: D

Rationale: It is NOT recommended to use the same syringe and needle in administering two different vaccines. This is to prevent contamination or mixing of different vaccines, which could potentially affect their effectiveness or pose a risk to the individual receiving the vaccines. It is important to use separate syringes and needles for each vaccine to ensure proper administration and prevent any adverse reactions.

Correct Answer: A

Rationale: This statement indicates a need for further instructions because drinking milk between meals may worsen heartburn for some individuals. Milk can temporarily neutralize stomach acid, but it can also stimulate acid production in the stomach leading to increased heartburn symptoms. Therefore, Nurse Harper should provide more guidance on appropriate dietary choices for managing heartburn, such as avoiding trigger foods like fatty or spicy foods, eating small, frequent meals, and not lying down immediately after eating.

Correct Answer: C

Rationale: In a missed abortion, the embryo has died, but the products of conception remain in the uterus, leading to the visualization of a gestational sac without an embryo on ultrasound. This is a type of missed miscarriage where the woman may not have any symptoms initially and the diagnosis is made during a routine ultrasound. The most common presenting symptom is painless vaginal bleeding. The absence of an embryo within the gestational sac can be confirmed through serial ultrasound examinations showing no fetal growth or cardiac activity. It is important for healthcare providers to provide appropriate counseling and management options to support the patient through this emotional experience.

Correct Answer: D

Rationale: It is essential for the nurse to instruct the patient to "Report any unusual bleeding or bruising to your healthcare provider." Warfarin is a medication that works by decreasing the clotting ability of the blood. This can increase the risk of bleeding, so it is important for the patient to be vigilant for any signs of abnormal bleeding. Prompt reporting of any unusual bleeding or bruising allows healthcare providers to adjust the dosage of warfarin to maintain a balance between preventing blood clots and minimizing the risk of bleeding complications. This instruction emphasizes the importance of close monitoring and communication with healthcare providers while on warfarin therapy.

Correct Answer: A

Rationale: The described presentation of a pruritic, annular rash with central clearing and a raised, scaly border that spreads outward in a centrifugal pattern is characteristic of tinea corporis, commonly known as ringworm. This fungal infection affects the skin and is typically ring-shaped, with a well-defined, slightly raised, and scaly border. The central area often clears as the lesion enlarges peripherally, resembling a ring. It is important to note that ringworm is not caused by a worm but by a fungus. Treatment typically involves antifungal medications applied topically or taken orally, depending on the severity of the infection.

Correct Answer: B

Rationale: Hodgkin's disease commonly affects young adults between the ages of 15 to 35 and older adults over the age of 50. It is not a disease that occurs most often in older adults. In fact, Hodgkin's disease has a bimodal distribution, meaning it peaks in young adults and again in older adults. It is important to consider the age distribution when suspecting Hodgkin's disease and not exclusively associate it with older adults.