A patient presents with well-demarcated, hypopigmented macules with fine scaling, affecting the trunk and proximal extremities. The patient reports a history of sun exposure and outdoor activities. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: The presentation of well-demarcated, hypopigmented macules with fine scaling on the trunk and proximal extremities is classic for tinea versicolor. Tinea versicolor is a common superficial fungal infection caused by Malassezia spp., which leads to hypo- or hyperpigmented patches on the skin. The condition often occurs in individuals with increased sebum production due to factors such as hot and humid climates, sweating, and oily skin. History of sun exposure and outdoor activities is also commonly reported by patients with tinea versicolor. Treatment usually involves antifungal medications applied topically or taken orally to eliminate the fungus. Differentiating tinea versicolor from other skin conditions, such as vitiligo, pityriasis rosea, or seborrheic keratosis, is important for appropriate management.

Correct Answer: C

Rationale: Choosing option C, asking the patient about their cultural beliefs and preferences related to pain, demonstrates cultural competence in pain assessment. Pain experiences can vary greatly across different cultures, and a patient's cultural background can influence how they perceive and express pain. By inquiring about the patient's cultural beliefs and preferences, the nurse can gain a better understanding of the patient's perspective on pain. This information is crucial for providing individualized and culturally sensitive pain management interventions. It also shows respect for the patient's unique cultural background and helps build a trusting and collaborative relationship between the nurse and the patient.

Correct Answer: A

Rationale: The combination of recurrent joint pain, swelling, and limited range of motion in multiple joints along with elevated ESR, positive RF, and presence of anti-CCP antibodies is classic for rheumatoid arthritis (RA). Elevated ESR indicates inflammation, positive rheumatoid factor (RF) is an autoantibody commonly found in the serum of patients with RA, and the presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies further supports the diagnosis of RA. These laboratory findings along with the clinical presentation are highly suggestive of rheumatoid arthritis. Systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) can have overlapping symptoms with RA, but the specific combination of elevated ESR, positive RF, and anti-CCP antibodies points more towards RA in this scenario.

Correct Answer: D

Rationale: Phenazopyridine HCl (Pyridium) is a medication commonly used to relieve the pain, burning, and discomfort associated with urinary tract infections (UTIs). One of the notable side effects of Phenazopyridine is the discoloration of urine, turning it a rusty-red or orange color. This color change is harmless and temporary, but it can be alarming to patients who are unaware of this side effect. Therefore, if a patient undergoing treatment for a UTI notices their urine has turned orange, it is most likely due to the administration of Phenazopyridine.

Correct Answer: A

Rationale: The scenario described, including cyclic pelvic pain, dysmenorrhea, dyspareunia, retroverted uterus, and a nodular mass behind the uterus, is most indicative of endometriosis. Endometriosis is a gynecological condition in which tissue similar to the endometrium (the tissue that lines the uterus) is found outside the uterus, typically on structures within the pelvis. The presence of endometrial tissue in abnormal locations can lead to symptoms such as pelvic pain, especially during menstruation (dysmenorrhea), painful intercourse (dyspareunia), and the formation of nodular masses (endometriomas) that can be felt on pelvic examination. It is important to note that while adenomyosis and uterine fibroids (leiomyomas) can also cause pelvic pain and dysmenorrhea, the specific findings of retroverted uterus and palpable nodular mass behind

Correct Answer: B

Rationale: In the community setting, the essential record about the patient is the patient's chart. This chart contains all important information about the patient, including medical history, treatment plans, medications, progress notes, and any other pertinent information related to the patient's care. It serves as a crucial document for healthcare providers to track and monitor the patient's health status, facilitate communication among team members, ensure continuity of care, and make informed clinical decisions. The patient's chart is a comprehensive and centralized source of information that guides the delivery of quality care in the community setting.

Correct Answer: A

Rationale: Betamethasone (Celestone) is a corticosteroid medication that is commonly used to promote fetal lung maturity in pregnant women at risk of preterm delivery. Administering betamethasone to the mother helps accelerate the production of surfactant in the fetal lungs, which is essential for proper lung function and development. This medication is typically given to pregnant women between 24 and 34 weeks of gestation to reduce the risk of respiratory distress syndrome in preterm infants. It does not prevent premature closure of the ductus arteriosus, delay delivery, or stop premature uterine contractions.

Correct Answer: A

Rationale: The presentation of sudden-onset, painless vision loss in the right eye with a cherry-red spot at the macula and attenuated retinal vessels is classic for central retinal artery occlusion (CRAO). In this condition, the blockage of the central retinal artery results in severe ischemia of the retina, leading to rapid and profound vision loss. The cherry-red spot at the macula is a result of preserved choroidal circulation contrasting with the pale, ischemic retina. Attenuated retinal vessels are also commonly observed due to decreased blood flow. Prompt evaluation and management are critical in CRAO to potentially restore some vision and prevent further ischemic damage to the retina.

Correct Answer: D

Rationale: In end-stage liver disease, pruritus (itching) can be a distressing symptom caused by the accumulation of bile salts in the skin due to impaired liver function. Cholestyramine and other bile acid sequestrants are the primary treatment for managing pruritus in these patients. These medications bind to the bile salts in the intestine, preventing their reabsorption and reducing the itching symptoms. Antihistamines may not be as effective for this type of pruritus since it is not histamine-mediated. Topical corticosteroids are generally not recommended for long-term use in liver disease due to the risk of systemic absorption and adverse effects. Avoiding hot showers or baths may provide some temporary relief but is not a definitive treatment. Therefore, prioritizing the prescription of cholestyramine or bile acid sequestrants would be the most appropriate intervention to address the severe pruritus in a patient with end-stage liver disease