During auscultation, the nurse hears an unfamiliar sound. The best action is to:

Correct Answer: B

Rationale: The correct answer is B because asking another nurse to double-check the finding is crucial for validation and ensuring accuracy in assessment. This step helps in confirming the unfamiliar sound and ruling out any potential errors or misinterpretations. It promotes patient safety and effective communication among healthcare providers. Ignoring the sound (Choice A) can lead to overlooking a significant finding that may impact the patient's condition. Documenting and continuing the assessment (Choice C) without validation may result in incomplete information and potential misdiagnosis. Repositioning the patient and listening again (Choice D) may not address the need for confirmation from another healthcare provider.

Correct Answer: C

Rationale: Rationale: Acromegaly is a condition caused by excessive growth hormone production, leading to overgrowth of bones in the face, head, hands, and feet. This results in characteristic features such as enlarged facial bones, hands, and feet. The correct answer is C because it aligns with the typical assessment findings in acromegaly. Summary of other choices: A (Heavy, flattened facial features): This is not consistent with acromegaly, as the condition is characterized by overgrowth of bone rather than flattened features. B (Growth retardation and a delayed onset of puberty): These findings are more indicative of growth hormone deficiency rather than excess, which is seen in acromegaly. D (Increased height and weight and delayed sexual development): While increased height and weight may occur, delayed sexual development is not a common feature of acromegaly.

Correct Answer: A

Rationale: The correct answer is A. The woman's history of diabetes and peripheral vascular disease puts her at increased risk for infection and lesions when trying to remove the corn with scissors. Diabetes can impair wound healing and increase the risk of infection. Peripheral vascular disease can lead to poor circulation, further complicating wound healing. Choices B, C, and D are incorrect because they do not address the specific risks associated with the woman's chronic conditions. Choice B is incorrect as diabetes often causes poor circulation, not increased circulation. Choice C is incorrect as age and visual impairment are not the primary reasons for discouraging the use of scissors. Choice D is incorrect as it focuses on range of motion rather than the specific risks related to diabetes and peripheral vascular disease.

Correct Answer: A

Rationale: The correct answer is A: Tinea capitis. Tinea capitis is a fungal infection of the scalp that often presents with hair loss, scaling, and broken hair in patches. In this case, the patient's symptoms of hair loss, patchy scaling, and broken hair are consistent with tinea capitis. The nurse should suspect this diagnosis based on the clinical presentation. Other choices are incorrect because: B: Folliculitis typically presents with inflamed hair follicles, pustules, and redness. It is not characterized by patchy hair loss and scaling. C: Toxic alopecia is hair loss due to exposure to toxins or chemicals, which is not suggested by the symptoms described. D: Seborrheic dermatitis presents with greasy, yellowish scaling on the scalp, but typically does not cause patchy hair loss as described in the case.

Correct Answer: D

Rationale: The correct answer is D: Labyrinth. The labyrinth is a structure in the inner ear that contains the vestibular system responsible for balance and spatial orientation. The sensation of spinning or vertigo is related to disturbances in the labyrinth. CN VIII, the vestibulocochlear nerve, carries information from the labyrinth to the brain. The cochlea (A) is responsible for hearing, not balance. The Organ of Corti (C) is a structure within the cochlea involved in hearing, not balance. Therefore, the correct choice is D as it directly relates to the sensation of spinning experienced by the patient.