During percussion of the abdomen, the nurse notes a dull sound over the liver. What does this indicate?

Correct Answer: C

Rationale: The dull sound over the liver during percussion indicates a normal finding. The liver is a solid organ, so it produces a dull sound. Air-filled organs would produce a tympanic sound. Presence of fluid would produce a shifting dullness. Presence of a tumor may not necessarily affect the percussion sound. Therefore, the dull sound over the liver is a normal finding during abdominal percussion, indicating option C is the correct answer.

Correct Answer: C

Rationale: The correct answer is C because the inability to palpate ulnar pulses in a patient with warm skin and normal capillary refill time is considered a normal variation. Ulnar pulses may be less prominent and harder to palpate compared to other pulses. Proceeding with the peripheral vascular evaluation is appropriate as this finding alone does not indicate any abnormalities or conditions that require immediate intervention. Checking for claudication (Choice A) is not necessary as the absence of ulnar pulses does not correlate with claudication. Referring the individual for further evaluation (Choice B) is premature and not warranted based on the information given. Asking about unusual cramping or tingling in the arm (Choice D) is not necessary at this point as the absence of ulnar pulses in this context is not indicative of any specific symptoms.

Correct Answer: B

Rationale: The correct answer is B: Inflammatory. The patient's symptoms of joint pain in the wrists and fingers, along with subjective fever and family history of rheumatoid arthritis, suggest an inflammatory process like rheumatoid arthritis. There is no mention of any infectious symptoms or recent activities that would suggest an infectious cause (choice A). The presentation does not point towards a hematologic issue (choice C) such as a blood disorder. Additionally, there is no history of trauma (choice D) that would explain the joint pain and fever. Therefore, based on the symptoms and family history provided, the most likely pathologic process is an inflammatory condition like rheumatoid arthritis.

Correct Answer: D

Rationale: The correct answer is D: To screen for depression. Susanne's symptoms of headaches, muscle aches, and fatigue for an extended period may indicate underlying depression. Screening for depression is important as it is a common cause of somatic symptoms. It is crucial to address mental health concerns that could be contributing to her physical symptoms. Referral to a neurologist (Choice A) or rheumatologist (Choice B) may not be necessary if there are no specific findings to suggest neurological or rheumatologic conditions. Telling the patient you can't find anything (Choice C) without exploring all possibilities is not appropriate. Screening for depression is the most appropriate next step to consider in this case.

Correct Answer: C

Rationale: The correct answer is C: Third-level. Unfamiliarity with heart-healthy dietary guidelines is a third-level priority problem because it is not immediately life-threatening or critical to address in the emergent setting. First-level priority problems are those directly impacting the patient's ABCs (airway, breathing, circulation) or immediate safety. Second-level priority problems are important but do not require immediate intervention to prevent harm. In this case, addressing the chest pain, palpitations, and the patient's appearance of being pale and diaphoretic are first- and second-level priorities as they may indicate a more urgent medical condition that needs immediate attention to ensure the patient's safety and stabilization.