The nurse is assessing cranial nerve XI (spinal accessory nerve). Which action is most appropriate?

Correct Answer: A

Rationale: The correct answer is A: Ask the patient to shrug their shoulders against resistance. This is the most appropriate action for assessing cranial nerve XI (spinal accessory nerve) because this nerve innervates the trapezius and sternocleidomastoid muscles, which are responsible for shoulder shrugging and head rotation, respectively. By asking the patient to shrug their shoulders against resistance, the nurse can assess the strength and function of the trapezius muscle, which is controlled by the spinal accessory nerve. Choices B, C, and D are incorrect: B: Having the patient stick out their tongue is used to assess cranial nerve XII (hypoglossal nerve), not cranial nerve XI. C: Testing the patient's ability to chew is used to assess cranial nerve V (trigeminal nerve), not cranial nerve XI. D: Evaluating the patient's sense of smell is used to assess cranial nerve I (olfactory nerve),

Correct Answer: A

Rationale: The correct answer is A: Mammography. Mammography is the initial investigation of choice for evaluating breast lumps in women over 40 years old. It helps to identify the characteristics of the mass and determine if it is suspicious for malignancy. Fine needle aspiration (B) may be used for further evaluation if mammography is inconclusive. Excisional biopsy (C) is typically reserved for definitive diagnosis after suspicious findings on mammography. Ultrasound (D) may be used as an adjunct to mammography but is not the first-line investigation in this scenario.

Correct Answer: B

Rationale: The most likely diagnosis for a 50-year-old man with a history of heavy alcohol use presenting with abdominal pain, jaundice, and ascites, along with elevated serum bilirubin, AST, and ALT, is cirrhosis. Cirrhosis is a chronic condition characterized by liver damage and scarring, commonly caused by long-term alcohol abuse. The elevated liver function tests and jaundice are indicative of liver dysfunction, while ascites is a common complication of cirrhosis due to portal hypertension. Chronic pancreatitis (choice A) typically presents with pancreatic enzyme abnormalities, not liver dysfunction. Hepatitis (choice C) may present with elevated liver enzymes but is less likely in a patient with a history of heavy alcohol use. Gallstones (choice D) can cause jaundice but are less likely to be the primary cause of liver dysfunction in this case.

Correct Answer: A

Rationale: The most likely diagnosis for the 60-year-old man with difficulty swallowing, weight loss, hoarse voice, smoking, and alcohol use is esophageal cancer. This is supported by the symptoms of dysphagia, weight loss, and hoarseness, which are common in esophageal cancer. Smoking and alcohol use are risk factors for developing esophageal cancer. Achalasia presents with dysphagia without weight loss or hoarseness. Gastroesophageal reflux disease typically presents with heartburn and regurgitation, not hoarseness or weight loss. Peptic ulcer disease usually presents with epigastric pain, not difficulty swallowing or hoarseness.

Correct Answer: C

Rationale: The correct answer is C: Failure of the accommodation reflex. When the pupils constrict in response to light but do not constrict when focused on a near object, it indicates a failure of the accommodation reflex. This reflex is responsible for adjusting the shape of the lens to focus on near objects. In this scenario, the pupils are reacting to light (normal pupillary response) but not adjusting properly for near vision, ruling out A. Failure of the consensual light reflex (B) would result in both pupils failing to constrict when exposed to light. Increased intracranial pressure (D) would typically present with other neurological signs and symptoms.