The nurse is performing a neurological assessment and notes a positive Romberg test. What does this finding indicate?

Correct Answer: B

Rationale: The Romberg test assesses balance and postural stability. A positive Romberg test indicates a deficit in proprioception, which is commonly seen in cerebellar ataxia or vestibular dysfunction. The cerebellum and vestibular system play crucial roles in maintaining balance and coordination. Cranial nerve dysfunction (A) does not directly affect balance. Peripheral neuropathy (C) primarily affects sensation and motor function, not balance. Increased intracranial pressure (D) may present with other neurological signs, but not specifically a positive Romberg test. Therefore, the correct answer is B.

Correct Answer: A

Rationale: The most likely cause of the man's symptoms is esophageal cancer (Choice A) due to his age, symptoms of dysphagia and weight loss, history of smoking and heavy alcohol use, and the presence of a palpable mass in the upper abdomen on examination. Esophageal cancer commonly presents with difficulty swallowing, weight loss, and risk factors such as smoking and alcohol use. The palpable mass indicates a more advanced disease stage. Choice B (Achalasia) is less likely due to the presence of a palpable mass, which is not typical of achalasia. Choice C (Gastroesophageal reflux disease) typically presents with heartburn and regurgitation rather than dysphagia and weight loss. Choice D (Peptic ulcer disease) is less likely as it does not typically cause a palpable mass or significant weight loss.

Correct Answer: B

Rationale: The correct answer is B: Congestive heart failure. Given the patient's history of hypertension, presenting symptoms of shortness of breath, pedal edema, crackles in the lungs, and jugular venous distention are classic signs of congestive heart failure. These symptoms are indicative of fluid overload and impaired cardiac function leading to fluid accumulation in the lungs and extremities. Other choices can be ruled out based on the lack of corresponding symptoms and physical examination findings related to those conditions. Chronic obstructive pulmonary disease (A) typically presents with chronic cough, wheezing, and sputum production. Pulmonary embolism (C) presents with sudden onset dyspnea, chest pain, and tachycardia. Renal failure (D) may present with decreased urine output, electrolyte abnormalities, and signs of uremia.

Correct Answer: A

Rationale: The correct answer is A: Postural hypotension. This condition typically presents with symptoms of dizziness and fainting upon standing due to a drop in blood pressure. In this case, the blood pressure of 90/60 mm Hg indicates hypotension, which is exacerbated by changes in position. Acute myocardial infarction (B) presents with chest pain and ECG changes, not dizziness. Arrhythmia (C) can cause palpitations but not necessarily dizziness. Hyperthyroidism (D) can cause palpitations and weight loss but not typically dizziness and fainting.

Correct Answer: C

Rationale: The correct answer is C: Psoriatic arthritis. The patient's history of psoriasis is a key clue. Psoriatic arthritis commonly affects individuals with psoriasis, presenting with joint pain and swelling. Rheumatoid arthritis (choice A) typically affects multiple joints symmetrically. Osteoarthritis (choice B) is more common in older individuals and does not have a strong association with psoriasis. Gout (choice D) is characterized by sudden, severe attacks of pain, usually in the joint at the base of the big toe, and is not typically associated with psoriasis.