Correct Answer: B

Rationale: The correct answer is B: suspect that the patient has hyperthyroidism. Periorbital edema is a common sign of hyperthyroidism due to the accumulation of fluid in the tissues around the eyes. By suspecting hyperthyroidism, the nurse can further assess for other associated symptoms and recommend appropriate diagnostic tests. Choice A (check for the presence of exophthalmos) is incorrect because exophthalmos refers to bulging eyes, which may be present in hyperthyroidism but is not directly related to periorbital edema. Choice C (ask the patient if he or she has a history of heart failure) is incorrect as periorbital edema is not typically associated with heart failure, which usually presents with generalized edema. Choice D (assess for blepharitis) is incorrect because while blepharitis can cause eyelid inflammation, it is not typically associated with periorbital edema seen in hyper

Correct Answer: B

Rationale: The correct answer is B because the image formed on the retina is indeed upside down and reversed from its actual appearance in the outside world due to the way light rays are refracted and focused by the cornea and lens. This phenomenon is known as the inverted retinal image. Choice A is incorrect as visual pathways cross at the optic chiasm, so the right side of the brain interprets vision for the left visual field from both eyes. Choice C is incorrect as light rays are refracted at the cornea and lens, not through the transparent media of the eye before striking the pupil. Choice D is incorrect as light impulses are conducted through the optic nerve to the occipital lobes, not the temporal lobes, where the primary visual cortex is located.

Correct Answer: D

Rationale: The correct answer is D: lichenification. Lichenification is the thickening and hardening of the skin due to chronic scratching or rubbing. In this case, the patient's continuous scratching has led to lichenification. The term "terrible itch" indicates a persistent and severe itching sensation, which aligns with the chronic scratching behavior. Choices A, B, and C are not correct because a keloid is an overgrowth of scar tissue, a fissure is a small cut or crack in the skin, and keratosis is the thickening of the outer layer of the skin. These conditions are not directly related to chronic scratching behavior.

Correct Answer: D

Rationale: The correct answer is D. Performing the otoscopic examination at the end of the assessment is the best approach for a 3-year-old with a suspected ear infection. This allows the child to become familiar with the nurse and the environment, reducing anxiety and increasing cooperation. It also prevents the child from becoming upset early in the examination, making it easier to complete the assessment. Choice A is incorrect because omitting the otoscopic exam based on the presence of a fever could lead to a missed diagnosis. Choice B is incorrect as pulling the ear up and back before inserting the speculum is not recommended as it may cause discomfort and increase resistance from the child. Choice C is incorrect as having the mother leave the room may increase the child's anxiety and make the examination more challenging.

Correct Answer: A

Rationale: Step-by-step rationale for why answer A is correct: 1. Leukoedema is a common benign condition in individuals of African descent. 2. Leukoedema presents as greyish-white lesions on the buccal mucosa. 3. It is typically asymptomatic and does not require treatment. 4. Leukoedema is not associated with any serious health concerns. Summary of why other choices are incorrect: B. Hyperpigmentation would present as dark patches, not greyish-white lesions. C. Torus palatinus is a bony growth on the hard palate, not a mucosal lesion. D. Cancerous lesions typically have different characteristics and would require further investigation.