When assessing a patient's pulse, the nurse notes that the amplitude is weaker during inspiration and stronger during expiration. When the nurse measures the blood pressure, the reading decreases 20 mm Hg during inspiration and increases with expiration. This patient is experiencing pulsus:

Correct Answer: D

Rationale: Step-by-step rationale for why the correct answer is D (Paradoxus): 1. Pulsus paradoxus is characterized by a decrease in pulse strength during inspiration and an increase during expiration, as seen in the patient's pulse assessment. 2. The blood pressure reading decreasing by 20 mm Hg during inspiration is indicative of pulsus paradoxus, as it reflects an exaggeration of the normal inspiratory drop in blood pressure. 3. Pulsus paradoxus is commonly associated with conditions like cardiac tamponade and severe asthma, which can cause this paradoxical pulse and blood pressure pattern. Summary of why the other choices are incorrect: A. Alternans: Alternating strong and weak pulse amplitudes, not related to the respiratory cycle. B. Bisferiens: Pulse with double systolic peaks, not related to respiratory cycle changes. C. Bigeminus: A pattern of every other heartbeat occurring prematurely, not related to respiratory cycle influences.

Correct Answer: D

Rationale: The correct answer is D: Do a skin biopsy in the office. This is the most appropriate action to take in this scenario as the presence of multiple small, blood-red, raised lesions without pain or bleeding warrants further investigation to determine the underlying cause. A skin biopsy would provide histological information about the nature of the lesions, helping to differentiate between various skin conditions such as angiomas, petechiae or purpura. This would guide the appropriate management and rule out any serious underlying conditions. Choice A (Reassure him that there is nothing to worry about) is incorrect as the appearance of these lesions warrants further investigation rather than immediate reassurance. Choice B (Do laboratory work to check for platelet problems) is not the most appropriate initial step without first obtaining more specific information about the nature of the lesions. Choice C (Obtain an extensive history regarding blood problems and bleeding disorders) may be necessary later but is not the initial step in this case.

Correct Answer: A

Rationale: The correct answer is A: Equal status seating. This is important during an interview to create a comfortable and balanced environment for both parties. It promotes open communication and mutual respect. B: Leading questions are not ideal as they can influence the interviewee's responses and lead to biased information. C: Passive listening is ineffective as it shows disinterest and lack of engagement in the conversation, hindering effective communication. D: Distancing can create a sense of physical and emotional separation, making it difficult to establish rapport and connection during the interview.

Correct Answer: B

Rationale: The correct answer is B: Connects the second metatarsal head to the first cuneiform. The Lisfranc ligament plays a crucial role in maintaining the stability of the midfoot by connecting the second metatarsal to the first cuneiform bone. This connection is essential in weight-bearing activities to prevent excessive movement and maintain proper alignment of the bones in the midfoot. The other choices are incorrect because: A) The distal tibia is not connected to the talus by the Lisfranc ligament, C) The preservation of the medial longitudinal arch is primarily achieved by other ligaments in the foot, and D) The primary ankle stabilizer is the deltoid ligament on the medial side of the ankle, not the Lisfranc ligament.

Correct Answer: D

Rationale: Boutonnière deformity is characterized by the rupture of the central slip and volar migration of lateral bands. This leads to hyperextension of the PIP joint and flexion of the DIP joint. This deformity is due to the disruption of the extensor mechanism, specifically the central slip. Rupture of the central slip allows the lateral bands to migrate volarly, causing the characteristic deformity. Options A, B, and C do not accurately describe the mechanism of Boutonnière deformity, making them incorrect choices. Option A describes mallet finger deformity, option B refers to trigger finger, and option C relates to carpal tunnel syndrome.