Which finding during a neurological assessment suggests damage to cranial nerve VIII (vestibulocochlear nerve)?

Correct Answer: B

Rationale: The correct answer is B: Loss of balance and hearing. Damage to cranial nerve VIII (vestibulocochlear nerve) affects balance and hearing as it is responsible for transmitting sensory information related to equilibrium and sound perception. Loss of balance indicates dysfunction in the vestibular component of the nerve, while hearing loss is related to the cochlear component. Difficulty swallowing (choice A) is associated with cranial nerves IX and X. Impaired eye movement (choice C) is linked to cranial nerves III, IV, and VI. Weakness in shoulder shrugging (choice D) is typically attributed to cranial nerve XI.

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: B

Rationale: The most likely diagnosis for the 40-year-old man with abdominal pain, vomiting, jaundice, ascites, elevated bilirubin, and elevated AST and ALT is cirrhosis. Cirrhosis is characterized by liver dysfunction due to chronic liver injury, which can be caused by alcohol use and liver disease. The presence of jaundice, ascites, and abnormal liver function tests are classic signs of advanced liver disease like cirrhosis. Chronic pancreatitis (A) typically presents with abdominal pain radiating to the back, and may not cause jaundice or ascites. Hepatitis (C) usually presents with symptoms like fatigue, nausea, and fever, and may or may not cause jaundice. Gallstones (D) can cause abdominal pain, but are less likely to present with jaundice, ascites, and liver function test abnormalities.

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.