While performing an assessment of a 65-year-old man with a history of hypertension and coronary artery disease, the nurse notices the presence of bilateral pitting edema in the lower legs. The skin is puffy and tight but normal in color. No increased redness or tenderness is observed over his lower legs, and the peripheral pulses are equal and strong. In this situation, the nurse suspects that the likely cause of the edema is which condition?

Correct Answer: A

Rationale: The correct answer is A: Heart failure. In this scenario, the presence of bilateral pitting edema in a patient with a history of hypertension and coronary artery disease suggests fluid overload due to heart failure. The puffy and tight skin without redness or tenderness indicates the edema is non-inflammatory. Equal and strong peripheral pulses suggest good circulation, ruling out venous thrombosis. Absence of signs like redness, warmth, or pain in the legs excludes local inflammation. Blockage of lymphatic drainage typically presents with unilateral edema and is less common in this patient population. Therefore, given the patient's history and physical findings, heart failure is the most likely cause of the bilateral pitting edema.

Correct Answer: C

Rationale: The correct answer is C: Turbinates. Turbinates are bony projections in the nasal cavity that increase surface area for warming, humidifying, and filtering air. Meatus (A) refers to the openings in the nasal cavity, septum (B) is the cartilage dividing the nostrils, and Kiesselbach plexus (D) is a vascular area in the anterior nasal septum. These choices are incorrect as they do not specifically refer to the structures that increase surface area in the nasal cavity.

Correct Answer: C

Rationale: The correct answer is C: Perform an otoscopic examination of the left nares. This is the correct next step to further assess the purulent drainage with a foul odor. By performing an otoscopic examination, the nurse can visualize the nasal passage and identify any underlying issues such as a possible foreign body, infection, or inflammation. It is important to rule out any potential serious conditions that may require medical intervention. Choice A is incorrect because antibiotics should not be prescribed without a proper assessment and diagnosis. Choice B is incorrect as waiting for a week can potentially lead to worsening of the condition. Choice D is incorrect as purulent drainage with a foul odor is not normal and should be further investigated.

Correct Answer: B

Rationale: Rationale for Correct Answer (B): The apices of the lungs extend 3 to 4 cm above the inner third of the clavicles. This is because the lungs extend superiorly in the thoracic cavity, reaching above the clavicles at their highest points. This anatomical fact is essential to understand the complete lung anatomy. Summary of Incorrect Choices: A: Incorrect. The apices of the lungs are not at the level of the second rib anteriorly. They extend higher in the thoracic cavity. C: Incorrect. The apices of the lungs are not located at the sixth rib anteriorly and the eighth rib laterally. They are positioned higher in the thoracic cavity. D: Incorrect. The apices of the lungs do not rest on the diaphragm at the fifth intercostal space in the midclavicular line. They extend above this point towards the clavicles.

Correct Answer: A

Rationale: The correct answer is A: Wheezes. In severe asthma, narrowed bronchioles cause turbulent airflow, producing high-pitched wheezing sounds during expiration. These sounds are continuous, musical, and often heard without a stethoscope. Bronchial sounds (B) are normal breath sounds heard over the trachea, not indicative of asthma. Bronchophony (C) refers to increased vocal resonance and is not associated with bronchoconstriction. Whispered pectoriloquy (D) is a technique used to assess for consolidation in the lungs, not characteristic of asthma.