NR-304 Health Assessment II - Set 5 - Part 2

Correct Answer: "Did the rash start on the nipple or elsewhere?"

Paget disease begins as a crust on the nipple apex and spreads outward onto the areola, while eczema starts on the areola or surrounding skin and may move inward. Where it began separates them. Option a is incorrect because cyclic variation is a feature of fibrocystic tissue and breast pain, not of a nipple skin lesion. Neither Paget disease nor eczema is defined by its relation to menstruation. Option b is incorrect because redness, scaling and thickening appear in both conditions and the surface appearance does not distinguish them. Only a skin biopsy settles the diagnosis once the history has raised suspicion. Option c is incorrect because circumstances at the moment of discovery carry no diagnostic weight for a persistent nipple lesion. A rash that keeps progressing despite topical treatment needs the location question instead.

Correct Answer: Turn her onto her left side right away

The enlarged uterus compresses the vena cava when the client lies supine, cutting venous return and cardiac output. Turning her to the left side lifts the uterus off the great vessels and relieves the symptoms immediately. Option b is incorrect because raising the legs does not move the uterus off the inferior vena cava, which is the mechanical obstruction causing the problem. The compression persists as long as she stays on her back. Option c is incorrect because measuring a number while the cause continues wastes the moments in which a simple position change would restore perfusion. Assessment never takes precedence over relieving an obvious mechanical cause. Option d is incorrect because oxygen cannot correct a fall in cardiac output produced by obstructed venous return, and keeping her supine sustains the very position responsible. Blood carrying that oxygen still cannot reach the heart.

Correct Answer: Indirect inguinal hernia descending through the canal

Youth, swelling that follows the cord into the scrotum, pain on straining, reduction when supine, and a mass that strikes the fingertip all mark the indirect type, which travels the canal from the internal ring. Option a is incorrect because a femoral hernia appears below the inguinal ligament in the upper medial thigh and is not palpable within the canal. It also occurs mainly in women and hurts constantly. Option b is incorrect because an incisional hernia develops through the scar of an earlier operation. Nothing in this history mentions previous surgery, and the swelling clearly follows the spermatic cord into the scrotum. Option d is incorrect because the direct variety is an acquired weakness seen in men past forty, is usually painless, sits close to the pubis, and pushes against the side of the finger rather than its tip.

Correct Answer: A horizontal slit across the cervix

Vaginal delivery stretches the external os and converts it from a small round opening into a transverse slit that may look irregular or stellate after lacerations. A round os persists in the woman who has never delivered vaginally. Option a is incorrect because a small round central os belongs to the nullipara, and it also persists after cesarean birth because nothing has passed through the canal. This client delivered vaginally three times. Option c is incorrect because a red ring of columnar epithelium around the os describes cervical eversion, or ectropion. That is a normal variant seen in pregnancy and with oral contraceptives, not a marker of parity. Option d is incorrect because pallor and a shrunken cervix reflect estrogen deficiency after menopause rather than obstetric history. A pinpoint opening is not a recognized description of any normal cervical os.

Correct Answer: The outer quadrants of the breast

The pectoral or anterior group lies inside the anterior axillary fold and drains the anterior chest wall and the outer quadrants of the breast, the region closest to the tail of Spence. Option b is incorrect because the hand and forearm drain to the lateral or humeral group, which lies against the upper humerus on the inner arm. That group carries very little breast lymph. Option c is incorrect because posterior chest wall and scapular drainage belongs to the subscapular group, palpated deep inside the posterior axillary fold along the lateral border of the scapula. That node was not the one described. Option d is incorrect because supraclavicular nodes receive outflow from the whole axilla and from thoracic and abdominal structures. Enlargement there points far beyond the breast and is never explained by a pectoral node finding.

Correct Answer: Acute bacterial prostatitis of the whole gland.

Fever, chills and malaise separate acute bacterial prostatitis from every other condition in this region. The gland is swollen, boggy, warm and exquisitely tender, and Escherichia coli is the usual organism. Option a is incorrect because hyperplasia produces voiding and storage symptoms without any systemic illness. The gland is symmetrically enlarged, smooth and rubbery, and it is nontender rather than hot and inflamed. Option b is incorrect because carcinoma is not a febrile illness and typically presents with a hard asymmetric nodule. Its discriminating symptom is continuous low back, pelvic and thigh pain from skeletal metastasis. Option c is incorrect because polyps cause no systemic symptoms whatever and are usually silent until found with a scope. They neither produce urethral discharge nor make a client febrile.

Correct Answer: "Begin screening now and repeat the mammogram every two years."

The task force recommends biennial screening mammography for people at average risk from age forty through seventy-four. The American Cancer Society differs, treating forty to forty-four as optional and advising annual imaging from forty-five. Option a is incorrect because the task force sets a two-year interval rather than a yearly one and stops at seventy-four, citing insufficient evidence beyond that age. Annual imaging belongs to a different guideline. Option b is incorrect because the starting age moved down to forty in the most recent statement, replacing an earlier position that left the forties to individual decision-making. Waiting a decade is no longer advised. Option d is incorrect because that schedule belongs to the American Cancer Society rather than the task force. Both bodies agree screening should be available from forty, but only one treats the early forties as optional.

Correct Answer: Hard, irregular, fixed and nontender

Malignant masses are solitary, stony hard, irregular and poorly delineated, fixed as invasion takes mobility away, and usually painless. This client's age and the upper outer quadrant location add further weight to that picture. Option a is incorrect because a rubbery, mobile lump with dull heavy pain describes benign disease, classically fibrocystic change. In this domain pain argues for a benign process while painlessness raises concern. Option b is incorrect because a well-defined edge that an examiner can trace all the way around is a benign feature, and cancers do not wax and wane with hormonal cycling. Option c is incorrect because softness and fluctuance suggest a fluid-filled simple cyst, which enlarges premenstrually and can be aspirated. Cyclic fullness belongs to hormone-responsive tissue, not to an invasive tumor.

Correct Answer: The woman with severe pain below the ligament

A tender, constantly painful bulge below the inguinal ligament in a woman describes a femoral hernia, which passes through a narrow unyielding ring and carries the highest risk of incarceration and strangulation. It needs evaluation first. Option b is incorrect because a painless round swelling near the pubis suggests a direct inguinal hernia. Its wide neck makes strangulation unlikely, so this client can safely wait behind someone with vascular compromise. Option c is incorrect because a bulge that reduces easily still has blood supply. Reducibility is reassuring, and a hernia that comes and goes with lifting is treated on a routine surgical schedule. Option d is incorrect because mild aching after exercise carries no sign of trapped bowel. Muscular strain accounts for most such complaints, and this client can be assessed once the urgent presentation is handled.

Correct Answer: Goodell and Chadwick signs

Softening of the cervix is Goodell sign, appearing at about four to six weeks. Bluish violet discoloration of the cervix and vaginal mucosa is Chadwick sign, appearing at about eight to twelve weeks. Option a is incorrect because Hegar sign is softening of the uterine isthmus, the short segment between cervix and body, felt between the examining fingers. The record names the cervix, not the isthmus. Option c is incorrect because it accounts for the softening twice and leaves the color change unexplained. Cyanosis of the cervix and vaginal mucosa must be matched to Chadwick, which is seen rather than felt. Option d is incorrect because Tanner is not a pregnancy sign at all. Tanner staging rates sexual maturity during puberty using breast development and pubic hair pattern, and it has no bearing on gestation.

Correct Answer: Nose, checking patency one nostril at a time

The script runs eyes, ears, then nose before the mouth and throat. Nasal patency is checked one nostril at a time, because patency is a unilateral property and testing both together only proves the client is breathing. Option a is incorrect because the mouth and throat block follows the nose, not the ears. That block carries cranial nerves nine, ten and twelve, including the pharyngeal scrape and the lingual consonant phrase. Option b is incorrect because respiratory assessment is block nine and comes after the whole head and neck region is finished. Moving to the chest now would leave the nose and mouth unexamined. Option c is incorrect because head, face and neck is block four and was completed before the eyes. The trigeminal, facial and spinal accessory nerves are already finished by the time the ears are done.

Correct Answer: A thrombosed external hemorrhoid at the margin.

A shiny blue or purplish sac at the anal margin with pain on defecation is a thrombosed external hemorrhoid. A clot has formed below the dentate line, where somatic innervation makes the lesion intensely painful. Option b is incorrect because a fistula appears as one or more small external openings with purulent or serosanguineous drainage and a cord like tract beneath the skin. It follows a previous anorectal abscess. Option c is incorrect because pilonidal disease produces midline or paramedian pits in the sacrococcygeal area that may contain hair. Those pits sit at the top of the natal cleft, not at the anal opening. Option d is incorrect because rectal prolapse appears as a red, moist, doughnut shaped protrusion showing concentric rings when the client strains. Its appearance is nothing like a small blue sac at the verge.

Correct Answer: Acute epididymitis from an ascending urinary organism

Gradual onset over days, preceding dysuria, an inflamed indurated scrotum, a normally positioned testis and a preserved cremasteric reflex point to epididymitis. Past age thirty-five the usual organisms are enteric coliforms rather than sexually transmitted ones. Option a is incorrect because torsion explodes in minutes, peaks in adolescence, and abolishes the cremasteric reflex while lifting the testis into a horizontal lie. None of those features appears in this presentation. Option b is incorrect because mumps orchitis follows parotid swelling by about four to seven days and strikes postpubertal males with systemic viral illness. This man reports urinary burning and no preceding parotitis. Option d is incorrect because a germ cell tumor presents as a painless firm lump inside the testis. Redness, edema and dysuria belong to infection, and tumors do not begin with burning urination.

Correct Answer: A sixty-six-year-old whose mother had breast cancer

Age sixty-five or older is on its own a relative risk above four, the strongest ordinary risk factor. Her mother's breast cancer adds a further first-degree relative factor on top of that age risk. Option a is incorrect because never having a full-term pregnancy raises risk only modestly, into the lowest banded range. At age thirty she also lacks the accumulated age risk that dominates the table. Option c is incorrect because a personal history of ovarian cancer falls in the same modest band as nulliparity and does not approach the weight of advanced age plus an affected mother. Option d is incorrect because being slightly overweight in the late thirties is not counted as a breast cancer risk factor at all. Obesity carries weight chiefly after menopause, which this client has not reached.

Correct Answer: Retraction or lag of one breast

Raising the arms lifts the pectoral fascia and with it both breasts, which should elevate symmetrically. A breast tethered by a fibrotic Cooper ligament lags behind or shows a dimple where skin is held down. Option b is incorrect because the inframammary ridge is assessed by palpation rather than by watching the breasts move. That firm transverse band is a normal structure and arm elevation reveals nothing about it. Option c is incorrect because discharge is produced by gently compressing the nipple between thumb and forefinger at the end of palpation. Lifting the arms cannot express fluid from a duct. Option d is incorrect because axillary nodes are found by reaching high into the axilla with the client seated and her arm supported. Inspection from the front does not detect node enlargement.

Correct Answer: It enters medial to the vessels through Hesselbach triangle

The direct hernia pushes straight forward through the weak floor of the canal within Hesselbach triangle, medial to the inferior epigastric vessels, and emerges close to the pubis. It rarely reaches the scrotum. Option a is incorrect because the internal ring lies lateral to those vessels and is the doorway of the indirect hernia, following the path the testis took during descent. The direct hernia never uses that opening. Option b is incorrect because travel down the full length of the canal and into the scrotum belongs to the indirect type. A direct hernia bulges forward near the pubis and seldom descends that far. Option c is incorrect because a protrusion below the inguinal ligament beside the femoral vein is a femoral hernia. That variety is commonest in women and carries the highest risk of strangulation.

Correct Answer: "Hormonal changes can cause this, and you should be evaluated."

Gynecomastia is not a normal finding at any age. It reflects a rise in the estrogen to androgen ratio, most often from falling testosterone in an older man, and the cause should be investigated. Option a is incorrect because calling the enlargement benign and expected closes off a workup that may uncover liver disease, thyroid disease, hypogonadism, malnutrition or a causative medication. Age alone never explains it. Option c is incorrect because prostate enlargement does not produce breast tissue growth. Estrogen given as treatment for prostate cancer is a recognized cause, but the gland itself has no such effect. Option d is incorrect because weight loss addresses fatty pseudogynecomastia, which is soft and diffuse with no discrete disc. True gynecomastia is glandular growth and will not melt away with dieting.

Correct Answer: Stop palpating and obtain cultures before antibiotics.

Vigorous manipulation of an acutely inflamed prostate can force organisms into the bloodstream, so palpation stops once tenderness is established. Cultures, a full set of vital signs and prompt provider notification follow, because antibiotics are urgent. Option a is incorrect because repeated firm palpation adds nothing diagnostically once tenderness is established and may worsen the client's condition acutely. A single gentle examination is all that the bedside diagnosis requires. Option b is incorrect because prostatic massage for a post massage urine sample is considered unnecessary and possibly dangerous here, since bacteraemia can be induced. The danger remains unproved, yet no source recommends massaging an inflamed gland. Option d is incorrect because carrying on and simply charting the finding delays treatment of a client who may be septic. Documentation is necessary but never substitutes for cultures, vital signs and urgent notification.

Correct Answer: Report redness or warmth in that arm

Stagnant protein-rich lymph is a culture medium and the skin is the only barrier, so any break or early cellulitis in that arm matters. Assistive personnel report redness, warmth or fever promptly. Option a is incorrect because vigorous massage is not a delegated comfort measure for an at-risk limb and may injure fragile skin. Lymphedema management uses complete decongestive physiotherapy directed by trained clinicians. Option c is incorrect because immobilizing the limb works against the exercise that helps move lymph out of the arm. Movement combined with compression and skin care is what keeps swelling controlled. Option d is incorrect because antiseptic scrubbing dries and abrades skin that must stay intact on a limb with impaired drainage. Gentle cleansing, moisturizing and prompt care of small wounds are taught instead.

Correct Answer: The axillary tail of Spence

The axillary tail of Spence is cone-shaped breast tissue projecting superolaterally from the upper outer quadrant into the axilla, lying close to the pectoral node group. It is normal breast tissue and must be palpated. Option a is incorrect because the inframammary ridge is a firm transverse band along the lower edge of the breast, not a projection into the axilla. Beginners often mistake that ridge for a mass. Option b is incorrect because a supernumerary nipple appears along the embryonic milk line as a small mole-like spot with a tiny nipple and areola. It contains no glandular tissue and is not palpable breast tissue. Option d is incorrect because pectoral nodes lie inside the anterior axillary fold and are normally not palpable at all. Smooth continuous breast tissue running up from the quadrant is anatomy, not adenopathy.