A 95-year-old female presents to the emergency department with painful joints. Upon examination, you notice bumps and lumps all over her hands. What are these likely to be?
Gout tophi
Rheumatoid nodules
Osteoarthritis nodes
Carpal tunnel syndrome
The Correct Answer is C
Choice A reason: Gout tophi are urate crystal deposits, typically on joints like the big toe, not widespread on hands. Osteoarthritis nodes (Heberden’s/Bouchard’s) are more common in elderly hands, so this is incorrect.
Choice B reason: Rheumatoid nodules occur in rheumatoid arthritis, usually near elbows, not diffusely on hands. Osteoarthritis nodes are bony growths on finger joints, more likely in this patient, so this is incorrect.
Choice C reason: Osteoarthritis nodes (Heberden’s and Bouchard’s) are bony lumps on finger joints, common in elderly women with joint pain. This matches the hand findings, making it the correct diagnosis.
Choice D reason: Carpal tunnel syndrome causes wrist pain and numbness, not joint lumps. Osteoarthritis nodes explain the hand bumps in this elderly patient, so this is incorrect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Pyuria, urgency, and frequency are typical UTI symptoms, but elderly patients often present with atypical signs like confusion. Confusion is more prominent in this age group, so this is less specific and incorrect.
Choice B reason: Dysuria, frequency, and suprapubic pain are common UTI symptoms, but elderly patients may show confusion instead of classic signs. Confusion and frequency are more likely, so this is incorrect.
Choice C reason: In elderly patients (85 years), UTIs often cause confusion due to altered mental status, alongside frequency. Atypical symptoms like confusion are common, making this the correct manifestation for this age group.
Choice D reason: Hematuria and flank pain suggest complicated UTIs or kidney issues, not typical in elderly UTI presentation. Confusion and frequency are more expected, so this is incorrect.
Correct Answer is A
Explanation
Choice A reason: Pulmonary emboli are a priority in ARDS, as they can cause or worsen hypoxemia and lung injury. Emboli block pulmonary arteries, leading to ventilation-perfusion mismatch, a common ARDS trigger, making this the correct condition to assess first.
Choice B reason: Pneumonia may contribute to ARDS but is less urgent than pulmonary emboli, which can rapidly cause life-threatening hypoxia. Emboli are a more immediate concern in ARDS, so this is incorrect.
Choice C reason: Acute pulmonary edema is linked to heart failure, not a primary ARDS cause. Pulmonary emboli directly trigger ARDS’s acute lung injury, making this less critical and incorrect for priority assessment.
Choice D reason: Heart failure may cause pulmonary edema but isn’t a primary ARDS trigger. Pulmonary emboli are a more urgent cause of ARDS-related hypoxia, so this is incorrect.
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