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 A
Explanation
Choice A reason: Ventilation-perfusion (V/Q) mismatch, where lung regions receive inadequate ventilation or perfusion, is the most common cause of hypoxemia. Conditions like pneumonia or pulmonary embolism disrupt this balance, reducing oxygen exchange, making this the primary cause in clinical settings.
Choice B reason: Hyperventilation with hypocapnia lowers carbon dioxide but does not typically cause hypoxemia, as oxygen levels are usually maintained or increased. It affects acid-base balance more than oxygenation, making this an incorrect primary cause of low oxygen levels.
Choice C reason: Reduced diffusion distance is not a cause but a facilitator of gas exchange. Impaired diffusion (e.g., pulmonary edema) can contribute to hypoxemia, but V/Q mismatch is more prevalent across conditions, making this less common as a primary cause.
Choice D reason: Shunting, where blood bypasses ventilated alveoli, causes hypoxemia but is less common than V/Q mismatch. It occurs in specific conditions like congenital heart defects or ARDS, but V/Q mismatch predominates in most respiratory disorders, making this incorrect.
Correct Answer is A
Explanation
Choice A reason: Acute pancreatitis is likely, given severe abdominal pain, elevated amylase and lipase, fever, hypotension (89/46 mm Hg), tachycardia (116 bpm), and alcohol history. These are classic signs, with C-reactive protein indicating inflammation, making this the first suspected diagnosis for this patient.
Choice B reason: Cholecystitis causes right upper quadrant pain and fever but is less associated with elevated amylase/lipase or severe hypotension. Pancreatitis aligns better with the patient’s alcohol use, vital signs, and lab results, so this is incorrect as the primary suspicion.
Choice C reason: Hepatitis C may cause liver inflammation but not acute abdominal pain or elevated amylase/lipase. The patient’s acute symptoms, alcohol history, and vital signs point to pancreatitis, not a chronic viral infection, making this incorrect for the first diagnosis.
Choice D reason: Liver cirrhosis is chronic, not acute, and doesn’t typically cause sudden pain or elevated amylase/lipase. Acute pancreatitis matches the patient’s acute presentation, alcohol use, and lab findings, so cirrhosis is incorrect as the initial suspected diagnosis.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.