A family member brought a senior to the clinic. The family member explained to the nurse that the patient suddenly from one day to the other, started with confusion, and agitation. The family states the patient used to be orientated and with very calm behavior. The nurse suspects that this patient is experiencing:

Delirium

Sundowning

Alzheimers

Dementia

Answer and Explanation

The Correct Answer is A

A. Delirium: Delirium is characterized by a sudden onset of confusion, agitation, and fluctuating levels of consciousness. It often develops over a short period, such as hours to days, and is typically associated with an underlying medical condition, medication, or infection. The patient's rapid change from being oriented and calm to confused and agitated suggests a sudden onset, which is indicative of delirium.
B. Sundowning: Sundowning refers to a pattern of increased confusion and agitation that occurs in the late afternoon or evening, primarily in individuals with dementia. While it involves fluctuations in mental status, it does not usually present with a sudden onset of symptoms as described in this case.
C. Alzheimer’s: Alzheimer’s disease is a form of chronic dementia characterized by gradual and progressive cognitive decline over months to years. The sudden onset of confusion and agitation does not align with the gradual progression typical of Alzheimer's disease.
D. Dementia: Dementia is a general term for a decline in cognitive ability that affects daily life, usually developing gradually over time. Unlike delirium, dementia does not present with a sudden change in behavior or mental status, making it less likely in this scenario where the change was abrupt.

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Correct Answer is C

Explanation

A) Pectoralis major tear: A tear of the pectoralis major muscle would likely cause pain and weakness, particularly in activities involving pushing or lifting. While it may affect shoulder movements, it is less likely to specifically impair the ability to reach behind the back and touch the shoulder blade compared to rotator cuff issues.
B) Arthritis: Arthritis, particularly osteoarthritis, can cause decreased range of motion and pain in the shoulder joint. However, the specific movement described—placing one hand behind the back to touch the shoulder blade—is most commonly affected by issues with the rotator cuff rather than arthritis alone.
C) Rotator Cuff Tendinitis: Rotator cuff tendinitis is a common cause of shoulder pain and decreased range of motion, particularly affecting movements that require lifting the arm or reaching behind the back. Tendinitis in the rotator cuff can lead to pain and difficulty performing the movement described due to inflammation and impingement of the tendons.
D) Gout: Gout is a type of arthritis caused by the accumulation of uric acid crystals in the joints, often affecting the big toe but can affect other joints. While it can cause joint pain and inflammation, it is less likely to specifically impair the shoulder movement described compared to rotator cuff tendinitis.

A. Egophony B. normal voice transmission. C. Air filled lungs D. Bronchophony

Correct Answer is A

Explanation

A. Egophony: Egophony is a type of abnormal voice sound transmission where the letter "E" is heard as an "A" when auscultated through a stethoscope. This can indicate underlying lung pathology, such as consolidation or infection, that alters the way sounds are transmitted through the lung tissue.
B. Normal voice transmission: Normal voice transmission would involve hearing the letter "E" clearly and accurately as the patient says it, without distortion. The presence of an "A" sound indicates an abnormal finding, not a normal one.
C. Air-filled lungs: Air-filled lungs typically transmit voice sounds clearly and normally. If the sound changes to an "A," this suggests a pathology that alters sound transmission, rather than indicating simply air-filled lungs.
D. Bronchophony: Bronchophony refers to the increased clarity of spoken sounds heard through the stethoscope over areas of lung consolidation, but it does not specifically describe the transformation of the letter "E" to "A." The specific change in sound transmission described here is characteristic of egophony.

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Naxlex Comprehensive Predictor Exams

The nurse asks the client to "place one hand behind the back and touch the shoulder blade" in the position shown. The patient explains he cannot perform the movement. What MOST likely is causing the patient decreased range of motion (ROM) in this joint?

Correct Answer is C

Explanation

During a respiratory physical assessment, the nurse directs the patient to say and repeat the letter E for the transmitted voice sounds assessment. The nurse by auscultation hears the letter A instead of E. This is known as:

Correct Answer is A

Explanation

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