1. A nurse is performing a comprehensive health assessment on a 65-yearold male patient who has a history of hypertension, diabetes, and smoking.

The nurse auscultates the patient's lungs and hears crackles in the lower

lobes bilaterally. What is the most likely cause of this finding?

a) Pneumonia

b) Asthma

c) Chronic obstructive pulmonary disease (COPD)*

d) Pulmonary edema

Rationale: Crackles are abnormal breath sounds that indicate fluid or

secretions in the alveoli. COPD is a chronic condition that causes airflow

obstruction and inflammation in the lungs, leading to mucus production

and impaired gas exchange. Smoking is a major risk factor for COPD.

Pneumonia, asthma, and pulmonary edema can also cause crackles, but

they are usually associated with other signs and symptoms, such as fever,

wheezes, and dyspnea.

2. A nurse is performing a comprehensive health assessment on a 45-yearold female patient who complains of fatigue, weight gain, and cold

intolerance. The nurse palpates the patient's thyroid gland and finds it

enlarged and firm. What is the most appropriate action for the nurse to

take next?

a) Ask the patient about her family history of thyroid disorders

b) Order a thyroid function test

c) Refer the patient to an endocrinologist*

d) Prescribe levothyroxine

Rationale: An enlarged and firm thyroid gland is a sign of goiter, which

can be caused by various thyroid disorders, such as hypothyroidism,

hyperthyroidism, or thyroid cancer. The nurse should refer the patient to

an endocrinologist for further evaluation and diagnosis, as thyroid

disorders can have serious complications if left untreated. Asking about

family history, ordering a thyroid function test, and prescribing

levothyroxine are not appropriate actions at this stage, as they do not

confirm the cause of the goiter or address the patient's symptoms.

3. A nurse is performing a comprehensive health assessment on a 25-yearold male patient who has a history of substance abuse. The nurse observes