A client asks a nurse to look at a raised lesion on the skin that has been present for about 5 years. Which is an "ABCD" characteristic of malignant melanoma?

Asymmetrical shape

Diameter less than 6mm

Color is uniform

Borders well demarcated

Answer and Explanation

The Correct Answer is A

A) Asymmetrical shape: One of the key "ABCD" characteristics of malignant melanoma is asymmetry. Melanomas often have an irregular shape where one half does not match the other, unlike benign moles, which are typically symmetrical. This characteristic helps in distinguishing malignant lesions from benign ones.
B) Diameter less than 6mm: Malignant melanomas are often larger than 6 mm in diameter, especially as they progress. While smaller lesions can still be malignant, a diameter less than 6 mm is not a distinguishing feature for melanoma. Typically, melanomas are identified as growing larger over time.
C) Color is uniform: Malignant melanomas usually exhibit multiple colors or uneven pigmentation rather than uniform color. Uniform color is more characteristic of benign moles. Melanomas can show a mix of colors, including shades of brown, black, and sometimes red or white.
D) Borders well demarcated: Malignant melanoma often has irregular, not well-defined borders. The edges of a melanoma are usually uneven or not clearly defined, unlike benign moles, which typically have smooth, well-demarcated borders.

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Correct Answer is D

Explanation

A) "Do you feel like crying often?": This question is more focused on assessing mood rather than cognitive function. While mood is an important aspect of mental health, it is not the primary focus in a neurological examination. The goal of a neurological assessment is to evaluate cognitive functions, orientation, and mental status.
B) "Do you have a history of psychotic disorder?": Asking about a history of psychotic disorders might be relevant in some contexts but does not directly assess the current mental status of the client. This question is more about past psychiatric history than current cognitive or neurological function.
C) "Can you tell me about your mood today?": While understanding a client’s mood can be valuable for overall mental health assessment, this question does not specifically assess cognitive functions or orientation. It is important to evaluate mood, but it is not the primary question for assessing neurological status.
D) "Can you tell me where you are right now?": This question is appropriate for assessing orientation, a key component of a neurological examination. Orientation questions assess a person's awareness of their current environment, which helps evaluate their cognitive function and mental status. This is directly relevant to a neurological assessment as it determines if the client is aware of their surroundings, which is crucial for understanding cognitive and neurological function.

A. 20 represents the distance a normal eye can read and 40 represents the distance your eye read the chart. B. 20 represents the distance you are placed from the chart and 40 represents the distance a normal eye read the chart. C. 20 represents the distance you are placed from the chart and 40 represents the distance your eye read the chart. D. 40 represents the distance you are placed from the chart and 20 represents the distance normal eye read the chart.

Correct Answer is B

Explanation

A) 20 represents the distance a normal eye can read and 40 represents the distance your eye read the chart: This option incorrectly reverses the interpretation of the numbers. The correct interpretation is that the first number represents the distance at which the patient is reading the chart, and the second number represents the distance at which a person with normal vision would be able to read the same line.
B) 20 represents the distance you are placed from the chart and 40 represents the distance a normal eye read the chart: This is the correct interpretation of visual acuity. In the Snellen chart system, the first number (20) represents the distance (in feet) from which the patient is viewing the chart, while the second number (40) represents the distance at which a person with normal vision (20/20) would be able to read the same line of the chart.
C) 20 represents the distance you are placed from the chart and 40 represents the distance your eye read the chart: This option is incorrect because it does not accurately describe what the numbers mean. The second number represents the distance at which normal vision can read the line, not the distance the patient’s eye read the chart.
D) 40 represents the distance you are placed from the chart and 20 represents the distance normal eye read the chart: This option incorrectly assigns the numbers. The distance of 20 feet is standard for testing vision, and 40 feet is the benchmark for normal vision. The correct understanding is that 20 is the test distance, and 40 is the comparison distance for normal vision.

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A client asks a nurse to look at a raised lesion on the skin that has been present for about 5 years. Which is an "ABCD" characteristic of malignant melanoma?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When the nurse is assessing a client's mental status as part of the neurological examination, which question would be most appropriate to ask?

Correct Answer is D

Explanation

A nurse is performing a complete physical examination on a patient. After examining the patient with the Snellen chart, the nurse documented distance vision in both eyes 20/40. The patient asks the nurse what 20/40 means:

Correct Answer is B

Explanation

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