49

A patient has reduced sensation in the extremities. What maximum temperature setting on the home water heater would be correct for this patient? Record your answer using a whole number. ___ ° F

120

In which condition does alteration of tactile sensation occur because of the pressure on the median nerve?

Carpal tunnel syndrome

The nurse is caring for a patient with reduced olfaction. Which instruction would be included in the nurse's teaching to promote safety? Select all that apply. One, some, or all responses may be correct.

Check food package dates Keep leftovers in labeled containers Use smoke detectors

A patient who has vision and hearing problems has a history of striking out at caregivers. Which nursing intervention is most appropriate?

Get the patient's consent before starting care

A 74-year-old patient who has returned to the nursing home after surgical removal of bilateral cataracts reports feeling a little uncertain about walking alone. Which approach would the nurse use to assist the patient with ambulation?

Have the patient grasp your arm just above the elbow and walk at a comfortable pace

A patient has been on contact isolation for 4 days because of a gastrointestinal infection. Which nursing measure will reduce sensory deprivation? Select all that apply. One, some, or all responses may be correct

Helping him to a chair or bringing a flower into the room istening to his feelings and perceptions

A patient has an inability to understand language or communicate orally. Which type of aphasia is the patient experiencing?

global

Which condition is defined as a hypersensitivity to tactile stimuli?

hyperesthesia

Which symptom is associated with dry eyes? Select all that apply. One, some, or all responses may be correct.

itching burning reduced vision

On assessment, the nurse finds that the patient has blurred vision, loss of central vision, and distortion of vertical lines. Which visual deficit is likely to be found in the patient?

macular degeneration

While assessing a newly admitted patient, the nurse realizes that the patient has a progressive hearing disorder. How would the nurse document this condition

presbycusis

An elderly patient reports to the nurse, "I have a difficult time clearly seeing objects that are close to me. However, I can clearly see objects at a distance." Which diagnosis does the nurse anticipate in the patient?

presbyopia

The home-health nurse visits a patient who has vision impairment. The nurse assesses his house and comes across a few things that are dangerous for this patient. Which factor in the patient's home environment may pose a danger to the patient's safety? Select all that apply. One, some, or all responses may be correct

Loose rugs placed over carpets A lack of handrails on the stairs A bathroom without shower or tub grab bars

The nurse is performing a physical assessment of an older adult. Which age-related hearing change is the nurse likely to find? Select all that apply. One, some, or all responses may be correct.

Low-pitched vowels are easily heard. Hearing acuity is decreased. Discrimination of consonants becomes difficult.

When communicating with a patient who has expressive aphasia, which strategy is priority for the nurse?

Offering pictures or a communication board so the patient can point

The nurse is assessing a child for auditory function. Which behavior of the child indicates a hearing impairment? Select all that apply. One, some, or all responses may be correct.

Slow development of speech Failure to be awakened by loud noise Frightened when unfamiliar people approach

On a home visit, the nurse finds that a patient has sensory impairment. Which environmental factor can increase the risk of falls for the patient? Select all that apply. One, some, or all responses may be correct.

Stairways without lamps Lack of handrails Phone cords in the main route of walking

The nurse is planning to conduct a hearing acuity test on a patient. Which activity would the nurse use to assess this sensory function? Select all that apply. One, some, or all responses may be correct.

Use the spoken word test. Observe the patient's behavior in a group. Use the tuning fork test

The medical record of an older adult reveals a stroke affecting the right hemisphere of the brain. Which assessment finding would the nurse expect to find? Select all that apply. One, some, or all responses may be correct.

Visual spatial alterations such as loss of half of a visual field Inattention and neglect, especially to the left side Difficulty with speech

An 82-year-old man tells the nurse that he is having difficulty hearing and that he has "too much earwax." Considering the patient's age, which question would the nurse ask?

"Have you ever experienced impacted earwax?"

A visually impaired patient presents to the clinic with knee pain. The nurse decides to assess the patient's visual sphere. Which question would the nurse include? Select all that apply. One, some, or all responses may be correct.

"Have you tried to correct your vision?" "Do you use any device to correct your vision?" "What problem do you have with your vision?"

The nurse is conducting discharge teaching for a patient with diminished tactile sensation. Which statement by the patient would indicate that additional teaching is needed?

"I have right-sided partial paralysis, so I should dress the left side of my body first."

In which condition is the use of hearing aids contraindicated? Select all that apply. One, some, or all responses may be correct.

A chronic feeling of dizziness Visible cerumen accumulation Traumatic deformity of the ear

Which information can be obtained from the Mini-Mental State Examination (MMSE)? Select all that apply. One, some, or all responses may be correct.

Abstract thinking measurement Orientation status of the patien Changes in problem-solving ability

Which strategy does the nurse use when communicating with a hearing-impaired patient? Select all that apply. One, some, or all responses may be correct.

Avoid eating or chewing while speaking. Use a normal tone of voice and normal inflections of speech. Use written information to enhance the spoken word.

The nurse is caring for a patient who wears corrective contact lenses. Which advice would the nurse provide the patient to prevent eye infections? Select all that apply. One, some, or all responses may be correct.

Avoid swimming while wearing contact lenses. Prevent contamination of the lens' storage case.Use appropriate solutions for disinfection.

The nurse is assessing a patient for tactile sensation. Which patient behavior indicates reduced tactile sensation? Select all that apply. One, some, or all responses may be correct.

Avoidance of touch by the patient Increased body odor in the patient Failure to respond to the sensation of needles

The nurse is performing a routine checkup of a pregnant woman. Which nursing intervention is helpful in preventing hearing impairment in the fetus? Select all that apply. One, some, or all responses may be correct.

Avoiding the use of ototoxic drugs Screening for rubella in the woman Testing for syphilis in the woman

While assessing a patient, the nurse realizes that the patient has a progressive hearing disorder and is visually impaired. Which effect can these sensory deprivations cause for the patient? Select all that apply. One, some, or all responses may be correct.

Boredom Disorientation Poor task performance

After an assessment, the nurse finds that a patient has reduced tactile sensation. How does the nurse improve the patient's tactile sensation?

By providing touch therapy to the patient

A patient is unable to conduct normal activities because of visual impairment. Which precaution could the family members take to help the patient perform normal activities? Select all that apply. One, some, or all responses may be correct.

Correct1 Remove clutter from the floor. Keep all flooring in good repair. Use low-pile carpeting in the home

The nurse is taking care of two patients with hearing impairments. Which precaution would the nurse take while communicating with these patients? Select all that apply. One, some, or all responses may be correct.

Ensure that the patients keep their eyeglasses clean. Use written information to enhance or supplement spoken communication. Keep the patient's hands free to allow communication through hand gestures

Which proprioceptive change is observed in older adults?

Increased difficulty with balance

The nurse is performing an assessment on a patient admitted to the emergency department with eye trauma. Which intervention would be the nurse's priority? Select all that apply. One, some, or all responses may be correct.

Orienting the patient to the environment to reduce anxiety and prevent further injury to the eye Placing necessary objects such as the call light and water in front of the patient to prevent falls because of reaching

The community health nurse is educating a group of parents on ways to avoid eye trauma. Which instruction would the nurse include? Select all that apply. One, some, or all responses may be correct.

Promote the use of safety equipment. Avoid the use of toys with pointed projections. Instruct the children not to run while carrying pointed objects

A junior nurse is caring for a patient in the intensive care unit (ICU). She finds that the patient is restless, anxious, and inattentive. The nurse understands that the patient is experiencing sensory overload. Which measure would the nurse take to make the patient comfortable? Select all that apply. One, some, or all responses may be correct.

Provide constant reorientation. control excessive stimuli.

A patient with a history of a hearing deficit comes to the medical clinic for a routine checkup. His wife died 2 years ago, and he admits to feeling lonely much of the time. Which intervention can the nurse use to reduce loneliness? Select all that apply. One, some, or all responses may be correct.

Providing information about local social groups in the patient's neighborhood Recommending that the patient consider making living arrangements that will put him closer to family or friends Introducing the idea of bringing a pet into the home

Which normal visual change is associated with aging? Select all that apply. One, some, or all responses may be correct.

Reduced visual fields Impaired night vision Reduced color discrimination

The nurse is teaching health promotion tips to an elderly patient with presbycusis. Which nursing action ensures effective communication? Select all that apply. One, some, or all responses may be correct.

Sitting at the same level while communicating with the patient Avoiding eating while communicating with the patient Speaking slowly and articulating sentences clearly

During an assessment, the nurse finds that a patient is able to express words but is unable to understand questions. What is the probable reason for this?

The patient has receptive or sensory aphasia

The nurse is performing a home care assessment on a patient with a hearing impairment. The patient reports, "I think my hearing aid is broken. I can't hear anything." Which teaching strategy used by the nurse would indicate that the patient needs additional instruction?

Turning hearing aid dial to a minimum setting

The nurse visits an elderly patient who has sensory alterations because of aging. The patient has impaired vision, impaired proprioception, and impaired sense of touch. The nurse observes the patient's home environment for the presence of hazards that could increase the risk of injury to the patient. Which item might increase the patient's risk of injury and should be changed? Select all that apply. One, some, or all responses may be correct.

Uneven, cracked walkways leading to the front or back door Loose area rugs and runners placed over carpeting Extension cords and phone cords in the main route of walking traffic

The nurse is caring for an older patient with glaucoma. When developing a discharge plan, which intervention enables the patient to function safely with existing deficits and continue a normal lifestyle?

Work closely with the patient to identify ways to modify his or her home environment, and refer the patient to appropriate community-based resources.

Which medicine may cause irritation of the optic nerve?

chloramphenicol

A patient comes to the clinic with knee pain. The patient is accompanied by his grandson because the patient has some degree of visual impairment. Which assessment finding will help determine that the patient is having difficulty seeing? Select all that apply. One, some, or all responses may be correct.

squinting overreaching for object Accidental falls