Sensory Perception

A charge nurse is discussing hearing tests with a newly licensed nurse. Which of the following information should the charge nurse include?

A tuning fork is placed against the client's mastoid bone during the Rinne test.

A nurse is providing teaching about safe ambulation to a client who has vision loss. Which of the following items should the nurse include in the teaching? (Select all that apply.)

A walking cane A walker

A nurse is teaching a group of older adult clients about the sensory system. The nurse should include that the aging process is most likely to cause which of the following changes?

Hearing loss

A nurse is providing discharge teaching to a client who has diabetic neuropathy. Which of the following information should the nurse include? (Select all that apply.)

Inspect the feet every day. Wear closed-toe shoes. Manage glucose levels.

A nurse is preparing to administer medications to a client. Which of the following classifications of medications should the nurse identify as being ototoxic? (Select all that apply.)

Loop diuretics NSAIDS Aminoglycoside antibiotics

A client is discussing an audiometer test with a client. Which of the following statements should the nurse make?

"You will wear headphones during the test"

A nurse is caring for a client who reports decreased peripheral vision. The nurse should identify this as a manifestation of which of the following visual impairments?

Glaucoma

A nurse is caring for a client who reports a recent change in smell and taste. Which of the following actions should the nurse take?

Ask the client about any recent illnesses or injuries

Inflammation in or the accumulation of fluid in the middle ear and can result in conductive hearing loss.

Otitis media

A nurse is caring for a middle adult client who asks about expected age-related changes. Which of the following sensory changes should the nurse include as an age-related change?

Presbyopia

A nurse is preparing a poster presentation about sensory alterations. Which of the following information should the nurse include about sensory deprivation?

Risk factors for sensory deprivation include experiencing total vision or hearing loss.

A deficit in the expect function of one of more of their five senses?

Sensory deficit

The experience of hearing sound when no external sound is present; generally caused by age-related hearing loss, an ear injury, cerumen (ear wax) blockage, or a problem with the circulatory system.

Tinnitus

A nurse is reviewing the medical history of a client who has conductive hearing loss. The nurse should identify which of the following factors as a potential cause of conductive hearing loss? (Select all that apply.)

Trauma to the outer ear Inflammation Cerumen buildup Otitis media

A disorder that affects a clients ability to articulate and understand speech and written language

aphasia

A test that determines how effectively vibrations are transmitted through the ossicles.

bone oscillator test

Clouding of the lens of the eye that causes the clients vision to be blurry, hazy, or less colorful

cataracts

A syndrome that has a rapid onset and causes a disturbance in mental ability resulting in confused thinking and reduced awareness of the environment

delirium

Occurs over time from elevated blood glucose and triglyceride levels; nerve damage and loss of sensation in the lower extremities

diabetic neuropathy

The leading cause of blindness in adults

diabetic retinopathy

An increase in intraocular pressure due to the buildup of fluid, or aqueous humor, that causes compression of the optic nerve.

glaucoma

Abnormal growth of bone in the middle ear that can cause conductive hearing loss.

otosclerosis

A disorder where a nonexistent smell is perceived

phantosmia

Loss of hearing that occurs due to aging

presbycusis

A nurse is reviewing the process of how a refraction assessment is performed with a client. Which of the following statements should the nurse make?

"This test is performed using lenses of various prescription strengths."

A nurse is caring for a client who is scheduled for an otoacoustic emissions (OAE) test. The client asks what to expect during the test. Which of the following responses should the nurse make?

"You will have a small probe placed in your ear canal during the test."

A nurse is preparing an in-service for a group of staff members about types of tests used to diagnose sensory impairments. Which of the following information should the nurse include?

A bone oscillator test measures how efficiently sound waves are transmitted through the ossicles.

A nurse is providing care for a client who has a sensory deficit. Which of the following actions is the nurse's priority for the client?

Keep the client's environment free from clutter.

A nurse is preparing to perform a cranial nerve assessment on a client. Which of the following actions should the nurse take to assess cranial nerve VIII?

Whisper something in one ear while occluding the other ear.

A nurse is caring for a client who states, "My doctor said I should have an EMG. What is that?" Which of the following responses should the nurse make?

"It is a test that determines if there is nerve damage affecting a muscle."

A charge nurse is discussing sensory processing disorder (SPD) with a newly licensed nurse. Which of the following statements should the charge nurse make?

"SPD causes clients to be overly sensitive to stimuli, such as the feel of fabric on their skin."

A nurse is reviewing the medical record of a client who reports recent anosmia. The nurse should identify which of the following conditions as a risk factor for developing anosmia?

Alzheimer's disease

A nurse is assessing a client for hearing loss. Which of the following findings should the nurse identify as an indication of a possible hearing loss? (Select all that apply.)

Asks for questions to be repeated Withdraws from social activities Describes sounds as being muffled

A nurse is reviewing discharge instructions with a client who has macular degeneration. Which of the following information should the nurse include in the instructions?

Availability of aids to enhance vision

A nurse is preparing to perform a cranial nerve assessment on a client. Which of the following actions should the nurse take to assess cranial nerve II?

Check the client's visual acuity using a Snellen chart.

A nurse is assessing a client who has delirium. Which of the following manifestations should the nurse expect? (Select all that apply.)

Difficulty maintaining attention Agitation Hallucinations Rambling speech

A nurse is assessing a client whose family is concerned that the client has developed dementia. Which of the following findings should the nurse identify as a manifestation of dementia?

Difficulty problem-solving

A condition in which a foul, salty, or metallic taste occurs in the mouth.

Dysgeusia

A nurse is caring for a client who has hearing loss. Which of the following actions should the nurse use to enhance communication with the client? (Select all that apply.)

Ensure the client wears their hearing aids. Use a sign language interpreter. Communicate using paper and pen. Face the client when speaking.

A nurse is caring for a client who has a visual impairment. Which of the following interventions is the nurses priority?

Ensure the clients safety

The most common type of hearing loss; occurs from problems either in the inner ear or on the vestibulocochlear (auditory) nerve (cranial nerve VIII)

Sensorineural hearing loss (SNHL)

A nurse is caring for an older adult client who reports unintended weight loss. The client reports that their food does not taste right. The nurse should inform the client that ability to taste which of the following can decrease with age? (Select all that apply.)

Sour Bitter Salty