sensory perception prep u

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?

"I will use Visine drops in his infected eye to help reduce redness."

Which statement describes benign paroxysmal positional vertigo (BPPV)?

The vertigo is usually accompanied by nausea and vomiting.

The client tells a nurse that "many voices in his head are telling him what he should do." The nurse thinks he may be experiencing:

a hallucination.

A nurse is assessing a newborn's reflexes. The nurse places his or her thumb to the ball of the newborn's foot to elicit which reflex?

plantar grasp

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as:

Acute angle-closure.

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate?

Alternatively patch one eye every 2 hours.

The nurse is preparing a care plan for the school-age child with a congenital hearing loss of 60 to 80 dB. Which nursing diagnoses should the nurse include on the care plan for this child?

Delayed growth and development Risk for injury Impaired verbal communication

Which terms refers to the progressive hearing loss associated with aging?

Presbycusis

The nurse is assessing a client's hearing using the Rinne test. When providing instruction to elicit client feedback, which instruction is essential?

Raise your hand when you no longer hear sound.

A nurse is working on a neurological unit with a nursing student who asks the difference between primary and secondary headaches. The nurse's correct response will include which of the following statements?

"A secondary headache is associated with an organic cause, such as a brain tumor."

The nurse is educating a client who has been prescribed atropine, an anticholinergic drug. Which instructions should the nurse provide to the client?

"Do not drive or operate machinery."

A 69-year-old client comes to the clinic for a routine checkup. Upon examination, the nurse practitioner informs the client that she has cataracts. The client then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner?

"Surgery is the only effective treatment for cataracts."

A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."

A client reports being struck in the eye by flying debris falling off a building being demolished. Following fluorescein staining and use of biomicroscope, it is determined the eye has an injury to the Bowman membrane and stromal layer. Which explanation should the nurse provide to the client regarding the extent of this injury?

"Your eye will heal slower with scar formation that impairs the transmission of light to some extent."

The nurse obtains a Snellen eye chart when assessing cranial nerve function. Which cranial nerve is the nurse testing when using the chart?

CN II

A patient has been diagnosed with bacterial conjunctivitis that was sexually transmitted. The nurse informs the patient that the isolated organism is which of the following?

Chlamydia trachomatis

The nurse assesses that her client has olfactory disturbances. Which of the following health topics would be important to teach the client?

Eliminating disturbing odors with adequate ventilation

A client is admitted to the intensive care unit. Which way can the nurse decrease sensory overload in this unit?

Explain unfamiliar procedures to the client.

Vitreous humor occupies the posterior portion of the eyeball. It is an amorphous biologic gel. When liquefaction of the gel occurs, as in aging, what can be seen during head movement?

Floaters

The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis?

Localized calf tenderness

A client is color blind. The nurse understands that this client has a problem with

cones

An 18-month-old infant is brought to the emergency room and the nurse notes a strong camphor-like smell. What should the nurse do first?

Determine the type of ingestion.

As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response?

Cranial nerve III

A nurse is caring for a client who is nursing her baby boy. The client reports afterpains. Secretion of which substance would the nurse identify as the cause of afterpains?

oxytocin

The nurse is caring for a client diagnosed with labyrinthitis. The nurse explains that manifestations of this disorder are generally expected:

to resolve in 10 to 14 days.

A nurse is educating a client recently diagnosed with early glaucoma. Which client statement indicates further teaching is necessary?

"I will take my latanoprost eye drops as soon as I start to feel pain."

The oncology nurse is caring for a client receiving chemotherapy. Which of the following statements would be a priority assessment for the nurse?

"Have you been experiencing any strange tastes or aftertastes lately?"

Which of the following nursing intervention can prevent a client from experiencing autonomic dysreflexia?

monitoring the patency of an indwelling urinary catheter

What assessment findings would the nurse expect in a client with progressive myasthenia gravis?

muscle weakness, difficulty swallowing, double vision, and difficulty speaking

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?

the costovertebral angle

The Eustachian tube connects the nasopharynx and the middle ear. In infants and children with abnormally patent tubes, what enters the Eustachian tube when the infant or child cries or blows his or her nose?

Air and secretions

A client who has a fractured ankle is complaining of knee and hip pain. What is the most likely cause of these symptoms?

All nerves that cross articulations innervate each joint of an extremity.

A client has blindness in the right eye. The nurse documenting in the electronic medical record would use which term for blindness in one eye?

Anopia

A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."

Two days after surgery to amputate the left lower leg, a client states that they have pain in the missing extremity. There is an existing prescription for PRN pain medication. Which action by the nurse is most appropriate?

Administer medication for the reported discomfort.

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response?

"I will report this to the pediatrician.

While working at the triage desk in the local emergency department, which client is likely having a medical emergency and needs to be seen first?

55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision

A client with visual agnosia due to extensive damage to the visual association cortex is learning how to cope with this impairment. What should the nurse prioritize in teaching this client?

Applying touch and sound when interacting in the environment will lessen the deficits of visual agnosia.

Braxton Hicks contractions are termed "practice contractions" and occur throughout pregnancy. When the woman's body is getting ready to go into labor, it begins to show anticipatory signs of impending labor. Among these signs are Braxton Hicks contractions that are more frequent and stronger in intensity. What differentiates Braxton Hicks contractions from true labor?

Braxton Hicks contractions usually decrease in intensity with walking.

A 64-year-old client comes to the clinic for a routine checkup and, while talking to the nurse, discusses some recent vision problems. Upon examination the nurse notices that the client's lenses are yellow. The client further states there have been problems with color discrimination as well as distance vision. What should the nurse suspect as the diagnosis for this client?

Cataracts

A client presents to the emergency department following an accident where he fell off a chair. The client reports initial hip numbness followed by increasing pain and muscle cramping. Which type of injury does the triage nurse suspect?

Closed hip fracture

The nurse is caring for a client who suffered a stroke 3 days ago and is assessing the client's state of arousal. Which is the best way to determine the client's level of being alert and responding appropriately to the environment?

Collecting mental status data, including level of consciousness, orientation, attention span, memory, and cognitive skills.

A client is waiting in a triage area to learn the medical status of family members following a motor vehicle accident. The client is pacing, taking deep breaths, and handwringing. Considering the effects in the body systems, what does the nurse anticipate the liver will do?

Convert glycogen to glucose for immediate use.

When a client reports that he feels like he is spinning but the room is stable, the nurse should document the finding as:

Subjective vertigo

The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as:

The withdrawal reflex is activated.

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur?

Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.

The nurse is testing the client's neurological status. Which action will the nurse take to assess the client's sense of touch?

Touch the temple with a cotton ball so the client can identify where being touched and if the touch is soft or sharp

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with

abnormal sensations.

The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be:

administration of topical beta-adrenergic antagonists to lower the pressure.

A client who is paraplegic cannot feel the lower extremities and has been positioned on the side. The nurse should inspect which area that is a potential pressure point when the client is in a side-lying position?

ankles

A client develops fever, headache, and burning/itching in the periorbital area. After a few days, a vesicular rash appears around the eyelid margins. The health care provider will likely prescribe:

antiviral medication for herpes zoster ophthalmicus.

A 5-year-old child is brought to the emergency department after injuries sustained in a motor vehicle accident. The child is diagnosed with a cervical spinal cord injury. Which assessment data would the nurse consider as most significant when assessing for signs of cervical spinal cord swelling?

changes in respiration

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?

headache following anesthesia

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion?

prevention and treatment of otitis media

The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS?

Decrease anxiety and fear during hospitalization and painful procedure.

A male client is admitted with a spinal injury that has damaged his sacral plexus. The nurse understands that this type of injury could affect the impulse stimulation for initiating the sexual act through which organ?

Glans penis

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse?

It involves unexplained, usually sudden, deficits in sensory or motor function.

The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack?

Meclizine (Antivert)

With eyes closed, an object is placed in a student's hand. The instructor asks the student to identify the object. When he does so correctly, this is primarily the responsibility of:

Meissner corpuscles

A client who is being treated in the critical care unit is experiencing a slowing of blood flow to the central retinal artery, ultimately resulting in edema of the client's optic papilla. Which assessment would most likely address the etiology of this health problem?

Monitoring of the client's intracranial pressure

The nurse is caring for a client with a spinal cord injury who has no awareness of the need to void. The nurse should document that the client has which type of incontinence?

Reflex (neurogenic) incontinence

What is the common cause of ectropion?

Relaxation of the orbicularis oculi muscle related to CN VII weakness

The nurse is instructing the client with dried cerumen blocking the ear canal on potential methods to reduce symptoms. Which at-home methods of cerumen removal are discouraged?

Removing the cerumen by means of a cotton tip applicator

Which symptoms would support the diagnosis of a stroke involving the posterior cerebral artery?

Repeating of verbal responses Loss of central vision

A client with migraines asks the nurse about symptoms of an aura. Which manifestations are characteristic of a migraine aura?

Seeing flickering lights or spots Feeling numbness in fingers Slurred speech

During his annual physical examination, a retired airplane mechanic reports noticeable hearing loss. The nurse practitioner prescribes a series of hearing tests to confirm or rule out noise-induced hearing loss, which is classified as a:

Sensorineural loss.

The nurse teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response?

The child is using the scale to predict what they would like, not what the child has.

A client seeks medical care when he wrecks his car because of poor eyesight. At the time of admission, his blood glucose level was 390 mg/dL. The client is diagnosed with diabetes (type 2). The ophthalmologist must perform an urgent intravitreal injection. The nurse explains this to the client by stating the doctor will:

put a needle with syringe into your eyeball and inject some medication to decrease active bleeding.

A nursing student is preparing a class for new mothers about adaptations they can expect in their newborns. Which information about newborn vision should the student include in the presentation?

Newborns have the ability to focus only on objects in close proximity.

A client presents to the emergency department stating numbness and tingling occurring down the left leg into the left foot. When documenting the experience, which medical terminology would the nurse be most correct to report?

Paresthesia

A client reports feeling a tingling sensation in the last two fingers of one hand after hitting the inner surface of the elbow on a desk. What is the cause of this symptom?

Paresthesia from temporary nerve compression

An adolescent is brought to the emergency department after being injured during a baseball game. The adolescent reports significant ankle pain, rating it as 8 on a scale of 0 to 10. Based on the nurse's understanding of pain impulses, the nurse would identify the adolescent's pain as reflecting which type of pain?

somatic

A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents?

some discomfort at the surgery site

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first?

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

Fentanyl has been administered to a client in labor. What assessment should the nurse prioritize?

Respiratory status