A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. What do these findings suggest?

Macular degeneration

Increased intraocular pressure or glaucoma

Vision that is normal for someone her age

The beginning stages of cataract formation

Answer and Explanation

The Correct Answer is A

A. Macular degeneration: The loss of central vision while maintaining peripheral vision is characteristic of macular degeneration, a common age-related condition that affects the macula, the central part of the retina responsible for sharp and detailed vision. Patients with this condition often struggle with tasks that require fine visual acuity, such as reading or recognizing faces.

B. Increased intraocular pressure or glaucoma: Glaucoma typically causes peripheral vision loss rather than central vision loss. Patients may not notice changes in their vision until the disease has progressed significantly, making this option less likely given the patient's symptoms.

C. Vision that is normal for someone her age: While age-related changes in vision are common, the specific symptoms described—difficulty reading, sewing, and recognizing faces—indicate a significant problem rather than a normal aging process. Conditions like macular degeneration should be considered when central vision loss is present.

D. The beginning stages of cataract formation: Cataracts generally cause blurred vision, glare, and difficulty with night vision. They typically affect overall vision rather than causing specific central vision loss while preserving peripheral vision. Therefore, while cataracts are common in older adults, they do not align with the symptoms described in this case.

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Correct Answer is B

Explanation

A. Palm: The palm of the hand is not ideal for palpating lymph nodes because it does not provide the fine sensitivity needed to detect subtle differences in size, texture, and tenderness.

B. Pads of fingers: The pads of the fingers are the best part of the hand to use when examining lymph nodes. This part allows for precise and gentle palpation, helping the nurse assess the size, consistency, and mobility of the lymph nodes effectively.

C. Base of hand: The base of the hand is less sensitive and not suitable for palpating lymph nodes as it provides less sensitivity compared to the pads of the fingers. The base of the hand is better suited for applying pressure during broader palpation techniques It does not provide the necessary tactile feedback for a thorough examination.

D. Ulnar surface: The ulnar surface of the hand is not typically used for palpation of lymph nodes. It is less sensitive compared to the pads of the fingers and is not appropriate for this examination.

A. Whisper a set of random numbers and letters, and then ask the patient to repeat them. B. Shield the lips so that the sound is muffled. C. Stand approximately 6 feet away to ensure that the patient can really hear at this distance. D. Ask the patient to place his or her finger in their ears to occlude outside noise.

Correct Answer is A

Explanation

A. Whisper a set of random numbers and letters, and then ask the patient to repeat them: The whispered voice test is a simple and reliable screening method for hearing loss. The nurse stands about 2 feet behind the patient, whispers a series of random numbers or letters, and asks the patient to repeat them. This helps assess high-frequency hearing loss.

B. Shield the lips so that the sound is muffled: While the test is performed without the patient seeing the nurse’s lips to prevent lip reading, deliberately muffling the sound is unnecessary and may alter the accuracy of the assessment.

C. Stand approximately 6 feet away to ensure that the patient can really hear at this distance: The whispered voice test is conducted at a standard distance of about 2 feet, not 6 feet. Increasing the distance may make the test unreliable.

D. Ask the patient to place his or her finger in their ears to occlude outside noise: The test should be performed in a quiet environment, but instructing the patient to occlude their ears is unnecessary. Instead, the nurse tests one ear at a time by covering the opposite ear.

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Naxlex Comprehensive Predictor Exams

A 33 year old patient presents with complaints of enlarged lymph nodes in their neck. The nurse will use which part of the hand to examine the lymph node size?

Correct Answer is B

Explanation

In performing a voice test to assess hearing, which of these actions would the nurse perform?

Correct Answer is A

Explanation

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