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 D

Explanation

A. Thought content: The four unrelated words test does not assess thought content, which refers to the patient’s ideas, beliefs, and perception of reality. Thought content is typically evaluated through direct questioning and observation of the patient’s speech patterns and behaviors.

B. Attention span: Attention span is assessed by evaluating the patient's ability to concentrate on simple tasks, such as following a set of instructions or completing a short mental exercise. The four unrelated words test is not designed to measure attention span directly.

C. Distant memory: Distant memory refers to the recall of events or information from the past, such as childhood experiences or historical events. The four unrelated words test assesses recent recall rather than distant memory.

D. New memory: The four unrelated words test evaluates the ability to form and retrieve new memories. The nurse provides the patient with four unrelated words, asks them to recall them after a few minutes, and reassesses recall at intervals. Impairments in new memory recall can indicate cognitive deficits seen in conditions like dementia or head trauma.

A. Behind with the nurse's hands placed firmly around his neck B. Behind with hands placed on throat C. The front with the nurse's thumbs placed on either side of his trachea and his head tilted forward D. Have the patient perform the exam

Correct Answer is C

Explanation

A. Behind with the nurse's hands placed firmly around his neck: This approach may be perceived as threatening or invasive, potentially increasing the patient's apprehension and discomfort. It is important to maintain a respectful and gentle approach, especially when working with a patient who may already feel uneasy.

B. Behind with hands placed on throat: Similar to option A, examining from behind and placing hands on the throat may cause anxiety and discomfort for the patient, particularly if they are not familiar with the procedure. This method does not provide a clear line of sight or reassurance for the patient.

C. The front with the nurse's thumbs placed on either side of his trachea and his head tilted forward: This technique is the most appropriate approach for examining the thyroid gland. Positioning the patient in front allows for better communication and visibility. Placing the thumbs on either side of the trachea is a standard method for palpating the thyroid, and having the patient tilt their head forward can help relax the neck muscles, making the examination more comfortable. Additionally, this approach allows the nurse to explain the procedure more easily, even with language barriers.

D. Have the patient perform the exam: While patient involvement in their care can be empowering, asking the patient to perform the exam may not be appropriate for a thyroid examination, as the nurse must assess the gland's size, consistency, and any potential nodules. This approach may also lead to further anxiety for the patient, who may not know how to perform the exam correctly.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse understands that the four unrelated words test provides information related to which cognitive function?

Correct Answer is D

Explanation

A visitor from Poland who does not speak English seems to be somewhat apprehensive about the nurse examining his neck. How should the nurse proceed that would allow the patient to feel more comfortable with the nurse examining his thyroid gland?

Correct Answer is C

Explanation

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

Which of the following tests could be used to assess the acoustic nerve? (Select All that Apply.)

The nurse is testing a patient's visual accommodation. How is accommodation assessed?

The nurse is preparing to assess the visual acuity of a 16-year-old patient for a routine physical. How should the nurse proceed?

Which of the following are the PRIMARY muscles of respiration? (Select All that Apply.)

The direction of blood flow through the heart is best described by which of these?

The nurse is listening to the breath sounds of a patient with severe asthma. Air passing through narrowed bronchioles would produce which of these adventitious sounds?