A client has dysfunction of the cochlear division of the vestibulocochlear nerve (cranial nerve VIII). The nurse should determine that the client is adequately adapting to this problem if he or she states a plan to obtain which item?

A pulse oximeter

A hearing aid

Eyeglasses

A bath thermometer

Answer and Explanation

The Correct Answer is B

A. A pulse oximeter is used to measure oxygen saturation and is not relevant to cochlear dysfunction.

B. A hearing aid is appropriate for someone with cochlear dysfunction as it can help amplify sound and improve hearing, indicating the client is adapting to the hearing loss.

C. Eyeglasses are used for vision problems and do not relate to the function of the cochlear division of the vestibulocochlear nerve.

D. A bath thermometer is used to measure water temperature and is not relevant to auditory

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Correct Answer is C

Explanation

A. This would show a regular rhythm with a consistent rate (60-100 bpm) and clear P waves before each QRS complex, which is not present in asystole.

B. This indicates a slow heart rate (below 60 bpm) but would still display P waves and QRS complexes; asystole shows no electrical activity.

C. This is the correct interpretation as it represents a flatline on the ECG, indicating no electrical activity in the heart.

D. This would show a rapid heart rate (above 100 bpm) with present P waves, which is not the case in asystole.

A. PICC line insertion site B. Breath sounds C. Temperature D. Heart rate

Correct Answer is ["A","C","D"]

Explanation

A. PICC line insertion site: The client reports pain, redness, and edema at the PICC line insertion site, which are signs of a possible infection. This finding requires immediate follow-up to prevent complications like bloodstream infection or sepsis.

B. Breath sounds: The client’s breath sounds are clear and unchanged from Day 1, so this finding does not require immediate follow-up.

C. Temperature: The client's temperature has risen to 39 °C (102.2 °F) from 37.2 °C (99 °F) on Day 1. Such a significant increase in temperature indicates a possible infection and needs prompt intervention.

D. Heart rate: The client’s heart rate has increased to 108/min from 66/min, suggesting tachycardia. This could be a response to infection, potentially linked to sepsis, and warrants immediate follow-up.

E. Albumin level: The albumin level has increased to within the normal range, which is a positive trend and does not require urgent intervention.

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A client has dysfunction of the cochlear division of the vestibulocochlear nerve (cranial nerve VIII). The nurse should determine that the client is adequately adapting to this problem if he or she states a plan to obtain which item?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

How should the nurse interpret the rhythm depicted in the image?

Correct Answer is C

Explanation

Select the 3 findings on day 3 that require immediate follow-up. Exhibits

Correct Answer is ["A","C","D"]

Explanation

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