A client is being admitted with a working diagnosis of acute otitis media. Upon a middle ear assessment with an otoscope, which finding is Inconsistent (pertinent negative) with this diagnosis?
pearly gray tympanic membrane
erythema tympanic membrane
edema of the tympanic membrane
bulging of the tympanic membrane
The Correct Answer is A
A) Pearly gray tympanic membrane: A healthy, normal tympanic membrane (eardrum) typically appears pearly gray and translucent. In the case of acute otitis media (AOM), the tympanic membrane usually appears erythematous (red) due to inflammation and may be bulging or swollen. A pearly gray tympanic membrane would be inconsistent with the diagnosis of acute otitis media, as it suggests a lack of infection or inflammation.
B) Erythema tympanic membrane: Erythema, or redness, of the tympanic membrane, is a common finding in acute otitis media. The inflammation from the infection causes the membrane to appear red or inflamed. This finding is consistent with the diagnosis of AOM and indicates irritation or infection in the middle ear.
C) Edema of the tympanic membrane: Edema (swelling) of the tympanic membrane is a common finding in acute otitis media. The middle ear becomes inflamed and fluid-filled, leading to swelling of the tympanic membrane. This is consistent with the diagnosis of AOM.
D) Bulging of the tympanic membrane: Bulging of the tympanic membrane is another classic sign of acute otitis media. The buildup of fluid and pus behind the eardrum causes it to bulge outward. This finding is consistent with AOM and indicates a more severe or advanced stage of the infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Pupil constriction: Pupil constriction (miosis) is not a typical sign of cataracts. Cataracts usually cause blurred or cloudy vision due to the clouding of the lens. Pupil constriction may occur in other conditions, such as in response to certain medications or neurological changes, but it is not associated with cataracts.
B) Cloudiness in the iris: The iris is the colored part of the eye that controls the size of the pupil. While cataracts affect vision, they typically involve the lens rather than the iris. Cloudiness in the iris could indicate other conditions, such as inflammation or infection, but it is not a characteristic of cataracts.
C) Redness in the sclera: Redness in the sclera (the white part of the eye) is usually caused by irritation, infection, or injury, such as conjunctivitis or subconjunctival hemorrhage. It is not a typical sign of cataracts, which primarily affect the lens and do not typically cause changes to the sclera.
D) Cloudiness in the lens: Cataracts are characterized by the clouding of the lens, which can result in blurry, hazy, or diminished vision. This cloudiness is visible during an eye examination, typically as a white or grayish opacity in the lens. This is the most consistent finding with cataracts.
Correct Answer is B
Explanation
A) Trachea is midline: Palpating the neck using a three-finger technique is not typically used to assess the position of the trachea. The trachea's position is assessed by placing one finger on each side of the trachea and gently palpating to check for any deviation from the midline. This technique is different from using three fingers to assess the thyroid.
B) Location of the thyroid: The three-finger technique is often used by nurses to palpate the thyroid gland. This method helps assess the size, shape, and consistency of the thyroid as well as to check for any enlargement (goiter) or tenderness. The technique is used to help guide the nurse’s fingers to the correct area for palpating the thyroid gland, typically located just below the Adam’s apple in the neck.
C) Location of lymph nodes: The location of lymph nodes is assessed by palpating different areas of the neck using the pads of the fingers or a gentle circular motion. The three-finger technique is not typically used to assess lymph nodes. Instead, lymph nodes are individually palpated with one or two fingers to feel for enlargement or tenderness.
D) Ability for client to swallow: Swallowing ability is assessed by observing the patient while they swallow fluids or food and by asking about any difficulty with swallowing (dysphagia). The three-finger technique does not assess swallowing directly; it is a method used for palpating structures in the neck like the thyroid.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.