A client who recently suffered a stroke suffers from right-sided homonymous hemianopsia. What is the best action for the nurse to take when caring for the client during mealtime?

Place food trays on the left side of the client.

Place food trays on the right side of the client.

Perform a focused visual exam.

Have the assistive personnel feed all meals to the client.

Answer and Explanation

The Correct Answer is A

Choice A reason: This is the correct answer because right-sided homonymous hemianopsia means that the client has lost vision in the right half of both eyes, so placing food trays on the left side of the client will help them see and access their food better.

Choice B reason: This is incorrect because placing food trays on the right side of the client will make it harder for them to see and reach their food, as they have no vision on that side.

Choice C reason: This is incorrect because performing a focused visual exam is not an appropriate action for the nurse to take during meal time. The nurse should assess the client's vision before or after meals, but not interfere with their eating.

Choice D reason: This is incorrect because having the assistive personnel feed all meals to the client will decrease their independence and dignity, as well as their ability to practice using their unaffected side. The nurse should encourage and assist the client to feed themselves as much as possible, and only provide assistance when needed.

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Correct Answer is D

Explanation

Choice A Reason: Decreased thickness of tympanic membranes is not a physiological change to hearing in older adult clients. The tympanic membranes are thin and flexible structures that vibrate in response to sound waves. The thickness of the tympanic membranes does not change significantly with age.

Choice B Reason: Decreased tinnitus is not a physiological change to hearing in older adult clients. Tinnitus is a ringing or buzzing sound in the ears that may be caused by various factors, such as noise exposure, ear infections, medications, or aging. Tinnitus may increase or decrease with age, depending on the underlying cause.

Choice C Reason: Decreased ear wax is not a physiological change to hearing in older adult clients. Ear wax is a natural substance that lubricates and protects the ear canal from dust, bacteria, and insects. Ear wax production may vary with age, but it does not affect hearing unless it accumulates and blocks the ear canal.

Choice D Reason: Decreased ability to hear high-frequency sounds is a physiological change to hearing in older adult clients. This is also known as presbycusis, which is a gradual loss of hearing that occurs as part of aging. Presbycusis affects the ability to hear high-pitched sounds, such as consonants, birdsong, or alarms.

A. "Ménière's disease is caused by an allergic response." B. "This medication can help offset the nauseous feeling." C. "Anticholinergics will help you rest." D. "This medication can help reduce vomiting episodes."

Correct Answer is A

Explanation

Choice A Reason: This is incorrect because Ménière's disease is not caused by an allergic response. Ménière's disease is a disorder of the inner ear that causes vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. The exact cause of Ménière's disease is unknown, but it may be related to fluid imbalance, infection, trauma, or autoimmune reaction.

Choice B Reason: This is correct because diphenhydramine can help offset the nauseous feeling. Diphenhydramine is an antihistamine that blocks histamine receptors in the brain and inner ear, which can reduce nausea and vomiting associated with vertigo.

Choice C Reason: This is correct because anticholinergics will help you rest. Anticholinergics are a class of drugs that block acetylcholine receptors in the brain and body, which can have sedative effects and reduce motion sickness. Diphenhydramine has anticholinergic properties.

Choice D Reason: This is correct because diphenhydramine can help reduce vomiting episodes. As mentioned above, diphenhydramine can reduce nausea and vomiting by blocking histamine receptors in the brain and inner ear.

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A client who recently suffered a stroke suffers from right-sided homonymous hemianopsia. What is the best action for the nurse to take when caring for the client during mealtime?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a class about physiological changes to hearing in older adult clients. Which of the following should the nurse include?

Correct Answer is D

Explanation

A client admitted with an acute exacerbation of Ménière's disease asks the student nurse why he was prescribed diphenhydramine. Which response by the student nurse requires correction by the primary nurse?

Correct Answer is A

Explanation

A nurse is preparing a client with extensive burns for hydrotherapy. What is the priority action by the nurse?

A client arrives with an upper respiratory infection and complains of otalgia, malaise, and nasal drainage. The client's temperature is 100.7 F. Which of the following will the nurse anticipate providing to the client?

The results of a client's audiogram indicate that the client has hearing at 15 decibels (dB). What action should the nurse take when communicating to the client?

A client arrives to the emergency department complaining of acute onset of nausea with projectile vomiting. The nurse's assessment findings include high-pitched sounds in the left upper quadrant. Which gastrointestinal disorder is consistent with these findings?

A nurse provides education to a client recently diagnosed with macular degeneration. Which of the following statements made by the client requires reinforcement of education by the nurse?

A nurse is caring for a client who has progressive presbycusis. Which of the following actions should the nurse take?

A nurse is caring for a client diagnosed with an inner ear infection. Which of the following manifestations will the nurse expect the client to report?

When performing an assessment, the nurse observes for bilateral equality. After performing a neurological assessment, which of the following will the nurse document when assessment findings indicate that there is left facial droop?