A nurse examines a patient’s tympanic membranes with an otoscope. The nurse understands the normal tympanic membrane exhibits which normal characteristic?
White with prominent capillaries
Pearly gray and transparent
Pulled in at the base of the cone of light
Light pink with a slight bulge
The Correct Answer is B
Choice A reason: A normal tympanic membrane is not white with prominent capillaries. Such an appearance may indicate inflammation or infection (e.g., otitis media), where increased vascularity or opacity occurs, making this an abnormal and incorrect characteristic.
Choice B reason: A normal tympanic membrane is pearly gray, slightly translucent, with a visible cone of light reflecting off its taut surface. This reflects healthy middle ear anatomy, with no fluid or inflammation, making this the correct description.
Choice C reason: A pulled-in tympanic membrane suggests negative middle ear pressure, often due to eustachian tube dysfunction, not a normal finding. The normal membrane is flat or slightly concave, making this an incorrect characteristic.
Choice D reason: Light pink with a slight bulge suggests inflammation or fluid (e.g., otitis media), not a normal tympanic membrane. Normal membranes are pearly gray and flat, not pink or bulging, making this an incorrect description.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Writing a series of numbers tests attention or working memory, not recent memory recall. Recalling words after a delay specifically assesses short-term memory, which is more relevant for a 70-year-old, so this is not the best method.
Choice B reason: Asking a patient to recall four words after 10 minutes directly tests recent memory, a key cognitive function in older adults. This method is standard in assessments like the Mini-Mental State Exam, making it the best choice for evaluating memory.
Choice C reason: Verifying information like a mother’s maiden name tests long-term memory, not recent recall. Recent memory involves retaining new information, so recalling words after a delay is more appropriate, making this incorrect.
Choice D reason: Naming past presidents relies on long-term memory and general knowledge, not recent memory. Recalling newly learned words after 10 minutes better assesses short-term memory, so this is not the best approach for recent memory.
Correct Answer is A
Explanation
Choice A reason: To calculate the dose, divide the ordered 180 mg by the concentration of 250 mg per 5 ml: (180 mg ÷ 250 mg) × 5 ml = 0.72 × 5 = 3.6 ml. This precise calculation ensures the correct amount of Dilantin is administered, matching the provider’s order.
Choice B reason: A 4.5 ml dose would deliver 225 mg (4.5 ml × 250 mg/5 ml), exceeding the ordered 180 mg. This overdose could increase the risk of toxicity, as Dilantin has a narrow therapeutic range, making this an incorrect choice.
Choice C reason: A 5 ml dose delivers 250 mg (5 ml × 250 mg/5 ml), significantly more than the ordered 180 mg. This excessive dose could lead to adverse effects like ataxia or nystagmus, rendering this choice incorrect for the prescribed amount.
Choice D reason: A 7 ml dose would provide 350 mg (7 ml × 250 mg/5 ml), far exceeding the ordered 180 mg. Such a high dose could cause severe toxicity, including neurological symptoms, making this an inappropriate and unsafe choice.
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