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 A
Explanation
Choice A reason: The human spinal column has 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused). The 5 lumbar vertebrae, located in the lower back, support significant weight and allow flexibility, making this choice correct for the vertebral count.
Choice B reason: The cervical spine consists of 7 vertebrae, not 12, which are designed for mobility and support of the head. The incorrect count of 12 aligns with the thoracic vertebrae, making this choice scientifically inaccurate for the cervical region.
Choice C reason: The sacral region has 5 vertebrae, which fuse into the sacrum in adults, not 7. The sacrum forms part of the pelvis, providing stability. The incorrect count of 7 corresponds to the cervical vertebrae, making this choice incorrect.
Choice D reason: The thoracic spine comprises 12 vertebrae, not 5, which articulate with the ribs to form the thoracic cage. The incorrect count of 5 aligns with the lumbar or sacral vertebrae, rendering this choice inaccurate for the thoracic region.
Correct Answer is D
Explanation
Choice A reason: Measuring respirations during pulse assessment can lead to inaccurate counts, as patients may alter their breathing when aware of pulse measurement. Conscious awareness often causes irregular or controlled breathing, which does not reflect the true respiratory rate, making this an unreliable time.
Choice B reason: Auscultation involves listening to lung or heart sounds, which requires patient cooperation and often affects breathing patterns. Patients may consciously modify their respirations during this process, leading to inaccurate respiratory rate measurements, rendering this an unsuitable time for assessment.
Choice C reason: Interviewing involves patient interaction, which can influence breathing due to speech or emotional responses. This conscious activity often results in irregular or controlled breathing patterns, making it an unreliable time to accurately measure the patient’s natural respiratory rate.
Choice D reason: Measuring respirations when the patient is sleeping ensures an undisturbed, natural breathing pattern, as the patient is unaware of the assessment. This allows the nurse to count the respiratory rate accurately, reflecting the true resting state, making it the optimal time.
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