After checking a client's pupillary response to light, the practical nurse (PN) tells the registered nurse (RN) that the client’s pupils are constricted with minimal response to light.
Before verifying the PN’s findings, which action should the RN take?

Administer PRN saline eye solution.

Review the client’s medication list.

Brighten the light in the client’s room.

Assess the client’s visual fields.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Administering PRN saline eye solution would not address the underlying cause of constricted pupils or provide diagnostic information. Saline solution is primarily used for lubrication or to flush irritants, and its application here would not be a scientific approach to understanding a neurological finding. Pupil constriction can indicate various physiological or pharmacological effects, requiring a more thorough investigation.

Choice B rationale

Medications, especially opioids or certain miotics, can cause pupillary constriction (miosis) by stimulating parasympathetic pathways, leading to acetylcholine release and sphincter pupillae contraction. Conversely, some medications affect adrenergic receptors, influencing pupil size. Reviewing the medication list is a crucial scientific step in differentiating between drug-induced miosis and a pathological neurological condition, ensuring patient safety and appropriate intervention.

Choice C rationale

Increasing the light intensity would typically cause further pupillary constriction through the pupillary light reflex, mediated by the optic and oculomotor nerves. However, if the pupils are already minimally responsive due to a physiological or pharmacological cause, brightening the light would not provide additional diagnostic information or elucidate the reason for the initial constricted state.

Choice D rationale

Assessing visual fields evaluates the integrity of the optic pathways and can detect deficits like scotomas or hemianopsia. While vision is related to pupillary function, assessing visual fields directly would not explain or verify constricted pupils with minimal light response. Pupillary abnormalities primarily indicate issues with the afferent (optic nerve) or efferent (oculomotor nerve) limbs of the pupillary reflex arc, not necessarily the entire visual field.

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Correct Answer is D

Explanation

Choice A rationale

Diminished appetite can be a symptom of various conditions, including gastrointestinal issues, psychological factors, or systemic illness, but it does not directly indicate a change in bone density. While chronic poor nutrition can impact bone health over time, a recent change in appetite alone is not a primary screening criterion for immediate bone density assessment.

Choice B rationale

Significant weight loss, while a general indicator of health changes, does not directly signal a need for bone density screening. It can result from various factors, including intentional dieting, illness, or metabolic changes. While severe underweight can contribute to osteoporosis risk, a 15 lb weight loss in isolation isn't a direct trigger for screening.

Choice C rationale

A lower body mass index (BMI) can indicate underweight, which is a risk factor for osteoporosis due to decreased mechanical loading on bones and potential nutritional deficiencies. However, a lower BMI alone does not immediately necessitate a bone density screening unless it falls into a critically low range or is accompanied by other specific risk factors.

Choice D rationale

A decrease in height in an adult, especially an older adult female, is a significant indicator of potential vertebral compression fractures, a hallmark of osteoporosis. This loss of height suggests a reduction in bone mass and structural integrity, prompting the need for a bone density screening to assess for osteopenia or osteoporosis. Normal height can vary greatly.

A. Forearm pronation. B. Hyperextension and palmar flexion. C. Forearm supination. D. Plantar flexion.

Correct Answer is B

Explanation

Choice A rationale

Forearm pronation involves rotating the forearm so the palm faces posteriorly or downward. While a component of upper extremity assessment, it primarily assesses the radioulnar joints and is not the most direct or specific motion for evaluating the integrity and mobility of the wrist joint itself.

Choice B rationale

Hyperextension and palmar flexion are fundamental movements of the wrist joint, directly assessing its range of motion in the sagittal plane. Ecchymosis often indicates soft tissue injury, and evaluating these specific movements helps pinpoint potential ligamentous or bony involvement, guiding subsequent diagnostic steps.

Choice C rationale

Forearm supination involves rotating the forearm so the palm faces anteriorly or upward. Similar to pronation, this movement primarily assesses the radioulnar joints and is not the primary motion used to evaluate the specific flexion and extension capabilities of the carpal bones and wrist ligaments.

Choice D rationale

Plantar flexion is a movement of the ankle joint, referring to the pointing of the toes downward. This motion is completely unrelated to assessing wrist mobility and is an inappropriate assessment for a client presenting with wrist pain and ecchymosis.

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After checking a client's pupillary response to light, the practical nurse (PN) tells the registered nurse (RN) that the client’s pupils are constricted with minimal response to light. Before verifying the PN’s findings, which action should the RN take?

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During a routine health screening of an adult female, the nurse notes several changes that have occurred over the past year. Which change indicates the need for a bone density screening?

Correct Answer is D

Explanation

A client is seen in the emergent care clinic for right wrist pain with a pattern of ecchymosis observed on the wrist. Which motion should the nurse instruct the client to perform to assess the wrist mobility?

Correct Answer is B

Explanation

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After checking a client's pupillary response to light, the practical nurse (PN) tells the registered nurse (RN) that the client’s pupils are constricted with minimal response to light.
Before verifying the PN’s findings, which action should the RN take?