During an examination, the nurse notices that the patient stumbles a little while walking, and, when she sits down, she holds on to the sides of the chair. The patient states, "It feels like the room is spinning!" The nurse notices that the patient is experiencing:

Subjective vertigo.

Tinnitus.

Dizziness.

Objective vertigo.

Answer and Explanation

The Correct Answer is D

A. Subjective vertigo: Subjective vertigo refers to the sensation of being dizzy but without the room spinning. The patient described the sensation of the room spinning.

B. Tinnitus: Tinnitus refers to a ringing or buzzing sound in the ears, not the sensation of the room spinning.

C. Dizziness: Dizziness can refer to a range of symptoms, but the description of the room spinning suggests vertigo, not just dizziness.

D. Objective vertigo: Objective vertigo refers to the sensation that the room is spinning, which the patient describes. This is typically a vestibular issue involving the inner ear.

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Correct Answer is B

Explanation

A. 1 minute: This is not the correct duration for assessing bowel sounds.

B. 2 minutes each quadrant: Bowel sounds should be auscultated for at least 2 minutes per quadrant before determining that they are absent.

C. 5 minutes: Listening for 5 minutes is excessive and typically unnecessary unless there is concern about a complete absence of bowel sounds.

D. 10 minutes: 10 minutes is also too long for auscultation unless specifically indicated by clinical findings, like suspected paralytic ileus.

A. Nerve degeneration in the inner ear B. Cilia becoming coarse and stiff C. Scarring of the tympanic membrane D. Atrophy of the apocrine glands

Correct Answer is A

Explanation

A. Nerve degeneration in the inner ear: This describes presbycusis, a common age-related hearing loss due to degeneration of the cochlea or auditory nerve, often affecting the ability to hear high-frequency sounds and distinguish sounds in noisy environments.
B. Cilia becoming coarse and stiff: This contributes to conductive hearing loss but does not typically cause difficulty localizing sounds.
C. Scarring of the tympanic membrane: This may result from repeated infections but usually causes conductive hearing loss.
D. Atrophy of the apocrine glands: This affects sweat production, not hearing.

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During an examination, the nurse notices that the patient stumbles a little while walking, and, when she sits down, she holds on to the sides of the chair. The patient states, "It feels like the room is spinning!" The nurse notices that the patient is experiencing:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During an abdominal assessment, the nurse is unable to hear bowel sounds in a patient's abdomen. How long should the nurse listen before reporting absent bowel sounds?

Correct Answer is B

Explanation

A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says that he "can't always tell where the sound is coming from" and the words often sound "mixed up." What might the nurse suspect as the cause for this change?

Correct Answer is A

Explanation

The nurse suspects that a patient has appendicitis. Which of these procedures are appropriate for use when assessing for appendicitis or a perforated appendix? (Select all that apply)

When assessing the abdomen most health care providers divide the abdomen into how many sections?

When performing a peripheral vascular assessment of the lower extremities, a nurse should place the fingertips just posterior to the medial malleolus in order to assess for which of the following peripheral pulses?

The nurse gave a client an instruction sheet for a colonoscopy. The client held the instructions approximately 18 inches from their face and read the description of the procedure aloud. The nurse recognizes that the client

In performing a voice test to assess hearing, which of these actions would the nurse perform?

The nurse is reviewing in age-related changes in the eye for a class. Which of these physiologic changes is responsible for presbyopia?