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

Would do well on a Rosenbaum card

is likely demonstrating signs of a stroke

Requires testing for visual acuity

Understands the colonoscopy procedure

Answer and Explanation

The Correct Answer is A

A. Rosenbaum card: Holding reading material at approximately 18 inches from the face suggests that the client has near vision sufficient to perform well on a Rosenbaum test, which evaluates near visual acuity.

B. Stroke: Difficulty reading instructions is not necessarily indicative of a stroke.

C. Visual acuity: While they may not need immediate testing, their near vision appears adequate.

D. Understands procedure: While reading aloud may indicate comprehension, the focus here is on their visual ability.

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Correct Answer is D

Explanation

A. Make note of this finding: Delaying action by merely reporting the finding later may compromise patient care.

B. Prepare to remove cerumen: Sudden hearing loss is unlikely to be caused by cerumen buildup without further assessment.

C. Irrigate with rubbing alcohol: This is inappropriate and could harm the ear.

D. Notify the health care provider: Sudden sensorineural hearing loss can be a medical emergency and should be promptly evaluated by the healthcare provider.

A. Ask the patient if he or she has experienced any unusual cramping or tingling in the arm. B. Refer the individual for further evaluation. C. Check for the presence of claudication. D. Consider this finding as normal, and proceed with the peripheral vascular evaluation.

Correct Answer is D

Explanation

A. Asking about cramping or tingling is unnecessary without other signs of compromised circulation.

B. Referral is not needed if perfusion is adequate.

C. Checking for claudication relates to arterial insufficiency, not absence of ulnar pulse.

D. Proceeding with the evaluation is appropriate if perfusion is adequate, as indicated by normal capillary refill and warm skin.

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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

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Naxlex Comprehensive Predictor Exams

A patient has been admitted after an accident at work. During the assessment, the patient is having trouble hearing and states, "I don't know what the matter is. All of a sudden, I can't hear you out of my left ear!" What should the nurse do next?

Correct Answer is D

Explanation

When performing a peripheral vascular assessment on a patient, the nurse is unable to palpate the ulnar pulses. The patient's skin is warm and capillary refill time is normal. Next, the nurse should;

Correct Answer is D

Explanation

The nurse is reviewing the risk factors for venous disease. Which of these situations best describes a person at highest risk for the development of venous disease?

A patient had abdominal surgery yesterday when auscultating his abdomen, you would expect to hear:

A nurse performs the Weber test on a healthy adult client. The nurse would expect which of the following normal finding?

When assessing the pupillary light reflex or PERRL (pupils, round, reactive to light), the nurse should use which technique?

During an assessment of an older adult, the nurse should expect to notice which finding as a normal physiologic change associated with the aging process?

During an eye examination, a client tells a nurse that their left eye feels dry and itchy and has noticed a lot of tearing. The nurse notices that the client's left lower eyelid is rolled out with exposure of the palpebral conjunctiva. The nurse would document these findings as: