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 B

Explanation

A. Lymphadenopathy: A bruit is not associated with lymphadenopathy; it is caused by turbulent blood flow.

B. Turbulent blood flow: A bruit is the sound of turbulent blood flow, which occurs due to partial arterial occlusion.

C. Hypermetabolic states: While bruits can be heard in various conditions, they are not typically associated with hypermetabolic states like fever or thyroid disease.

D. Venous disease: Bruits are arterial in origin, not related to venous disease.

A. Stops any movement, and appears to listen for the sound B. Consider this a normal finding. C. Shows no obvious response to the noise. D. Shows a startle and acoustic blink reflex.

Correct Answer is B

Explanation

A. Stops any movement, and appears to listen for the sound: This does not relate to the corneal light reflex test.

B. Consider this a normal finding: Symmetric light reflection at the same clock position in both eyes indicates normal alignment of the eyes.

C. Shows no obvious response to the noise: This response is unrelated to the corneal light reflex test.

D. Shows a startle and acoustic blink reflex: This describes a normal response to a loud noise, not the corneal light reflex test.

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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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When auscultating over a patient's femoral arteries, the nurse notices the presence of a bruit on the left side. The nurse knows that bruits:

Correct Answer is B

Explanation

When performing the corneal light reflex assessment, the nurse notes that the light is reflected at 2 o'clock in each eye. The nurse should:

Correct Answer is B

Explanation

The nurse is watching a new graduate nurse perform auscultation of a patient's abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?

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?

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:

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

The nurse is performing an eye assessment on an 80-year-old patient. Which of these findings is considered abnormal?

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

A 45-year-old man is in the clinic for a physical examination. During the abdominal assessment, the nurse percusses the abdomen and notices an area of dullness above the right costal margin of approximately 11 cm. How should the nurse proceed?

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