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The nurse is assessing a patient in the acute hospital setting that has had a diagnosis of right-sided stroke. The nurse completes a comprehensive neurological assessment including assessing the client for graphesthesia. What are the actions the nurse would take to perform this assessment appropriately?

The client will close the eyes and identify what number the nurse writes in the palm of the client's hand with a blunt-ended object.

The nurse will simultaneously touch the client in the same area on both sides of the body, and the client will identify where the touch occurred.

The nurse will ask the client to close his eyes, and will ask that he identify a familiar object placed in the client’s hand.

The client is asked to identify the number of points felt when the nurse touches the client with the ends of two applicators at the same time.

Answer and Explanation

The Correct Answer is A

Choice A reason: Graphesthesia tests cortical sensory function by tracing numbers on the palm with eyes closed. A right-sided stroke may impair this on the left side, making this the correct method to assess parietal lobe processing accurately here.
Choice B reason: Simultaneous bilateral touch tests extinction, not graphesthesia. This assesses neglect, not the ability to interpret shapes, missing the specific sensory integration focus needed for graphesthesia in this stroke assessment entirely and fully here.
Choice C reason: Identifying objects with eyes closed tests stereognosis, not graphesthesia. This evaluates tactile recognition, not number tracing, diverging from the precise cortical sensory skill targeted in this neurological exam for stroke effects here.
Choice D reason: Two-point discrimination tests sensory acuity, not graphesthesia. This measures point differentiation, not shape recognition, making it unrelated to assessing the parietal lobe’s interpretive ability post-stroke as intended in this scenario fully.

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Correct Answer is C

Explanation

Choice A reason: Morphine treats severe pain but isn’t first-line for headaches worsened by coughing, which may signal increased intracranial pressure. Without neurological assessment, this risks masking symptoms of serious conditions like brain tumors, delaying critical diagnosis and intervention.

Choice B reason: Palpating occipital lymph nodes checks for infection or inflammation, but headaches worsened by coughing or sneezing suggest intracranial issues, not lymphatic ones. This action misses the priority of assessing brain function tied to the client’s specific symptom pattern.

Choice C reason: Neurological assessment, like checking reflexes or pupil response, is vital for morning headaches worsening with coughing, hinting at possible intracranial pressure from masses or bleeds. It’s the most direct step to rule out life-threatening causes promptly.

Choice D reason: Explaining migraines assumes a diagnosis without evidence. Morning headaches improving later, worsened by strain, don’t align with typical migraine patterns, risking misdiagnosis of serious conditions like sinus thrombosis, necessitating neurological evaluation over premature reassurance.

A. "Ear candles are a good way to help remove impacted cerumen." B. "You should gently irrigate with normal saline." C. "Wash the pinna of your ear with a warm, moist washcloth." D. "If you note fullness in your ear, try to remove the impaction with a cotton swab."

Correct Answer is C

Explanation

Choice A reason: Ear candles are unsafe, risking burns or wax deeper in the canal. They don’t effectively remove cerumen and can perforate the eardrum, contradicting evidence-based hygiene practices for preventing ear infections or blockages entirely in this context.

Choice B reason: Irrigation with saline is for impacted cerumen, not routine hygiene. It’s a clinical procedure, not a daily prevention measure, and risks pushing wax further or damaging the canal if done improperly, making it less suitable here.

Choice C reason: Washing the pinna with a warm, moist washcloth safely cleans the outer ear, preventing debris buildup without risking the canal or eardrum. This simple, effective hygiene step aligns with illness prevention goals for routine ear care perfectly.

Choice D reason: Cotton swabs can push cerumen deeper, causing impaction or eardrum perforation. This unsafe practice increases infection risk, opposing hygiene goals, and is widely discouraged in favor of external cleaning for safe ear maintenance consistently.

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Naxlex Comprehensive Predictor Exams

A client comes in with complaints of a headache. The client states, "I always wake up with a headache in the morning, but it gets better in a couple hours. I notice that it always gets worse if I cough or sneeze." What action by the nurse is most appropriate?

Correct Answer is C

Explanation

A health promotion teaching is focusing on hygiene and the prevention of illness. When instructing clients on how to clean their ears, what action should the nurse recommend?

Correct Answer is C

Explanation

An older adult client has been admitted due to decreased cognition. What assessment finding is most suggestive of delirium as the cause of the client's cognitive impairment?

A client is seeking medical help due to loss of central vision. What diagnosis might the nurse suspect?

While inspecting the tympanic membrane the nurse notes a pearly gray and shiny appearance. What would this finding indicate?

A nurse is completing the Romberg's test on a patient. Which is the correct technique for conducting this?

The nurse is conducting a focused neurologic assessment on an 81-year-old client. What finding below is an age-related neurologic change?

The nurse is performing a peripheral vascular assessment of an adult client. The nurse is palpating the client's peripheral pulses but knows that some are not palpable, even in healthy clients. What pulse is not palpable in a large proportion of healthy clients?

The nurse has begun the objective assessment of a client's heart and neck vessels and is assessing the client's jugular veins. What finding would the nurse consider to be expected in a healthy client?