The nurse is performing an assessment on a patient and asks the patient to close their eyes and places a familiar object in the patient's hand.
The nurse asks the patient to identify the object.
This is known as:
Graphesthesia.
Rhomberg.
Superficial reflexes.
Stereognosis.
The Correct Answer is D
Choice A rationale
Graphesthesia is a sensory ability that allows an individual to recognize numbers or letters traced on their skin with their eyes closed. This assesses cortical sensory function, specifically the ability to interpret tactile stimuli, which is distinct from identifying a three-dimensional object by touch alone.
Choice B rationale
The Romberg test assesses proprioception and cerebellar function by asking the patient to stand with feet together and eyes closed. A positive Romberg sign indicates a loss of balance, suggesting a deficit in proprioception or vestibular function, and is not related to the identification of objects by touch.
Choice C rationale
Superficial reflexes, such as the plantar reflex or abdominal reflex, are elicited by light tactile stimulation of the skin and involve spinal cord reflex arcs. These reflexes assess the integrity of specific neurological pathways and are distinct from the cognitive process of identifying an object through tactile recognition.
Choice D rationale
Stereognosis is the ability to recognize familiar objects by touch and manipulation, without visual input. This cortical sensory function integrates tactile, proprioceptive, and kinesthetic sensations to form a mental image of the object's shape, size, and texture, allowing for its identification.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Frostbite causes localized tissue damage due to ice crystal formation and cellular dehydration, leading to impaired circulation. While frostbite can affect capillary refill, a 5-second refill time in the absence of cold exposure or other correlating symptoms makes frostbite a less likely primary consideration and requires broader assessment.
Choice B rationale
Venous insufficiency involves impaired blood return to the heart, leading to venous stasis and edema. Capillary refill primarily assesses arterial perfusion and microcirculatory integrity, not venous outflow. Therefore, venous insufficiency would not typically manifest as a prolonged capillary refill time as a primary symptom.
Choice C rationale
Normal capillary refill time in adults is typically less than 2 seconds. A 5-second capillary refill time indicates impaired peripheral perfusion, suggesting inadequate blood flow to the capillaries. This delay warrants further investigation to identify underlying causes such as dehydration, hypovolemia, or peripheral vascular compromise.
Choice D rationale
Normal capillary refill time is typically less than 2 seconds. A 5-second refill time is significantly prolonged and indicates compromised peripheral circulation. Considering this normal would lead to a missed opportunity to identify and address a potentially serious underlying physiological issue affecting tissue perfusion.
Correct Answer is D
Explanation
Choice A rationale
Drug tolerance refers to a phenomenon where a patient's response to a specific drug decreases over time, requiring larger doses to achieve the same therapeutic effect. This often occurs due to physiological adaptations, such as altered receptor sensitivity or increased drug metabolism, and is distinct from simply taking multiple medications.
Choice B rationale
A pharmacogenetic reaction involves an individual's unique genetic makeup influencing their response to a drug, leading to altered drug metabolism, efficacy, or adverse effects. This is a specific type of drug response based on genetic variations and is not synonymous with the practice of taking numerous medications.
Choice C rationale
Drug toxicity refers to adverse effects that occur when the concentration of a drug in the body exceeds the therapeutic range, leading to harmful or undesirable physiological effects. While taking multiple drugs can increase the risk of toxicity, toxicity itself is a consequence, not the term for taking numerous drugs.
Choice D rationale
Polypharmacy is the medical term used to describe the practice of taking multiple medications concurrently, often more than is medically necessary or when the potential for adverse drug interactions and side effects outweighs the benefits. This is a common issue in older adults due to the presence of multiple chronic conditions requiring different pharmacological interventions.
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