The nurse performs a visual assessment on a patient and documents the findings using the acronym PERRLA. Which assessment finding does PERRLA indicate?
Palpebral angle rigid, right and left angles
Patient's eyes round, regular, lively, active
Pupils equal, round, and reactive to light and accommodation
Pupils equilateral, regular, round, little accommodation
The Correct Answer is C
A. Palpebral angle rigid, right and left angles is not a part of the PERRLA assessment. The term refers to the space between the eyelids, which is not assessed with the PERRLA acronym.
B. Patient's eyes round, regular, lively, active is a description of the general appearance of the eyes but does not correspond to the PERRLA acronym, which specifically addresses the pupils' response to light and accommodation.
C. PERRLA stands for Pupils Equal, Round, and Reactive to Light and Accommodation. This means the pupils should be equal in size, round in shape, react to light (constricting when exposed to light), and accommodate (adjust) when focusing on near or far objects. This is a standard neurological assessment used to evaluate the functioning of the eyes and the nervous system.
D. Pupils equilateral, regular, round, little accommodation does not accurately describe PERRLA. The correct term is "accommodation," which refers to the pupils' ability to adjust when focusing on near or far objects, not "little accommodation."
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The sympathetic nervous system is responsible for the "fight or flight" response. This response includes tachycardia (increased heart rate) and dilated pupils (mydriasis), both of which are common physiological changes during sympathetic activation.
B. Pupil constriction and bronchoconstriction are associated with the parasympathetic nervous system, which is responsible for the "rest and digest" functions.
C. Increased peristalsis and abdominal cramping are also associated with the parasympathetic nervous system, as it promotes digestion and relaxation of the body.
D. Hypoglycemia and headache are not direct indicators of sympathetic activation. Hypoglycemia can occur for various reasons, and headaches can be caused by multiple factors, but they are not specific signs of sympathetic nervous system activation.
Correct Answer is A
Explanation
A. TIA stands for Transient Ischemic Attack, which is a temporary disruption of blood flow to the brain. Symptoms typically last for minutes to hours and resolve within 24 hours without causing permanent neurological damage.
B. CVA stands for Cerebrovascular Accident, which refers to a stroke. A CVA causes permanent neurological damage due to a lack of blood flow to the brain.
C. TPN stands for Total Parenteral Nutrition, which is a method of delivering nutrition intravenously to patients who cannot eat or absorb food normally. It is unrelated to cerebral circulation.
D. MI stands for Myocardial Infarction, which is a heart attack. It involves damage to the heart muscle due to a lack of blood flow but does not refer to cerebral circulation.
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