The nurse plans to assess the client's hearing.
What action should the nurse take when performing the Weber's test?
The nurse will understand the unaffected ear will show lateralization to the Weber's test.
Place the activated tuning fork to the mid skull and ask if the patient can hear it louder in either ear.
Place the activated tuning fork to the patient's mastoid bone first then place over air.
Place the activated tuning fork to the client's ear over the mastoid bone then activate it again over the air.
The Correct Answer is B
Choice A rationale
Lateralization to the unaffected ear in Weber's test actually indicates sensorineural hearing loss in the affected ear. This choice is incorrect as it doesn’t describe the correct procedure for the test.
Choice B rationale
The Weber's test involves placing an activated tuning fork in the midline of the skull and asking the patient if the sound is heard more loudly in either ear. This helps determine if there is lateralization, which is key in diagnosing the type of hearing loss. Thus, this is the correct procedure for the test.
Choice C rationale
Placing the tuning fork on the mastoid bone and then over air is actually part of the Rinne test, not the Weber test. This choice is, therefore, incorrect for the Weber test.
Choice D rationale
Similar to Choice C, this process describes the Rinne test, which compares air conduction and bone conduction of sound. This is not the correct method for performing Weber’s test.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Scleroderma is a chronic autoimmune disorder characterized by hardening and tightening of the skin and connective tissues. While it affects the skin, it is unrelated to emphysema and bronchitis, making it an unlikely finding in this client.
Choice B rationale
Pedal erythema, or redness of the feet, can result from various causes, including infections, allergies, and circulatory issues. However, it is not commonly associated with emphysema and bronchitis, making it an unlikely finding in this client.
Choice C rationale
Anasarca is generalized body swelling due to fluid retention, often seen in severe heart failure, liver disease, and kidney failure. While this condition involves significant swelling, it is not typically linked to emphysema and bronchitis.
Choice D rationale
Clubbing of the nails is a common finding in chronic respiratory conditions like emphysema and bronchitis. It involves bulbous enlargement of the fingertips and nail curvature, resulting from prolonged low oxygen levels, making it a likely finding in this client.
Correct Answer is D
Explanation
Choice A rationale
Lordosis refers to an excessive inward curvature of the lumbar spine, often referred to as swayback. This condition causes the lower back to arch more than normal, leading to a prominent abdomen and buttocks. Lordosis does not affect the thoracic spine and does not cause an exaggerated curvature in that region.
Choice B rationale
Scoliosis is a lateral curvature of the spine that results in an S- or C-shaped curve. It can occur in the thoracic, lumbar, or cervical regions of the spine. Scoliosis involves a sideways deviation rather than an exaggerated curvature in the thoracic spine.
Choice C rationale
Spinal dysplasia is a broad term that refers to various congenital abnormalities affecting the development of the spine. It includes conditions such as spina bifida, kyphosis, and scoliosis, each with distinct characteristics. The term itself does not specify an exaggerated thoracic curvature.
Choice D rationale
Kyphosis is an exaggerated outward curvature of the thoracic spine, resulting in a rounded or hunched back appearance. This condition is common in elderly individuals and can be caused by factors such as osteoporosis, vertebral fractures, or degenerative changes. It leads to a noticeable forward bend of the upper back.
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