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
Myopia, or nearsightedness, is when distant objects appear blurry because light rays focus in front of the retina. A Snellen exam result of 20/50 means the client can see at 20 feet what someone with normal vision sees at 50 feet, indicating reduced distance vision. However, this condition does not correlate with the ability to read the Rosenbaum chart, which is for near vision, thus excluding myopia.
Choice B rationale
Normal vision is not indicated by a Snellen exam result of 20/50, as this signifies a visual impairment where the client sees at 20 feet what a person with normal vision sees at 50 feet. Normal vision would be indicated by 20/20 on the Snellen exam.
Choice C rationale
Presbyopia is the age-related loss of the eye's ability to focus on near objects, typically noticeable in people over 40. Although this condition involves difficulty reading at close range, the client's uncorrected Snellen exam result of 20/50 pertains to distance vision, which differentiates presbyopia from the given scenario.
Choice D rationale
Hyperopia, or farsightedness, is when close objects appear blurry because light rays focus behind the retina. The client's ability to read the Rosenbaum chart without difficulty indicates good near vision, while the Snellen exam result of 20/50 reflects reduced distance vision, thus supporting the diagnosis of hyperopia.
Correct Answer is A
Explanation
Choice A rationale
Rhonchi are low-pitched, continuous breath sounds that are often indicative of secretions in the large airways. These sounds may change or clear with coughing, so the nurse should have the patient cough and then auscultate again to reassess the presence of rhonchi.
Choice B rationale
Wheezes are high-pitched, musical sounds heard primarily during expiration. They are caused by narrowed airways, typically due to asthma or other obstructive lung conditions. Wheezes do not usually clear with coughing and require specific treatments to address airway constriction.
Choice C rationale
Crackles are discontinuous, popping sounds heard during inspiration and are associated with fluid in the alveoli, such as in conditions like pneumonia or heart failure. Crackles are not typically cleared by coughing and may persist despite the patient's efforts to clear their airways.
Choice D rationale
Stridor is a high-pitched, harsh sound heard during inspiration, often indicating upper airway obstruction. Stridor is a medical emergency and requires immediate intervention to secure the airway. It does not clear with coughing and signifies a critical respiratory issue. .
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