The nurse understands that the four unrelated words test provides information related to which cognitive function?

Thought content

Attention span

Distant memory

New memory

Answer and Explanation

The Correct Answer is D

A. Thought content: The four unrelated words test does not assess thought content, which refers to the patient’s ideas, beliefs, and perception of reality. Thought content is typically evaluated through direct questioning and observation of the patient’s speech patterns and behaviors.

B. Attention span: Attention span is assessed by evaluating the patient's ability to concentrate on simple tasks, such as following a set of instructions or completing a short mental exercise. The four unrelated words test is not designed to measure attention span directly.

C. Distant memory: Distant memory refers to the recall of events or information from the past, such as childhood experiences or historical events. The four unrelated words test assesses recent recall rather than distant memory.

D. New memory: The four unrelated words test evaluates the ability to form and retrieve new memories. The nurse provides the patient with four unrelated words, asks them to recall them after a few minutes, and reassesses recall at intervals. Impairments in new memory recall can indicate cognitive deficits seen in conditions like dementia or head trauma.

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Correct Answer is ["B","C","E","F"]

Explanation

A. Forlani: No known clinical test named "Forlani" is used to assess the acoustic nerve (cranial nerve VIII). Standard assessments for hearing and vestibular function do not include this test, making this an incorrect option.

B. Rinne: The Rinne test evaluates conductive versus sensorineural hearing loss by comparing air conduction and bone conduction using a tuning fork. Normally, air conduction should be greater than bone conduction, but in conductive hearing loss, bone conduction is either equal to or greater than air conduction. It helps assess cranial nerve VIII function and differentiate between middle and inner ear pathology.

C. Weber: The Weber test is another tuning fork test used to differentiate between conductive and sensorineural hearing loss. The tuning fork is placed on the midline of the forehead, and sound should be heard equally in both ears. If sound lateralizes to one ear, it suggests conductive hearing loss in that ear or sensorineural loss in the opposite ear, aiding in the evaluation of cranial nerve VIII.

D. Kinecki: No known clinical test named "Kinecki" is used to assess the acoustic nerve. The main tests for hearing assessment involve tuning forks, spoken-word tests, and audiometry, none of which include a test by this name, making this option incorrect.

E. Whisper Test: The Whisper Test is a simple screening method to assess hearing by whispering words or numbers behind the patient and having them repeat what was heard. This test evaluates the function of cranial nerve VIII by determining whether the patient can perceive soft sounds at a standard distance, providing a quick but effective measure of hearing acuity.

F. Audiogram (formal hearing test): An audiogram is a comprehensive, formal test that measures hearing ability at different frequencies and intensities. It provides detailed information about sensorineural and conductive hearing loss by assessing how well different pitches and volumes are detected, making it one of the most accurate methods for evaluating cranial nerve VIII function.

A. Behind with the nurse's hands placed firmly around his neck B. Behind with hands placed on throat C. The front with the nurse's thumbs placed on either side of his trachea and his head tilted forward D. Have the patient perform the exam

Correct Answer is C

Explanation

A. Behind with the nurse's hands placed firmly around his neck: This approach may be perceived as threatening or invasive, potentially increasing the patient's apprehension and discomfort. It is important to maintain a respectful and gentle approach, especially when working with a patient who may already feel uneasy.

B. Behind with hands placed on throat: Similar to option A, examining from behind and placing hands on the throat may cause anxiety and discomfort for the patient, particularly if they are not familiar with the procedure. This method does not provide a clear line of sight or reassurance for the patient.

C. The front with the nurse's thumbs placed on either side of his trachea and his head tilted forward: This technique is the most appropriate approach for examining the thyroid gland. Positioning the patient in front allows for better communication and visibility. Placing the thumbs on either side of the trachea is a standard method for palpating the thyroid, and having the patient tilt their head forward can help relax the neck muscles, making the examination more comfortable. Additionally, this approach allows the nurse to explain the procedure more easily, even with language barriers.

D. Have the patient perform the exam: While patient involvement in their care can be empowering, asking the patient to perform the exam may not be appropriate for a thyroid examination, as the nurse must assess the gland's size, consistency, and any potential nodules. This approach may also lead to further anxiety for the patient, who may not know how to perform the exam correctly.

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The nurse understands that the four unrelated words test provides information related to which cognitive function?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following tests could be used to assess the acoustic nerve? (Select All that Apply.)

Correct Answer is ["B","C","E","F"]

Explanation

A visitor from Poland who does not speak English seems to be somewhat apprehensive about the nurse examining his neck. How should the nurse proceed that would allow the patient to feel more comfortable with the nurse examining his thyroid gland?

Correct Answer is C

Explanation

The nurse is reviewing the function of the cranial nerves (CNS). Which CN is responsible for conducting nerve impulses to the brain for hearing?

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