Using the Glasgow Coma Scale, which number indicates that the patient is in a comatose state?

Answer and Explanation

The Correct Answer is D

A.   A GCS of 15 indicates full consciousness and alertness.
B.   A GCS of 12 indicates moderate impairment of consciousness.
C.   A GCS of 6 indicates severe impairment, but not necessarily comatose.
D.   A GCS of 8 or below is considered to indicate a comatose state.

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Correct Answer is ["A","B","D"]

Explanation

A. A lesion that is asymmetrical is concerning, as melanoma and other skin cancers tend to be irregular in shape. This is an important warning sign.
B. Red and black coloration in a lesion is concerning because it can indicate changes in blood flow or necrosis, both of which are suspicious for malignancy.
C. A flat lesion does not automatically indicate a problem, as many benign lesions, like moles, can be flat. The texture or elevation of the lesion is not always a concern unless there are other risk factors.
D. A lesion larger than 6 mm is concerning, especially if it is changing in size or shape. Larger lesions should be evaluated by a healthcare provider for potential malignancy.
E. Round edges are typically a characteristic of benign lesions, so this is not as concerning unless there are other warning signs present.

A. Testing visual acuity B. Eliciting the gag reflex C. Observing for facial symmetry D. Checking the pupillary response to light

Correct Answer is D

Explanation

A. Testing visual acuity: This assesses cranial nerve II (optic), not cranial nerve III.
B. Eliciting the gag reflex: This assesses cranial nerve IX and X (glossopharyngeal and vagus), not cranial nerve III.
C. Observing for facial symmetry: This assesses cranial nerve VII (facial nerve), not cranial nerve III.
D. Checking the pupillary response to light: Cranial nerve III (oculomotor) is responsible for controlling pupil constriction in response to light, making this the correct method to assess cranial nerve III.

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Using the Glasgow Coma Scale, which number indicates that the patient is in a comatose state?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When assessing a lesion on the skin, which of the following findings are concerning? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

A nurse is assessing a client's cranial nerves as part of a neurological examination. Which of the following actions should the nurse take to assess cranial nerve IlI?

Correct Answer is D

Explanation

A nurse is caring for a client who has reported experiencing abuse at home. Which of the following actions should be a priority for the nurse?

A nurse is planning care for a client who is confined to bed. Which of the following actions should the nurse include in the plan?

When assessing a client's skin, the nurse finds freckles. How would the nurse document the lesions?

A nurse in a dermatologist's office is planning an educational session about skin cancer. Which of the following should the nurse include as risk factors for skin cancer? (Select all that apply.)

The nurse is examining a patient's ears, which of the following findings is considered the expected findings?

A nurse is preparing to perform a cranial nerve examination on a client. Which of the following actions should the nurse take to check cranial nerve VII?

When assessing a client's skin, the nurse finds acne. How would the nurse document the lesions?

A nurse is assessing a client who has a stage 2 pressure injury. Which of the following findings should the nurse expect?