Exam 94: Sensory Alterations

Which nursing assessment best measures cognitive functioning?

A nurse is caring for an elderly patient who was in a motor vehicle accident because he thought the stop light was green.The patient asks the nurse if he should no longer drive.Which response by the nurse is most therapeutic?

The nurse is aware that which patient is most at risk for sensory deprivation?

The nurse is caring for a patient in acute respiratory distress.The patient has multiple monitoring systems on that constantly beep and make noise.The patient is becoming agitated and frustrated over inability to sleep.Which action by the nurse is most appropriate for this patient?

The nurse is caring for a patient with conductive hearing loss resulting from prolonged cerumen impaction.Which intervention by the nurse is most important in establishing effective communication with the patient?

A patient informs the nurse that she often becomes nauseated when riding in motor vehicles.The nurse knows that this is related to which sensory deficit?

A new nurse is caring for a patient who is undergoing chemotherapy for cancer.The patient is becoming malnourished because nothing tastes good.Which recommendation by the nurse would be most appropriate for this patient?

The nurse is caring for a patient with expressive aphasia from a traumatic brain injury.Which desired outcome should be included in the plan of care?

The home health nurse is caring for a patient with a tactile deficit; the nurse is concerned about injury related to inability to feel harmful stimuli.The nurse evaluates that the patient is able to safely care for himself when the patient demonstrates which action?

A nurse is caring for a patient who recently had a stroke and is going to be discharged at the end of the week.The nurse notices that the patient is having difficulty with attempting to eat his meal and is becoming tearful.The nurse includes which intervention in the patient's plan of care?

A home health nurse is assembling a puzzle with an elderly patient and notices that the patient is having difficulty connecting two puzzle pieces.The nurse knows that this is most likely related to which aspect of sensory deprivation?

A nurse is administering a vaccine to a 4-year-old child who is visually impaired.After the needle enters the arm,the child says,"Ow,that was sharp!" The nurse knows that the ability to recognize and interpret stimuli is known as

A nurse is caring for a patient who is experiencing vertigo.Which nursing intervention would assist the patient in controlling the vertigo?

The nurse is developing a plan of care for a patient who is having a prosthetic eye placed.Which nursing diagnosis related to patient safety is the priority for the nurse to include in the plan of care?

The nurse is caring for a patient who is a well-known surgeon at the hospital.Because of his status,all the hospital's physicians want to be sure to pay him a visit.The nurse notices the patient becoming more agitated and withdrawn with each group of visitors.The nurse asks the patient if he would like a "Do not disturb" sign placed on the door.A few hours later,the nurse notices a physician who is not involved in the patient's care attempting to enter the room.Which response by the nurse is most appropriate?

Which nursing diagnosis addresses psychological concerns for a patient with both hearing and visual sensory impairment?

A nurse is caring for a patient with right-sided weakness following a stroke.Which nursing action would be least effective in promoting positive adaptation of the patient's sensory deficit?

A nurse is caring for a patient with a nursing diagnosis of Hearing deficit related to presbycusis.Which assessment of the patient would indicate an adaptation to the sensory deficit?

The nurse is caring for a patient who is having difficulty understanding written and spoken word? The nurse suspects the patient has _____ aphasia.

What nursing action can the nurse implement to comfort an elderly patient with sensory deprivation to improve meaningful stimuli?