Question 1

Which of the following sensory changes are normal with aging?

Accepted Answer

A)  Impaired night vision 
B)  Difficulty hearing low pitch 
C)  Increase in taste discrimination 
D)  Heightened sense of smell 
A)  Impaired night vision 
B)  Difficulty hearing low pitch 
C)  Increase in taste discrimination 
D)  Heightened sense of smell

Question 2

Often blindness occurs during childhood.Which health preventative measure is most appropriate to prevent vision impairment?

Accepted Answer

A)  Screen young children early for visual impairments. 
B)  Instruct parents to report reduced eye contact from their child immediately. 
C)  Include rubella and syphilis screening in the preconception care plan. 
D)  Administer prophylactic antibiotics to all newborns. 
A)  Screen young children early for visual impairments. 
B)  Instruct parents to report reduced eye contact from their child immediately. 
C)  Include rubella and syphilis screening in the preconception care plan. 
D)  Administer prophylactic antibiotics to all newborns.

Question 3

What is the involuntary motion of retracting the body from painful stimuli?

Accepted Answer

A)  Sensation 
B)  Reception 
C)  Perception 
D)  Reaction 
A)  Sensation 
B)  Reception 
C)  Perception 
D)  Reaction

Question 4

The nurse is caring for a patient who is recovering from a traumatic brain injury and frequently becomes disoriented to everything except her location.Which nursing intervention would be effective in orienting a patient with neurological deficit?

Accepted Answer

A)  Assessing the patient's level of consciousness and documenting every 4 hours 
B)  Keeping a day-by-day calendar at the patient's bedside and having the patient manage it 
C)  Placing a patient observer in the patient's room for safety 
D)  Informing the patient that she cannot be discharged unless she is awake, alert, and oriented 
A)  Assessing the patient's level of consciousness and documenting every 4 hours 
B)  Keeping a day-by-day calendar at the patient's bedside and having the patient manage it 
C)  Placing a patient observer in the patient's room for safety 
D)  Informing the patient that she cannot be discharged unless she is awake, alert, and oriented

Question 5

The nurse would utilize the Snellen chart for assessment of which patient?

Accepted Answer

A)  A patient who is having difficulty remembering how to perform familiar tasks 
B)  A patient who turns the television up as loud as possible 
C)  A patient who holds his newspaper 2 inches from his face 
D)  A patient who frequently reports the incorrect time from the clock across the room 
A)  A patient who is having difficulty remembering how to perform familiar tasks 
B)  A patient who turns the television up as loud as possible 
C)  A patient who holds his newspaper 2 inches from his face 
D)  A patient who frequently reports the incorrect time from the clock across the room

Question 6

Which assessment question should the nurse ask to best understand how visual alterations are affecting the patient's self-care ability?

Accepted Answer

A)  "Have you stopped reading books or switched to books on audiotape?" 
B)  "Are you able to prepare a meal or write a check?" 
C)  "How do you protect yourself from injury at work?" 
D)  "How does your vision impairment make you feel?" 
A)  "Have you stopped reading books or switched to books on audiotape?" 
B)  "Are you able to prepare a meal or write a check?" 
C)  "How do you protect yourself from injury at work?" 
D)  "How does your vision impairment make you feel?"

Question 7

The nurse would be most concerned about the risk of malnutrition for a patient with which sensory deficit?

Accepted Answer

A)  Xerostomia 
B)  Disequilibrium 
C)  Cataracts 
D)  Peripheral neuropathy 
A)  Xerostomia 
B)  Disequilibrium 
C)  Cataracts 
D)  Peripheral neuropathy

Question 8

A nurse is establishing a relationship with the patient who is visually impaired.Which is the most appropriate method to teach the patient how to contact the nurse for assistance?

Accepted Answer

A)  Place a raised Braille sticker on the call button, and instruct the patient to press for assistance. 
B)  Instruct the patient to yell at the top of his lungs to get the attention of the staff. 
C)  Explain to the patient that a staff person will stop by once an hour to see if the patient needs anything. 
D)  Share cell phone numbers with the patient so he can call the nurse if he needs her. 
A)  Place a raised Braille sticker on the call button, and instruct the patient to press for assistance. 
B)  Instruct the patient to yell at the top of his lungs to get the attention of the staff. 
C)  Explain to the patient that a staff person will stop by once an hour to see if the patient needs anything. 
D)  Share cell phone numbers with the patient so he can call the nurse if he needs her.

Question 9

The nurse is creating a plan of care for a patient with glaucoma.Which nursing diagnosis addresses the complication of the sensory deficit that places the patient at greatest risk for injury?

Accepted Answer

A)  Risk for falls 
B)  Body image disturbance 
C)  Social isolation 
D)  Fear 
A)  Risk for falls 
B)  Body image disturbance 
C)  Social isolation 
D)  Fear

Exam 94: Sensory Alterations

Which of the following sensory changes are normal with aging?

Often blindness occurs during childhood.Which health preventative measure is most appropriate to prevent vision impairment?

What is the involuntary motion of retracting the body from painful stimuli?

The nurse is caring for a patient who is recovering from a traumatic brain injury and frequently becomes disoriented to everything except her location.Which nursing intervention would be effective in orienting a patient with neurological deficit?

The nurse would utilize the Snellen chart for assessment of which patient?

Which assessment question should the nurse ask to best understand how visual alterations are affecting the patient's self-care ability?

The nurse would be most concerned about the risk of malnutrition for a patient with which sensory deficit?

A nurse is establishing a relationship with the patient who is visually impaired.Which is the most appropriate method to teach the patient how to contact the nurse for assistance?

The nurse is creating a plan of care for a patient with glaucoma.Which nursing diagnosis addresses the complication of the sensory deficit that places the patient at greatest risk for injury?

Health and Wellness

The Canadian Health Care Delivery System

The Development of Nursing in Canada

Community Health Nursing Practice

Theoretical Foundations of Nursing Practice

Research As a Basis for Practice

Nursing Values and Ethics

Legal Implications in Nursing Practice

Global Health, culture, and Diversity

Nursing Leadership, management, and Collaborative Practice

Critical Thinking in Nursing Practice

Nursing Assessment and Diagnosis

Planning and Implementing Nursing Care

Evaluation of Nursing Care

Documenting and Reporting

Nursing Informatics and Canadian Nursing Practice

Communication

Caring in Nursing Practice

Family Nursing

Patient Education

Developmental Theories

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Stress and Adaptation

Vital Signs

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Cardiopulmonary Functioning and Oxygenation

Fluid, electrolyte, and Acid-base Balances

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the Health Care Delivery System

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Critical Thinking in Nursing Practice

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