NURS 345 Exam 4 Review Questions
and Correct Answers
The nurse will be alert for which cognitive alterations when caring for a 40-year-old
patient admitted to the emergency department with a high blood alcohol level?
SATA:
- Delirium
- Slurred speech
- Expressive aphasia
- Ringing in the ears
- Exogenous depression ✅- Delirium
- Slurred speech
- Exogenous depression
The nurse notes the presence of which alterations when admitting a 30-year-old patient
with suspected meningitis?
- Hypoglycemia
- Light sensitivity
- Aphasia
- Motor deficits ✅- Light sensitivity
Which sensory deficit poses the greatest danger to the safety of an 80-year-old patient
with Alzheimer's disease?
- Anosomia
- Loss of taste
- Isolation
- Vertigo ✅- Vertigo
The nurse is aware that a patient kept in strict isolation after a bone marrow transplant
is at increased risk of developing which cognitive alteration?
- Dementia
- Sundowning
- Sensory deprivation
- Delirium ✅- Sensory deprivation
The nurse recognizes that a patient with peripheral neuropathy is at increased risk for
which sensory alteration?
- Hearing loss
- Ringing in the ears
- Sensory deprivation
- Injury ✅- Injury
The nurse recognizes which sensory alteration in a 79-year-old patient who has lost
interest in eating and has lost five pounds over the past month? SATA:
,- Depression
- Anosmia
- Presbycusis
- Presbyopia
- Sensory deprivation ✅- Depression
- Anosmia
- Sensory deprivation
A 28-year-old patient who suffered a head injury is alert and oriented but does not
respond to questions in a timely manner. The nurse suspects which hearing alteration?
- Meniere's disease
- Conductive hearing loss
- Sensorineural hearing loss
- Presbycusis ✅- Sensorineural hearing loss
The nurse can expect which sensory alterations in a patient with Meniere's disease?
SATA:
- Hearing loss
- Vertigo
- Light sensitization
- Noise confusion
- Cognitive deprivation ✅- Hearing loss
- Vertigo
The nurse should be prepared for which cognitive alteration when caring for patients
receiving narcotic pain medications?
- Altered auditory ability
- Decreased consciousness
- Anosmia
- Combativeness ✅- Decreased consciousness
A nurse caring for older patients expects to encounter which age-related sensory
impairments?
SATA:
- Presbyopia
- Presbycusis
- Hallucinations
- Decreased taste
- Sensorineural hearing loss ✅- Presbyopia
- Presbycusis
- Decreased taste
The nurse knows that a patient with long-term diabetes mellitus is at high risk for which
alteration?
SATA:
- Peripheral neuropathy
, - Presbyopia
- Meniere's disease
- Depression
- Retinopathy ✅- Peripheral neuropathy
- Retinopathy
Which cognitive or sensory factors should a nursing student consider when caring for a
patient who is blind? SATA:
- Eating assistance
- Safety needs
- Pain management
- Activities of daily living (ADLs)
- Verbal communication ✅- Eating assistance
- Safety needs
- Activities of daily living (ADLs)
The nurse is prioritizing multiple nursing diagnoses for a patient admitted with dementia.
What would the nurse recognize as important when prioritizing nursing diagnoses?
- The priority diagnoses are the ones that can be resolved the quickest and easiest.
- The priority nursing diagnosis is one that directly correlates with the medical diagnosis.
- The diagnosis that will cause harm or a potential threat to the patient, if not addressed,
is the priority diagnosis.
- The diagnosis that is most important to the patient is the priority diagnosis. ✅- The
diagnosis that will cause harm or a potential threat to the patient, if not addressed, is the
priority diagnosis.
The nurse collects assessment data for a newly admitted patient, which includes:
respirations deep, unlabored; warm and dry skin. The patient tends to wander off and
does not remember doing so. The patient also shows inability to remember his name,
the date, or the year. Hospital records indicate that the patient had a previous stroke.
What should the nurse develop as an appropriately written nursing diagnosis for this
patient?
- Acute Confusion related to cerebral hypoxia secondary to a clot in the cerebral artery,
as evidenced by not oriented to person and confused about place and time
- Chronic Confusion related to alterations in brain function, as evidenced by wandering
and inability to remember his name
- Social Isolation related to alterations in mental status secondary to dementia, as
evidenced by a flat affect
- Impaired Verbal Communication related to weakness on the right side of the body, as
evidenced by t ✅- Chronic Confusion related to alterations in brain function, as
evidenced by wandering and inability to remember his name
An older adult patient is brought to the emergency department (ED) by a family member
who reports that the patient is recently confused. Assessment data reveals that the
patient is alert, but does not know the current month or their location. The patient is also
speaking in short sentences. When the patient is asked questions regarding the past
and Correct Answers
The nurse will be alert for which cognitive alterations when caring for a 40-year-old
patient admitted to the emergency department with a high blood alcohol level?
SATA:
- Delirium
- Slurred speech
- Expressive aphasia
- Ringing in the ears
- Exogenous depression ✅- Delirium
- Slurred speech
- Exogenous depression
The nurse notes the presence of which alterations when admitting a 30-year-old patient
with suspected meningitis?
- Hypoglycemia
- Light sensitivity
- Aphasia
- Motor deficits ✅- Light sensitivity
Which sensory deficit poses the greatest danger to the safety of an 80-year-old patient
with Alzheimer's disease?
- Anosomia
- Loss of taste
- Isolation
- Vertigo ✅- Vertigo
The nurse is aware that a patient kept in strict isolation after a bone marrow transplant
is at increased risk of developing which cognitive alteration?
- Dementia
- Sundowning
- Sensory deprivation
- Delirium ✅- Sensory deprivation
The nurse recognizes that a patient with peripheral neuropathy is at increased risk for
which sensory alteration?
- Hearing loss
- Ringing in the ears
- Sensory deprivation
- Injury ✅- Injury
The nurse recognizes which sensory alteration in a 79-year-old patient who has lost
interest in eating and has lost five pounds over the past month? SATA:
,- Depression
- Anosmia
- Presbycusis
- Presbyopia
- Sensory deprivation ✅- Depression
- Anosmia
- Sensory deprivation
A 28-year-old patient who suffered a head injury is alert and oriented but does not
respond to questions in a timely manner. The nurse suspects which hearing alteration?
- Meniere's disease
- Conductive hearing loss
- Sensorineural hearing loss
- Presbycusis ✅- Sensorineural hearing loss
The nurse can expect which sensory alterations in a patient with Meniere's disease?
SATA:
- Hearing loss
- Vertigo
- Light sensitization
- Noise confusion
- Cognitive deprivation ✅- Hearing loss
- Vertigo
The nurse should be prepared for which cognitive alteration when caring for patients
receiving narcotic pain medications?
- Altered auditory ability
- Decreased consciousness
- Anosmia
- Combativeness ✅- Decreased consciousness
A nurse caring for older patients expects to encounter which age-related sensory
impairments?
SATA:
- Presbyopia
- Presbycusis
- Hallucinations
- Decreased taste
- Sensorineural hearing loss ✅- Presbyopia
- Presbycusis
- Decreased taste
The nurse knows that a patient with long-term diabetes mellitus is at high risk for which
alteration?
SATA:
- Peripheral neuropathy
, - Presbyopia
- Meniere's disease
- Depression
- Retinopathy ✅- Peripheral neuropathy
- Retinopathy
Which cognitive or sensory factors should a nursing student consider when caring for a
patient who is blind? SATA:
- Eating assistance
- Safety needs
- Pain management
- Activities of daily living (ADLs)
- Verbal communication ✅- Eating assistance
- Safety needs
- Activities of daily living (ADLs)
The nurse is prioritizing multiple nursing diagnoses for a patient admitted with dementia.
What would the nurse recognize as important when prioritizing nursing diagnoses?
- The priority diagnoses are the ones that can be resolved the quickest and easiest.
- The priority nursing diagnosis is one that directly correlates with the medical diagnosis.
- The diagnosis that will cause harm or a potential threat to the patient, if not addressed,
is the priority diagnosis.
- The diagnosis that is most important to the patient is the priority diagnosis. ✅- The
diagnosis that will cause harm or a potential threat to the patient, if not addressed, is the
priority diagnosis.
The nurse collects assessment data for a newly admitted patient, which includes:
respirations deep, unlabored; warm and dry skin. The patient tends to wander off and
does not remember doing so. The patient also shows inability to remember his name,
the date, or the year. Hospital records indicate that the patient had a previous stroke.
What should the nurse develop as an appropriately written nursing diagnosis for this
patient?
- Acute Confusion related to cerebral hypoxia secondary to a clot in the cerebral artery,
as evidenced by not oriented to person and confused about place and time
- Chronic Confusion related to alterations in brain function, as evidenced by wandering
and inability to remember his name
- Social Isolation related to alterations in mental status secondary to dementia, as
evidenced by a flat affect
- Impaired Verbal Communication related to weakness on the right side of the body, as
evidenced by t ✅- Chronic Confusion related to alterations in brain function, as
evidenced by wandering and inability to remember his name
An older adult patient is brought to the emergency department (ED) by a family member
who reports that the patient is recently confused. Assessment data reveals that the
patient is alert, but does not know the current month or their location. The patient is also
speaking in short sentences. When the patient is asked questions regarding the past
