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Exam (elaborations)

NURS 6002 Exam 2 exam with 100- correct answers 2024.

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NURS 6002 Exam 2 exam with 100- correct answers 2024.

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Institution
NURS 6002
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NURS 6002

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Uploaded on
September 16, 2024
Number of pages
19
Written in
2024/2025
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NURS 6002 Exam 2 exam with
100% correct answers

A nurse who is assessing an older female patient in a long-term care
facility notes that the patient is at risk for sensory deprivation r/t
severe RA limiting her activity. Which interventions would the nurse
recommend based on this finding? Select all that apply.


A. Use a lower tone when communicating w/ the pt
B. Provide interaction w/ children and pets
C. Decrease environmental noise
D. Ensure that the pt shares meals w/ other pts
E. Discourage the use of sedatives
F. Provide adequate lighting and clear pathways of clutter - answer
B, D, E


A nurse is assessing a 78yo male pt for kinesthetic and visceral
disturbances. Which techniques would the nurse use for this
assessment? Select all that apply.


A. The nurse asks the pt if he is bored and if so, why
B. The nurse asks the pt is anything interferes with w/ the
functioning of his senses
C. The nurse asks the pt if he noticed any changes in the way he
perceives his body
D. The nurse asks the pt if he has found it difficult to communicate
verbally
E. The nurse notes if the pt withdraws from being touched
F. The nurse notes if the pt seems unsure of his body parts or
position - answer C, E, F

,To assess for kinesthetic and visceral disturbances, the nurse would
assess for perceived body changes inside and out, and changes in
body parts or position. Asking if anything interferes with his senses
assesses reception, and asking about difficulty communicating
assesses for transmission-perception-reaction.


A nurse asks a pt to close her eyes, state when she feels something,
and describe the feeling. The nurse then brushes the pt's skin w/ a
cotton ball, and touches the pt's skin w/ both sides of a safety pin.
Which sense is the nurse assessing?


A. Gustatory
B. Olfactory
C. Tactile
D. Kinesthetic - answer C


A nurse observes that a pt who has cataracts is sitting closer to the
TV than usual. The nurse would interpret that the etiologic basis of
this sensory problem is an alteration in:


A. Environmental stimuli
B. Sensory reception
C. Nerve impulse conduction
D. Impulse translation - answer B


Cataracts are interfering w/ the pt's ability to receive visual stimuli:
altered sensory reception


Which action would be most important for a nurse to include in the
plan of care for a pt who is 85yo and has presbycusis?

, A. Obtaining large-print written material
B. Speaking distinctly, using lower frequencies
C. Decreasing tactile stimulation
D. Initiating a safety program to prevent falls - answer B


A pt is in the late stages of AIDS, which is now affecting his brain as
well as other major organ systems. The pt confides to the nurse that
he feels terribly alone b/c most of his friends are afraid to visit. The
nurse determines that the least likely underlying etiology for his
sensory problems would be:


A. Stimulation
B. Reception
C. Transmission-perception-reaction
D. Emotional response - answer D


Emotional responses are an effect of sensory deprivation, and
although they may be occurring w/ this pt, they are not the
underlying etiology for his condition. This pt is receiving decreased
environmental stimuli, is more likely experiencing problems w/
reception b/c of major organ involvement, and his impaired brain
function will impair impulse transmission-perception-reaction.


Which pt would a nurse assess as being at greatest risk for sensory
deprivation?


A. An older man confined to bed at home after a stroke
B. An adolescent in an oncology unit working on HW supplied by
friends
C. A woman in labor
D. A toddler in a playroom awaiting same-day surgery - answer A

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