A nurse is performing a complete physical examination on a patient. After examining the patient with the Snellen chart, the nurse documented distance vision in both eyes 20/40. The patient asks the nurse what 20/40 means:

20 represents the distance you are placed from the chart and 40 represents the distance a normal eye read the chart.

20 represents the distance a normal eye can read and 40 represents the distance your eye read the chart.

20 represents the distance you are placed from the chart and 40 represents the distance your eye read the chart.

40 represents the distance you are placed from the chart and 20 represents the distance a normal eye read the chart.

Answer and Explanation

The Correct Answer is A

A. 20 represents the distance you are placed from the chart and 40 represents the distance a normal eye reads the chart:

This is correct. The first number (20) represents the distance in feet the patient is from the Snellen chart. The second number (40) indicates the distance at which a person with normal vision can read the same line. Therefore, 20/40 means that what the patient can read at 20 feet, a person with normal vision can read at 40 feet.

B. 20 represents the distance a normal eye can read and 40 represents the distance your eye reads the chart:

This is incorrect. The first number should represent the distance the patient is from the chart, not the normal eye's reading distance.

C. 20 represents the distance you are placed from the chart and 40 represents the distance your eye reads the chart:

This is incorrect. While the first number is correct (the distance from the chart), the second number should represent the distance a person with normal vision can read the same line, not the patient's distance.

D. 40 represents the distance you are placed from the chart and 20 represents the distance a normal eye reads the chart:

This is incorrect. The standard for visual acuity measurements is that the first number represents the testing distance (usually 20 feet), and the second number represents the distance at which a normal eye can read the line.

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Correct Answer is C

Explanation

(a) Diarrhea: Diarrhea is an abnormal gastrointestinal response characterized by frequent, loose, or watery stools. It can be caused by infections, medications, or underlying gastrointestinal disorders. Pallor, or paleness of the skin, typically does not directly lead to diarrhea unless there are specific underlying conditions affecting both circulation and gastrointestinal function.

(b) Diaphoresis: Diaphoresis refers to excessive sweating, which can occur due to sympathetic nervous system activation, fever, or anxiety. While diaphoresis may be associated with conditions causing increased sympathetic activity, it is not directly related to pallor, which indicates reduced blood flow to the skin.

(c) Fainting: Pallor is often a sign of decreased blood flow to the skin, indicating potential hypoperfusion. If severe, this reduced circulation can lead to fainting (syncope) due to inadequate blood supply to the brain. Therefore, after noting pallor, the nurse should be prepared to manage the client for potential fainting episodes by ensuring safety and providing appropriate interventions.

(d) Vomiting: Vomiting is the forceful expulsion of stomach contents through the mouth and can be caused by various factors such as gastrointestinal irritation, infection, or systemic illnesses. Pallor does not directly cause vomiting, although severe systemic conditions affecting circulation could potentially lead to nausea and vomiting as part of a broader clinical picture.

A. the patient is unable to see in half of the visual field (same visual field) in each eye B. the patient can see from one eye but not through the other one. C. the patient is unable to see in half of the visual field (opposite visual field) in each eye D. No visual impairment

Correct Answer is A

Explanation

a) The patient is unable to see in half of the visual field (same visual field) in each eye:

Homonymous hemianopsia is a condition where there is a loss of vision in the same side of the visual field in both eyes. This occurs due to damage to the visual pathways after the optic chiasm, often from a stroke or brain injury, resulting in the loss of either the right or left visual field in both eyes.

b) The patient can see from one eye but not through the other one:

This description fits a condition called monocular blindness, which is typically caused by damage to the optic nerve before it reaches the optic chiasm. Homonymous hemianopsia involves both eyes and specific visual fields, not complete loss of vision in one eye.

c) The patient is unable to see in half of the visual field (opposite visual field) in each eye:

This option describes bitemporal hemianopsia, which results in loss of vision in the outer (temporal) fields of both eyes and is often due to damage at the optic chiasm. Homonymous hemianopsia involves the same side of the visual field in both eyes, not the opposite visual fields.

d) No visual impairment:

Homonymous hemianopsia is characterized by significant visual impairment, specifically the loss of half the visual field in both eyes on the same side. Therefore, it is incorrect to say there is no visual impairment with this condition.

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A nurse is performing a complete physical examination on a patient. After examining the patient with the Snellen chart, the nurse documented distance vision in both eyes 20/40. The patient asks the nurse what 20/40 means:

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Naxlex Comprehensive Predictor Exams

What abnormal physical response should the nurse be prepared to manage after noting pallor in a client?

Correct Answer is C

Explanation

A patient is diagnosed with Homonymous Hemianopsia. The nurse expects to find what defects in the visual field of this patient:

Correct Answer is A

Explanation

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