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 D

Explanation

Exophthalmos:

Exophthalmos, or protruding eyeballs, is typically associated with hyperthyroidism (Graves' disease) rather than hypothyroidism. It results from the accumulation of fluid and swelling behind the eyeballs.

(b) Palpitations:

Palpitations, or rapid heartbeat, are more commonly associated with hyperthyroidism due to the increased metabolic rate and sympathetic nervous system stimulation. In hypothyroidism, bradycardia (slow heart rate) is more likely.

Diaphoresis, or excessive sweating, is not a typical finding in hypothyroidism. It is more commonly associated with conditions that cause autonomic dysfunction or hypermetabolic states.

(d) Weight gain:

Weight gain is a hallmark symptom of hypothyroidism. It occurs due to a slowing down of the metabolic rate, leading to reduced calorie expenditure and potential fluid retention.

A. "I do not eat salty foods and snacks B. "My rings are not fitting on my fingers like they usually do" C. "I exercise about 20 minutes a day by walking" D. "High blood pressure is present in my mother & grandmother"

Correct Answer is B

Explanation

A) "I do not eat salty foods and snacks": This statement indicates the client's dietary habits and, while it can impact overall health, it does not necessarily require immediate validation unless there is reason to doubt its accuracy or it is related to a specific health concern being addressed.

B) "My rings are not fitting on my fingers like they usually do": This statement suggests a change in the client's physical condition, likely indicating fluid retention or edema. This symptom requires validation as it could signify an underlying issue such as heart failure, kidney problems, or other medical conditions that need prompt attention.

C) "I exercise about 20 minutes a day by walking": This statement reflects the client's physical activity routine. While it's important for assessing overall health and fitness, it does not demand immediate validation unless related to a specific health issue.

D) "High blood pressure is present in my mother & grandmother": This statement provides valuable family history information, which is important for assessing genetic risk factors. However, it does not require urgent validation compared to physical changes indicating potential health problems.

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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:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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