A nurse is performing Weber's test for a client who has hearing loss. Which of the following actions should the nurse take?
Place a vibrating tuning fork against the midline vertex of the client's head.
Have the client repeat a phrase spoken by the nurse while the nurse's mouth is hidden.
Whisper words for the client to identify.
Ask the client to occlude one ear with a finger.
The Correct Answer is A
A. Place a vibrating tuning fork against the midline vertex of the client's head: The Weber test is performed by placing a vibrating tuning fork on the midline of the client's forehead or vertex of the head. This tests for lateralization of sound, helping to distinguish between conductive and sensorineural hearing loss based on which ear hears the sound louder.
B. Have the client repeat a phrase spoken by the nurse while the nurse's mouth is hidden: This action refers to the "speech discrimination test" rather than the Weber test. It is not part of the Weber test, which is specifically used to assess the lateralization of sound.
C. Whisper words for the client to identify: This refers to a different hearing test, called the "whisper test," used to assess hearing ability, not the Weber test. The Weber test specifically uses a tuning fork to assess how sound is heard by the client.
D. Ask the client to occlude one ear with a finger: While blocking one ear can be used in other tests (like Rinne's test), it is not necessary for the Weber test, which involves placing the tuning fork in the center of the head.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Notify the primary care provider: Notifying the provider is important, but first, the nurse should assess the client’s condition by obtaining vital signs. This helps determine if immediate intervention is needed, like administering antidotes or treatments.
B. Obtain the client's vital signs: The first step is assessing the client’s physical status by checking vital signs. This helps identify signs of toxicity or immediate adverse effects from the overdose, guiding further actions.
C. Educate the client about potential adverse effects: Education is important, but it’s not the first priority in the case of an overdose. The nurse should first focus on assessing and stabilizing the client before providing information on potential adverse effects.
D. Complete an incident report: While an incident report is necessary, it is not the immediate priority. The nurse must first ensure the client’s safety and health by assessing and managing the overdose.
Correct Answer is D
Explanation
A. Muscle flaccidity: Hypocalcemia typically causes muscle twitching or spasms, not flaccidity. Muscle flaccidity is more often associated with conditions like hyperkalemia or electrolyte imbalances affecting muscle tone in different ways.
B. Lethargy: Lethargy can occur in various conditions, but it is not a hallmark of hypocalcemia. Instead, hypocalcemia usually causes symptoms like irritability, confusion, and muscle cramps rather than general lethargy.
C. Constipation: Constipation is more commonly associated with hypercalcemia, not hypocalcemia. Low calcium levels tend to cause neuromuscular and cardiac symptoms rather than gastrointestinal issues like constipation.
D. Positive Chvostek's sign: A positive Chvostek's sign, which is a twitching of the facial muscles when tapping the facial nerve, is a classic sign of hypocalcemia. It indicates increased neuromuscular excitability, which is characteristic of low calcium levels.
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