The nurse is reviewing a client's medical record with a documented Snellen exam of 20/50, uncorrected.
Patient could read the Rosenbaum chart without difficulty.
Based on this information, the client has:
Myopia.
Normal vision.
Presbyopia.
Hyperopia.
The Correct Answer is D
Choice A rationale
Myopia, or nearsightedness, is when distant objects appear blurry because light rays focus in front of the retina. A Snellen exam result of 20/50 means the client can see at 20 feet what someone with normal vision sees at 50 feet, indicating reduced distance vision. However, this condition does not correlate with the ability to read the Rosenbaum chart, which is for near vision, thus excluding myopia.
Choice B rationale
Normal vision is not indicated by a Snellen exam result of 20/50, as this signifies a visual impairment where the client sees at 20 feet what a person with normal vision sees at 50 feet. Normal vision would be indicated by 20/20 on the Snellen exam.
Choice C rationale
Presbyopia is the age-related loss of the eye's ability to focus on near objects, typically noticeable in people over 40. Although this condition involves difficulty reading at close range, the client's uncorrected Snellen exam result of 20/50 pertains to distance vision, which differentiates presbyopia from the given scenario.
Choice D rationale
Hyperopia, or farsightedness, is when close objects appear blurry because light rays focus behind the retina. The client's ability to read the Rosenbaum chart without difficulty indicates good near vision, while the Snellen exam result of 20/50 reflects reduced distance vision, thus supporting the diagnosis of hyperopia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Functional incontinence occurs when an individual cannot reach the bathroom in time due to physical or cognitive limitations. It is not related to stress or pressure on the bladder but rather to external factors that impede timely access to toileting facilities.
Choice B rationale
Reflex incontinence is characterized by involuntary loss of urine due to a lack of signal awareness or detrusor muscle overactivity. It is typically associated with neurological conditions such as spinal cord injuries or multiple sclerosis. This type of incontinence does not involve stress-related triggers like coughing or sneezing.
Choice C rationale
Stress incontinence involves the involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or physical exertion. This type of incontinence is commonly seen in women, particularly after childbirth or during menopause, due to weakened pelvic floor muscles or sphincter dysfunction.
Choice D rationale
Urge incontinence is characterized by a sudden and intense urge to urinate, often resulting in involuntary urine leakage before reaching the bathroom. It is typically caused by overactive bladder muscles or nerve signals and is not specifically triggered by actions like coughing or sneezing.
Correct Answer is A
Explanation
Choice A rationale
Rhonchi are low-pitched, continuous breath sounds that are often indicative of secretions in the large airways. These sounds may change or clear with coughing, so the nurse should have the patient cough and then auscultate again to reassess the presence of rhonchi.
Choice B rationale
Wheezes are high-pitched, musical sounds heard primarily during expiration. They are caused by narrowed airways, typically due to asthma or other obstructive lung conditions. Wheezes do not usually clear with coughing and require specific treatments to address airway constriction.
Choice C rationale
Crackles are discontinuous, popping sounds heard during inspiration and are associated with fluid in the alveoli, such as in conditions like pneumonia or heart failure. Crackles are not typically cleared by coughing and may persist despite the patient's efforts to clear their airways.
Choice D rationale
Stridor is a high-pitched, harsh sound heard during inspiration, often indicating upper airway obstruction. Stridor is a medical emergency and requires immediate intervention to secure the airway. It does not clear with coughing and signifies a critical respiratory issue. .
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