Which client should receive the pictured examination first?
a client with nausea, vomiting, and abdominal pain
a client with chest tightness and heartburn
a client with facial drooping and left-sided weakness
a client with fatigue, fever, and productive cough
The Correct Answer is C
Choice A rationale: A client with nausea, vomiting, and abdominal pain may have gastroenteritis, food poisoning, or appendicitis, which are not directly related to the eyes.
Choice B rationale: A client with chest tightness and heartburn may have gastroesophageal reflux disease (GERD), angina, or myocardial infarction (MI), which are also not associated with the eyes.
Choice C rationale: A client with facial drooping and left-sided weakness may have a stroke, which is a medical emergency that requires immediate attention. An eye examination can help detect signs of stroke, such as pupil asymmetry, visual field defects, or eye movement abnormalities. A stroke can cause permanent brain damage or death if not treated promptly.
Choice D rationale: A client with fatigue, fever, and productive cough may have a respiratory infection, such as pneumonia or tuberculosis, which are unlikely to affect the eyes unless there is a systemic complication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: Petit mal seizures, also known as absence seizures, involve a sudden lapse in consciousness for a brief duration, typically 5 to 30 seconds.
Choice B rationale: Clonic seizures involve rhythmic jerking movements.
Choice C rationale: Tonic-clonic seizures involve both tonic (muscle stiffness) and clonic (rhythmic jerking) phases.
Choice D rationale: Tonic seizures involve muscle stiffness but don't usually present as sudden lapses of consciousness in a short duration.
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Correct Answer is D
Explanation
Choice A rationale: This may indicate a different condition such as gastroenteritis rather than Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS).
Choice B rationale: This is more indicative of diabetic ketoacidosis (DKA) rather than HHNS.
Choice C rationale: A 72-year-old with a history of diabetes, elevated blood glucose, and complaints of thirst and frequent urination might have uncontrolled diabetes, but the absence of severe hyperglycemia and other symptoms specific to HHNS makes this choice less likely.
Choice D rationale: This fits the criteria for HHNS. The infection, missed medication, and extremely high blood glucose levels suggest the possibility of Hyperglycemic Hyperosmolar Nonketotic Syndrome.
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