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Med Surg Proctored Exam
Total Questions : 60
Showing 10 questions, Sign in for moreA nurse performs the Snellen test on a client and obtains these results: Left eye 20/40, Right eye 20/30. What conclusion can the nurse make in regard to the client's vision based on these results?
During an instruction session on breast self-examination, the nurse would instruct a client to perform the exam at which time?
Lacking physical activities in older adult could cause which of the followings.
A client is concerned about a right breast lump. What questions are appropriate for reviewing of this system? Select all that apply.
The nurse plans to assess an adult client's kidneys for tenderness. The nurse should assess the area at the
A woman asks about the risk for developing breast cancer. Which of the following are considered as risk factors? Select all that apply.
Which of the following statement is best to describe clinical judgement?
The nurse is assessing a client's hearing and gathers the following data: speaks very softly, denies hearing loss, has never had and cannot afford additional hearing tests, fails whisper test. What is your hypothesis for this patient?
Explanation
Hearing loss involves the disruption of sound conduction or neural transmission within the auditory pathway. Specific etiologies include presbycusis, cerumen impaction, or chronic noise exposure. Progressive loss often leads to compensatory behaviors and decreased social engagement.
Rationale:
The client's tendency to speak softly is a common clinical indicator of sensorineural hearing loss. Because the individual cannot hear their own voice clearly, they lose the ability to modulate vocal intensity, often leading to an inappropriately quiet speech volume. The client's denial suggests psychological defense mechanisms or a gradual adaptation to sensory decline. Patients often attribute hearing difficulties to others mumbling, demonstrating a lack of insight into their own progressive functional impairment and the need for clinical intervention. Failing the whisper test is a highly sensitive bedside indicator of hearing acuity deficits. This physical assessment finding provides objective evidence that contradicts the client's self-report, necessitating further diagnostic evaluation using audiometry to determine the exact decibel loss. The inability to afford testing highlights a significant socioeconomic barrier to healthcare access. Financial constraints prevent the client from obtaining necessary audiological screening, which increases the risk of long-term cognitive decline and social isolation associated with untreated sensory deprivation.
A nurse assesses the skin of an older adult's forearms and observes purpura. What is the most likely cause of this skin condition?
Explanation
The integumentary system undergoes dermal atrophy and loss of subcutaneous collagen with age. This leads to extravasation of erythrocytes into the dermis following minor trauma. Common sites include the extensor surfaces of the forearms and the dorsal aspects of the hands.
Rationale:
The primary cause is the progressive thinning of the dermis and loss of supportive connective tissue. As the skin loses its structural collagen and elastin, the underlying small blood vessels become poorly supported, making them highly susceptible to rupture from even minimal mechanical pressure or friction.
Vascular fragility in the elderly is exacerbated by chronic sun exposure, which further degrades the extracellular matrix. The resulting ecchymoses are typically well-demarcated and purple in color. Unlike inflammatory rashes, these lesions do not blanch under pressure and resolve without leaving a significant scar. Medications like anticoagulants or corticosteroids often aggravate the condition by further weakening the vessel walls or thinning the skin. These pharmacological agents increase the risk of subcutaneous hemorrhage, leading to larger or more frequent patches of purpura that take longer for the body to reabsorb. Diagnosis is usually based on clinical inspection of the characteristic lesions and a history of age-related skin changes. It is vital to distinguish this from systemic coagulopathy or thrombocytopenia. The nurse should focus on skin protection and avoiding trauma to the fragile cutaneous layers of the extremities.
List one tool that is used to assess the depression status in older adult.
Explanation
Depression in geriatrics often presents as pseudodementia or somatic complaints rather than overt sadness. The screening process accounts for cognitive changes and age-related comorbidities. Frequent monitoring is vital to prevent failure to thrive and ensure appropriate neuropsychiatric or pharmacological intervention.
Rationale:
The Geriatric Depression Scale is a validated tool specifically designed for the older population. It utilizes a yes/no format, which minimizes the cognitive load on patients compared to Likert scales. This simplicity improves the reliability of the data collected during the initial psychiatric screening process. This assessment tool focuses on affective symptoms rather than physical complaints like fatigue or insomnia. Because many older adults have chronic illnesses, excluding somatic factors prevents the false inflation of depression scores that might otherwise occur with standard psychometric instruments used in younger populations. The short-form version consists of 15 questions, making it an efficient screening method for busy clinical settings. A score ≥ 5 suggests depressive symptoms, necessitating a more comprehensive clinical interview to differentiate between clinical depression and other neurocognitive disorders like Alzheimer's disease. Early identification using this tool allows for the implementation of targeted interventions such as psychotherapy or antidepressants. By objectively measuring the severity of the symptoms, nurses can track the patient's progress over time and adjust the interdisciplinary plan of care to improve quality of life.
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