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Questions 164

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Question 1 of 5

The nurse is talking with a client with unilateral facial paralysis. Which of the following statements by the client would require follow-up? Select all that apply.

Correct Answer: A,E

Rationale: Chewing on the affected side risks injury due to impaired sensation, and ice may worsen symptoms in conditions like Bell’s palsy. Closing the eyelid, taping at night, and soft foods are appropriate for facial paralysis management.

Question 2 of 5

Damage to the VIII cranial nerve results in:

Correct Answer: B

Rationale: The VIII cranial nerve (vestibulocochlear) is responsible for hearing and balance; damage causes sensorineural hearing loss, affecting the inner ear or nerve pathways.

Question 3 of 5

A client visiting a family planning clinic is suspected of having an STD. The most diagnostic test for all stages of treponema pallidum (syphilis) is the:

Correct Answer: C

Rationale: The FTA-Abs test is the most specific and diagnostic for all stages of syphilis. VDRL and RPR are non-treponemal tests that can have false positives, so A and B are incorrect. Thayer-Martin culture is used for gonorrhea, so D is incorrect.

Question 4 of 5

A client is admitted with a head injury. Which vital sign assessment is most indicative of increased intracranial pressure?

Correct Answer: B

Rationale: Vital signs correlating with increased intracranial pressure are an elevated BP with a widening pulse pressure, a slow pulse rate, and an elevated temperature with involvement of the hypothalamus. Answer C relates to hypovolemia, so it is incorrect. Answers A and D do not relate to increased intracranial pressure and are therefore incorrect.

Question 5 of 5

A client is being evaluated for carpal tunnel syndrome. The nurse is observed asking the client to place the backs of her hands together and flex them at the same time. Which assessment is the nurse performing?

Correct Answer: A

Rationale: Phalen's maneuver involves flexing the wrists with the backs of the hands together to assess for carpal tunnel syndrome, as it may reproduce symptoms. Tinel's sign involves tapping over the median nerve. Kernig's and Brudzinski's are tests for meningitis, not carpal tunnel syndrome.

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