Which of the ff would describe the discomfort experienced by a client with a tension headache?

Correct Answer: B

Rationale: Tension headaches are commonly described as a sensation of pressure, tightness, or steady constriction around the head. This discomfort is usually felt on both sides of the head, rather than being localized to one specific area. Unlike migraines which may have a pulsating or throbbing quality, tension headaches are characterized by a continuous dull ache. Sensitivity to light (photophobia) and vague headaches are more commonly associated with migraines, not tension headaches. Temporary unilateral paralysis and peri orbital pain are not typical symptoms of tension headaches.

Correct Answer: D

Rationale: By assessing the patient's swallowing reflex, the nurse can determine if the patient is able to swallow food and liquids properly, which is crucial for adequate nutrition intake. Bell's Palsy can affect facial muscles, including those involved in chewing and swallowing. A impaired swallowing reflex can lead to difficulties in eating and drinking, which in turn may affect the patient's nutrition status. Monitoring meal trays (A) may not provide direct information about the patient's ability to swallow, as a patient may not be able to communicate swallowing difficulties. Checking twice-weekly weights (B) may indicate weight changes, but it may not necessarily give insight into nutrition adequacy related to swallowing ability. Measuring intake and output (C) may help track calorie intake and fluid balance, but it may not specifically address swallowing issues that can impact nutrition in a patient with Bell's Palsy. Assessing the swallowing reflex (D) directly addresses the patient's ability to consume food and

Correct Answer: C

Rationale: The nursing intervention in preparation for a brain scanning test such as an MRI or CT scan should include explaining to the patient (Mr. RR in this case) that although his head will be supported in place for a period of time during the test, the procedure itself will not be painful. Providing this explanation helps to alleviate any anxiety or fear Mr. RR may have about the test and ensures that he feels comfortable and well-informed before the procedure. This communication is key to promoting a positive patient experience and ensuring cooperation during the test. It also helps in managing patient expectations and reducing any potential stress or discomfort during the scanning process.

Correct Answer: A

Rationale: When testing visual fields, the nurse is assessing the peripheral vision. Peripheral vision refers to the outer area of the visual field, away from the center of gaze. It allows individuals to detect objects, movement, and stimuli in their surroundings without needing to focus directly on them. Testing peripheral vision is important for detecting potential visual field deficits that can impede daily activities and safety, such as driving or navigating crowded spaces. By assessing the peripheral vision, healthcare professionals can identify any limitations or abnormalities that may require further evaluation or intervention.

Correct Answer: B

Rationale: Glaucoma is a group of eye conditions that damage the optic nerve, usually due to high intraocular pressure (IOP). In glaucoma, there is an imbalance between the production and drainage of aqueous humor in the eye, leading to increased pressure inside the eye. This elevated pressure can cause damage to the optic nerve, which is essential for vision, resulting in vision loss. Therefore, the best description by the nurse to explain glaucoma to a patient would be that there is an increase in intraocular pressure (Choice B).