NCLEX-PN
Sensory NCLEX Questions Questions
Extract:
Question 1 of 5
The nurse is assessing the client’s sensory system. Which assessment data indicate an abnormal stereognosis test?
Correct Answer: D
Rationale: Abnormal stereognosis is the inability to identify objects (e.g., a key) by touch with eyes closed, indicating parietal lobe dysfunction.
Toe movement, sharp/dull, and Babinski reflex test other functions.
Question 2 of 5
An adult man fell off a ladder and hit his head. His wife rushed to help him and found him unconscious. After regaining consciousness several minutes later, he was drowsy and had trouble staying awake. He is admitted to the hospital for evaluation. When the nurse enters the room, he is sleeping. While caring for the client, the nurse finds that his systolic blood pressure has increased, his pulse has decreased, and his temperature is slightly elevated. What does this suggest?
Correct Answer: C
Rationale: Increased systolic blood pressure, decreased pulse, and elevated temperature suggest increased intracranial pressure (Cushing's triad) post-head injury.
Question 3 of 5
The doctor orders a Tensilon test for a woman suspected of having myasthenia gravis. Which statement is true about this test?
Correct Answer: A
Rationale: A positive Tensilon test shows increased muscle strength within one minute, confirming myasthenia gravis, as Tensilon enhances acetylcholine activity.
Question 4 of 5
The client's eyes, tested with the use of a Snellen chart, show 20/40 vision in the right eye and 20/30 in the left eye. How should the nurse interpret these results?
Correct Answer: C
Rationale: The Snellen chart is used to test distance vision. The numbers recorded indicate that at 20 feet (the first number) the client is able to read what a person with normal vision can read at another distance (second number). The left eye's vision recorded as 20/30 has better vision than the right eye with vision recorded as 20/40. The Snellen chart is not used to measure intraocular pressure, suggest glaucoma testing, or determine astigmatism.
Question 5 of 5
The nurse is assessing the client’s sensory system. Which assessment data indicate an abnormal stereognosis test?
Correct Answer: D
Rationale: Abnormal stereognosis is the inability to identify objects (e.g., a key) by touch with eyes closed, indicating parietal lobe dysfunction.
Toe movement, sharp/dull, and Babinski reflex test other functions.