Question

During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is described by which statement?

Answer 1

Correct Answers:

Using gentle pressure in a rotating pattern, palpate with both hands to compare the two sides

Rationale :

💠 This technique uses gentle pressure with the finger pads in a small circular (rotary) motion, which is the recommended method for assessing cervical lymph nodes.

💠 Palpating with both hands simultaneously allows the nurse to compare the size, shape, mobility, and consistency of nodes on both sides of the neck.

💠 Bilateral comparison is essential to detect subtle asymmetry, such as enlargement or firmness on one side that may indicate infection or malignancy.

💠 Using gentle rather than firm pressure reduces client discomfort and improves the nurse’s ability to feel small, superficial nodes.

💠 This method reflects best practice in head and neck assessment and supports accurate, systematic evaluation of lymphatic findings.

Gently pinch each node between one's thumb and forefinger, and then move down the neck muscle.

💠 Pinching each node between the thumb and forefinger can be uncomfortable and is not the recommended technique for routine cervical lymph node assessment.

💠 This approach focuses on isolated, focal pressure instead of broad, gentle palpation, which may cause tenderness and make the client tense.

💠 When tissues are compressed too tightly, small nodes may be pushed away or missed, reducing the sensitivity of the exam.

💠 The method also does not emphasize simultaneous bilateral comparison, which is key to identifying asymmetry and abnormal changes.

💠 Because it risks discomfort and does not follow standard bilateral, rotary palpation, it is not the best technique.

Gently palpate by applying pressure in a rotating pattern, one lymph node at a time.

💠 While gentle, rotating palpation is appropriate, this description lacks the essential feature of using both hands to compare sides simultaneously.

💠 Evaluating one node at a time on one side only may miss important right–left differences in node size, consistency, or tenderness.

💠 Bilateral comparison helps detect unilateral enlargement, which may be an early sign of localized infection or malignancy.

💠 This approach is therefore incomplete because it does not use the full bilateral assessment strategy recommended for cervical lymph nodes.

💠 Although partially correct, it is not the best description of the optimal technique for lymph node palpation in the neck.

Using strong pressure, palpate with both hands to compare the two sides.

💠 Using strong pressure on cervical lymph nodes can cause unnecessary pain, especially if nodes are already tender or inflamed.

💠 Excessive pressure may compress and displace nodes, making it more difficult to assess their true size and mobility.

💠 Lymph node assessment is intended to be gentle, with light to moderate pressure that is enough to feel structures without causing discomfort.

💠 While bilateral comparison is correct, the use of strong pressure directly contradicts recommended gentle palpation technique.

💠 Because it increases the risk of client discomfort and inaccurate findings, this method is not appropriate.

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Answer 2

Correct Answers:

"Cover one ear, I will stand 2 feet behind you, then repeat the whispered word after I state the word."

Rationale :

🔷 The whisper test evaluates high-frequency hearing and screens for high-tone hearing loss in each ear separately.

🔷 The nurse stands about 2 feet (0.6 m) behind the client to reduce visual cues and prevent the client from lip-reading.

🔷 Having the client cover one ear isolates the uncovered ear, allowing accurate assessment of that ear’s hearing ability.

🔷 The nurse whispers letters, numbers, or simple words and asks the client to repeat the words, assessing how well the sound is perceived.

🔷 This option correctly includes distance, position (behind), and instruction that align with standard whisper test technique.

"Cover one ear, I will stand 5 feet behind you, then repeat the whispered word after I state the word."

🔷 Standing 5 feet behind the client places the nurse too far away for a consistent and reliable whispered voice intensity.

🔷 At this distance, even clients with normal hearing may struggle to hear the whisper, risking false-positive results for hearing loss.

🔷 The whisper test depends on a controlled, standardized distance, typically about 1–2 feet, for accuracy.

🔷 Although the position behind and covering one ear are correct, the distance is not consistent with recommended practice.

🔷 Therefore, this instruction does not meet best-practice standards for the whisper test.

"Cover one ear, I will stand 2 feet in front of you, then repeat the whispered word after I state the word."

🔷 Standing in front of the client allows them to see the nurse’s lips, which can lead to lip-reading and falsely normal test results.

🔷 The purpose of the whisper test is to evaluate auditory perception, not the ability to interpret visual speech cues.

🔷 Even though the distance (2 feet) is appropriate, the position (in front) undermines the test’s validity.

🔷 Clients may appear to hear well because they are visually compensating, masking true hearing impairment.

🔷 For these reasons, this instruction is not appropriate for a proper whisper test.

"Cover one ear, I will stand 5 feet in front of you, then repeat the whispered word after I state the word."

🔷 This option combines incorrect distance and incorrect positioning, making the whisper test highly unreliable.

🔷 At 5 feet, the whisper may be inaudible even to those with normal hearing, increasing the risk of overestimating hearing loss.

🔷 Standing in front permits lip-reading, which can distort the assessment by allowing visual compensation.

🔷 Accurate whisper testing requires minimizing visual cues and using a standardized short distance behind the client.

🔷 Because it fails to meet both distance and position requirements, this is not an acceptable technique.

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Answer 3

Correct Answers:

Sudden, severe eye pain.
Client states, "I could see pretty good this morning then all of a sudden everything is cloudy."
Headache.

Rationale :

Sudden, severe eye pain.

✴️ Primary angle-closure glaucoma is an acute eye emergency characterized by sudden, severe eye pain due to rapidly increased intraocular pressure (IOP).

✴️ The drainage angle between the iris and cornea becomes blocked, leading to impaired aqueous humor outflow and pressure buildup.

✴️ Clients may describe the pain as intense, throbbing, or deep, sometimes accompanied by redness and a hard, firm globe.

✴️ This acute pain is a key distinguishing feature from chronic forms of glaucoma, which are typically painless.

✴️ Recognizing sudden severe eye pain with other ocular symptoms is critical for urgent ophthalmologic referral to prevent permanent vision loss.

Client states, "I could see pretty good this morning then all of a sudden everything is cloudy."

✴️ The description of sudden onset of cloudy vision fits the acute nature of angle-closure glaucoma, where IOP rises quickly.

✴️ Rapid pressure changes affect the cornea and optic nerve, producing blurred or cloudy vision within hours.

✴️ This contrasts with chronic open-angle glaucoma, where vision declines gradually and painlessly over time.

✴️ A history of “vision was fine earlier and then suddenly became cloudy” strongly suggests an acute ocular process, not a slow degenerative change.

✴️ This symptom, in combination with eye pain and headache, points toward primary angle-closure glaucoma and requires emergency treatment.

Headache.

✴️ Elevated intraocular pressure can cause referred pain that manifests as a headache, often on the same side as the affected eye.

✴️ Clients may also experience nausea and vomiting due to the intensity of pain and autonomic response.

✴️ When headache coexists with eye pain and sudden visual changes, it suggests a systemic reaction to high IOP.

✴️ This cluster of symptoms—eye pain, cloudy vision, halos, headache, and nausea—is typical of acute angle-closure glaucoma.

✴️ Because headache is part of this acute symptom complex, it is considered a supporting sign of primary angle-closure glaucoma.

Client states, "I see flashes of light."

✴️ Flashes of light (photopsia) are more characteristic of retinal detachment or retinal tears, not primary angle-closure glaucoma.

✴️ In retinal detachment, clients often describe flashes, floaters, or a curtain over their vision, reflecting retinal traction or separation.

✴️ Angle-closure glaucoma symptoms more commonly include severe eye pain, halos around lights, blurred vision, headache, and nausea, rather than isolated flashes.

✴️ While both conditions are urgent ocular problems, recognizing the different symptom patterns guides appropriate triage and management.

✴️ Because flashes of light more strongly indicate retinal pathology, this is not a classic sign of primary angle-closure glaucoma.

Client states, "My vision has been getting worse over time."

✴️ The statement “getting worse over time” suggests a chronic, progressive condition, such as primary open-angle glaucoma, diabetic retinopathy, or macular degeneration.

✴️ Primary open-angle glaucoma typically involves slow, painless loss of peripheral vision rather than sudden, severe symptoms.

✴️ Angle-closure glaucoma, in contrast, presents with abrupt onset of pain and marked visual changes within a short time frame.

✴️ Distinguishing between sudden vs. gradual vision loss is essential for differentiating acute emergencies from chronic diseases.

✴️ Because this description reflects a gradual decline, it is not typical of primary angle-closure glaucoma.

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Answer 4

Correct Answers:

Weight gain

Rationale :

🔹 Hypothyroidism is characterized by reduced production of thyroid hormones (T3 and T4), leading to a slowed metabolic rate.

🔹 With a slower metabolism, the body burns fewer calories, making weight gain common even if food intake has not increased.

🔹 Clients often report associated symptoms such as fatigue, cold intolerance, dry skin, constipation, and lethargy, all consistent with a low metabolic state.

🔹 Accumulation of subcutaneous fluid and slowed fat and carbohydrate metabolism contribute to gradual increase in body weight.

🔹 Recognizing unexplained weight gain with other signs helps the nurse suspect hypothyroidism and prompt further endocrine evaluation.

Diaphoresis

🔹 Diaphoresis (excessive sweating) is typically associated with hyperthyroidism, where there is increased metabolic activity and heat production.

🔹 In hypothyroidism, skin is more often cool, dry, and rough, and clients complain of feeling cold, not sweating excessively.

🔹 Sweating reflects sympathetic activation and high metabolic rate, which does not match the slowed physiology seen in hypothyroid states.

🔹 Using diaphoresis as a cue could mislead assessment toward thyroid hormone excess rather than deficiency.

🔹 Therefore, diaphoresis is not an expected finding in hypothyroidism and instead suggests hypermetabolic conditions.

Exophthalmos

🔹 Exophthalmos (protrusion of the eyeballs) is a classic sign of Graves’ disease, which is a form of hyperthyroidism, not hypothyroidism.

🔹 It results from autoimmune inflammation and tissue expansion behind the eye, causing forward displacement of the globe.

🔹 Clients with hypothyroidism are more likely to have puffy face, periorbital edema, and coarse features, but not true exophthalmos.

🔹 Confusing exophthalmos with hypothyroidism can lead to inappropriate diagnostic focus and treatment, since the underlying pathophysiology differs.

🔹 Thus, exophthalmos is characteristic of hyperthyroid disease, not an expected finding in hypothyroid clients.

Palpitations

🔹 Palpitations and tachycardia are commonly seen in hyperthyroidism, where excess thyroid hormone stimulates the cardiovascular system.

🔹 In hypothyroidism, the heart rate is more often slow (bradycardic), and clients experience sluggishness and fatigue rather than a racing heart.

🔹 Palpitations reflect increased cardiac workload and sympathetic tone, consistent with high metabolic states, not low metabolic states.

🔹 Relying on palpitations to suggest hypothyroidism would misdirect the nurse toward an overactive rather than underactive thyroid disorder.

🔹 Therefore, palpitations are not a typical expected finding in hypothyroidism.

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Answer 5

Correct Answers:

Decreased ability to identify odors

Rationale :

🌟 Aging is associated with reduced sensitivity of olfactory receptors and degeneration of olfactory nerve fibers, leading to decreased sense of smell (hyposmia).

🌟 Older adults may have difficulty identifying subtle or complex odors, such as smoke, gas, or spoiled food, increasing safety risks.

🌟 This diminished smell also affects taste perception, because flavor detection is partly dependent on olfactory input.

🌟 The change is considered a normal age-related finding, though it should still prompt safety counseling (e.g., stove use, food storage).

🌟 Nurses should recognize this as an expected finding and incorporate it into nutrition assessment, safety education, and overall geriatric care.

Finer and less prominent nasal hair

🌟 With aging, nasal hair (vibrissae) often becomes coarser, thicker, and more prominent, especially in older men.

🌟 Coarse hair may extend beyond the nostril, becoming more visible and sometimes bothersome cosmetically.

🌟 The primary function of nasal hair—to filter dust and particles—remains, but its texture and visibility commonly increase, not decrease.

🌟 Saying nasal hair becomes finer and less prominent contradicts typical age-related physical changes observed in clinical practice.

🌟 Therefore, this option does not accurately describe a normal age-related change in the nasal structures.

Hypertrophy of the gums

🌟 Older adults more often experience gingival recession rather than hypertrophy, with gums pulling away from the teeth and exposing tooth roots.

🌟 Age-related changes, combined with chronic plaque, periodontal disease, and denture use, contribute to gum atrophy and tooth loss, not thickening.

🌟 Gingival hypertrophy is more commonly associated with certain medications (e.g., phenytoin, some calcium channel blockers) or specific conditions, not aging alone.

🌟 Typical normal aging findings include drier oral mucosa, reduced saliva, and gum recession, rather than enlargement of the gingiva.

🌟 Thus, hypertrophy of the gums is not considered a standard age-related change.

Increased production of saliva

🌟 Aging is more commonly associated with decreased saliva production (xerostomia), especially due to polypharmacy and systemic conditions.

🌟 Reduced saliva can lead to difficulty chewing and swallowing, altered taste, and increased risk for dental caries and oral infections.

🌟 Many medications taken by older adults (e.g., anticholinergics, antidepressants, antihypertensives) further reduce salivary flow.

🌟 Increased saliva production would be atypical and would prompt evaluation for other issues, such as reflux or local irritation, rather than normal aging.

🌟 Therefore, increased saliva is not a typical age-related finding in older adults.

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Answer 6

Correct Answers:

Sensorineural hearing loss that occurs with aging

Rationale :

🔷 Presbycusis is defined as age-related sensorineural hearing loss, caused by degeneration of hair cells in the cochlea and age-related changes in the auditory nerve.

🔷 It primarily affects the ability to hear high-frequency sounds, making speech—especially consonants—more difficult to understand.

🔷 Clients often state that they can “hear but not understand,” and may have difficulty hearing in noisy environments.

🔷 This condition occurs gradually and bilaterally, which helps distinguish it from sudden or unilateral hearing loss due to disease.

🔷 Because presbycusis is a sensorineural (inner ear/nerve) decline, this is the correct description of expected assessment findings.

Conductive hearing loss that occurs with aging

🔷 Conductive hearing loss involves outer or middle ear problems (e.g., cerumen, otitis media, perforated tympanic membrane).

🔷 Conductive loss affects sound transmission, not the nerve or cochlea, so it does not match presbycusis.

🔷 Presbycusis originates from degeneration of inner-ear structures, not mechanical obstruction in the external/middle ear.

🔷 Conductive loss may improve with cerumen removal or treatment, which is different from permanent presbycusis.

🔷 Therefore, this option does not describe age-related hearing loss.

Tinnitus that occurs with aging

🔷 Tinnitus may accompany presbycusis, but it is not the primary defining feature and is also associated with many other disorders.

🔷 Tinnitus can occur due to medications, noise exposure, hypertension, or ear injury, so it is not specific to aging.

🔷 Presbycusis is diagnosed based on sensorineural decline, not simply the presence of ringing sounds.

🔷 Therefore, although tinnitus may occur, it is not the key assessment finding expected for presbycusis.

🔷 The defining change remains sensorineural hearing loss, not tinnitus.

Nystagmus that occurs with aging

🔷 Nystagmus is an abnormal, involuntary eye movement, indicating vestibular or neurological dysfunction—not age-related hearing loss.

🔷 It is associated with vertigo, cerebellar disorders, or labyrinthitis, not presbycusis.

🔷 Because presbycusis affects the auditory system, the presence of nystagmus would signal a totally different condition.

🔷 Nystagmus is not an expected finding in age-related hearing decline.

🔷 Thus, this option is incorrect for presbycusis.

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Answer 7

Correct Answers:

Smoking

Rationale :

🟢 Smoking directly affects oral mucosa, teeth, gums, throat tissues, and significantly increases the risk for oral cancer.

🟢 It contributes to periodontal disease, tooth loss, leukoplakia, and chronic irritation of the throat.

🟢 Smoking also reduces salivary flow, increasing risk of dental decay and mouth infections.

🟢 Tobacco use is the #1 modifiable risk factor affecting mouth and throat health.

🟢 Because of its strong and direct impact, smoking must always be addressed during an oral-throat health history.

Sinusitis

🟢 Sinusitis primarily affects the nasal cavities and sinuses, not the mouth or throat directly.

🟢 Although sinus drainage may cause throat irritation, it is not a primary factor affecting mouth/throat tissue health.

🟢 Assessing sinusitis is more relevant to upper respiratory assessment, not oral cavity risk.

🟢 It does not significantly influence gum disease, oral cancer, or mucosal integrity.

🟢 Therefore, it is not the main priority concern for mouth and throat health history.

Allergies

🟢 Allergies mainly affect the nasal mucosa and airway, with secondary issues such as postnasal drip or throat irritation.

🟢 They do not directly damage oral tissues, gums, or salivary glands.

🟢 Allergic symptoms may cause dryness or discomfort, but not disease of the oral cavity.

🟢 Unlike smoking, they do not increase the risk of oral cancer or mucosal pathology.

🟢 Therefore, allergies are not the priority mouth-throat risk factor.

Epistaxis

🟢 Epistaxis (nosebleeds) involves the nasal septum, not the mouth or throat directly.

🟢 It does not contribute to gum disease, throat cancer, or oral mucosal damage.

🟢 While blood may drain into the throat, this is incidental, not pathological.

🟢 Epistaxis is evaluated under nasal assessment, not oral health history.

🟢 Thus, it does not directly affect mouth and throat health.

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Answer 8

Correct Answers:

Difficulty swallowing

Rationale :

✨ Dysphagia is formally defined as difficulty swallowing, involving problems with the oral, pharyngeal, or esophageal phase of swallowing.

✨ Causes include neurological disorders, stroke, tumors, muscular disease, or structural abnormalities.

✨ Clients may cough, choke, or report food “sticking” in the throat or chest.

✨ Dysphagia increases the risk of aspiration, pneumonia, malnutrition, and dehydration.

✨ Because the definition is precisely difficulty swallowing, this is the correct response.

Difficulty chewing

✨ Difficulty chewing is called mastication impairment, not dysphagia.

✨ Chewing issues involve teeth, jaw muscles, or temporomandibular joint, not the swallowing mechanism.

✨ Dysphagia only begins after food reaches the throat or esophagus, not during chewing.

✨ The distinction is important because treatment differs (e.g., dental vs. swallowing therapy).

✨ Thus, chewing difficulty is not the correct definition.

Difficulty speaking

✨ Difficulty speaking is termed dysarthria or aphasia, depending on the cause.

✨ It involves speech muscles and language centers, not the swallowing pathway.

✨ Dysphagia is related to food movement, not speech formation.

✨ The two conditions may coexist but are not interchangeable.

✨ Therefore, this option is incorrect.

Difficulty hearing

✨ Difficulty hearing (hearing loss) has no direct connection to the swallowing mechanism.

✨ Hearing disorders affect the auditory system, not the oral-pharyngeal phases.

✨ The term dysphagia always refers to swallowing problems, not auditory issues.

✨ Confusing the two would mislead clinical assessment.

✨ Hence, this option is inaccurate.

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Answer 9

Correct Answers:

Fever

Rationale :

🌟 Fever increases metabolic rate, leading the body to require more oxygen, prompting faster breathing (tachypnea).

🌟 Pyrogens elevate metabolic activity, which stimulates the respiratory center to increase respiratory rate.

🌟 Tachypnea helps the body remove extra CO₂ produced during fever.

🌟 Fever-related tachypnea is common in infections and systemic inflammation.

🌟 With an RR of 26, fever is a highly likely physiologic cause.

Anesthesia

🌟 Anesthesia typically causes respiratory depression, not tachypnea.

🌟 Many anesthetic agents slow breathing by depressing the central nervous system.

🌟 Post-anesthesia clients are more likely to have slow or shallow breathing, not rapid.

🌟 Tachypnea would be an unexpected response unless complications occur.

🌟 Therefore, anesthesia is not a likely cause of rapid breathing.

Drug overdose

🌟 Most drug overdoses (e.g., opioids, sedatives) produce respiratory depression, not increased respiratory rate.

🌟 Overdoses usually reduce respiratory drive through CNS suppression.

🌟 Tachypnea would be inconsistent unless the overdose involves a stimulant, which is uncommon in clinical presentations.

🌟 With common hospital drugs, expect slow breathing, not tachypnea.

🌟 Thus, overdose is not the probable cause.

Meningitis

🌟 Meningitis typically presents with fever, neck stiffness, severe headache, and altered mental status.

🌟 While fever may cause tachypnea, tachypnea alone does not indicate meningitis.

🌟 Meningitis would also show neurological signs, not isolated rapid breathing.

🌟 Without other symptoms, meningitis is less likely.

🌟 Therefore, fever alone explains the tachypnea more directly.

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Answer 10

Correct Answers:

Impaired Gas Exchange

Rationale :

♦ The client has an oxygen saturation of 91%, indicating impaired oxygenation at the alveolar level.

♦ Shortness of breath and increased RR (22) demonstrate the body’s attempt to compensate for low O₂.

♦ Gas exchange reflects the ability of lungs and blood to exchange oxygen and carbon dioxide, making it the most urgent physiological need.

♦ If uncorrected, impaired gas exchange can rapidly progress to respiratory failure.

♦ Because oxygenation is a life-sustaining priority, this diagnosis comes before airway clearance or breathing pattern issues.

Ineffective Breathing Pattern

♦ A breathing rate of 22 is only mildly elevated and does not necessarily impair ventilation pattern.

♦ The priority concern is oxygen desaturation (91%), not rhythm or pattern.

♦ Breathing pattern is secondary unless the pattern itself threatens oxygenation.

♦ In this case, oxygen exchange—not breathing mechanics—is the major problem.

♦ Therefore, this is not the priority diagnosis.

Activity Intolerance

♦ Although SOB may limit activity, the primary physiologic problem is impaired oxygenation, not activity tolerance.

♦ Activity intolerance does not represent an immediate danger compared to gas exchange failure.

♦ This diagnosis would be considered later, after stabilizing oxygen needs.

♦ Severe fatigue or exertional SOB would guide this diagnosis, but not here.

♦ Thus, activity intolerance is not urgent.

Ineffective Airway Clearance

♦ Airway clearance issues involve secretions, obstruction, or coughing inability, none of which are indicated.

♦ Lung sounds and other airway findings are not provided—you cannot assume obstruction.

♦ The oxygen saturation suggests alveolar gas exchange impairment, not blocked airway.

♦ No evidence of mucus buildup or ineffective cough is present.

♦ Therefore, this is not the priority diagnosis.

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QLexNursing

1 :
During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is described by which statement?

2 :
During an examination of a client, the nurse performs the whisper test. Which instruction should the nurse provide to the client?

3 :
A client with a history of hypertension presents to the clinic with eye pain. Which assessment findings indicate that the client may be experiencing primary angle-closure glaucoma? Select all that apply.

4 :
A nurse is assessing a client with hypothyroidism. The nurse should expect which of the following findings?

5 :
Which age-related change will the nurse expect to find during the assessment of an older adult client?

6 :
Which assessment findings should the nurse expect for a client with presbycusis?

7 :
The nurse is completing a health history of the mouth and throat. Which health concern should the nurse inquire about that directly effects mouth and throat health?

8 :
Dysphagia is defined as?

9 :
A nurse is completing a respiratory assessment on a client. The client has rapid breathing and a respiratory rate of 26. What is the possible cause of these findings?

10 :
A nurse is caring for a client with increased shortness of breath, a heart rate of 98 beats per minute, respiratory rate of 22 breaths per minute, blood pressure of 132/84 mm Hg and an oxygen saturation of 91% on room air. Which nursing diagnosis is the priority for this client?

QLexNursing

1 : During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is described by which statement?

2 : During an examination of a client, the nurse performs the whisper test. Which instruction should the nurse provide to the client?

3 : A client with a history of hypertension presents to the clinic with eye pain. Which assessment findings indicate that the client may be experiencing primary angle-closure glaucoma? Select all that apply.

4 : A nurse is assessing a client with hypothyroidism. The nurse should expect which of the following findings?

5 : Which age-related change will the nurse expect to find during the assessment of an older adult client?

6 : Which assessment findings should the nurse expect for a client with presbycusis?

7 : The nurse is completing a health history of the mouth and throat. Which health concern should the nurse inquire about that directly effects mouth and throat health?

8 : Dysphagia is defined as?

9 : A nurse is completing a respiratory assessment on a client. The client has rapid breathing and a respiratory rate of 26. What is the possible cause of these findings?

10 : A nurse is caring for a client with increased shortness of breath, a heart rate of 98 beats per minute, respiratory rate of 22 breaths per minute, blood pressure of 132/84 mm Hg and an oxygen saturation of 91% on room air. Which nursing diagnosis is the priority for this client?

1 :
During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is described by which statement?

2 :
During an examination of a client, the nurse performs the whisper test. Which instruction should the nurse provide to the client?

3 :
A client with a history of hypertension presents to the clinic with eye pain. Which assessment findings indicate that the client may be experiencing primary angle-closure glaucoma? Select all that apply.

4 :
A nurse is assessing a client with hypothyroidism. The nurse should expect which of the following findings?

5 :
Which age-related change will the nurse expect to find during the assessment of an older adult client?

6 :
Which assessment findings should the nurse expect for a client with presbycusis?

7 :
The nurse is completing a health history of the mouth and throat. Which health concern should the nurse inquire about that directly effects mouth and throat health?

8 :
Dysphagia is defined as?

9 :
A nurse is completing a respiratory assessment on a client. The client has rapid breathing and a respiratory rate of 26. What is the possible cause of these findings?

10 :
A nurse is caring for a client with increased shortness of breath, a heart rate of 98 beats per minute, respiratory rate of 22 breaths per minute, blood pressure of 132/84 mm Hg and an oxygen saturation of 91% on room air. Which nursing diagnosis is the priority for this client?