The nurse is performing the Romberg test on a client during a neurological assessment. Which of the following best describes the rationale for conducting the Romberg test?
To measure respiratory rate and depth.
To evaluate coordination and fine motor skills.
To test for proprioception and vestibular function.
To assess cranial nerve function related to facial expression.
The Correct Answer is C
Choice A reason:
The Romberg test is not used to measure respiratory rate and depth. Respiratory assessments involve observing breathing patterns, rate, and depth, which are unrelated to the Romberg test.
Choice B reason:
While the Romberg test can provide some information about coordination, its primary purpose is not to evaluate fine motor skills. Fine motor skills are typically assessed through tasks that involve precise hand and finger movements.
Choice C reason:
The Romberg test is used to test for proprioception and vestibular function. It assesses the client’s ability to maintain balance with their eyes closed, which helps identify issues with proprioception (the sense of body position) and vestibular function (the inner ear’s role in balance).
Choice D reason:
The Romberg test does not assess cranial nerve function related to facial expression. Cranial nerve assessments involve specific tests for each nerve, such as asking the client to smile or raise their eyebrows to evaluate facial nerve function.
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Correct Answer is D
Explanation
Choice A reason:
Seasonal allergies, also known as allergic rhinitis, can be exacerbated by air pollutants, including ozone. However, individuals with asthma are more severely affected by ozone exposure. Ozone can trigger asthma attacks and worsen symptoms, making it a more critical concern for those with asthma.
Choice B reason:
Mitral valve disease affects the heart’s mitral valve and can lead to symptoms such as shortness of breath and fatigue. While air pollution can impact cardiovascular health, ozone specifically poses a greater risk to individuals with respiratory conditions like asthma rather than those with mitral valve disease.
Choice C reason:
Nasal polyps are noncancerous growths in the nasal passages or sinuses that can cause breathing difficulties and chronic sinus infections. Although air pollutants can irritate the nasal passages, individuals with asthma are more vulnerable to the harmful effects of ozone, which can exacerbate their respiratory symptoms.
Choice D reason:
Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to difficulty breathing. Ozone exposure can significantly worsen asthma symptoms, trigger asthma attacks, and reduce lung function. Therefore, individuals with asthma are especially vulnerable to the effects of ozone.
Correct Answer is ["B","E"]
Explanation
Choice A reason:
“I may experience urinary incontinence.” This statement is correct. Urinary incontinence is a common symptom of MS due to the disease’s impact on the nervous system. The client does not need additional teaching regarding this statement.
Choice B reason:
“I should not exercise because this may trigger an exacerbation.” This statement indicates a need for additional teaching. Regular exercise is beneficial for individuals with MS and can help improve strength, mobility, and overall well-being. The nurse should educate the client on safe and appropriate exercise routines.
Choice C reason:
“I need to check the water temperature before I take a bath.” This statement is correct. Clients with MS may have impaired sensation and are at risk for burns if the water is too hot. Checking the water temperature is a necessary precaution.
Choice D reason:
“I may experience visual disturbances.” This statement is correct. Visual disturbances, such as blurred vision or double vision, are common symptoms of MS. The client does not need additional teaching regarding this statement.
Choice E reason:
“I should alternate the eye patch every other day to help with the double vision.” This statement indicates a need for additional teaching. While using an eye patch can help manage double vision, it should be alternated more frequently, typically every few hours, to prevent strain on the covered eye.