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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View Related questions
Correct Answer is D
Explanation
Choice A reason:
Encouraging the client to use ice therapy to alleviate muscle stiffness is not the best approach for managing multiple sclerosis (MS). While ice therapy can provide temporary relief for muscle stiffness, it does not address the need to increase venous return, prevent stiffness, or maintain muscle strength and endurance. Gentle stretching exercises are more effective for these goals.
Choice B reason:
Administering interferon is a common treatment for MS to help reduce the frequency and severity of relapses. However, it does not directly address the need to increase venous return, prevent stiffness, or maintain muscle strength and endurance. Exercise and physical therapy are more appropriate for these specific goals.
Choice C reason:
Administering corticosteroids is used to manage acute exacerbations of MS by reducing inflammation. While corticosteroids can help manage symptoms during a flare-up, they do not directly contribute to increasing venous return, preventing stiffness, or maintaining muscle strength and endurance. Regular exercise is more effective for these purposes.
Choice D reason:
Encouraging the client to perform gentle stretching exercises daily is the most appropriate action. Stretching exercises help increase venous return, prevent stiffness, and maintain muscle strength and endurance. Regular physical activity is essential for managing MS symptoms and improving overall function and quality of life.
Correct Answer is B
Explanation
Choice A reason:
Restricting drinking fluids before and during meals is not an appropriate suggestion for improving nutritional status. While it might help prevent early satiety in some cases, it does not address the underlying issues related to Myasthenia gravis, such as muscle weakness affecting chewing and swallowing.
Choice B reason:
Planning medication doses to occur before meals is a crucial strategy for clients with Myasthenia gravis. Medications such as anticholinesterase agents can help improve muscle strength, making it easier for the client to chew and swallow food. This approach can enhance the client’s ability to consume adequate nutrition during meals.
Choice C reason:
Increasing the amount of fat and carbohydrates in meals might help with caloric intake, but it does not address the specific challenges faced by clients with Myasthenia gravis. The focus should be on strategies that improve the client’s ability to eat effectively, rather than just altering the macronutrient composition of meals.
Choice D reason:
Eating three large meals per day can be challenging for clients with Myasthenia gravis due to muscle fatigue. Smaller, more frequent meals are often recommended to help manage energy levels and ensure adequate nutrition without overwhelming the client.