NR-302 Health Assessment I - Set 4 - Part 3

Correct Answer: Refer the child for a full eye examination

A two line difference between eyes suggests unilateral disease or amblyopia even when both eyes seem usable, so the finding is reported and referred while the visual system can still respond to treatment. Option a is incorrect because waiting a year wastes part of the window in which amblyopia responds. Treatment works best in the early school years and results fall off sharply as the child gets older. Option b is incorrect because reassurance hides a difference the good eye is already masking. Amblyopia is painless, the child will not complain, and the only way to catch it is to act on the screening. Option d is incorrect because testing without correction measures an uncorrected eye and cannot be compared with the corrected result already obtained. Distance lenses stay on so the recorded number reflects usable vision.

Correct Answer: Sensorineural loss in the left ear

A cochlea damaged by noise cannot process the tone by either route, so the healthy right side hears it. Lateralization away from the symptomatic ear, with normal drums, points to sensorineural loss. Option a is incorrect because a blocked left ear would capture the tone rather than lose it. Conductive problems drive the Weber toward the poorer side, and the drums here look entirely normal anyway. Option c is incorrect because the client describes trouble on the left, while the right ear is the one hearing the fork. Naming the right ear as impaired contradicts both the history and the test. Option d is incorrect because impacted wax is visible on inspection, and this examination found clear canals with intact membranes. Years of foundry noise, not a canal blockage, account for the gradual pattern described.

Correct Answer: Face her and speak clearly at a lower pitch

Facing the resident lets her use lip movement and expression, and dropping the pitch helps because the high tones are the ones lost. Reducing noise and rephrasing add more than volume does. Option a is incorrect because shouting distorts speech, exaggerates the painful jump in loudness that often accompanies this loss, and hides the mouth behind a strained face. A nod is not proof of understanding. Option b is incorrect because saying identical words again rarely helps when specific consonants are missing. Choosing different wording gives the resident a fresh set of sounds, and extra volume adds distortion instead of clarity. Option d is incorrect because replacing all speech with notes assumes a level of vision and literacy that may not be there. Written key words support conversation; they are not a substitute for it.

Correct Answer: Arrange dental review of the denture fit soon

A denture loosens as the mouth changes, and a poor fit causes sore spots, less chewing and falling intake. Dental review restores the fit, and a lesion that will not heal under a plate needs evaluation. Option a is incorrect because alcohol dries the mucosa further and stings atrophic tissue. Clients with xerostomia do better with frequent sips of water, sugar free gum, saliva substitutes and fluoride toothpaste twice daily. Option b is incorrect because abandoning the plate removes what little chewing surface remains and speeds the weight loss already under way. The denture should come out at night and for oral examination, not permanently. Option c is incorrect because heavy salt and sugar work against blood pressure control and invite decay in an already dry mouth. Herbs, spices, lemon and varied texture lift flavor without those costs.

Correct Answer: Up and back toward the occiput

The adult external canal curves downward and forward along an S shape, so lifting the pinna up and back aligns the canal with the speculum and brings the drum into view. Option b is incorrect because down and back is the maneuver reserved for infants and children under about three years, whose shorter canal slopes upward. Using it on an adult leaves the canal bent and the drum hidden. Option c is incorrect because pulling straight out does nothing to correct the S shaped bend of the canal. The speculum then presses against the canal wall, producing pain and a partial view of the membrane. Option d is incorrect because forward and down moves the auricle toward the tragus and narrows the opening rather than opening it. No standard age group is examined this way, and the drum stays out of sight.

Correct Answer: Document a normal variant and reassure the client

A torus palatinus is a benign bony growth along the midline of the hard palate, covered by normal mucosa and stable for years. It needs no treatment unless it interferes with dentures. Option a is incorrect because biopsy is reserved for lesions that could be malignant, such as a raised white patch or a non-healing ulcer. A smooth midline bony ridge carries no such risk. Option c is incorrect because withholding fluids belongs to clients who fail a swallow screen or show coughing and a wet voice. This client has a stable bony prominence and swallows normally. Option d is incorrect because cultures identify infection, and nothing here suggests one. Infected palatal tissue would look red or ulcerated with exudate, whereas the mucosa over this ridge is intact and normal in color.

Correct Answer: A deviated nasal septum from prior trauma

A deviated septum bends to one side after development or injury and produces fixed one-sided obstruction. It stays smooth, mucosa covered and continuous with the rest of the septum rather than forming a mass. Option a is incorrect because polyps look pale gray or bluish, glistening and soft, and they hang mobile from the lateral wall. They are usually bilateral and cause loss of smell rather than one fixed blockage. Option b is incorrect because a nasal foreign body is a toddler problem that announces itself with one-sided foul purulent drainage over days to weeks. This client reports an old injury and has no drainage at all. Option c is incorrect because a furuncle is a small red boil in the skin lined vestibule, exquisitely painful to touch. Nothing in this description mentions pain, redness or a discrete raised swelling at the opening.

Correct Answer: Select the largest speculum the canal admits comfortably

The widest speculum the canal will accept comfortably gives the broadest field and the best illumination, and its size also stops the tip from being pushed too far into the sensitive bony portion. Option a is incorrect because a narrow tip cuts down the field of view and the light reaching the drum. It also slides deeper into the canal, where the bony wall is thin and tender. Option c is incorrect because heating equipment in hot water risks burning canal skin and is not part of otoscopy. A clean or disposable tip at room temperature is what the examination calls for. Option d is incorrect because age alone does not determine tip size; the diameter of this client's canal does. Two adults of the same age may need different specula, so the fit is judged at the ear.

Correct Answer: Record two plus tonsils as an expected finding

Tonsils reaching halfway to the uvula are graded two plus. Lymphoid tissue is normally larger in school age children, and pink symmetric tonsils without exudate need documentation rather than treatment. Option b is incorrect because the two sides are described as equal. Asymmetry without infection is the finding that raises concern for malignancy and earns a referral, and this child does not have it. Option c is incorrect because grade alone never drives surgery. Referral rests on repeated documented infections or on sleep symptoms such as snoring, witnessed pauses in breathing and daytime sleepiness, none of which appear here. Option d is incorrect because nothing points to a bacterial throat infection. Streptococcal disease brings abrupt fever, exudate on swollen tonsils and tender anterior cervical nodes, while this child is well and here for routine screening.

Correct Answer: Press upward under the brow ridges and cheeks

Thumbs go under the bony brow ridges beside the nose and press up for the frontal sinuses, then up over the cheeks below the cheekbones for the maxillary sinuses. No tenderness is expected. Option a is incorrect because pressing on the globes can injure the eyes and gives no information about either sinus. Pressure must be applied to bone, directed up beneath the brow rather than onto soft tissue. Option b is incorrect because the nasal bridge overlies no sinus cavity. Palpating there assesses the bony dorsum for fracture or displacement after trauma, which is a separate part of the external nasal examination. Option d is incorrect because the ethmoid air cells sitting between the orbits cannot be reached by any bedside maneuver. Pressing at the orbital corners tests nothing and may be uncomfortable for the client.