The nurse is preparing to conduct a physical assessment on a patient with otosclerosis. Which finding should the nurse anticipate in this patient?
A. Purulent drainage is observed or reported with cyanosis of the tympanic membrane.
B. Diminished hearing is noted in the lower tones, such as a man's speaking voice.
C. Rinne test results show that bone conduction is equal or greater than air conduction.
D. Severe vertigo is present when questioned.
Answer: C
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The nurse is reviewing normal female development with a mother of a 10-year-old daughter. The mother states, "I noticed that my daughter developed breast buds about a year ago. When do you think she will start her menstrual cycle?"
What is the nurse's best response? a. "In about a year." b. "Likely any time now." c. "Does your daughter know what to expect?" d. "It is impossible to predict when she will start her cycle."
During the health history, the mother of a 4-month-old child tells the nurse she is concerned that her baby is not doing what he should be at this age. What is the nurse's best response?
A) "I'll be able to tell you more after I do his physical." B) "Fill out the questionnaire and then I can let you know." C) "Tell me what concerns you." D) "All mothers worry about their babies. I'm sure he's doing well."
The nurse is caring for a client in the fourth stage of labor. Which assessment findings should the nurse identify as a potential complication? (Select all that apply.)
a. Soft boggy uterus b. Maternal temperature of 99° F c. High uterine fundus displaced to the right d. Intense vaginal pain unrelieved by analgesics e. Half of a lochia pad saturated in the first hour after birth
The nurse is caring for a child with increased intracranial pressure (ICP). What interventions should the nurse plan for this child? (Select all that apply.)
a. Avoid jarring the bed. b. Keep the room brightly lit. c. Keep the bed in a flat position. d. Administer prescribed stool softeners. e. Administer a prescribed antiemetic for nausea.