Which technique should a nurse use in performing the Rinne tuning fork test?

A. Start the fork vibrating and place the stem on the mastoid process. When the client no longer feels the vibration, move it in front of the pinna and ask the client to indicate when sound is no longer heard.
B. Start the fork vibrating and place the stem on the mastoid process. When the client no longer hears sound, move it in front of the pinna and ask the client to indicate when sound is no longer heard.
C. Start the fork vibrating, hold the fork in front of the pinna, and ask the client to indicate when sound is no longer heard. Then place the stem on the mastoid process and ask the client to indicate when he or she no longer feels the vibration.
D. Start the fork vibrating, hold the fork in front of the pinna, and ask the client to indicate when sound is no longer heard. Then place the stem on the mastoid process and ask the client to indicate when he or she no longer hears the sound.


B
This test compares hearing by air conduction with hearing by bone conduction. The client should hear the vibrations, not "feel" them. The nurse performs the Rinne tuning fork test by placing the vibrating tuning fork stem on the client's mastoid process. The client indicates when he or she no longer hears the sound, and the nurse quickly brings the tuning fork in front of the pinna without touching the client, asking whether he or she still hears the sound. The client normally continues to hear the sound twice as long with the tuning fork in front of the pinna after not hearing it with the tuning fork touching the mastoid process.

Nursing

You might also like to view...

A woman arrives at the ICU after being the victim of a terrorist attack in a nearby shopping center involving a gas that spewed from a metal canister

The woman complains of a burning sensation in her eyes, mouth, and throat, and the nurse observes blistering on her face and arms. What chemical agent should the nurse suspect, and what intervention should she implement? A) Vesicant agent; apply lotion B) Nerve agent; administer benzodiazepine C) Vesicant agent; soap and water blot D) Nerve agent; provide ventilatory support

Nursing

Which of the following identified the ethical principles of respect for persons, beneficence, and justice as relevant to the conduct of research using human subjects in the United States?

a. Declaration of Helsinki b. Department of Health, Education, and Welfare regulations c. National Commission for the Protection of Human Subjects ordinance d. Nuremberg Code

Nursing

The advanced practice nurse would like to move to a large metropolitan area. How will this move impact the advanced practice nurse's practice?

1. This would be an unwise move for the nurse, as advanced practice is limited to rural areas. 2. There would be no problem if the move is to a medically underserved area. 3. There would be no problem is the move is to an area that is primarily minority. 4. There is no problem as the practice requirements are the same.

Nursing

After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every:

1. 1 to 2 weeks 2. 3 to 4 weeks 3. 2 to 3 months 4. 6 to 9 months

Nursing