When the Patient Turns His Head Quickly During the Admission

question 20

Multiple Choice

When the patient turns his head quickly during the admission assessment,the nurse observes nystagmus. What is the indicated nursing action?

• A)Assess the patient with a Rinne test.
• B)Place a fall-risk bracelet on the patient.
• C)Ask the patient to watch the mouths of staff when they are speaking.
• D)Remind unlicensed assistive personnel to speak loudly to the patient.

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Definitions:

Interpretive Value

The significance or meaning that is attributed to a piece of information or data when it is analyzed or understood in a particular context.

Electra Complex

A psychoanalytic concept proposed by Freud, describing a girl's sense of competition with her mother for the affection of her father.

Collective Unconscious

A concept proposed by Carl Jung, suggesting that part of the unconscious mind is shared among beings of the same species containing innate, universal predispositions.

Erogenous Zones

Areas of the body particularly sensitive to stimulation, which can lead to sexual arousal.