Prefinals - Sensory Perception

Question 1

Is the process of receiving stimuli or data

Answer 1

Sensory reception

Question 2

External stimuli are:

Answer 2

Visual (sight)
Auditory (sound)
Olfactory (smell)
Tactile (touch)
Gustatory (taste)

Question 3

Refers to the awareness of the position and movement of body parts

Answer 3

Kinesthetic

Question 4

The ability to perceive and understand an object through touch by its size, shape, and texture

Answer 4

Stereognosis

Question 5

Refers to any large organ within the body

Answer 5

Visceral

Question 6

Involves the conscious organization and translation of the data or stimuli into meaningful information

Answer 6

Sensory perception

Question 7

Four aspects of the sensory process:

Answer 7

Stimulus
Receptor
Impulse conduction
Perception

Question 8

An agent or act that stimulates a nerve receptor

Answer 8

Stimulus

Question 9

A nerve cell that converts stimulus into a nerve impulse

Answer 9

Receptor

Question 10

The pathway where the nerve impulse travels along nerve pathways

Answer 10

Impulse conduction

Question 11

This takes place in the brain, where specialized brain cells interpret the nature and quality of the sensory stimuli

Answer 11

Perception

Question 12

For the individual to receive and interpret stimuli, the brain must be alert, this is managed by this mechanism in the brain

Answer 12

Arousal Mechanism

Question 13

Is thought to mediate the arousal mechanism. This is found in the brainstem

Answer 13

Reticular Activating System

Question 14

2 components of the RAS:

Answer 14

Reticular excitatory area
Reticular inhibitory area

Question 15

Is the term used to describe the state in which an individual is in optimal arousal

Answer 15

Sensoristasis

Question 16

Is the ability to perceive internal and external stimuli, and to respond appropriately through thought and action

Answer 16

Awareness

Question 17

States of awareness:

Answer 17

Full Consciousness
Disoriented
Confused
Somnolent
Semicomatose
Coma

Question 18

Alert, oriented to time, place, person, understands verbal and written words

Answer 18

Full Consciousness

Question 19

Not oriented to time, place, or person

Answer 19

Disoriented

Question 20

Reduced awareness, easily bewildered, poor memory, misinterprets stimuli, impaired judgment

Answer 20

Confused

Question 21

Extreme drowsiness but will respond to stimuli

Answer 21

Somnolent

Question 22

Can be aroused by extreme or repeated stimuli

Answer 22

Semicomatose

Question 23

Will not respond to verbal stimuli

Answer 23

Coma

Question 24

Factors Affecting Sensory Function:

Answer 24

Developmental Stage
Culture
Stress
Medications and Illness
Lifestyle and Personality
Sensory Alterations

Question 25

Is a lack of culturally assistive, supportive, or facilitative acts

Answer 25

Culture Deprivation or Culture Care Deprivation

Question 26

Is generally thought of as a decrease in or lack of meaningful stimuli

Answer 26

Sensory Deprivation

Question 27

Responses to Sensory Deprivation:

Answer 27

Excessive yawning, drowsiness, sleeping Decreased attention span, difficulty concentrating, decreased problem-solving ability Impaired memory Periodic disorientation, general or nocturnal confusion Preoccupation with somatic complaints, such as palpitations Hallucinations or delusions Crying, annoyance over small matters, depression Apathy, emotional lability

Question 28

Clients with sensory deprivation are those that:

Answer 28

Are confined in a nonstimulating or monotonous environment in the home or healthcare agency Have impaired vision or hearing Have mobility restrictions such as quadriplegia or paraplegia with bedrest, traction apparatus Are unable to process stimuli, like clients who have brain damage or taking medications that affect the central nervous system Have emotional disorders and withdraw within themselves Have limited social contact with family and friends

Question 29

Generally occurs when an individual is unable to process or manage the amount or intensity of sensory stimuli

Answer 29

Sensory overload

Question 30

3 factors that contribute to sensory overload:

Answer 30

Increased quality or quantity of internal stimuli, such as pain, dyspnea, or anxiety Increased quality or quantity of external stimuli, such as noisy healthcare settings, intrusive diagnostic studies, or contact with many strangers Inability to disregard stimuli selectively

Question 31

Responses to Sensory Overload:

Answer 31

Complaints of fatigue, sleeplessness Irritability, anxiety, restlessness Periodic or general disorientation Reduced problem-solving ability and task performance Increased muscle tension Scattered attention and racing thoughts

Question 32

Clients with sensory overload are those that:

Answer 32

Have pain or discomfort Are acutely ill and have been admitted to an acute care facility Are being closely monitored in an intensive care unit and have intrusive tubes such as IVs, catheters, or nasogastric or endotracheal tubes Have decreased cognitive ability

Question 33

Is impaired reception, perception, or both of one or more of the senses. This can include things like blindness and deafness.

Answer 33

Sensory Deficits

Question 34

How the body responds to the loss of sensory function. Things like using the left ear when there is hearing loss in the right ear.

Answer 34

Compensatory behavior

Question 35

Nursing assessment of sensory-perceptual functioning includes six components:

Answer 35

Nursing history Mental status examination Physical examination Identification of clients at risk Client’s environment Client’s social support network

Question 36

The nurse assesses the client’s current sensory perceptions, usual functioning, sensory deficits, and potential problems

Answer 36

Nursing History

Question 37

This includes data on mental status, including level of consciousness, orientation, memory, and attention span

Answer 37

Mental Status Examination

Question 38

This assessment determines whether the senses are impaired. This can include testing for vision, hearing, smelling, tasting, feeling, and kinesthetic senses.

Answer 38

Physical Examination

Question 39

A nurse should assess this for quality, quantity, and types of stimuli.

Answer 39

Client Environment

Question 40

Nonstimulating environments include:

Answer 40

Severely restrict physical activity Limit social contact with family and friends

Question 41

The degree of isolation an individual feels is significantly influenced by the quality and quantity of support from family members and friends.

Answer 41

Social Support Network

Question 42

For social support network, a nurse should assess:

Answer 42

Who visits and when If the client lives alone Any signs indicating social deprivation (withdrawal from contact with others to avoid dependence on others or embarrassment, negative self-image, reports lack of meaningful communication with others, absence of opportunities to discuss fears or concerns that facilitate coping mechanisms)

Question 43

Is the leading cause of blindness in adults older than 65

Answer 43

Age-related Macular Degeneration

Question 44

Are opacities of the lens. Development is slow and painless and may be unilateral or bilateral. They are the leading cause of blindness in the world.

Answer 44

Cataracts

Question 45

Is associated with optic nerve damage due to an increase in intraocular pressure and leads to vision loss. It is the 2nd most common cause of blindness in the US

Answer 45

Glaucoma

Question 46

Is a microvascular disease of the eye, occurring in both type 1 and type 2 diabetes.

Answer 46

Diabetic Retinopathy

Question 47

Otherwise known as acute confusion. It has an abrupt onset and a cause, that when treated, reverses the confusion.

Answer 47

Delirium

Question 48

Is often called chronic confusion. It has symptoms that are gradual and irreversible

Answer 48

Dementia

Question 49

Is considered the golden standard in identifying clients with delirium

Answer 49

Confusion Assessment Method

Question 50

Is a screening tool in which family members are interviewed to maximize the detection of delirium in clients

Answer 50

Family CAM or FAM-CAM