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A patient is ready to be discharged home after a cataract extraction with intraocular lens implant and the nurse is reviewing signs and symptoms that need to be reported to the ophthalmologist immediately. Which of the patients statements best demonstrates an adequate understanding?
- A. I need to call the doctor if I get nauseated.
- B. I need to call the doctor if I have a light morning discharge.
- C. I need to call the doctor if I get a scratchy feeling.
- D. I need to call the doctor if I see flashing lights.
Correct Answer: D
Rationale: Flashing lights may signal retinal detachment, requiring immediate reporting post-cataract surgery. Nausea, mild discharge, and scratchiness are less concerning.
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A patients ocular tumor has necessitated enucleation and the patient will be fitted with a prosthesis. The nurse should address what nursing diagnosis when planning the patients discharge education?
- A. Disturbed body image
- B. Chronic pain
- C. Ineffective protection
- D. Unilateral neglect
Correct Answer: A
Rationale: Enucleation and prosthesis use significantly impact body image. Chronic pain, ineffective protection, and unilateral neglect are not typically associated with this procedure.
A patient has had a sudden loss of vision after head trauma. How should the nurse best describe the placement of items on the dinner tray?
- A. Explain the location of items using clock cues.
- B. Explain that each of the items on the tray is clearly separated.
- C. Describe the location of items from the bottom of the plate to the top.
- D. Ask the patient to describe the location of items before confirming their location.
Correct Answer: A
Rationale: Clock cues (e.g., meat at 3 o'clock) effectively orient a visually impaired patient to tray items. Separation, top-to-bottom descriptions, or patient guesses are less practical.
The registered nurse taking shift report learns that an assigned patient is blind. How should the nurse best communicate with this patient?
- A. Provide instructions in simple, clear terms.
- B. Introduce herself in a firm, loud voice at the doorway of the room.
- C. Lightly touch the patients arm and then introduce herself.
- D. State her name and role immediately after entering the patients room.
Correct Answer: D
Rationale: Stating name and role first identifies the nurse without startling the blind patient. Simplifying instructions or using a loud voice is unnecessary, and touching before introducing may cause discomfort.
A patient with glaucoma has presented for a scheduled clinic visit and tells the nurse that she has begun taking an herbal remedy for her condition that was recommended by a work colleague. What instruction should the nurse provide to the patient?
- A. The patient should discuss this new remedy with her ophthalmologist promptly.
- B. The patient should monitor her IOP closely for the next several weeks.
- C. The patient should do further research on the herbal remedy.
- D. The patient should report any adverse effects to her pharmacist.
Correct Answer: A
Rationale: Herbal remedies may interact with glaucoma treatment, so prompt discussion with the ophthalmologist is essential. Self-monitoring IOP is not feasible, and research or pharmacist reporting is secondary.
The nurse has taken shift report on her patients and has been told that one patient has an ocular condition that has primarily affected the rods in his eyes. Considering this information, what should the nurse do while caring for the patient?
- A. Ensure adequate lighting in the patients room.
- B. Provide a dimly lit room to aid vision by limiting contrast.
- C. Carefully point out color differences for the patient.
- D. Carefully point out fine details for the patient.
Correct Answer: A
Rationale: Rods are responsible for low-light vision, so adequate lighting compensates for rod impairment. Dim lighting worsens vision, and rods do not affect color or fine detail perception.