Nokea
An older client has decided to give up driving due to cataracts. What assessment information is most important to collect?
- A. Family history of visual problems
- B. Impact on daily activities
- C. History of falls
- D. Access to transportation
Correct Answer: B
Rationale: Cataracts can significantly impair vision, affecting the client's ability to perform daily activities safely. Assessing the impact on daily activities is critical to understanding the client's needs and planning appropriate interventions. Family history, falls, and transportation access are relevant but secondary to the immediate impact on daily functioning.
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A client has been taught about retinitis pigmentosa (RP). What statement by the client indicates a need for further teaching?
- A. I should continue wearing sunglasses.
- B. Beta carotene, lutein, and zeaxanthin are good supplements.
- C. I may qualify for a retinal transplant one day soon.
- D. Vitamin A has been shown to slow progression of RP.
Correct Answer: C
Rationale: Retinal transplants are not a current or near-future treatment for retinitis pigmentosa. Sunglasses help protect against cataracts, and supplements like beta carotene, lutein, zeaxanthin, and vitamin A may slow RP progression.
Which actions by the unlicensed assistive personnel (UAP) warrant intervention by the nurse? (Select all that apply.)
- A. Holding the wet washcloth in the microwave
- B. Holding the cloth on the client using an Ace wrap
- C. Turning the cloth so it remains warm on the client
- D. Using a clean washcloth for the compress
- E. Washing the hands on entering the clients room
Correct Answer: A,B
Rationale: The washcloth should be warmed under running warm water, as microwaving it can lead to burns. Gentle pressure is used to hold the compress in place, not an Ace wrap. The other actions are correct.
A client has a foreign body in the eye. What action by the nurse takes priority?
- A. Administering ordered antibiotics
- B. Assessing visual acuity in the affected eye
- C. Obtaining consent for immediate enucleation
- D. Removing the object immediately
Correct Answer: A
Rationale: To prevent infection, antibiotics are provided. Visual acuity in the affected eye cannot be assessed with a foreign body present. Enucleation is not typically required, and only an ophthalmologist should remove the foreign body.
A client has been prescribed brinzolamide (Azopt). What assessment by the nurse requires consultation with the provider?
- A. Allergy to eggs
- B. Allergy to sulfonamides
- C. Use of beta blockers
- D. History of asthma
Correct Answer: B
Rationale: Brinzolamide is similar to sulfonamides, and an allergic reaction could occur in clients with a sulfonamide allergy. The other findings are not directly related to brinzolamide.
A client asks why blindness occurred from glaucoma. What explanation by the nurse is best?
- A. Because eye pressure was too high, the tissue died.
- B. Glaucoma always leads to permanent blindness.
- C. The traumatic damage to your eye was too great.
- D. The infection occurs so quickly, it can be treated.
Correct Answer: A
Rationale: Glaucoma is caused when the intraocular pressure becomes too high and stays high long enough to cause tissue ischemia and death. At that point, vision loss is permanent. Glaucoma does not always cause blindness, trauma is not the most common cause, and glaucoma is not an infection.