During an ophthalmic assessment, which of the ff are the nurses expected to observe carefully? Choose all that apply
- A. Level of central vision
- B. Pupil responses
- C. External eye appearance
- D. Eye movements
Correct Answer: B
Rationale: During an ophthalmic assessment, the nurses are expected to observe the following carefully:
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Which intervention should the nurse implement to maintain the skin integrity of the preterm newborn?
- A. Cleanse skin with a gentle alkaline-based soap and water.
- B. Cleanse skin with a neutral pH solution only when necessary.
- C. Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution.
- D. Avoid cleaning skin.
Correct Answer: B
Rationale: Preterm newborns have delicate skin that is more susceptible to damage and irritation. Using a neutral pH solution for cleansing helps to maintain the skin's natural acidity and prevent disruption of the skin barrier. It is important to avoid over-bathing or using harsh alkaline-based soaps that can strip the skin of its natural oils and cause dryness or irritation. Cleansing the skin only when necessary helps to protect the fragile skin of preterm newborns and reduce the risk of skin breakdown or injury.
When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which of the following?
- A. Restricting fluids
- B. Forcing fluids
- C. Restricting sodium
- D. Restricting potassium
Correct Answer: C
Rationale: For clients diagnosed with hyperparathyroidism, it is important to restrict sodium in the diet. High sodium intake can worsen calcium loss from the bones and increase the risk of kidney stones, both of which are concerns for individuals with hyperparathyroidism. Therefore, it is crucial to advise the client to limit their sodium intake to help manage their condition effectively.
Which of the following guidekines does not observe surgical asepisi in the operating room?
- A. sterile articles may touch other sterile articles or surface and remain sterile
- B. gowns of surgical team are considered sterile in front from the chest down to the bottom of the gown
- C. whenever a sterile barrier is breached, the area must be considered contaminated
- D. sterile drapes are used to create a sterile field
Correct Answer: A
Rationale: This statement is incorrect and does not observe surgical asepsis in the operating room. In surgical asepsis, it is crucial that sterile articles do not touch other sterile articles or surfaces to prevent contamination. Any contact between sterile items or surfaces can lead to the transfer of microorganisms, compromising the sterility of the environment. Maintaining a sterile field is essential to prevent surgical site infections and ensure the safety of the patient undergoing the procedure.
ahmed 2 months old come to emergency department with epistaxis and prolong PTT, clotting and bleeding time , what you suspect ahmed have :
- A. thalassemia
- B. hemophilia
- C. leukemia
- D. sickle anemia
Correct Answer: B
Rationale: Ahmed is presenting with epistaxis (nosebleed) and prolonged PTT (partial thromboplastin time), clotting time, and bleeding time, which are indicative of a bleeding disorder. Given the symptoms and lab findings, hemophilia is the most likely cause. Hemophilia is an inherited bleeding disorder characterized by deficiency or dysfunction of clotting factors, particularly Factor VIII (hemophilia A) or Factor IX (hemophilia B). Patients with hemophilia often present with spontaneous bleeding episodes, such as nosebleeds, bruising, and prolonged bleeding after injury or surgery. Thalassemia, leukemia, and sickle cell anemia are not associated with prolonged clotting times and bleeding presentations, making hemophilia the most appropriate choice in this scenario.
The nurse understands that labyrinthitis is treated primarily with which of the ff. drug categories?
- A. Antihistamines
- B. Anti-inflammatories
- C. Antispasmotics
- D. Antiemetics
Correct Answer: A
Rationale: Labyrinthitis is an inner ear disorder that is often caused by a viral infection. Antihistamines are commonly used in the treatment of labyrinthitis to help reduce symptoms such as dizziness, nausea, and vomiting. Antihistamines work by blocking the effects of histamine, which is a chemical in the body that can cause these symptoms. Additionally, antihistamines can help alleviate any associated allergies or inflammation in the inner ear that may be contributing to the condition. Other treatment options for labyrinthitis may include vestibular rehabilitation exercises, antiemetics for nausea and vomiting, and medications to manage dizziness.
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