Nokea
Which instruction should the nurse discuss with the female client with viral conjunctivitis?
- A. Contact the HCP if pain occurs.
- B. Do not share towels or linens.
- C. Apply warm compresses to the eyes.
- D. Apply makeup very lightly.
Correct Answer: B
Rationale: Not sharing towels or linens prevents viral conjunctivitis spread. Pain warrants HCP contact but is less preventive, compresses are soothing but secondary, and makeup should be avoided.
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The emergency department nurse is assessing a client who has a needle in the sclera of the right eyeball just below the iris. Which should the nurse implement first?
- A. Remove the needle with tweezers.
- B. Notify an ophthalmologist to care for the client.
- C. Stabilize the right eye and place a patch over the left eye.
- D. Irrigate the right eye to wash the needle out of the eye.
Correct Answer: C
Rationale: Stabilizing the eye and patching the unaffected eye prevents movement and further damage until surgical removal. Removing the needle, notifying later, or irrigating risks harm.
The nurse is administering eyedrops to the client. Which guidelines should the nurse adhere to when instilling the drops into the eye? Select all that apply.
- A. Do not touch the tip of the medication container to the eye.
- B. Apply gentle pressure on the outer canthus of the eye.
- C. Apply sterile gloves prior to instilling eyedrops.
- D. Hold the lower lid down and instill drops into the conjunctiva.
- E. Gently pat the skin to absorb excess eyedrops on the cheek.
Correct Answer: A,D,E
Rationale: Avoiding container contact prevents contamination, instilling into the conjunctiva ensures absorption, and patting excess drops maintains hygiene. Pressure on the outer canthus is incorrect (nasolacrimal duct pressure prevents systemic absorption), and sterile gloves are unnecessary.
The client with macular degeneration is told the condition is progressing to an advanced stage. Which findings should the nurse expect when completing the assessment? Select all that apply.
- A. Curtain appearance over part of the visual field
- B. Loss of peripheral vision in the affected eye
- C. Difficulty seeing in dimly lit environments
- D. Visual distortions in the central vision
- E. Clouding of the lens in both eyes
Correct Answer: C,D
Rationale: Difficulty seeing in dimly lit environments is from the slow breakdown of the outer layer of the retina and the formation of drusen within the macula. The macula is the area of central vision, and with macular degeneration, there is the loss or distortion of central vision. Curtain appearance is associated with retinal detachment, peripheral vision loss with glaucoma, and clouding of the lens with cataracts.
The 72-year-old client tells the nurse food does not taste good anymore and he has lost a little weight. Which information should the nurse discuss with the client?
- A. Suggest using extra seasoning when cooking.
- B. Instruct the client to keep a seven (7)-day food diary.
- C. Refer the client to a dietitian immediately.
- D. Recommend eating three (3) meals a day.
Correct Answer: B
Rationale: A food diary identifies intake patterns and weight loss causes, guiding intervention. Extra seasoning is premature, dietitian referral is secondary, and three meals are standard advice.
The nurse who is at a local park sees a young man on the ground who has fallen and has a stick lodged in his eye. Which intervention should the nurse implement at the scene?
- A. Carefully remove the stick from the eye.
- B. Stabilize the stick as best as possible.
- C. Flush the eye with water if available.
- D. Place the young man in a high-Fowler's position.
Correct Answer: B
Rationale: Stabilizing the stick prevents further damage until surgical removal. Removing it risks bleeding, flushing is contraindicated, and positioning is secondary.