Nokea
Which symptom should the nurse closely monitor for and report immediately in a client who has just undergone cataract surgery?
- A. Hypotension
- B. Nausea and vomiting
- C. Intense pain in the eye or near the brow
- D. Increased urine output
Correct Answer: C
Rationale: Intense pain could indicate complications such as infection or increased intraocular pressure.
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What is the primary goal of treating hyperopia?
- A. Improve near vision
- B. Improve distance vision
- C. Correct astigmatism
- D. None of the above
Correct Answer: A
Rationale: Hyperopia primarily affects near vision, so treatment focuses on improving it.
Tom reports abdominal pain that started over the periumbilical area and moved to the right lower quadrant area. Tom probably has
- A. Crohn's disease.
- B. Cholecystitis.
- C. Appendicitis.
- D. Diverticulitis.
Correct Answer: C
Rationale: Appendicitis typically presents with migrating pain from the periumbilical area to the right lower quadrant.
What is the nurse’s evaluation of Mr. Singer not testing for proper placement of his nasogastric tube?
- A. Mr. Singer must be stopped before the instillation of the feeding
- B. There is no possibility that the tube will get into Mr. Singer’s trachea
- C. If Mr. Singer shows no breathing difficulties, he can proceed with his feeding
- D. The greatest danger for Mr. Singer is the aspiration of the feeding into his lung
Correct Answer: D
Rationale: Aspiration poses a serious risk if the tube is misplaced.
The nurse is assessing a client with delayed wound healing. Which of the following risk factors is most important in this situation?
- A. Glucose level of 120 mg/dl.
- B. History of myocardial infarction.
- C. Long term steroid usage.
- D. Diet high in carbohydrates.
Correct Answer: C
Rationale: Steroids impair wound healing by affecting collagen formation and immune response.
Trevor Gilbert, 59, arrives at the ambulatory surgery department as instructed prior to his back surgery. The baseline history taken on Mr. Gilbert should include:
- A. experiences he's had with hospitalizations.
- B. reactions to his childhood immunizations.
- C. what type of diet he's on and his compliance with it.
- D. what he believes will happen as a result of the surgery.
Correct Answer: D
Rationale: A preoperative assessment should include the patient's history, but the focus should be particularly on his expectations of this particular hospitalization. Knowledge about whether he received his childhood immunizations is important, but his reactions to those, even if he knows what they were, is not the most important information to gain today. The type of diet he's on is good information, but again not the most important information listed here. It is vital to determine the patient's expectations of his surgery, in order to correct any misperceptions he may have about the outcome, or reason, for this invasive treatment.