A client complains of excessive tearing of the eyes. Which assessment would the nurse do next?
Assess the nasolacrimal sac
Test pupillary reaction to light
Inspect the palpebral conjunctiva
Perform the eye positions test
The Correct Answer is A
A) Assess the nasolacrimal sac: Excessive tearing, or epiphora, can result from an obstruction in the nasolacrimal duct, which drains tears from the eye into the nasal cavity. By assessing the nasolacrimal sac, the nurse can determine if there is any blockage or infection causing the excessive tearing, making this the most appropriate next step.
B) Test pupillary reaction to light: While testing pupillary reaction to light is important in a comprehensive eye exam, it does not directly address the issue of excessive tearing. This test is more focused on evaluating neurological function and overall eye health.
C) Inspect the palpebral conjunctiva: Inspecting the palpebral conjunctiva can help identify inflammation, infection, or foreign bodies that may cause discomfort or tearing. However, it does not specifically address the cause of excessive tearing related to nasolacrimal duct obstruction.
D) Perform the eye positions test: The eye positions test assesses extraocular muscle function and cranial nerve integrity. While it is important for a complete eye examination, it is not directly related to the symptom of excessive tearing, which is more likely due to issues with tear drainage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The Body Mass Index (BMI) is calculated using the formula:
BMI = weight(kg) / height(m)2
First, we need to convert the height from feet and inches to meters.
There are approximately 0.3048 meters in a foot and 0.0254 meters in an inch.
So, 5 feet 5 inches is approximately 1.65 meters.
Substituting the given values into the formula:
BMI = 60 / (1.65)2
This gives us a BMI of approximately 22 when rounded to the nearest whole number.
Therefore, the correct answer is 22 BMI.
Correct Answer is C
Explanation
A) Blockage of the tear ducts causing excessive tearing:
Blockage of tear ducts (dacryostenosis) results in excessive tearing (epiphora) due to inadequate drainage of tears into the nasal cavity. It does not directly contribute to glaucoma, which primarily involves increased intraocular pressure (IOP) and optic nerve damage.
B) Inflammation of the cornea resulting in blurry vision:
Corneal inflammation (keratitis) can cause blurry vision, pain, and sensitivity to light, but it is not the primary pathophysiology of glaucoma. Glaucoma primarily involves damage to the optic nerve due to elevated IOP.
C) Increased intraocular pressure (IOP) leading to optic nerve damage:
Glaucoma is characterized by elevated IOP, which puts pressure on the optic nerve and can lead to progressive damage and vision loss if untreated. This is the primary pathophysiological process in most types of glaucoma.
D) Degeneration of the lens leading to cataracts:
Cataracts involve the clouding of the lens of the eye, leading to visual impairment. While cataracts are a common condition in older adults, they are not directly related to the pathophysiology of glaucoma, which primarily involves elevated IOP and optic nerve damage.
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