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
A. Nail Beds:
While peripheral cyanosis can cause bluish discoloration of the nail beds, central cyanosis is more indicative of systemic hypoxemia and is best assessed in areas with rich blood supply, such as the oral mucosa.
B. Sclera:
The sclera is more commonly used to assess for jaundice (yellowing) rather than cyanosis. Cyanosis is not typically visible in the sclera.
C. Oral Mucosa:
Central cyanosis is most accurately assessed in areas with high vascularization, such as the oral mucosa. This area provides a clear indication of oxygenation status and can reveal hypoxemia more reliably than peripheral sites.
D. Palms:
Similar to the nail beds, the palms can show signs of peripheral cyanosis but are not the primary site for assessing central cyanosis. The oral mucosa remains the best site for this assessment.
Correct Answer is A
Explanation
A) Fish: Fish, especially fatty fish like salmon, mackerel, sardines, and trout, are rich sources of omega-3 fatty acids. Omega-3 fatty acids are essential for heart health, reducing inflammation, and supporting brain function. Including fish in the diet is highly recommended for obtaining these beneficial fats naturally.
B) Leafy green vegetables: While leafy green vegetables provide many essential nutrients, they are not significant sources of omega-3 fatty acids. They are more commonly known for their vitamins, minerals, and fiber content, which are important for overall health but do not provide the omega-3s that fish does.
C) Corn oil: Corn oil is high in omega-6 fatty acids rather than omega-3 fatty acids. While omega-6 fatty acids are also necessary for health, they should be balanced with omega-3s to maintain optimal health. Corn oil does not contribute significantly to omega-3 intake.
D) Dietary supplements: While omega-3 supplements can be a good alternative for those who do not consume enough fish, obtaining nutrients from whole foods is generally preferred for additional health benefits, such as protein and other nutrients found in fish. Supplements should be considered when dietary intake is insufficient.
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