A client with homonymous hemianopsia resulting from a stroke has a disturbed sensory perception.
An appropriate nursing intervention to help the client learn to compensate for this deficit during the rehabilitation period would be to:
Approach the client from the unaffected side.
Apply an eye patch to the affected eye.
Teach exercises involving the eye muscles with full range of motion twice per day.
Teach the client scanning techniques.
The Correct Answer is D
Choice A rationale
Approaching the client from the unaffected side does not stimulate compensation or adaptation. It limits the opportunity for neural adjustment and rehabilitation to optimize functional use of the affected side.
Choice B rationale
Eye patches may address double vision but are ineffective in enhancing sensory perception compensation for hemianopsia. Rehabilitation focuses on improving spatial awareness, not restricting visual fields.
Choice C rationale
Muscle exercises aid ocular health but do not scientifically compensate for hemianopsia. Scanning techniques provide more effective sensory perception rehabilitation in spatial deficits caused by this condition.
Choice D rationale
Scanning techniques teach clients to move their head or eyes consciously to view their entire surroundings. This method compensates for sensory deficits, helping clients adapt effectively during rehabilitation. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Cervical spinal cord injuries at or above C3 disrupt the phrenic nerve, impairing diaphragm control, leading to respiratory failure. Mechanical ventilation compensates for the loss of neural signals required for effective breathing.
Choice B rationale
Unconsciousness alone does not necessitate ventilation unless breathing is compromised. Here, respiratory failure stems from cervical nerve injury, not loss of consciousness, requiring mechanical support.
Choice C rationale
The lungs themselves are not damaged in cervical spinal cord injuries; the issue lies in disrupted nerve signals needed for diaphragm and respiratory muscle function, necessitating ventilatory assistance.
Choice D rationale
Smoking history does not explain the acute respiratory failure caused by cervical spinal cord injuries. The need for ventilation directly results from damage to the neural control of respiratory muscles.
Correct Answer is B
Explanation
Choice A rationale
Reviewing the safety data sheet does not directly alleviate the immediate chemical injury or prevent further damage. Immediate irrigation of the eyes is the priority after chemical exposure to minimize damage to the ocular surface.
Choice B rationale
Continuous irrigation removes chemical agents from the eyes and prevents further damage. Ensuring a pain-free state and checking pH confirm the removal of irritants, essential for preventing deeper eye tissue damage.
Choice C rationale
Miotic drops reduce intraocular pressure but do not address acute chemical injury. Pain relief is secondary to irrigating and neutralizing pH, which directly prevents ongoing tissue damage and irritation.
Choice D rationale
Assessing visual acuity and vital signs is important but secondary to preventing further chemical penetration. Immediate irrigation prevents damage progression and is prioritized over assessments during the acute phase of exposure.
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