A nurse in a provider's office is caring for a client who has blepharitis. Which of the following actions should the nurse take first?

Reinforce teaching with the client about proper instillation of antibiotic eye drops.

Apply warm compresses to the affected eye.

Dim the lights in the client examination room.

Inspect the eyes for drainage or redness.

Answer and Explanation

The Correct Answer is D

Choice A reason: This is an important action, but not the first one. The nurse should first address the client's comfort and inflammation before teaching them how to use the eye drops.

Choice B reason: Option B (warm compresses) is a key intervention for blepharitis to improve meibomian gland function and reduce crusting. However, assessment (Option D) must precede treatment to ensure no contraindications (e.g., corneal abrasion) and tailor care appropriately.

Choice C reason: This is a helpful action, but not the first one. The nurse should first apply warm compresses to the affected eye, and then dim the lights to reduce the sensitivity and pain.

Choice D reason: The first step in the nursing process is assessment. Even with a diagnosis of blepharitis, the nurse must inspect the eyes to evaluate the current severity, presence of drainage (e.g., purulent vs. serous), redness, or signs of secondary infection (e.g., bacterial involvement). This informs subsequent interventions.

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Correct Answer is C

Explanation

Choice A reason: This is a vague and unhelpful response, because it does not provide any information or reassurance to the client who has a new diagnosis of MS. The nurse should explain the general course of MS and the possible variations among clients.

Choice B reason: This is a sympathetic but incomplete response, because it does not address the client's question or provide any information about the course of MS. The nurse should acknowledge the client's feelings and provide factual and realistic information.

Choice C reason: This is the best response, because it provides accurate and relevant information about the course of MS, which is a chronic and progressive disease that affects the central nervous system. MS can cause acute episodes of neurological symptoms, such as vision loss, numbness, weakness, or fatigue, which are followed by periods of remission, when the symptoms improve or disappear. The length and frequency of the episodes and remissions can vary among clients.

Choice D reason: This is a dismissive and unrealistic response, because it does not answer the client's question or respect the client's right to know about the course of MS. The nurse should not avoid the client's concerns or minimize the impact of the diagnosis. The nurse should help the client cope with the uncertainty and plan for the future.

A. Instruct the client to blink several times after instillation of the medication. B. Ask the client to look straight ahead during instillation of the medication. C. Apply pressure to the bridge of the nose after instillation of the medication. D. Place each drop of the medication directly on to the client's cornea.

Correct Answer is C

Explanation

Choice A reason: This is an incorrect action, because instructing the client to blink several times after instillation of the medication can cause the medication to drain out of the eye and reduce its effectiveness.

Choice B reason: This is a correct action, but not the best one. Asking the client to look straight ahead during instillation of the medication can help the nurse to aim the drop accurately and avoid touching the eye with the dropper.

Choice C reason: This is the best action, because applying pressure to the bridge of the nose after instillation of the medication can prevent the medication from entering the systemic circulation and causing adverse effects, such as bradycardia, hypotension, or bronchospasm.

Choice D reason: This is an incorrect action, because placing each drop of the medication directly on to the client's cornea can cause irritation, injury, or infection to the eye. The medication should be placed in the lower conjunctival sac of the eye.

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A nurse in a provider's office is caring for a client who has blepharitis. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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