A nurse in the emergency department is preparing to irrigate the eyes of a client who received a chemical splash on their face. Which of the following actions should the nurse take?
Completely irrigate one eye before irrigating the second eye.
Inform the client they will need to blink their eyes rapidly during the irrigation process.
Delay the irrigation process until the type of chemical in the eyes is identified.
Ask the client to count the number of fingers held up by the nurse prior to irrigating their eyes.
The Correct Answer is A
Choice A rationale:
Completely irrigating one eye before irrigating the second eye is the correct action to take when a client receives a chemical splash on their face. This approach helps prevent the potential spread of the chemical from one eye to the other. Irrigation should be done immediately to flush out the chemical and minimize its harmful effects.
Choice B rationale:
Informing the client to blink their eyes rapidly during the irrigation process is not recommended. Blinking may exacerbate the dispersion of the chemical and could lead to further damage to the eyes. Instead, the client should keep their eyes open during irrigation.
Choice C rationale:
Delaying the irrigation process until the type of chemical in the eyes is identified is not appropriate. Time is critical in minimizing the impact of the chemical on the eyes. Immediate irrigation is essential, regardless of the type of chemical, to remove the substance from the eyes.
Choice D rationale:
Asking the client to count the number of fingers held up by the nurse before irrigating their eyes is not relevant in this situation. The priority is to initiate immediate irrigation to remove the chemical from the eyes. Assessing the client's visual acuity can be done later in the evaluation process after the eyes have been irrigated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
the correct answer is Choice A.
Choice A rationale: Basal cell carcinoma (BCC) is a type of skin cancer that develops in basal cells, a type of cell within the skin that produces new skin cells1.One of the common symptoms of BCC is a pearly white, skin-colored or pink bump1.This can also appear as a shiny or pearly nodule with a smooth surface2.Therefore, a pearly, waxy nodule is a characteristic lesion of basal cell carcinoma
Choice B rationale: An irregular border on a variegated-colored lesion is more commonly associated with melanoma, another type of skin cancer, rather than basal cell carcinoma1.While BCC can have a variety of appearances, an irregular border on a variegated-colored lesion is not typically characteristic of BCC
Choice C rationale: A firm, nodular, crusty, or ulcerated lesion can be a sign of several types of skin conditions, including squamous cell carcinoma, another type of skin cancer1.While BCC can sometimes appear as a firm nodule1, the description of a crusty or ulcerated lesion is not as characteristic of BCC as a pearly, waxy nodule
Choice D rationale: A weeping vesicle is not typically associated with basal cell carcinoma1.BCC lesions are more likely to appear as a shiny bump or nodule, or a flat, scaly patch1.A weeping vesicle could be indicative of a different skin condition
Correct Answer is A
Explanation
Choice A rationale:
Testicular cancer may present as a painless lump or swelling in the testicle. It's important for the client to monitor for any new or unusual lumps, as they could be indicative of cancer.
Choice B rationale:
A decreased size of the testicle is not a typical manifestation of testicular cancer. It is more commonly associated with conditions like testicular atrophy due to other causes.
Choice C rationale:
Asymmetry in the position of the testicles, with one testicle descending lower than the other, is a normal variation and not a sign of testicular cancer.
Choice D rationale:
Dilated veins above the testicle can be a sign of a varicocele, which is a separate condition from testicular cancer. It is caused by abnormal enlargement of veins in the scrotum and is generally not associated with cancer.
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