A nurse is assessing a client who has heart failure and a new prescription for metoprolol. Which of the following findings should the nurse identify as an adverse effect of the medication?

Choice A reason: Ocular irrigation should be performed from the inner corner (near the nose) toward the outer corner to avoid contaminating the other eye and to ensure that the flushing fluid and any chemical residue flow away from the unaffected eye. This method helps to minimize the risk of spreading the chemical to the other eye and allows for a more effective removal of the chemical from the affected eye.

Choice B reason: While positioning the client upright is correct, having the head turned toward the right side is not specifically recommended. The client should be positioned in a way that facilitates the flow of the irrigation fluid away from the unaffected eye, which typically means tilting the head to the side of the affected eye.

Choice C reason: Placing a strip of pH paper under the upper lid of the affected eye is done to measure the pH of the tear film and determine the acidity or alkalinity of the chemical involved. However, this is not an immediate action during the initial irrigation process. The first priority is to dilute and remove the chemical from the eye as quickly as possible.

Choice D reason: While sterile water can be used for ocular irrigation, it is not the first choice. The preferred solution for ocular irrigation is a saline solution or specific eye irrigating solutions because they are isotonic and less irritating to the eye tissues. Sterile water may cause discomfort due to its hypotonicity, which can lead to cellular swelling.

Choice A reason : Pressing down on the orbital area of the eye is not a recommended method for eliciting a response from a painful stimulus in an unresponsive patient due to the potential for injury to the eye.

Choice B reason : Pressing down on the trapezius muscle is an acceptable method for eliciting a response from a painful stimulus in an unresponsive patient. This technique is less invasive and can be performed safely to assess the patient's level of consciousness or response to pain without causing harm⁸.

Choice C reason : Using a 25-gauge needle is not an appropriate method for eliciting a response from a painful stimulus in an unresponsive patient. This could cause unnecessary harm and is not a standard practice in clinical settings.

Choice D reason : Eliciting a reflex with a reflex hammer is a method used to assess reflexes, not to elicit a response from a painful stimulus in an unresponsive patient. This tool is used to test neurological function and reflex integrity, not to assess pain response.