A nurse is assessing a client who has vision impairment related to acute angle-closure glaucoma. Which of the following manifestations should the nurse expect?
A yellowed sclera
Brisk pupil reactivity
Client reports a curtainlike obstruction over the visual field
Client reports seeing colored halos around lights
The Correct Answer is D
A) A yellowed sclera:
A yellowed sclera is typically associated with jaundice, which is related to liver conditions, not acute angle-closure glaucoma. This symptom is not indicative of glaucoma.
B) Brisk pupil reactivity:
In acute angle-closure glaucoma, the pupil is often mid-dilated and sluggish to react to light due to increased intraocular pressure. Brisk pupil reactivity is not a characteristic finding in this condition.
C) Client reports a curtainlike obstruction over the visual field:
A curtainlike obstruction over the visual field is usually associated with retinal detachment, not acute angle-closure glaucoma. This description does not align with the symptoms of glaucoma.
D) Client reports seeing colored halos around lights:
Seeing colored halos around lights is a classic symptom of acute angle-closure glaucoma. This occurs due to the elevated intraocular pressure affecting the corneal surface and causing light diffraction. This manifestation is a key indicator of the condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Place the client in a semi-Fowler's position:
While positioning can be beneficial for various conditions, it does not directly address the core issue of hypothermia. Rewarming the client effectively is the primary concern in hypothermia management.
B) Infuse warm IV fluids:
Administering warm IV fluids is a crucial intervention for moderate hypothermia as it helps increase the client's core body temperature more rapidly and effectively. This method ensures that the body's internal temperature is raised, which is vital for stabilizing the client.
C) Assess the client's skin hourly when using a heating blanket:
Monitoring the skin is important to prevent burns or skin damage from a heating blanket, but it is a supportive measure rather than a primary intervention. The key priority is to rewarm the client’s core.
D) Rewarm the client's extremities first:
Rewarming the extremities first can actually be harmful in hypothermia, as it can lead to a drop in core body temperature due to the return of cold blood from the periphery to the core (afterdrop). The focus should be on warming the core body first.
Correct Answer is B
Explanation
A) Provide a detailed account of the feelings and sounds the client will experience:
While explaining the procedure can be helpful, it might increase anxiety for someone with claustrophobia by focusing on potentially distressing details. It's more effective to use relaxation techniques or medications to manage acute anxiety.
B) Obtain a prescription for clonazepam:
Clonazepam, a benzodiazepine, can help reduce anxiety and is often used to manage claustrophobia during procedures like an MRI. This medication can help the client stay calm and more comfortable during the scan.
C) Obtain a prescription for ziprasidone:
Ziprasidone is an antipsychotic medication and is not typically used for managing situational anxiety or claustrophobia. Using an appropriate anxiolytic like clonazepam is more effective in this context.
D) Inform the client that the time spent in the MRI machine will only be 5 min:
This statement is misleading as MRI scans usually take longer than 5 minutes. Providing inaccurate information can undermine trust and increase anxiety if the procedure takes longer than stated.
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