A nurse is assessing the visual acuity of a client who wears glasses using a Snellen chart. Which of the following actions should the nurse take?
Position the client 3 meters (10 feet) away from the chart
Document the largest line the client can read on the chart
Instruct the client to begin the assessment with both eyes open
Begin by testing the client while they are wearing glasses
The Correct Answer is D
To test visual acuity using a Snellen chart, the nurse should have the patient wear glasses or contact lenses if they normally wear them . The patient should stand 20 feet from the chart . The nurse should tell the patient to first cover the right eye, then left eye, and lastly read the chart with both eyes .
The other options are not correct because:
a). The client should be positioned 20 feet away from the chart, not 3 meters (10 feet).
b) The nurse should document the smallest line the client can read accurately on the chart, not the largest line.
c) The nurse should instruct the client to begin the assessment by covering one eye and reading aloud the letters on the chart, beginning at the top and moving toward the bottom
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
As individuals age, there is a natural decline in kidney function. This can result in a reduced ability to filter and excrete medications and their metabolites from the body. The decreased kidney function can lead to a longer half-life of medications, increased drug accumulation, and an increased risk of adverse drug reactions. It is important for the nurse to adjust medication dosages and frequencies based on the individual's renal function to prevent drug toxicity.
Increased liver function: Aging is associated with a gradual decline in liver function. While there may be some individual variations, in general, liver function decreases rather than increases with age. However, changes in liver function can affect the metabolism and elimination of medications. Some medications may require dosage adjustments based on liver function, but it is not a common physiological change in older adults.
Increased metabolism: Aging is generally associated with a decrease in metabolism rather than an increase. The metabolic rate tends to slow down with age, which can affect the pharmacokinetics of medications. Slower metabolism can result in medications taking longer to be metabolized and cleared from the body, potentially leading to prolonged drug effects.
Decreased pulmonary function: While it is true that lung function decreases with age, the impact on medication administration is not as significant compared to kidney function. Medications are usually administered through non-pulmonary routes (e.g., oral, intravenous, transdermal), and decreased pulmonary function primarily affects the absorption of inhaled medications. However, certain respiratory conditions or compromised lung function may influence medication choices or require adjusted dosing.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Explanation
Compartment syndrome occurs when there is increased pressure within a closed muscle compartment, leading to reduced blood flow to the muscles and nerves in that compartment. In this case, the open fracture and subsequent reduction and stabilization procedure can cause swelling and increased pressure within the affected compartment. This can impede blood flow and potentially lead to tissue damage. Common symptoms include severe pain, swelling, numbness, and decreased or absent pulses. Immediate medical attention is necessary if compartment syndrome is suspected.
Deep Vein Thrombosis (DVT) refers to the formation of blood clots within the deep veins, typically in the lower extremities. In the case of a client with an open fracture and immobilization with a splint, the risk of DVT increases due to factors such as reduced mobility, injury to blood vessels, and blood stasis. DVT can lead to serious complications if a clot dislodges and travels to the lungs, causing a pulmonary embolism. Symptoms of DVT may include pain, swelling, warmth, and redness in the affected limb.
While osteomyelitis and fat embolism syndrome can occur as complications of long bone fractures, they are not explicitly mentioned in the given scenario. Osteomyelitis refers to an infection in the bone, which can develop if bacteria enter an open fracture. Fat embolism syndrome can occur when fat globules from the bone marrow enter the bloodstream, usually following a long bone fracture.
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