A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply.)

Keep objects in the client's room in the same place.

Approach the client from the side.

Ensure there is high-wattage lighting in the client's room.

Allow extra time for the client to perform tasks.

Touch the client gently to announce presence.

Answer and Explanation

Correct Answer : A,C,D

A.   Keeping objects in the same place help maintain a safe environment and independence for a client with vision loss.
B.   When caring for a client with vision loss, the nurse should avoid approaching the client from the side since it may startle them.
C.   Providing high-wattage lighting can improve visibility for clients with partial vision loss. Adequate lighting reduces shadows and enhances contrast, making it easier for the client to see their surroundings

D. Allowing extra time for tasks helps orient them to the nurse's presence and facilitates communication.
E. While gentle touch can be a way to announce presence, it is better to verbally announce oneself first to avoid startling the client, particularly if they are not expecting contact.

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Correct Answer is D

Explanation

A. Potatoes do not contain significant levels of tyramine and are generally safe to consume with MAOIs.
B. Grapefruit does not contain significant levels of tyramine and are generally safe to consume with MAOIs.
C. Eggs do not contain significant levels of tyramine and are generally safe to consume with MAOIs.

D. MAOIs (Monoamine Oxidase Inhibitors) require dietary restrictions to avoid tyramine, which is found in high levels in aged cheeses. High tyramine intake while on MAOIs can lead to hypertensive crises.

A. Schedules a bag and tubing change for 24 hr after the start of the infusion B. Plans for a check of the client's fingerstick glucose level every 6 hr C. Gradually increases the TPN infusion rate each hour until the prescribed rate is achieved D. Uses the TPN IV tubing to administer the client's next dose of antibiotics

Correct Answer is D

Explanation

A: Changing the TPN bag and tubing every 24 hours is standard practice to prevent infection, so this action is appropriate.
B: Checking glucose levels every 6 hours is necessary because TPN can significantly affect blood glucose levels.
C: Gradually increasing the TPN rate is a standard procedure to monitor tolerance to the infusion.
D: This indicates a need for intervention. TPN lines should not be used for any other infusions to prevent contamination and interactions between the nutrition formula and medications.

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A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply.)

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