A nurse is obtaining a preoperative medical and surgical history from a client scheduled for a cataract extraction procedure. Which of the following client statements require further investigation by the nurse?

A) "Damage occurs from the penetrating object shattering the skull and causing an infection." While penetrating traumatic brain injuries can lead to skull fractures and subsequent infections, the primary mechanism of brain damage in these injuries is related to the direct impact of the penetrating object on brain tissue rather than the shattering of the skull.

B) "Damage to the brain is related to coup and contrecoup injuries." Coup and contrecoup injuries occur when the brain impacts the skull's interior surface due to rapid deceleration or acceleration, commonly seen in closed head injuries such as concussions. Penetrating traumatic brain injuries involve direct penetration of foreign objects into the brain tissue, and coup-contrecoup injuries are not typically associated with these types of injuries.

C) "Damage occurs from the penetrating injury causing leakage of cerebrospinal fluid." While penetrating injuries may result in cerebrospinal fluid leakage, this is not the primary mechanism through which they cause brain damage. Leakage of cerebrospinal fluid is more commonly associated with certain types of head trauma, such as skull fractures, rather than solely penetrating injuries.

D) "Damage to the brain is related to the size, route, and rate of speed of the object entering the brain." This statement is correct. The extent of brain damage in penetrating traumatic brain injuries depends on various factors, including the size, shape, and velocity of the penetrating object, as well as the route it takes through the brain tissue. Larger, faster-moving objects tend to cause more extensive damage, whereas smaller objects or those with slower velocities may cause more localized damage. Therefore, understanding these factors is crucial in assessing and managing patients with penetrating traumatic brain injuries.

A) "Vision changes occur when pressure in the eye is increased due to a decrease of aqueous humor." This statement describes a mechanism associated with glaucoma, not cataracts. In cataracts, vision changes occur due to the opacity or cloudiness of the lens, not changes in intraocular pressure.

B) "Vision changes occur when blood vessels leak fluid or blood under a portion of the retina." This statement describes a mechanism associated with retinal diseases like diabetic retinopathy, not cataracts. In cataracts, the lens becomes cloudy, affecting the passage of light through the eye.

C) "Vision changes occur when the cloudy lens alters the passage of light through the eye." This statement is correct. Cataracts cause the lens of the eye to become cloudy, which interferes with the passage of light through the eye. This results in vision changes such as blurred vision, glare, and difficulty seeing in low light conditions.

D) "Vision changes occur when retinal tissue pulls away from the blood vessels in the eye." This statement describes a mechanism associated with retinal detachment, not cataracts. In cataracts, the lens becomes opaque, but the retinal tissue remains intact.