A nurse is performing a focused assessment for a client's vision. What visual assessment is the nurse making when she extends her hand for the client to shake?
Depth perception
Peripheral vision
Color deficit
Double vision
The Correct Answer is B
Choice A Reason: Depth perception is the ability to judge the distance and position of objects in three-dimensional space. Depth perception is assessed by asking the client to touch the tip of a pen or pencil held by the nurse, or by using a stereopsis test.
Choice B Reason: Peripheral vision is the ability to see objects and movements outside the direct line of vision. Peripheral vision is assessed by asking the client to shake the hand of the nurse, who stands at an angle to the client's side, or by using a confrontation test.
Choice C Reason: Color deficit is the inability to distinguish certain colors or shades of colors. Color deficit is assessed by asking the client to identify numbers or shapes on a color plate test, such as the Ishihara test.
Choice D Reason: Double vision is the perception of two images of a single object. Double vision is assessed by asking the client to cover one eye and look at an object, then switch eyes and compare the images, or by using a cover-uncover test.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This is incorrect because applying the medication when you are experiencing eye pain can be ineffective or harmful for treating open-angle glaucoma. Open-angle glaucoma is a chronic condition that causes increased pressure inside the eye and damage to the optic nerve, which can lead to vision loss. Eye pain is not a common symptom of open-angle glaucoma, but rather an indication of acute angle closure glaucoma, which is a medical emergency that requires immediate treatment. The nurse should instruct the client to apply the medication as prescribed, regardless of pain level, and seek medical attention if they experience severe eye pain, headache, nausea, or blurred vision.
Choice B reason: This is incorrect because using the medication only until the intraocular pressure returns to normal can cause recurrence or worsening of open-angle glaucoma. Intraocular pressure is the pressure inside
the eye that can affect eye health and vision. Normal intraocular pressure ranges from 10 to 21 mmHg, but it can vary depending on age, time of day, or other factors. The nurse should instruct the client to monitor their intraocular pressure regularly and report any changes to their provider, but not to stop using
the medication without consulting their provider first.
Choice C reason: This is incorrect because using the medication for approximately 10 days, then gradually tapering off can cause rebound or adverse effects of open-angle glaucoma. The medication for open-angle glaucoma can be either beta-blockers, such as timolol, or cholinergic agents, such as pilocarpine, which work by reducing fluid production or increasing fluid drainage in the eye. The nurse should instruct the client to follow their provider's instructions on how long and how much to use the medication and not to change or discontinue it abruptly without their provider's approval.
Choice D reason: This is correct because applying the medication on a regular schedule for the rest of your life can help control and prevent the progression of open-angle glaucoma. Open-angle glaucoma is a lifelong condition that requires consistent and continuous treatment to maintain normal intraocular pressure and prevent vision loss. The nurse should instruct the client to apply the medication at the same time every day and not to miss or skip any doses. The nurse should also teach the client how to store, handle, and administer the medication properly and safely.
Correct Answer is A
Explanation
Choice A reason: This is correct because the lesion on the child's head is most likely a hemangioma, which is a benign tumor of blood vessels that appears as a red or purple mark on the skin. Hemangiomas are common in newborns and usually grow during the first year of life, then shrink and fade over several years. The nurse should reassure the client that hemangiomas are harmless and do not require treatment unless they interfere with vision, breathing, or feeding.
Choice B reason: This is incorrect because the lesion on the child's head will not spread, but rather grow and shrink within a limited area. The nurse should not alarm the client by suggesting that the lesion will spread to other parts of the body or become malignant. The nurse should explain that hemangiomas are not contagious or infectious and do not affect the child's overall health or development.
Choice C reason: This is incorrect because the lesion on the child's head is not caused by scarring from the birth process, but rather by abnormal growth of blood vessels in the skin. The nurse should not confuse or misinform the client about the cause of the lesion. The nurse should explain that hemangiomas are not related to trauma, infection, or genetics, but rather to unknown factors that influence blood vessel formation during fetal development.
Choice D reason: This is incorrect because the lesion on the child's head is not a precancerous lesion and does not need a referral to a dermatologist. The nurse should not scare or mislead the client by suggesting that the lesion is a sign of cancer or requires further evaluation or treatment. The nurse should explain that hemangiomas are benign and usually resolve on their own without any complications or sequelae.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.