A nurse is preparing to administer eye drops to a client. Which of the following nursing actions is appropriate?

Have the client tilt her head slightly so that the medication enters the nasolacrimal duct.

Gently wash away any exudate along the eyelid margin from the outside towards the inner canthus.

Use aseptic technique and drop the medication into the conjunctival sac.

Drop prescribed number of drops onto the cornea.

Answer and Explanation

The Correct Answer is C

A. Tilted head position facilitates drainage into the nasolacrimal duct, not necessarily into the eye.

B. Washing away exudate is not necessary before administering eye drops.

C. Using aseptic technique to drop medication into the conjunctival sac ensures proper delivery of the medication to the eye.

D. Dropping medication onto the cornea can cause discomfort and may not effectively reach the eye.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Insert an indwelling catheter if the client has not voided in 3 hr: This task is within the LPN’s scope of practice, including sterile procedures such as catheterization. The RN retains the responsibility to evaluate the client’s overall status but may direct the LPN to insert a catheter under specific conditions.
B. Obtain the abdominal girth now and every 4 hr: This is a non-sterile, routine measurement and would be more appropriately assigned to assistive personnel rather than an LPN.
C. Assess and document the level of consciousness every hour: Assessment of neurological status requires RN-level clinical judgment, particularly in clients at risk for hepatic encephalopathy.
D. Measure the amount of gastric drainage every 2 hr: Although within an LPN’s scope, this task is repetitive and routine and may be more appropriate for assistive personnel under supervision.

Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}

Explanation

A. It would not be appropriate to place the client on restraints as this would increase agitation and he is not violent.

B. The client may have a urinary tract infection (UTI) that is causing fever, hypotension, and confusion. Monitoring elimination can help assess the severity of the infection and the need for antibiotics.

C. Dimming the lights can help reduce sensory overload and agitation in the client.

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A nurse is preparing to administer eye drops to a client. Which of the following nursing actions is appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse delegates tasks to a licensed practical nurse (LPN) and an assistive personnel (AP). When admitting a client who is experiencing acute liver failure and who has ascites and an NG tube, which of the following tasks is most appropriate for the nurse to delegate to the LPN?

Correct Answer is A

Explanation

A nurse is caring for a client in the intensive care unit. Exhibits Complete the following sentence by using the list of options. The nurse should first plan to dropdown and then dropdown

Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}

Explanation

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