A nurse is providing discharge teaching to a client who is postoperative following the surgical repair of a detached retina.
Which of the following statements by the client indicates an understanding of the teaching?
I can lift objects that are less than 10 pounds
I can resume activities, such as sewing
I can go jogging after 2 weeks
I should bend at the waist when putting on my shoes
The Correct Answer is A
The correct answer is A. I can lift objects that are less than 10 pounds.
Here's a breakdown of why the other options are incorrect:
- B. I can resume activities, such as sewing. - Sewing requires fine motor skills and close eye work, which can increase intraocular pressure and potentially worsen the detached retina.
- C. I can go jogging after 2 weeks. - Strenuous activities like jogging can increase blood pressure and strain the eye, potentially leading to another retinal detachment.
- D. I should bend at the waist when putting on my shoes. - Bending at the waist increases intraocular pressure and can strain the eye. It's recommended to sit down or use a stool to put on shoes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A, administer a fluid bolus.
Choice A rationale:
Administering a fluid bolus is appropriate when a client’s urine output is low, which in this case is less than the minimum expected output of 30 mL/hr. The dark yellow color of the urine also suggests dehydration or concentrated urine, which can be addressed with increased fluid intake.
Choice B rationale:
Initiating continuous bladder irrigation is typically done to clear the urinary tract of blood clots or debris following urologic surgery, not for low urine output or dark urine. Therefore, this intervention is not indicated based on the given scenario.
Choice C rationale:
Obtaining a urine specimen for culture and sensitivity is an action taken when there is a suspicion of a urinary tract infection. The scenario does not provide evidence of infection, such as fever or cloudy urine with a strong odor, so this would not be the first intervention to anticipate.
Choice D rationale:
Clamping the catheter tubing is done in preparation for catheter removal or to assess if the client can void without the catheter. It is not an appropriate intervention for low urine output or dark urine and could potentially cause bladder distention or discomfort.
Correct Answer is B
Explanation
Choice A reason:
Ketorolac is incorrect because it is an NSAID that is used for short-term pain relief. It has a higher risk of causing irritation to the stomach lining and is not recommended for clients with a history of peptic ulcers.
Choice B reason:
Acetaminophen is the correct answer. When caring for a client who reports a headache and has a history of a peptic ulcer, the nurse should administer Acetaminophen. Acetaminophen is an analgesic (pain reliever) and antipyretic (fever reducer) that does not have anti-inflammatory properties. It is a suitable option for pain relief in clients with a history of peptic ulcers because it is less likely to cause irritation to the stomach lining compared to nonsteroidal anti-inflammatory drugs (NSAIDs).
Choice C reason
Aspirin is not appropriate: Aspirin is an NSAID with anti-inflammatory, analgesic, and antipyretic properties. Like other NSAIDs, it can increase the risk of stomach irritation and should be avoided in clients with a history of peptic ulcers.
Choice D reason:
Ibuprofen is not the right option: Ibuprofen is another NSAID commonly used for pain relief and reducing inflammation and fever. Like other NSAIDs, it can irritate the stomach lining and is not recommended for clients with a history of peptic ulcers.
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