An environmental service attendant is brought to an urgent care clinic after having bleach splash to their eyes and face.
The client spent 10 minutes at the eye wash station rinsing their face and eyes prior to arrival.
The client reports 9 (0-10 scale) of burning to their eyes and periorbital area.
The sclera of both eyes are deep red.
The urgent care nurse will first:
Review the safety data sheet online for products with bleach.
Continue irrigating eyes with saline until pain-free, then check pH of both eyes.
Contact the physician for miotic ophthalmic drops for pain control.
Assess visual acuity of both eyes and check vital signs.
The Correct Answer is B
Choice A rationale
Reviewing the safety data sheet does not directly alleviate the immediate chemical injury or prevent further damage. Immediate irrigation of the eyes is the priority after chemical exposure to minimize damage to the ocular surface.
Choice B rationale
Continuous irrigation removes chemical agents from the eyes and prevents further damage. Ensuring a pain-free state and checking pH confirm the removal of irritants, essential for preventing deeper eye tissue damage.
Choice C rationale
Miotic drops reduce intraocular pressure but do not address acute chemical injury. Pain relief is secondary to irrigating and neutralizing pH, which directly prevents ongoing tissue damage and irritation.
Choice D rationale
Assessing visual acuity and vital signs is important but secondary to preventing further chemical penetration. Immediate irrigation prevents damage progression and is prioritized over assessments during the acute phase of exposure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Chin tuck alters airway mechanics, reducing aspiration risk by improving epiglottic closure and minimizing passage of food into respiratory pathways.
Choice B rationale
Pureeing protein may ease swallowing but does not inherently reduce aspiration risk compared to specific swallowing techniques.
Choice C rationale
Unsupervised snack access increases aspiration risk, as dysphagia requires monitored intake to prevent respiratory complications.
Choice D rationale
Background music may provide relaxation but does not scientifically mitigate aspiration risks in dysphagia-related interventions. .
Correct Answer is B
Explanation
Choice A rationale
Nitroprusside is a vasodilator for hypertensive crises but is contraindicated in elevated ICP because it increases cerebral blood volume and exacerbates intracranial pressure, worsening the patient's condition.
Choice B rationale
Hypertonic saline (3%) helps reduce ICP by drawing excess fluid from brain tissue into the bloodstream through osmosis, effectively lowering intracranial pressure while maintaining cerebral perfusion.
Choice C rationale
Furosemide is a loop diuretic that reduces fluid overload but does not specifically target ICP. It is less effective in managing the osmotic balance required for intracranial pressure reduction.
Choice D rationale
Norepinephrine is a vasopressor used to treat hypotension and improve perfusion but does not lower ICP and may increase cerebral vasoconstriction, exacerbating intracranial hypertension. .
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