The caregiver of an elderly client asks the nurse what can be done about the chronic bilateral inflammation of the eyelid margins that keeps recurring. Which of the following is the information that the nurse will provide?
Instill eye drops in both eyes every hour around the clock
Use sterile gloves when assisting with activities of daily living
Use baby shampoo on the eyelid margins
Use a salt scrub inside the eyelid
The Correct Answer is C
Choice A Reason: This choice is incorrect. Instilling eye drops in both eyes every hour around the clock is not an information that the nurse will provide, as it is not a recommended treatment for chronic bilateral inflammation of the eyelid margins. This condition is also known as blepharitis, which is a common and chronic disorder that causes redness, itching, burning, and crusting of the eyelids. Eye drops may be used to relieve symptoms, but not every hour or without a prescription.
Choice B Reason: This choice is incorrect. Using sterile gloves when assisting with activities of daily living is not an information that the nurse will provide, as it is not a necessary precaution for chronic bilateral inflammation of the eyelid margins. Blepharitis is not contagious or infectious, but rather caused by an overgrowth of bacteria or mites on the eyelids, or by an underlying skin condition such as seborrheic dermatitis or rosacea.
Choice C Reason: This is the correct choice. Using baby shampoo on the eyelid margins is an information that the nurse will provide, as it is a simple and effective way to clean and soothe the eyelids. Baby shampoo is gentle and non-irritating, and can help remove excess oil, debris, and scales from the eyelids. The nurse will instruct the caregiver to dilute a few drops of baby shampoo with warm water, apply it to a cotton ball or washcloth, and gently rub it along the eyelid margins. The nurse will also advise to rinse well with water and pat dry with a clean towel.
Choice D Reason: This choice is incorrect. Using a salt scrub inside the eyelid is not an information that the nurse will provide, as it is a harmful and painful method that can damage and irritate the eye. Salt scrub is abrasive and drying, and can cause corneal abrasion, infection, or inflammation. The nurse will warn the caregiver to avoid using any harsh or unapproved products on or near the eye.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason: This choice is incorrect. Cranial Nerve VIII is the vestibulocochlear nerve, which is responsible for hearing and balance. It does not affect vision or eye movements.
Choice B Reason: This is the correct choice. Cranial Nerve II is the optic nerve, which is responsible for transmitting visual information from the retina to the brain. It affects visual field and visual acuity, which are measures of peripheral and central vision, respectively.
Choice C Reason: This choice is incorrect. Cranial Nerve I is the olfactory nerve, which is responsible for smell. It does not affect vision or eye movements.
Choice D Reason: This choice is incorrect. Cranial Nerve VII is the facial nerve, which is responsible for facial expressions and taste. It does not affect vision or eye movements.
Correct Answer is D
Explanation
Choice A reason: This is incorrect because administering IV ketorolac is not a priority intervention for a client with cholecystitis. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal bleeding and kidney damage, which are contraindicated in cholecystitis. The nurse should administer analgesics as prescribed, but only after assessing the pain level and severity.
Choice B reason: This is incorrect because reporting findings to healthcare provider is not a priority intervention for a client with cholecystitis. The nurse should communicate with the healthcare provider about the client's condition and treatment plan, but only after assessing the pain level and other vital signs.
Choice C reason: This is incorrect because offering a high-calorie, high-fat meal is not an intervention for a client with cholecystitis, but a potential trigger. High-fat foods can stimulate the gallbladder to contract and cause more pain and inflammation. The nurse should advise the client to avoid fatty foods and follow a low-fat diet.
Choice D reason: This is the correct answer because assessing the pain level is a priority intervention for a client with cholecystitis. Pain is the most common symptom of cholecystitis and can indicate the severity and complications of the condition. The nurse should assess the pain level using a numeric or descriptive scale, and monitor for changes in location, intensity, and duration.
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