The emergency department nurse is caring for a patient who has had a chemical splash in both eyes. What is the priority nursing action?
Instill anesthetic eye drops in both eyes
Perform a visual acuity exam
Determine the pH of the chemical splash
Irrigate both eyes with normal saline
The Correct Answer is D
A. Anesthetic eye drops can help with pain, but irrigation is the priority to prevent further damage.
B. A visual acuity exam is part of the assessment but should be performed after initial irrigation to prevent further damage.
C. Determining the pH of the chemical splash can guide further treatment but is secondary to immediate irrigation to dilute and remove the chemical.
D. Irrigating both eyes with normal saline is the priority action to dilute and flush out the chemical, reducing the risk of further injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Scheduled voiding is less effective in patients with a flaccid bladder because there is no voluntary control of bladder function.
B. Intermittent catheterization is the preferred management technique for a flaccid or atonic bladder, allowing the bladder to empty at regular intervals and reducing the risk of infection associated with continuous catheters.
C. An indwelling catheter is usually avoided for long-term use due to a higher risk of infection.
D. An external catheter is generally not effective for flaccid or atonic bladder management in spinal cord injuries as it doesn’t actively empty the bladder.
Correct Answer is B
Explanation
A. Appetite changes are a possible side effect but are not as critical to report immediately.
B. Severe abdominal pain may indicate pancreatitis or liver issues, both serious side effects of valproic acid that require prompt medical attention.
C. Mild indigestion can be a common, non-serious side effect of valproic acid and does not typically require urgent attention.
D. Weight gain is another common side effect of valproic acid but does not necessitate immediate reporting unless it becomes significant.
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