The unlicensed assistive personnel (UAP) tells the practical nurse (PN) that a resident of the long-term care facility is reporting eye pain and photophobia. The resident is being treated for bacterial conjunctivitis. Upon entering the resident's room, the PN observes that the UAP has darkened the room and placed a warm compress over the resident's eyes. Which action should the PN take?
Turn lights on in the room.
Remove the warm compress.
Elevate the head of the bed.
Offer an oral analgesic.
None
None
The Correct Answer is B
The correct answer is choice B. Remove the warm compress.
Choice A rationale:
Turning the lights on in the room would likely exacerbate the resident’s photophobia (sensitivity to light), causing more discomfort. Photophobia is a common symptom of bacterial conjunctivitis, and keeping the room dim can help alleviate this discomfort.
Choice B rationale:
Removing the warm compress is the correct action. Warm compresses can sometimes be used to relieve symptoms of conjunctivitis, but they are generally more appropriate for viral or allergic conjunctivitis. In the case of bacterial conjunctivitis, warm compresses can potentially worsen the infection by providing a warm, moist environment that promotes bacterial growth. Instead, a cool compress is often recommended to reduce inflammation and discomfort.
Choice C rationale:
Elevating the head of the bed can help reduce swelling and promote drainage, but it is not directly related to the immediate relief of eye pain and photophobia in bacterial conjunctivitis. This action might be more relevant for conditions involving fluid retention or respiratory issues.
Choice D rationale:
Offering an oral analgesic could help manage the resident’s pain, but it does not address the underlying issue of the warm compress potentially worsening the bacterial infection. Pain management is important, but it should be combined with appropriate measures to treat the infection and alleviate symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This is the finding that the PN should instruct the postpartum client to report to the charge nurse because it may indicate an infection, such as endometritis, mastitis, or urinary tract infection, that requires prompt treatment. The PN should also instruct the client to monitor for other signs of infection, such as foul-smelling lochia, redness or tenderness of the breasts, or dysuria.
A. Increased diaphoresis during the day and night is a normal finding in the postpartum period and does not need to be reported. It is caused by hormonal changes and fluid shifts that occur after delivery.
B. Breast engorgement on the fourth postpartum day is a normal finding in the postpartum period and does not need to be reported. It is caused by increased blood flow and milk production in the breasts.
C. Lochia color that changes to light pink or white is a normal finding in the postpartum period and does not need to be reported. It indicates that the uterine lining is healing and regenerating after delivery.
Correct Answer is D
Explanation
The correct answer is choice D - Bilateral lung sounds.
Choice A rationale:
Heart sounds. While assessing heart sounds is crucial, the question specifically mentions complications of left-sided heart failure, which primarily affects the lungs. Therefore, assessing lung sounds is a higher priority in this situation.
Choice B rationale:
Mood and affect. While assessing the client's mood and affect is important for holistic care, it is not the most critical assessment to implement first in the case of left-sided heart failure complications.
Choice C rationale:
Chest pain. Although chest pain may be a symptom of left-sided heart failure complications, assessing bilateral lung sounds takes precedence as it directly relates to the client's respiratory status.
Choice D rationale:
Bilateral lung sounds. In left-sided heart failure, fluid can accumulate in the lungs, leading to pulmonary congestion and impaired gas exchange. Therefore, assessing lung sounds helps identify any respiratory distress early on, allowing prompt intervention and prevention of further complications.
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