When preparing to examine a client's sclera and conjunctiva during an eye examination, the nurse should instruct the client to move both eyes to look in which direction?
Down
To the left
To the right
Up
The Correct Answer is D
Choice A Reason:
Looking down does not typically expose the sclera and conjunctiva for examination. The lower eyelid covers more of the sclera when the eyes are directed downward, making it less accessible for observation.
Choice B Reason:
Moving the eyes to the left is not the standard direction for examining the sclera and conjunctiva. This movement would not provide an optimal view of the entire sclera and conjunctiva, as it would only stretch the lateral part of the conjunctiva.
Choice C Reason:
Directing the eyes to the right, similar to moving them to the left, does not offer the best exposure for examining the sclera and conjunctiva. The medial part of the conjunctiva would be stretched, but the rest would not be easily visible.
Choice D Reason:
Instructing the client to look up is the correct procedure when examining the sclera and conjunctiva. By looking upward, the client exposes more of the sclera and the palpebral conjunctiva, allowing the nurse to inspect these areas thoroughly for any abnormalities such as redness, swelling, or foreign bodies.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice a reason:
Rhonchi are coarse, rattling respiratory sounds somewhat like snoring, usually caused by obstruction or secretion in the larger airways. They are not considered normal breath sounds and are typically heard in conditions such as chronic bronchitis.
Choice b reason:
Crackles are the sounds you will hear in a lung field that has fluid in the small airways. These sounds are commonly heard in patients with pneumonia, heart failure, and restrictive pulmonary diseases. They are not normal breath sounds.
Choice c reason:
Bronchovesicular sounds are normal breath sounds heard over the main bronchus area and over the upper right posterior lung field. They have a medium pitch and intensity and are heard on both inspiration and expiration. In a healthy individual, these sounds are expected to be heard in the 1st and 2nd intercostal spaces near the sternal body.
Choice d reason:
Tracheal breath sounds are harsh, high-pitched sounds heard when auscultating over the trachea in the neck. They are not normally heard over the intercostal spaces of the chest wall.
Correct Answer is ["A","B","C","D"]
Explanation
Choice a reason:
Wearing nonslip shoes in the house can prevent falls, which are a common cause of traumatic brain injuries (TBIs) in adolescents. Falls often occur due to slippery surfaces, and nonslip shoes provide better traction, reducing the risk of such accidents.
Choice b reason:
Supervised use of guns by an adult is crucial to prevent accidental shootings, which can result in TBIs or even more severe outcomes. Adolescents may not fully understand the risks associated with handling firearms, and adult supervision ensures that safety measures are followed.
Choice c reason:
The consistent use of seat belts in vehicles is one of the most effective ways to prevent TBIs during car accidents. Seat belts keep occupants from being ejected or hitting the interior of the car, significantly reducing the risk of head injuries.
Choice d reason:
Avoiding risky activities such as snowboarding without proper safety measures can prevent sports-related TBIs. While snowboarding, wearing a helmet and other protective gear is essential to protect the head during falls or collisions.
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