Which information should the nurse include when giving discharge instructions to a client following a left eye cataract extraction with a lens implant?
Observe pupil response of the right eye.
Turn, cough, and deep breathe every 2 hours.
Sleep flat in a supine position.
Administer a stool softener.
The Correct Answer is D
D A stool softener can help prevent straining during bowel movements, which could increase intraocular pressure and potentially harm the surgical site. Additionally, the nurse should advise the client to avoid activities that could increase pressure in the eye, such as bending at the waist, lifting heavy objects, or engaging in strenuous activities for a certain period post-surgery.
A Monitoring for changes in pupillary sizes is not specific to this type of surgery.
B Turn, cough, and deep breathe every 2 hours: This instruction is more relevant for clients who have undergone surgery or are at risk of developing respiratory complications, such as pneumonia. It is not specifically related to cataract extraction with a lens implant.
C Clients are usually advised to sleep with the head elevated or to avoid lying on the operative side to minimize the risk of intraocular pressure changes and discomfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E","H"]
Explanation
A. Send blood for a complete blood count, electrolytes: This is appropriate for assessing the client's overall health status and electrolyte balance, which may be affected by pneumonia and enalapril therapy.
B.Enalapril 10 mg every morning: This is the client's maintenance dose of enalapril for managing hypertension, and it should be continued unless there are specific contraindications or concerns about renal function.
C.Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase blood pressure and interfere with the antihypertensive effects of enalapril. Additionally, NSAIDs can potentially worsen renal function, which may already be compromised in a client with pneumonia.
D.Admit to the medical floor: This is appropriate for a client with pneumonia who may require close monitoring and management of respiratory status and other complications.
E.Supplemental oxygen 10 L/min via nasal cannula: High-flow oxygen can decrease respiratory drive and potentially worsen ventilation-perfusion (V/Q) matching, especially in clients with pneumonia.
F.Vital signs every 4 hours: Regular monitoring of vital signs is essential for assessing the client's response to treatment and identifying any signs of deterioration.
G.Continuous pulse oximetry: Continuous pulse oximetry provides real-time monitoring of oxygen saturation and helps assess the effectiveness of oxygen therapy and the client's respiratory status.
H.While a chest x-ray is often indicated for diagnosing pneumonia, ordering it "now" may not be necessary unless the client's condition is unstable or if there are specific concerns regarding the severity of the pneumonia
Correct Answer is A
Explanation
A. Refer the client to the healthcare provider at the clinic to obtain a medication prescription is appropriate because it acknowledges the client's interest in taking oseltamivir to treat their influenza symptoms.
B. Advising the client that once symptoms occur it is too late to receive an influenza vaccination is not relevant to the client's question about taking oseltamivir to treat their existing influenza symptoms. It addresses the timing of influenza vaccination, which is typically recommended before the onset of flu season or at the beginning of flu season, rather than during an active infection.
C. Instructing the client that over-the-counter medications are sufficient to manage influenza symptoms is not accurate because while over-the-counter medications can help relieve some influenza symptoms such as fever, cough, and congestion, they do not directly treat the underlying viral infection.
D. Explaining to the client that antibiotics are not useful in treating viral infections such as influenza is true but does not address the client's specific question about taking oseltamivir to treat their influenza symptoms.
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