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.

Answer and Explanation

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.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"B"}}

Explanation

A. Rhonchi are abnormal breath sounds that indicate the presence of mucus or fluid in the airways. Finding rhonchi in the right lung suggests the presence of respiratory congestion or obstruction, which may indicate ineffective treatment or ongoing respiratory issues.

B. Symmetric chest expansion indicates equal and adequate movement of both sides of the chest during inhalation. This finding suggests that there are no restrictions or abnormalities in the chest wall or lung tissue, which is indicative of effective treatment.

C. Oxygen saturation greater than 94% indicates adequate oxygenation of the blood, which is a positive indicator of effective treatment, particularly in clients with respiratory issues such as pneumonia or COPD.

D. A PaCO2 level of 55 mm Hg indicates hypercapnia, which is an elevated level of carbon dioxide in the blood. This finding suggests inadequate ventilation or respiratory failure, indicating ineffective treatment.

E. The ability to ambulate without experiencing shortness of breath suggests improved respiratory function and effective treatment, as it indicates adequate oxygenation and ventilation.

F. Diminished breath sounds suggest reduced airflow or lung volume in the affected area. This finding may indicate ongoing respiratory issues or incomplete resolution of the condition, suggesting ineffective treatment.

A. Raise hands above the head to expand the diaphragm. B. Increase breathing rate for a full 30 seconds. C. Draw air in through nose and exhale slowly through pursed lips. D. Lay down on each side with knees bent and breathe from abdomen.

Correct Answer is C

Explanation

C. This technique, known as pursed lip breathing, can help improve gas exchange by slowing down the respiratory rate, promoting more efficient exhalation, and reducing air trapping in the lungs.

A. While raising the hands above the head can help expand the chest and improve lung expansion to some extent, it may not be as effective as pursed lip breathing in improving gas exchange or alleviating dyspnea.

B. Increasing the breathing rate for a full 30 seconds may not be beneficial and could potentially worsen dyspnea, especially in individuals with emphysema or other respiratory conditions.

D. While changing positions and focusing on diaphragmatic breathing can be helpful techniques in managing dyspnea, lying down on each side with knees bent may not be practical for a client who is ambulatory and experiencing mild dyspnea after ambulation.

To assess the quality of an adult client's pain, which approach should the nurse use?

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Which information should the nurse include when giving discharge instructions to a client following a left eye cataract extraction with a lens implant?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Patient Data Exhibits Mark whether the assessment findings indicate that the treatment was effective or ineffective. Assessment Findings

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"B"}}

Explanation

The nurse is caring for a client with emphysema who is mildly dyspneic after ambulation. Which instruction should the nurse provide to the client to improve gas exchange?

Correct Answer is C

Explanation

A client receives a prescription for vancomycin 500 mg IV every 8 hours. The medication is provided in "500 mg per 100 mL of dextrose 5% in water." To administer the medication over an hour, the nurse should set the infusion pump to deliver how many mL/hr? (Enter numerical value only.)

The nurse is admitting a client with possible tuberculosis (TB). The client is placed in a private room with airborne precautions pending diagnostic test results. Which diagnostic test should the nurse review to confirm the diagnosis of TB?

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The healthcare provider prescribes an IV solution of clindamycin 850 mg in 75 mL of DW to infuse over 30 minutes. The drop factor is 15 gtt/mL. The nurse should regulate the IV to deliver how many glt/minute? (Enler numeric value only. If rounding is required, round to the nearest whole number.)

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