A male client is admitted to the stroke rehabilitation unit and is demonstrating right homonymous hemianopsia. The practical nurse (PN) observes that the client only eats the foods on the left side of the plate and tray. Which is the best action for the PN to use with this client to compensate for the visual field deficit?

Choice A reason: Placing the food and utensils in the client's left visual field and leaving him alone does not address the underlying issue of the visual field deficit. While it may temporarily solve the problem of the client eating only the food on the left side, it does not encourage the client to adapt to or compensate for the right homonymous hemianopsia. The goal of rehabilitation is to help the client develop strategies to manage their condition independently, and this approach does not foster such skills.
Choice B reason: Feeding the client foods that are on the right side of his visual field is not the most effective approach, as it does not promote the client's independence or help them adapt to their visual field deficit. While it ensures the client consumes the food on the right side, it does not teach the client to compensate for their hemianopsia, which is an essential aspect of their rehabilitation.
Choice C reason: Reminding the client to look all over the tray to view and eat all the foods provided is the best approach. This action helps the client become more aware of their visual field deficit and encourages them to develop the habit of scanning their environment. Teaching the client to consistently look around their entire visual field promotes independence and helps them adapt to daily activities despite their condition. This strategy supports the goal of rehabilitation, which is to enhance the client's ability to manage their visual impairment independently.
Choice D reason: Prompting the client to rotate his plate to see foods on the right side of the tray is a practical solution, but it does not address the broader need for the client to learn to scan their environment. While rotating the plate may temporarily help the client access the food on the right side, it does not encourage the development of compensatory strategies for the visual field deficit. Encouraging the client to look all over the tray is a more effective approach for long-term adaptation and independence.

Choice A reason: Coughing over the catheter site while cleansing the skin introduces a risk of infection. The client needs to be educated about the importance of maintaining a sterile environment to avoid contamination and infection. This behavior indicates a lack of understanding of infection control practices, which are crucial in peritoneal dialysis self-care.
Choice B reason: Wearing one sterile glove while cleansing the insertion site may seem insufficient, but it is not as immediately critical as coughing over the site. The client should be reminded of the importance of using sterile techniques, but this behavior does not pose as immediate a risk as choice A.
Choice C reason: Washing hands before opening the 4 by 4 dressing packet demonstrates good hygiene practices. This behavior indicates that the client understands the importance of hand hygiene in preventing infection, and does not require additional teaching.
Choice D reason: Pouring antiseptic solution and sterile water on sterile dressings is an appropriate practice. This behavior shows that the client is following the necessary steps to maintain a sterile environment and does not need additional teaching.