A middle-aged client reports a sudden onset of seeing flashing lights and floating spots. Which is the best nursing action?

Initiate a referral for ophthalmic evaluation as soon as possible.

Advise the client to maintain normal activities, but avoid contact sports until the spots resolve

Instruct the client to rest, and report to the emergency department if eye pain develops.

Tell the client to apply warm, moist compresses and notify the healthcare provider if there is no improvement.

Answer and Explanation

The Correct Answer is A

A.   The sudden onset of flashing lights and floaters can be a symptom of a detached retina, a serious eye condition that requires immediate medical attention.
B.   This is incorrect. The client should not engage in any activities until the condition is evaluated by a healthcare professional.
C.   While rest might seem appropriate, the client should seek immediate medical attention due to the potential seriousness of the symptoms.
D.   Warm compresses are not indicated for this condition, and the client should seek immediate medical attention.

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Correct Answer is A

Explanation

A. Placing protective padding between the client and bed rails is a safety measure to prevent injury during a seizure. This action helps protect the client from head or body trauma if they hit the bed rails or any surrounding surfaces during the seizure.
B. Providing privacy is important for maintaining the client’s dignity during a seizure, but it is not the most immediate concern. The primary focus during a seizure should be on ensuring the client’s safety and monitoring the event. Privacy can be considered once the immediate safety and medical needs are addressed.
C. Observing the client's behavior during the seizure is essential for documentation and subsequent medical evaluation. It helps in identifying the type, duration, and characteristics of the seizure, which is crucial for diagnosis and treatment. However, observation alone does not address immediate safety needs or interventions required during the seizure.
D. Recording the client's level of consciousness after the seizure is important for assessing the postictal state and the extent of recovery. This information is valuable for understanding the impact of the seizure and guiding further medical care. However, during the seizure, immediate actions should focus on ensuring safety and managing the seizure itself.

A. Minimize intake of spicy foods. B. Remain upright following meals. C. Avoid wearing tight fitting clothes. D. Begin a smoking cessation program.

Correct Answer is B

Explanation

A. Spicy foods can exacerbate GERD symptoms by irritating the esophagus and increasing acid production. While minimizing spicy foods is important, it is one of several dietary changes that can help manage GERD. It’s beneficial but may not be the single most critical instruction compared to other lifestyle modifications.
B. Remaining upright after meals is crucial for managing GERD. Lying down or reclining too soon after eating can allow stomach acid to flow back into the esophagus, worsening symptoms. Staying upright helps to facilitate digestion and reduce acid reflux, making this practice highly important for symptom control and prevention of reflux.
C. Tight-fitting clothes can increase abdominal pressure, which may contribute to the occurrence of acid reflux. While this is a helpful instruction to prevent exacerbation of symptoms, it may not be as directly impactful as remaining upright after meals.
D. Smoking can weaken the lower esophageal sphincter (LES), making it easier for stomach acid to reflux into the esophagus. However, while important, this instruction might be considered a secondary priority compared to immediate practical strategies like maintaining an upright position after eating.

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A middle-aged client reports a sudden onset of seeing flashing lights and floating spots. Which is the best nursing action?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is B

Explanation

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