A nurse is administering multiple types of ophthalmic drops to a client. Which of the following actions should the nurse take?
Hold the dropper 3 cm (1.2 in) away from the client's eye.
Massage the client's eyelids for 20 seconds after instillation.
Wait 5 min between the administration of each medication.
Ask the client to close their eyes tightly after instilling each medication.
The Correct Answer is C
A. The dropper should be held about 1 cm (0.4 in) away from the eye to avoid touching or injuring the eye or contaminating the dropper tip.
B. Massaging the eyelids after instillation is not a standard practice and may cause discomfort or injury to the eye.
C. Administering multiple ophthalmic medications requires a sufficient interval between doses to prevent interactions and ensure effectiveness.
D. Asking the client to close their eyes tightly may squeeze out some of the medication or increase intraocular pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
A. This abbreviation can be misinterpreted as "units," "cc," or "you." It is recommended to avoid its use to prevent misinterpretation.
B. This abbreviation stands for intake and output, which is commonly used in healthcare documentation and is not on The Joint Commission's Do Not Use list.
C. IU can be mistaken for intravenous or international unit.
D. This abbreviation stands for once daily and is prone to misinterpretation, as it can be mistaken for qid (four times daily). It is recommended to avoid its use to prevent dosing errors.
E. This abbreviation stands for pro re nata, indicating "as needed" medication administration, and is not on The Joint Commission's Do Not Use list.
Correct Answer is A
Explanation
A. Obtaining the client's type and cross-match is the first action the nurse should take because it ensures that the client will have compatible blood available for transfusion if needed during surgery.
B. This is important but should only be done after obtaining the client’s type and cross-match.
C. This should be done after obtaining the client’s type and cross-match.
D. While an incident report may be necessary, the immediate priority is to address the oversight and ensure patient safety.
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