A nurse is caring for a client who has left homonymous hemianopsia. Which of the following is an appropriate nursing intervention for this client?
Place the wheelchair on the client's left side.
Orient the client to the food on the plate using the clock method.
Teach the client to turn scan to the right to see objects on the right side of the body.
Place the bedside table on the right side of the bed.
The Correct Answer is C
Choice A reason:
Placing the wheelchair on the client's left side is not helpful for someone with left homonymous hemianopsia, as the client will have difficulty seeing the left side. This intervention does not address the visual deficit properly.
Choice B reason:
Orienting the client to the food on the plate using the clock method is beneficial for clients with visual impairments, but it is not specific to addressing left homonymous hemianopsia. It does not help the client scan their environment effectively.
Choice C reason:
Teaching the client to turn their head to scan to the right helps compensate for the left-sided visual field loss. This strategy allows the client to detect objects in their blind spot and improves their ability to navigate their environment safely.
Choice D reason:
Placing the bedside table on the right side of the bed ensures it is within the client’s field of vision and easily accessible, which is a supportive measure. However, teaching scanning techniques is more critical in helping the client adjust to their visual deficit.
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Related Questions
Correct Answer is B
Explanation
Choice A reason:
Calculating the total intake includes converting ounces to milliliters and adding all fluid intakes. 4 oz juice equals 120 mL, 6 oz hot tea equals 180 mL, ice chips are counted as half their volume, so 100 mL ice chips equals 50 mL, 150 mL IV bolus, and 8 oz broth equals 240 mL. Adding these up: 120 + 180 + 50 + 150 + 240 = 740 mL. Choice A, 600 mL, underestimates the total intake, excluding necessary details in the calculation.
Choice B reason:
Let’s calculate step by step:
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Juice: 4 oz × 30 mL = 120 mL
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Tea: 6 oz × 30 mL = 180 mL
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Ice chips: 100 mL × 0.5 = 50 mL (since only half of the volume of ice is counted as fluid)
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IV bolus: 150 mL
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Broth: 8 oz × 30 mL = 240 mL
Now add them:
120 + 180 + 50 + 150 + 240 = 740 mL
Choice C reason:
800 mL inaccurately inflates the total intake. Accurate calculation yields 740 mL as the total fluid intake, considering all conversions and additions. Choice C misrepresents this value.
Choice D reason:
900 mL is another overestimate. Proper conversion and summation of all fluids indicate the total intake is 740 mL. Choice D is significantly higher than this calculated total, demonstrating the importance of precise conversion and addition for accurate records.
Correct Answer is ["B","C","D"]
Explanation
Choice A reason: Grilled chicken is a suitable food choice for clients taking MAOIs. It does not contain significant levels of tyramine and poses no risk of causing hypertensive crises, which can occur when tyramine-rich foods are consumed.
Choice B reason: This is the correct answer. Red wine contains high levels of tyramine, which can interact with MAOIs to cause severe hypertensive crises. Patients on MAOIs are advised to avoid all forms of fermented alcoholic beverages.
Choice C reason: This is the correct answer. Smoked sausage is another food high in tyramine. The fermentation and curing processes increase tyramine content, making it unsafe for patients on MAOIs.
Choice D reason: This is the correct answer. Aged cheddar and other aged cheeses contain high levels of tyramine due to the aging process. Consuming these can lead to dangerous blood pressure elevations in patients taking MAOIs.
Choice E reason: Cereal is typically safe for clients on MAOIs as it generally does not contain tyramine. Regular cereal options are suitable for a diet that needs to avoid tyramine-rich foods.
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