A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply.)

Keep objects in the client's room in the same place.

Approach the client from the side.

Ensure there is high-wattage lighting in the client's room.

Allow extra time for the client to perform tasks.

Touch the client gently to announce presence.

Answer and Explanation

Correct Answer : A,C,D

A.   Keeping objects in the same place help maintain a safe environment and independence for a client with vision loss.
B.   When caring for a client with vision loss, the nurse should avoid approaching the client from the side since it may startle them.
C.   Providing high-wattage lighting can improve visibility for clients with partial vision loss. Adequate lighting reduces shadows and enhances contrast, making it easier for the client to see their surroundings

D. Allowing extra time for tasks helps orient them to the nurse's presence and facilitates communication.
E. While gentle touch can be a way to announce presence, it is better to verbally announce oneself first to avoid startling the client, particularly if they are not expecting contact.

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Correct Answer is A

Explanation

A. Acetaminophen is a suitable option for pain relief in clients with a history of peptic ulcer because it does not typically irritate the gastric mucosa or increase the risk of gastrointestinal bleeding.
B. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastric ulceration and bleeding, especially in clients with a history of peptic ulcer.
C. Aspirin is also an NSAID and can increase the risk of gastric ulceration and bleeding, particularly in individuals with a history of peptic ulcer.
D. Ketorolac is an NSAID with a high risk of gastrointestinal side effects, including peptic ulceration and bleeding, and should be avoided in clients with a history of peptic ulcer.

A. A client who is receiving heparin for deep-vein thrombosis. B. A client who is 1 day postoperative following a vertebroplasty. C. A client who has COPD and a respiratory rate of 44/min. D. A client who has cancer and a sealed implant for radiation therapy.

Correct Answer is B

Explanation

A: Heparin administration requires careful monitoring of clotting times, so discharging this client early may not be safe or appropriate.
B: A vertebroplasty is a procedure that injects cement into a fractured vertebra to help relieve pain and stabilize the spine. The recovery time for this procedure is usually short and the complications are rare.
C: This client has a respiratory rate suggestive of respiratory distress and may require immediate medical attention, hence early discharge is not an option.
D: The client with cancer and a sealed implant for radiation therapy may require ongoing monitoring and supportive care, so early discharge may not be advisable.

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A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply.)

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