A nurse is performing a tonometry test on a client with a suspected diagnosis of glaucoma. The nurse looks at the documented test results and notes an intraocular pressure (IOP) value of 23 mm Hg. What should the nurse's initial action be?

Note the time of day the test was done.

Apply normal saline drops.

Instruct the client to sleep with the head of the bed flat.

Contact the primary health care provider.

Answer and Explanation

The Correct Answer is D

A. While noting the time of day is important for documentation, it does not address the immediate concern of elevated intraocular pressure (IOP).
B. Applying normal saline drops is not indicated in the immediate management of elevated IOP in glaucoma; it does not directly affect IOP levels.
C. Instructing the client to sleep with the head of the bed flat is not advisable, as elevated head positions may help decrease IOP.
D. An IOP of 23 mm Hg is above the normal range (10-21 mm Hg) and indicates potential glaucoma. Therefore, contacting the primary health care provider for further evaluation and treatment is the most appropriate initial action.

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Correct Answer is A

Explanation

A. Baked fish is rich in iodine, which supports thyroid function and can be beneficial for clients with hypothyroidism. Iodine is necessary for thyroid hormone production.
B. Tuna salad may contain iodine, but it is not as reliable a source as baked fish and may also contain added fats.
C. Bran flakes are high in fiber, which can interfere with the absorption of thyroid medications.
D. Cantaloupe, while nutritious, does not provide significant levels of iodine or nutrients that directly support thyroid function.

A. Lower the client's legs. B. Check for a full bladder. C. Administer a nitrate antihypertensive. D. Administer pain medication.

Correct Answer is B

Explanation

A. Lowering the client's legs is not effective in managing autonomic dysreflexia and may not alleviate the cause of the high blood pressure.
B. Checking for a full bladder is the priority because bladder distension is a common trigger for autonomic dysreflexia in clients with spinal cord injuries, and relieving it can reduce the severe hypertensive response.
C. Antihypertensives may be used if non-pharmacological measures fail, but addressing the cause is the first action.
D. Pain medication is not indicated as the immediate intervention for autonomic dysreflexia, as the priority is identifying and removing the trigger.

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A nurse is performing a tonometry test on a client with a suspected diagnosis of glaucoma. The nurse looks at the documented test results and notes an intraocular pressure (IOP) value of 23 mm Hg. What should the nurse's initial action be?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting a client diagnosed with hypothyroidism with meal planning. Which of the following foods should the nurse recommend that the client add to the diet?

Correct Answer is A

Explanation

A nurse is caring for a client who has quadriplegia due to a spinal cord injury and reports having a severe headache. The nurse obtains a blood pressure reading of 210/108 mm Hg and suspects the client is experiencing autonomic dysreflexia. What should the nurse prioritize as the initial action?

Correct Answer is B

Explanation

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