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 B

Explanation

A. Quadriplegia, or tetraplegia, is typically associated with injuries at or above the C4 level, not T2-T3.
B. A T2-T3 spinal cord injury can lead to loss of sensation and motor function below the level of injury, affecting the thoracic region and lower body.
C. Hemiplegia, which refers to paralysis on one side of the body, is typically due to brain injuries or strokes, not spinal cord injuries.
D. While bladder control may be affected, the most direct impact of T2-T3 injury is the loss of sensation and motor function below that level.

A. Hypotension B. Dehydration C. Hyponatremia D. Hypokalemia

Correct Answer is D

Explanation

A. Hypotension is not typically associated with adrenal cortex hyperfunction; in fact, patients may experience hypertension due to excess cortisol and aldosterone.
B. Dehydration is more common with adrenal insufficiency than hyperfunction, as excess hormone production often leads to fluid retention.
C. Hyponatremia is generally not a concern with adrenal cortex hyperfunction; clients may experience hypernatremia instead due to fluid retention.
D. Hypokalemia is a significant risk in clients with adrenal cortex hyperfunction, especially due to the effects of excessive aldosterone, which promotes sodium retention and potassium excretion.

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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 caring for a client who has had a spinal cord injury at the level of the T2-T3 vertebrae. When planning care, the nurse should anticipate which of the following types of disability?

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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