A nurse is planning care for a client 1 day postoperative following a detached retinal repair.
Which of the following instructions should the nurse include?
Allow the client to ambulate.
Remove the eye patch during the day.
Encourage coughing and deep-breathing.
Avoid reading and writing.
The Correct Answer is D
Choice A rationale
Allowing the client to ambulate one day after a detached retinal repair is not recommended. Ambulation can increase intraocular pressure and disrupt the healing process of the retina. The client should be advised to limit physical activity to prevent any strain on the eye.
Choice B rationale
Removing the eye patch during the day is not advisable as it can expose the eye to potential injury or infection. The eye patch helps protect the eye and maintain the correct position for healing. It should be worn as directed by the healthcare provider.
Choice C rationale
Encouraging coughing and deep-breathing exercises is not appropriate for a client who has undergone retinal repair. These activities can increase intraocular pressure and risk detachment of the retina. The client should avoid activities that cause strain or pressure on the eyes.
Choice D rationale
Avoiding reading and writing is crucial for a client one day postoperative following a detached retinal repair. These activities can cause rapid eye movements and strain, which can interfere with the healing process and reattachment of the retina. The client should be advised to rest their eyes and avoid any activities that require intense focus or eye movement.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Dysphagia, or difficulty swallowing, is not a common manifestation of acoustic neuroma. It is more commonly associated with conditions affecting the throat or esophagus.
Choice B rationale
Apraxia, a motor disorder caused by damage to the brain, is not typically associated with acoustic neuroma. It affects the ability to perform coordinated movements.
Choice C rationale
Vertigo, or a sensation of spinning, is a common manifestation of acoustic neuroma. The tumor affects the vestibular nerve, which is responsible for balance and spatial orientation.
Choice D rationale
Diplopia, or double vision, is not a common symptom of acoustic neuroma. It is more often associated with conditions affecting the muscles or nerves controlling eye movement.
Correct Answer is A
Explanation
Choice A rationale
A CD4-T-cell count of 180 cells/mm³ indicates severe immunosuppression in a client with HIV, making them highly susceptible to opportunistic infections. This is a critical value that requires immediate attention to prevent life-threatening complications.
Choice B rationale
A positive Western blot test confirms the presence of HIV antibodies but does not indicate the current immune status or the urgency of the client’s condition.
Choice C rationale
Platelets at 150,000/mm³ are within the normal range and do not indicate an immediate threat to the client’s health.
Choice D rationale
A WBC count of 5,000/mm³ is within the normal range and does not indicate an immediate threat to the client’s health.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.