A nurse is talking with a client who is scheduled for surgery to repair retinal detachment. Which of the following preoperative instructions should the nurse include?
Restrict head movement.
Remove eye patch in one month.
Apply cool compresses.
Eye drops to constrict the pupils will be prescribed.
The Correct Answer is A
Choice A reason:
Restricting head movement is a crucial preoperative instruction for a client scheduled for retinal detachment surgery. This helps to prevent further detachment and ensures that the retina remains in the best possible position for surgery. Keeping the head still minimizes the risk of additional damage and helps maintain the current state of the retina.
Choice B reason:
Removing an eye patch in one month is not a standard preoperative instruction. Eye patches are typically used postoperatively to protect the eye and aid in healing. The duration for wearing an eye patch varies depending on the specific case and the surgeon’s recommendations.
Choice C reason:
Applying cool compresses is not a typical preoperative instruction for retinal detachment surgery. Cool compresses are generally used to reduce swelling and discomfort postoperatively. Preoperative care focuses more on stabilizing the condition and preparing the client for surgery.
Choice D reason:
Eye drops to constrict the pupils are not commonly prescribed preoperatively for retinal detachment surgery. Instead, eye drops to dilate the pupils are often used to allow the surgeon a better view of the retina during the procedure. Pupil constriction is not typically necessary before surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Free T4
In primary hypothyroidism, the thyroid gland is underactive and does not produce enough thyroid hormones. As a result, free T4 levels are typically low, not elevated. Free T4 is a direct measure of the active thyroid hormone available in the blood. Therefore, an elevation in free T4 is not expected in primary hypothyroidism.
Choice B reason: Thyroid-stimulating hormone (TSH)
Thyroid-stimulating hormone (TSH) is elevated in primary hypothyroidism due to the lack of negative feedback from low thyroid hormone levels. The pituitary gland produces more TSH in an attempt to stimulate the thyroid gland to produce more hormones. This is a hallmark finding in primary hypothyroidism and is used as a key diagnostic indicator.
Choice C reason: Serum T3
Serum T3 levels can be variable in primary hypothyroidism. While they may be low, they are often maintained within the normal range until the condition becomes severe. This is because T3 is produced in smaller quantities and has a shorter half-life compared to T4. Therefore, an elevation in serum T3 is not typically seen in primary hypothyroidism.
Choice D reason: Serum T4
Similar to free T4, serum T4 levels are usually low in primary hypothyroidism. The thyroid gland’s reduced ability to produce thyroid hormones results in decreased levels of both free and total T4. Thus, an elevation in serum T4 is not expected in primary hypothyroidism.
Correct Answer is B
Explanation
Choice A reason: Testing new nurses for exposure to tuberculosis is an example of secondary prevention. Secondary prevention aims to detect and treat diseases early in their course to prevent progression. Testing for tuberculosis exposure helps identify the disease early so that treatment can begin promptly.
Choice B reason: Providing treatment for clients who have chronic obstructive pulmonary disease is an example of tertiary prevention. Tertiary prevention focuses on managing and improving the quality of life for individuals with chronic diseases. It aims to reduce the impact of the disease and prevent complications.
Choice C reason: Performing screening for sexually transmitted infections is an example of secondary prevention. Screening helps detect infections early, allowing for timely treatment and reducing the spread of the disease.
Choice D reason: Administering influenza immunizations at a local health fair is an example of primary prevention. Primary prevention aims to prevent diseases before they occur by reducing risk factors and promoting health. Immunizations help prevent the onset of influenza.
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