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: 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.
Correct Answer is A
Explanation
Choice A reason: Have you had a recent influenza infection?
Guillain-Barré syndrome (GBS) is often preceded by an infection, most commonly respiratory or gastrointestinal infections. Influenza is a significant respiratory infection that can trigger GBS. Asking about recent influenza infection helps in identifying a potential cause of the syndrome. According to the Mayo Clinic, many cases of GBS occur after a respiratory or gastrointestinal infection1. Therefore, this question is crucial in the assessment of a client with suspected GBS.
Choice B reason: Have you traveled overseas recently?
While travel history can be relevant in diagnosing various conditions, it is less directly related to Guillain-Barré syndrome. GBS is not typically associated with travel but rather with infections that can occur anywhere. Therefore, this question is less pertinent compared to asking about recent infections.
Choice C reason: Do you have a history of chronic alcohol abuse?
Chronic alcohol abuse can lead to various neurological conditions, but it is not specifically linked to Guillain-Barré syndrome. GBS is an acute condition often triggered by an infection, not by chronic alcohol use. Thus, while this question might be relevant in a broader neurological assessment, it is not directly related to GBS.
Choice D reason: Are you taking a multivitamin?
The use of multivitamins is generally not related to the development of Guillain-Barré syndrome. This question does not help in identifying the cause or confirming the diagnosis of GBS. It is more relevant to a general health assessment rather than a specific inquiry for GBS.
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