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 D
Explanation
Choice A reason: Consume a high-protein diet
A high-protein diet is not typically recommended for clients with hepatitis B. While protein is essential for overall health, excessive protein intake can put additional strain on the liver, which is already compromised in hepatitis B patients. A balanced diet with adequate protein, carbohydrates, and fats is more appropriate.
Choice B reason: You may donate blood 6 months after completing the medication regimen
Clients with hepatitis B should not donate blood. The hepatitis B virus can be transmitted through blood, and even after completing a medication regimen, the virus can still be present in the blood. Therefore, this statement is incorrect and potentially harmful.
Choice C reason: Take acetaminophen every 4 hours, as needed, for discomfort
Acetaminophen should be used with caution in clients with hepatitis B. The liver metabolizes acetaminophen, and excessive use can lead to liver damage. It is crucial to consult with a healthcare provider before taking any medication, including acetaminophen, to avoid exacerbating liver issues.
Choice D reason: Rest frequently throughout the day
Resting frequently throughout the day is an important part of managing hepatitis B. The liver plays a crucial role in energy metabolism, and when it is compromised, clients may experience fatigue. Adequate rest helps the body recover and manage symptoms more effectively.
Correct Answer is A
Explanation
Choice A reason: Dilated scalp veins are a common manifestation of hydrocephalus in newborns. The increased intracranial pressure caused by the accumulation of cerebrospinal fluid (CSF) can lead to prominent veins on the scalp. This is due to the increased pressure within the skull, which causes the veins to become more visible.
Choice B reason: Overriding suture lines are not typically associated with hydrocephalus. Overriding sutures are more commonly seen in conditions where there is a decrease in intracranial pressure, such as dehydration or after a significant loss of brain volume.
Choice C reason: Hypertension is not a direct manifestation of hydrocephalus in newborns. While increased intracranial pressure can affect various bodily functions, hypertension is not a primary symptom. Instead, symptoms like irritability, poor feeding, and vomiting are more common.
Choice D reason: A backward sloping appearance of the forehead is not a typical feature of hydrocephalus. Hydrocephalus usually causes an increase in head size and a bulging fontanelle, but it does not typically result in a backward sloping forehead.
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