Following laser trabeculoplasty surgery for open-angle glaucoma, the client reports acute pain deep within the eye.
Which action should the nurse take?

Administer an antiemetic to prevent vomiting.

Report the complaint of eye pain to the surgeon.

Apply bilateral eye shields to reduce photosensitivity.

Begin postoperative prophylactic antibiotics.

Answer and Explanation

The Correct Answer is B

Choice A rationale

While nausea and vomiting can be side effects of eye surgery, they are not typically associated with acute pain deep within the eye following laser trabeculoplasty. Therefore, administering an antiemetic would not address the client’s primary complaint.

Choice B rationale

Acute pain deep within the eye following laser trabeculoplasty is not a typical postoperative symptom and could indicate a complication such as increased intraocular pressure or inflammation. Therefore, the nurse should report this complaint to the surgeon immediately for further evaluation.

Choice C rationale

While eye shields can help reduce photosensitivity after eye surgery, they would not typically alleviate acute pain deep within the eye. Therefore, this action would not address the client’s primary complaint.

Choice D rationale

While prophylactic antibiotics can help prevent infection after eye surgery, they would not typically alleviate acute pain deep within the eye. Therefore, this action would not address the client’s primary complaint.

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Correct Answer is ["A","B","D"]

Explanation

Choice A rationale

Checking capillary refill on bilateral upper extremities can help assess peripheral circulation and identify any potential vascular injuries.

Choice B rationale

Administering morphine 2 mg IV as ordered would help manage the patient’s pain.

Choice C rationale

Performing range of motion exercises may not be appropriate immediately after the fall and before the extent of the patient’s injuries are fully assessed.

Choice D rationale

Administering ondansetron 4 mg IV as ordered can help manage any nausea or vomiting that the patient may experience, which can be a side effect of the morphine or a result of the fall itself. TemazepamTemazepam Explore

A. gravida 5 para 5 B. delivery of a 9 lb 1 oz (4.1 kg) female C. labor for 25 hours and forceps were used to assist with the delivery D. client had a 4th degree laceration E. Estimated blood loss was 600 mL after delivery F. Lochia rubra moderate with small clots G. Episiotomy edges well approximated H. A 1,000 mL bag of lactated Ringer’s solution containing 10 units of oxytocin is infusing I. The IV is patent, without redness or swelling J. given an epidural for anesthesia that was effective K. vital signs were stable

Correct Answer is ["A","B","C","D","E","F"]

Explanation

Based on the client’s history and physical, the following areas increase the risk for postpartum hemorrhage:

Gravida 5 Para 5 (G5P5): Multiparity (having given birth 5 times) can increase the risk of postpartum hemorrhage due to uterine atony (lack of muscle tone) resulting from repeated stretching of the uterus.
Delivery of a 9 lb 1 oz (4.1 kg) baby: Macrosomia (large baby) can overstretch the uterus, increasing the risk of uterine atony and postpartum hemorrhage.
Labor for 25 hours and use of forceps for delivery: Prolonged labor and instrumental delivery can lead to uterine fatigue and atony, increasing the risk of postpartum hemorrhage.
4th degree laceration: Severe lacerations can lead to significant blood loss.
Estimated blood loss was 600 mL after delivery: This is a significant amount of blood loss and could indicate a risk for further hemorrhage.
Lochia rubra moderate with small clots: This could indicate ongoing blood loss.

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Following laser trabeculoplasty surgery for open-angle glaucoma, the client reports acute pain deep within the eye.Which action should the nurse take?

Nursing Test Bank

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Following laser trabeculoplasty surgery for open-angle glaucoma, the client reports acute pain deep within the eye.
Which action should the nurse take?