The nurse is caring for a client diagnosed with multiple sclerosis (MS) who is complaining of diplopia. Which intervention would be appropriate for the client with this problem?
Assess for conjunctival bleeding
Encourage the use of sunglasses when outside
Alternate the use of an eye patch on each eye
Apply cool compresses for pain relief
This result is consistent with partially compensated respiratory alkalosis. In respiratory alkalosis, the pH would be elevated (alkalotic), PaCO2 would be low (indicating hyperventilation), and the kidneys would attempt to compensate by lowering bicarbonate (HCO3). In this case, the low PaCO2 (23 mmHg) and the low HCO3 (14 mEq/L) demonstrate partial compensation. The pH is also elevated at 7.64, which aligns with alkalosis. This is the correct answer for partially compensated respiratory alkalosis.
The Correct Answer is C
A) Assess for conjunctival bleeding
Conjunctival bleeding refers to blood in the white part of the eye (the conjunctiva), which is typically associated with trauma, infections, or certain blood disorders, but it is not a common cause of diplopia (double vision). Diplopia in multiple sclerosis (MS) is more often due to nerve damage affecting the eye muscles or the pathways controlling eye movement. Therefore, assessing for conjunctival bleeding is not a priority intervention for a client with diplopia related to MS.
B) Encourage the use of sunglasses when outside
While wearing sunglasses may help alleviate light sensitivity, which is a common symptom in individuals with MS, it is not the most appropriate intervention for treating diplopia itself. Diplopia is typically caused by issues with eye muscle control or coordination, often related to the central nervous system. Therefore, while sunglasses might provide comfort, they do not address the underlying cause of the double vision.
C) Alternate the use of an eye patch on each eye
Alternating the use of an eye patch on each eye is an effective intervention for managing diplopia, especially when the cause is related to misalignment or weakness of the eye muscles. The eye patch works by covering one eye at a time to prevent double vision. In MS, this technique can help reduce the visual disturbance and provide relief until further interventions (such as eye exercises or medications) can be considered. This approach is commonly used to manage diplopia caused by nerve involvement affecting ocular muscle function.
D) Apply cool compresses for pain relief
Cool compresses may provide relief for eye irritation or inflammation, but they are not typically used to treat diplopia. Diplopia in MS is more related to neuromuscular dysfunction or nerve damage, rather than acute inflammation or irritation of the eye. Therefore, while a cool compress may offer temporary relief for other symptoms, it is not a targeted solution for double vision in this context.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Explanation of each option:
A. Respiratory rate of 10 breaths per minute:
A respiratory rate of 10 breaths per minute would be too slow in a patient with ARDS and hypoxemia. In response to hypoxemia, the body typically increases the respiratory rate to improve oxygenation. A respiratory rate of 10 breaths per minute would not be expected in this situation.
B. Respiratory rate of 32 breaths per minute: The arterial blood gas (ABG) results indicate respiratory alkalosis with hypoxemia, which is a common finding in patients with acute respiratory distress syndrome (ARDS). pH 7.59: This is alkalotic, meaning the body is experiencing respiratory alkalosis.
PaCO2 29 mmHg: The PaCO2 is low, indicating hyperventilation, which is a compensatory response to the alkalosis in an attempt to reduce carbon dioxide levels.
PaO2 55 mmHg: This is severely low, indicating hypoxemia (low oxygen levels in the blood), a hallmark of ARDS. HCO3 22 mEq/L: The bicarbonate is normal, suggesting that the metabolic component has not yet compensated for the respiratory alkalosis, or that it is in the early stages of compensation. Given these ABG results, the body is attempting to compensate for hypoxemia by increasing respiratory rate (tachypnea), which leads to hyperventilation and further reduction in PaCO2. Therefore, an expected assessment finding in this scenario would be a high respiratory rate (such as 32 breaths per minute), which is a compensatory response to hypoxemia.
C. Blood pressure 86/42 mmHg:
While hypotension can occur in severe cases of ARDS due to impaired oxygenation and circulation, it is not directly reflected by the ABG results provided. Hypoxemia and alkalosis would more likely lead to tachypnea and compensatory mechanisms like tachycardia, rather than significant hypotension unless there is another contributing factor, such as shock or sepsis. Therefore, hypotension is not the most expected finding based on these ABGs.
D. Heart rate of 45 beats per minute:
A heart rate of 45 beats per minute is bradycardic, which would be unusual in a patient with hypoxemia and respiratory alkalosis. Tachycardia is a more common compensatory response to hypoxia, as the heart works harder to improve oxygen delivery to tissues. A heart rate of 45 beats per minute would be more suggestive of a different underlying condition, such as vagal stimulation or cardiac conduction issues, but it is not the expected response in this case.
Correct Answer is D
Explanation
A. In the prone position:
The prone position has been shown to be beneficial in certain respiratory conditions, particularly in acute respiratory distress syndrome (ARDS), where it can help improve oxygenation by redistributing blood flow in the lungs. However, prone positioning is typically not the first choice for pneumonia, especially when it is localized to specific lobes of the lung. It is more commonly used in cases of diffuse bilateral lung injury or severe hypoxemia. Therefore, while prone positioning can improve oxygenation in ARDS, it is not specifically targeted for secretion removal in localized pneumonia.
B. In high-Fowler's position:
The high-Fowler's position (sitting up at a 60-90 degree angle) can help with dyspnea and promote lung expansion in conditions like heart failure or dyspneic states. However, for pneumonia, it is not as effective as lateral positioning for facilitating secretion drainage from specific lung lobes. The high-Fowler's position may be useful for promoting overall comfort and reducing dyspnea, but it is not the best position for improving secretion removal from the right middle and lower lobes.
C. On the left side:
Positioning the patient on the left side is not ideal for right middle and lower lobe pneumonia, as it would not optimize drainage from the affected lobes. The right middle and lower lobes are better drained when the patient is positioned on the right side, as gravity can help move the secretions from the affected lobes toward the larger airways for easier clearance.
D. On the right side: In the case of right middle and lower lobe pneumonia, positioning the client on the right side can help optimize ventilation and promote better secretion removal from the affected areas of the lung. This position allows gravity to assist in draining secretions from the right middle and lower lobes toward the larger airways, where they can be more easily cleared by coughing or suctioning. This positioning can improve oxygenation and facilitate secretion management, which is crucial for improving respiratory function in pneumonia.
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