The nurse is performing a focused interview and eye assessment on a client. Which assessment findings indicate the client is experiencing a vision problem? (Select all that apply)
As the nurse dims the lights in the room, the client’s pupils dilate.
As the nurse checks for accommodation, the pupils remain dilated.
The clients far vision acuity is 20/20 bilaterally.
The client exhibits a symmetrical pupillary light reflex response.
Correct Answer : B,E
A. Dilated pupils in response to dimmed lights are a normal response and not an indication of a
vision problem.
B. Pupils that remain dilated during an accommodation test indicate that the client may have an
issue with their autonomic nervous system and is not able to adjust their pupil size appropriately.
C. Far vision acuity of 20/20 bilaterally indicates normal vision.
D. A symmetrical pupillary light reflex response is a normal finding and not an indication of a vision
problem.
E. Frowning and squinting while reading the Snellen chart may indicate that the client is having difficulty seeing the letters clearly and may have a vision problem.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
This is the medication that the nurse should expect to administer to the client who is receiving treatment for gestational diabetes mellitus. Gestational diabetes mellitus (GDM) is a condition that occurs when a pregnant woman has high blood sugar levels that are not controlled by diet and exercise alone. GDM can cause complications for the mother and the baby, such as preeclampsia, macrosomia, hypoglycemia, and birth trauma¹. The primary treatments for GDM are diet and increased exercise. However, some women may need medication to lower their blood sugar levels.
The most common medication used for GDM is insulin, which is a hormone that helps the body use glucose for energy. Insulin can be given by injection or by an insulin pump¹. However, some women may prefer oral medications over insulin injections. One of the oral medications that can be used for GDM is glyburide, which is a sulfonylurea drug that stimulates the pancreas to produce more insulin. Glyburide can lower blood sugar levels and reduce the need for insulin in some women with GDM²³. Glyburide is generally safe and effective for GDM, but it may cause side effects such as hypoglycemia, weight gain, nausea, and allergic reactions²⁴.
The other options are not correct because they are not medications used for gestational diabetes mellitus.
b) Levothyroxine
Levothyroxine is a synthetic form of thyroxine, which is a hormone produced by the thyroid gland. Levothyroxine is used to treat hypothyroidism, which is a condition that occurs when the thyroid gland does not produce enough thyroid hormones. Hypothyroidism can cause symptoms such as fatigue, weight gain,cold intolerance, and depression. Levothyroxine is not used to treat gestational diabetes mellitus.
c) Nifedipine
Nifedipine is a calcium channel blocker that relaxes the blood vessels and lowers blood pressure. Nifedipine is used to treat hypertension, angina, and preterm labor. Hypertension is a condition that occurs when the blood pressure is too high. Angina is a type of chest pain that occurs when the heart does not get enough oxygen. Preterm labor is a condition that occurs when the uterus contracts and dilates before 37 weeks of pregnancy. Nifedipine is not used to treat gestational diabetes mellitus.
d) Chlorpromazine
Chlorpromazine is an antipsychotic drug that blocks dopamine receptors in the brain. Chlorpromazine is used to treat schizophrenia, bipolar disorder, and nausea and vomiting. Schizophrenia is a mental disorder that causes distorted thoughts, hallucinations, and delusions. Bipolar disorder is a mental disorder that causes mood swings between mania and depression. Nausea and vomiting are symptoms that can be caused by various conditions or treatments. Chlorpromazine is not used to treat gestational diabetes mellitus.
Correct Answer is D
Explanation
This response demonstrates respect for the client's religious beliefs and a willingness to work with the client to meet their needs. It also opens up a dialogue between the nurse and the client to develop a plan of care that is consistent with the client's beliefs and values.
Option a, "Fasting is harmful to your body," is not an appropriate response as it does not respect the client's religious beliefs and may be perceived as insensitive or disrespectful.
Option b, "You must have food during times of illness," may be accurate in some situations, but it is not relevant to the client's request to fast during Ramadan.
Option c, "I will let your healthcare provider know that you need to be discharged," is not an appropriate response as it does not address the client's request to fast during Ramadan and may be perceived as dismissive or unhelpful.
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