The nurse is planning the home care of a client who is receiving a mydriatic medication. Which environment is best for this client?

A cool, humidified air.

A quiet, restful environment.

A dimly lit room.

A warm room temperature.

Answer and Explanation

The Correct Answer is C

Choice A reason: A cool, humidified air is not relevant for this client, as it does not affect the eyes or vision. A cool, humidified air may be beneficial for clients with respiratory conditions, such as asthma or bronchitis.

Choice B reason: A quiet, restful environment is not specific for this client, as it does not address the effects of mydriatic medication on the eyes or vision. A quiet, restful environment may be helpful for clients with stress, anxiety, or insomnia.

Choice C reason: A dimly lit room is the best environment for this client, as it reduces the glare and discomfort caused by mydriatic medication. Mydriatic medication is a type of eye drop that dilates the pupils and prevents them from constricting in response to light. This can improve the examination of the retina and optic nerve, but it also makes the eyes more sensitive to light and reduces the ability to focus on near objects.

Choice D reason: A warm room temperature is not necessary for this client, as it does not affect the eyes or vision. A warm room temperature may be comfortable for clients with cold intolerance, such as hypothyroidism or Raynaud's phenomenon.

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Correct Answer is C

Explanation

Choice A reason: Checking the client's capillary glucose level is not relevant to this finding, as acetaminophen does not affect blood glucose levels. The yellow color of the skin may indicate jaundice, which is a sign of liver damage caused by acetaminophen overdose or toxicity.

Choice B reason: Advising the client to reduce the medication dose is not sufficient to address this finding, as acetaminophen can cause irreversible liver damage if taken in excess or for prolonged periods. The client may need immediate medical attention and treatment with an antidote such as N-acetylcysteine.

Choice C reason: Reporting the finding to the healthcare provider is the appropriate action to take, as the yellow color of the skin may indicate jaundice, which is a sign of liver failure caused by acetaminophen overdose or toxicity. The healthcare provider can order further tests and interventions to assess and treat the client's condition.

Choice D reason: Using a pulse oximeter to assess oxygen saturation is not related to this finding, as acetaminophen does not affect oxygen levels. The yellow color of the skin may indicate jaundice, which is a sign of liver dysfunction caused by acetaminophen overdose or toxicity.

A. Implement neutropenic precautions. B. Inform the client that the medication has been effective. C. Review the client's culture and sensitivity reports. D. Assess the client's vital signs.

Correct Answer is B

Explanation

Choice A reason: Neutropenic precautions are necessary when the WBC count is critically low, typically below the normal range. Since the client’s WBC count is now within the normal range, these precautions are no longer required.

Choice B reason: Filgrastim is designed to increase white blood cell (WBC) production in individuals with neutropenia. In this case, the client’s WBC count has increased from 2,500/mm³ (2.5 x 10⁹/L) to 5,000/mm³ (5 x 10⁹/L), reaching the lower limit of the normal reference range (5,000 to 10,000/mm³ or 5 to 10 x 10⁹/L). This indicates that the medication has achieved its desired effect, and it is appropriate to inform the client of this positive outcome.

Choice C reason:reason: Reviewing culture and sensitivity reports would be relevant if there was evidence of infection or a need to evaluate ongoing treatment for an infection. This is not indicated by the scenario provided.

Choice D reason: While assessing vital signs is generally important, there is no indication in this scenario that an acute issue requiring immediate vital sign monitoring is present.

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The nurse is planning the home care of a client who is receiving a mydriatic medication. Which environment is best for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While assessing a client who takes acetaminophen for chronic pain, the nurse observes that the client's skin looks yellow in color. Which action should the nurse take in response to this finding?

Correct Answer is C

Explanation

After receiving five doses of filgrastim, the nurse notes that the client's white blood cell count has increased from 2,500/mm3 (2.5 x 109/L) to 5,000/mm3 (5 x 109/L). Which action should the nurse implement? White Blood Cell (WBC) [Reference Range: 5000 to 10,000/mm3 (5 to 10 x 109/L)]

Correct Answer is B

Explanation

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