The nurse is preparing an older adult client for discharge following cataract extraction. Which instruction should be included in the discharge teaching?
Avoid straining at stool, bending, or lifting heavy objects.
Irrigate conjunctiva with ophthalmic saline prior to instilling antibiotic ointment.
Do not read without direct lighting for 6 weeks.
Limit exposure to sunlight during the first 2 weeks when the cornea is healing.
The Correct Answer is A
A. Avoid straining at stool, bending, or lifting heavy objects: These activities can increase intraocular pressure and disrupt healing of the surgical site after cataract extraction. The client should be taught to avoid anything that could strain the eye and risk complications like hemorrhage or wound dehiscence.
B. Irrigate conjunctiva with ophthalmic saline prior to instilling antibiotic ointment:
Routine irrigation is not required and may introduce additional risk. Clients are instructed on proper hand hygiene and drop instillation rather than conjunctival irrigation.
C. Do not read without direct lighting for 6 weeks: While good lighting helps reduce eye strain, reading in lower light does not delay healing after cataract surgery. This instruction is unnecessary and could limit the client’s ability to resume normal activities.
D. Limit exposure to sunlight during the first 2 weeks when the cornea is healing: Although bright light can be uncomfortable post-surgery, wearing sunglasses typically offers sufficient protection. There is no requirement to restrict sunlight exposure completely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L): This client’s fasting glucose is well above the normal range. Prednisone can increase blood glucose levels, placing the child at risk for hyperglycemia. This indicates a need for urgent education on blood glucose management while on steroids.
B. An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L): This blood glucose level is within normal limits for random testing. No immediate need for change in diabetic teaching is evident based on this value.
C. A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L): Her result meets the upper limit range for gestational diabetes. While she requires ongoing monitoring, her values do not indicate a need for urgent intervention.
D. An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%: Although this indicates poor long-term control, it reflects a chronic issue. The child with an acutely elevated fasting glucose and corticosteroid use is at greater immediate risk and thus has higher priority for education.
Correct Answer is C
Explanation
A. Instruct the client to cough as the suction tip is removed: Coughing can help clear secretions, but this action is not the primary safety concern during suctioning. The priority is minimizing the risk of injury, infection, and contamination during the procedure
B. Instil 3 mL of 0.9% sodium chloride before suctioning: Instilling saline before suctioning is generally not recommended as it can lead to complications, such as increasing mucus production, which can make suctioning more difficult.
C. Wear protective goggles while performing the procedure: Suctioning a tracheostomy can involve secretions that may potentially splash, so it’s important to wear protective goggles, as well as other appropriate personal protective equipment, to ensure safety and prevent contamination.
D. Apply a water-soluble lubricant to the catheter: Applying lubricant to the catheter is not recommended. The suction catheter should be kept sterile and dry to avoid introducing any contaminants into the trachea or the airway.
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