What actions should a nurse implement when assessing a patient's accommodation? (Select all that apply.)
Move his or her finger slowly toward the patient's nose
Checking for a nystagmus
Assess for convergence
Observe for pupillary constriction.
Note blinking
Hold his or her finger approximately 20 inches in front of the patient's eyes.
Correct Answer : A,C,D
a) Move his or her finger slowly toward the patient's nose: This is an appropriate action for testing accommodation, as it assesses the ability of the eyes to converge and maintain focus on the object as it moves closer.
b) Checking for a nystagmus: This is not directly related to accommodation, though nystagmus can be observed in other assessments for visual and neurological conditions.
c) Assess for convergence: Convergence is part of the accommodation process. It involves the eyes turning inward to focus on a near object.
d) Observe for pupillary constriction: Pupillary constriction is a key part of the accommodation response when focusing on a near object.
e) Note blinking: This is not necessary for assessing accommodation. Blinking can occur for various reasons but is not a direct sign of accommodation.
f) Hold his or her finger approximately 20 inches in front of the patient's eyes: For accommodation testing, the object should be moved closer, typically within 6-8 inches from the eyes.
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Related Questions
Correct Answer is ["A","C","D"]
Explanation
a) Move his or her finger slowly toward the patient's nose: This is an appropriate action for testing accommodation, as it assesses the ability of the eyes to converge and maintain focus on the object as it moves closer.
b) Checking for a nystagmus: This is not directly related to accommodation, though nystagmus can be observed in other assessments for visual and neurological conditions.
c) Assess for convergence: Convergence is part of the accommodation process. It involves the eyes turning inward to focus on a near object.
d) Observe for pupillary constriction: Pupillary constriction is a key part of the accommodation response when focusing on a near object.
e) Note blinking: This is not necessary for assessing accommodation. Blinking can occur for various reasons but is not a direct sign of accommodation.
f) Hold his or her finger approximately 20 inches in front of the patient's eyes: For accommodation testing, the object should be moved closer, typically within 6-8 inches from the eyes.
Correct Answer is A
Explanation
a) Continuous swallowing: Continuous swallowing may indicate bleeding as the child is attempting to swallow blood that has accumulated in the throat.
b) Poor fluid intake: Poor fluid intake is not a primary sign of hemorrhage but could occur due to pain or discomfort post-surgery.
c) Drooling: Drooling can occur due to difficulty swallowing after a tonsillectomy but is not a direct indicator of bleeding.
d) Increased pain: While pain may increase after surgery, increased pain alone is not a definitive sign of hemorrhage.
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