When preparing to examine a client's sclera and conjunctiva during an eye examination, the nurse should instruct the client to move both eyes to look in which direction?

Choice a reason:
The oral mucosa is the most reliable area to evaluate for central cyanosis in a client with asthma. Central cyanosis reflects a decrease in arterial oxygenation and is best assessed where the blood flow is high and the skin is thin, which is the case with the oral mucosa. It is less likely to be affected by peripheral factors such as temperature and is therefore a more accurate indicator of oxygen saturation in the central circulation.

Choice b reason:
While ear lobes can show signs of cyanosis, they are not the most reliable indicator of central cyanosis because they are more prone to peripheral cyanosis. Peripheral cyanosis can occur in the ear lobes due to local vasoconstriction or decreased blood flow, which may not reflect central oxygenation levels.

Choice c reason:
The soles of the feet are not a reliable indicator of central cyanosis, especially in a client with asthma. The skin on the soles is thicker and has less blood flow compared to the oral mucosa, making it a poor site for assessing central cyanosis. Additionally, the soles can be affected by peripheral factors like pressure and temperature.

Choice d reason:
Conjunctivae are not the most reliable indicator of central cyanosis. While they can show signs of cyanosis, the assessment can be affected by environmental factors and the presence of blood vessels in the conjunctiva that may not accurately reflect central oxygenation levels.

Choice a reason:
A penlight is used to provide illumination during an examination, not to move the tongue. It helps the nurse to visualize the mouth floor and other areas by casting light, but it does not have the physical structure to manipulate the tongue.

Choice b reason:
Gloves are worn by healthcare professionals to maintain hygiene and protect both the patient and the nurse from the transmission of infectious agents. They are not used to move the tongue to one side during an examination.

Choice c reason:
A gauze pad is the correct tool to use when the nurse needs to move the tongue to one side during an examination of the mouth floor. The nurse can wrap the gauze pad around the tongue for a better grip, which allows for safe and effective retraction of the tongue without causing discomfort to the patient.

Choice d reason:
A tongue blade, also known as a tongue depressor, is typically used to depress the tongue to examine the back of the throat, not to move the tongue to one side. It is used to hold the tongue down so that the nurse can inspect the oropharynx and other structures.