When the nurse is gathering history from a client newly diagnosed with glaucoma, the client reports the following statement to the nurse.
Which statement would be consistent with the client's diagnosis?

Choice A rationale

Rheumatoid arthritis involves an autoimmune response where the body attacks the synovial membrane, causing chronic inflammation. Morning stiffness is a classic, expected symptom of this disease caused by joint congestion and inactivity during sleep. While uncomfortable for the patient, it does not represent an acute physiological crisis requiring immediate intervention over other potentially unstable patients. The nurse can address this after checking more critical respiratory or vascular concerns.

Choice B rationale

Corticosteroids are frequently used to manage inflammatory or autoimmune conditions by suppressing the immune system and reducing cytokine production. An 8 AM scheduled dose is a routine medication administration task. While maintaining the medication schedule is important for therapeutic blood levels, it is not an emergency. Administering a medication thirty minutes after shift report is a standard nursing duty that follows the assessment of unstable patients according to triage principles.

Choice C rationale

Scleroderma or systemic sclerosis can lead to pulmonary fibrosis and pulmonary hypertension as collagen overproduction affects lung tissue and vasculature. Dyspnea, especially a new or recent episode, indicates potential respiratory compromise or cardiac involvement which is life-threatening. Normal respiratory rates are 12 to 20 breaths per minute. Any patient showing signs of breathing difficulty must be prioritized first to ensure adequate oxygenation and to prevent rapid clinical decline or respiratory failure.

Choice D rationale

Gout is caused by the accumulation of urate crystals in the joint, leading to intense inflammatory pain. Arthrocentesis is a procedure used to aspirate synovial fluid for diagnosis or to relieve pressure. While an acute gout attack is very painful, it is not immediately life-threatening. The patient is stable and awaiting a scheduled diagnostic procedure. The nurse should assess this patient after addressing the client with dyspnea but before routine medication administration.

Choice A rationale

Tilting the head back utilizes gravity to help the drop enter the eye. Pulling the lower lid down creates a pocket known as the conjunctival sac, which is the safest anatomical location for medication absorption. This method avoids direct contact with the sensitive cornea, reducing the risk of irritation or corneal abrasion while ensuring the medication is retained within the ocular surface rather than draining immediately.

Choice B rationale

The inner canthus contains the lacrimal duct system. Instilling drops directly into the inner canthus or keeping the eye closed during administration promotes systemic absorption through the nasolacrimal duct. This can reduce the local therapeutic effect on the eye and potentially cause systemic side effects. Correct technique involves applying pressure to the punctum after instillation to prevent the medication from entering the systemic circulation through this specific area.

Choice C rationale

The center of the eyeball consists of the cornea, which is highly innervated with sensory pain fibers. Instilling a chemical substance or a drop directly onto the cornea triggers a strong blink reflex and significant discomfort or pain for the patient. This action can also lead to corneal scarring or accidental injury if the dropper bottle touches the eye surface. Medication should always be placed in the lower conjunctival sac instead.

Choice D rationale

Pulling the upper eyelid up and placing medication on the cornea is clinically inappropriate. The cornea is the clear, protective outer layer of the eye, and direct application can cause damage or severe irritation. Standard nursing practice emphasizes using the lower eyelid to create a reservoir. Placing drops on the upper globe increases the risk of the patient blinking the medication out before it can be absorbed by the ocular tissues.