Which disorder would the nurse suspect in a patient complaining of intense headaches, bloodshot eyes, and blurred vision? This is considered a medical emergency.
Detached retina
Macular degeneration
Cataracts
Angle-closure glaucoma
The Correct Answer is D
Choice A reason: A detached retina is a serious condition that occurs when the retina, the light-sensitive layer of tissue at the back of the eye, separates from its underlying support tissue. It can cause vision loss or blindness if not treated promptly. However, it does not usually cause intense headaches or bloodshot eyes, but rather flashes of light, floaters, or a curtain-like shadow over the visual field.
Choice B reason: Macular degeneration is a common eye disorder that affects the macula, the central part of the retina that is responsible for sharp and detailed vision. It can cause blurred or distorted vision, especially in the center of the visual field. However, it does not usually cause intense headaches or bloodshot eyes, but rather difficulty reading, recognizing faces, or seeing colors.
Choice C reason: Cataracts are cloudy areas in the lens of the eye that can impair vision. They are usually related to aging, but can also be caused by other factors such as diabetes, trauma, or radiation. They can cause blurred or dim vision, sensitivity to light, or halos around lights. However, they do not usually cause intense headaches or bloodshot eyes, but rather gradual and painless vision loss.
Choice D reason: Angle-closure glaucoma is a type of glaucoma that occurs when the drainage angle of the eye becomes blocked, causing a sudden increase in the pressure inside the eye. It can damage the optic nerve and lead to permanent vision loss if not treated immediately. It can cause intense headaches, bloodshot eyes, blurred vision, nausea, vomiting, or seeing rainbow-colored rings around lights. It is a medical emergency that requires immediate attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Raises all four side rails is not the best intervention, as it may not prevent the client from falling and may increase the risk of injury and entrapment. Raising all four side rails may also be considered a form of restraint, which should be avoided unless absolutely necessary.
Choice B reason: Orders a two-person assist with a transfer is not the best intervention, as it may not be appropriate for the client's level of mobility and may reduce the client's independence and self-esteem. The nurse should assess the client's ability to transfer and use the appropriate assistive device and number of staff to ensure safety and comfort.
Choice C reason: Gives the client a dry erase board is the best intervention, as it can facilitate the client's communication and expression of needs and preferences. The client may have difficulty speaking or writing due to the stroke, which can affect the language and motor areas of the brain. A dry erase board can allow the client to use simple words, symbols, or drawings to convey their messages.
Choice D reason: May need to incorporate repetition is not the best intervention, as it is not specific and may not be effective for the client's learning and retention. The nurse should use individualized and evidence-based strategies to teach the client and their family about the stroke, its effects, and the rehabilitation plan. Repetition may be one of the strategies, but not the only one.
Choice E reason: None of the above is not the correct answer, as there is one choice that is the best intervention for the nurse to implement when caring for this client.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A reason: This is a correct answer because Alzheimer's disease affects the brain cells and causes them to degenerate and die. This leads to a gradual decline in cognitive abilities, such as memory, language, reasoning, and problem-solving.
Choice B reason: This is a correct answer because Alzheimer's disease interferes with the daily activities and routines of the affected person. They may experience a decline from their previous level of functioning, such as forgetting appointments, misplacing items, or getting lost.
Choice C reason: This is an incorrect answer because easily frustrated is not a specific outcome of the early stage of Alzheimer's disease. Although some people with Alzheimer's disease may become frustrated, irritated, or angry due to their cognitive impairment, this is not a universal or diagnostic symptom.
Choice D reason: This is a correct answer because Alzheimer's disease affects the short-term memory first, causing the person to forget recent events, conversations, or names. This is called mild memory loss, and it is one of the most common signs of the early stage of Alzheimer's disease.
Choice E reason: This is a correct answer because Alzheimer's disease affects the frontal lobe of the brain, which is responsible for executive functions, such as planning, organizing, decision-making, and judgement. This leads to impaired judgement, such as making poor financial choices, neglecting personal hygiene, or acting inappropriately.
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