Level 1 Exam 1 Success Session

The client who had cataract surgery with a lens implant 1 week ago remarks to the home care nurse that after his daughter left to go to her home in another state yesterday, he combined all of his prescribed eye drops together in one container so he had fewer drops to administer. What is the nurse's best response?

• This is not a good idea because not all of the drugs are on the same schedule.

• That is a good idea; just remember to not touch the dropper to your eye when giving yourself the drops.

• Call your surgeon immediately and get new prescriptions because together these drugs can lower your blood pressure.

• Call your surgeon immediately and get new prescriptions to use one at a time because these drugs cannot be mixed together.

Answer explanation

Correct Answer:  “Call your surgeon immediately and get new prescriptions to use one at a time because these drugs cannot be mixed together."

 

 

 

Rationale:   These drugs are not to be mixed together.

Not only is the chance for contamination high, but the drug concentrations and effectiveness are also reduced when mixed together.

Even when the drugs are administered separately, they should be given 5 to 10 minutes apart.

Which precaution is most important for the nurse to teach a 62-year-old client newly diagnosed with early-stage dry age-related macular degeneration?

• Quit smoking

• Quit drinking alcoholic beverages

• Eat more dark green, red, and yellow vegetables

• Wear dark glasses whenever he or she is outside or in bright interior lighting environments

Answer explanation

Correct Answer:  Quit smoking

 

 

 

Rationale:   Dry AMD is more common and progresses at a faster rate among smokers than among nonsmokers.

 

Thus, quitting smoking can slow the rate of AMD progression.

 

Avoiding alcohol and bright light (even ultraviolet light) is not related to AMD development or progression.

 

Although increasing long-term dietary intake of antioxidants, vitamin B12, and the carotenoids lutein and zeaxanthin that are found in green, red, and yellow vegetables is thought to help slow the progression of AMD, the effects are not as profound as quitting smoking.

A client with glaucoma is being assessed for new symptoms. Which symptom indicates a high priority need for reassessment of intraocular pressure?

• Burning in the eye

• Inability to differentiate colors

• Increased sensitivity to light

• Gradual vision changes

Answer explanation

Correct Answer:  Gradual vision changes

 

 

 

Rationale:   Gradual vision changes are an indication of increased intraocular pressure.

 

A burning sensation in the eye usually indicates inflammation and/or infection.

 

An inability to differentiate colors is an early sign of cataracts.

 

An increased sensitivity to light might be a sign of a corneal abrasion.

In addition to aging, which of the following may contribute to hearing loss in the older adult?

 

 

Select all that apply. One, some, or all responses may be correct.

• Exposure to loud noises

• Recurrent otitis media and trauma

• Excessive hair in the ear

• Certain medications

• Diabetes

Answer explanation

Correct Answer:  Exposure to loud noises

Recurrent otitis media and trauma

Certain medications

 

Diabetes

 

The nurse is caring for a client that is hearing impaired. Which approach will facilitate communication?

• Speak frequently

• Speak loudly

• Speak directly into the impaired ear

• Speak in a normal tone

Answer explanation

Correct Answer:  Speak in a normal tone

 

 

 

Rationale:   Speaking in a normal tone to the client with impaired hearing and not shouting are important.

 

The nurse should talk directly to the client while facing the client and speak clearly.

 

If the client does not seem to understand what is said, the nurse should express it differently.

 

Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear.

The 77-year-old male smoker has developed cataracts on both eyes and is awaiting surgery. The cataracts have prevented the patient from driving, reading, and seeing television. Which statement would be appropriate for the nurse in the preoperative holding area to communicate to the patient?

• Did your eye doctor explain to you that you could choose to use eye drops six times a day to dissolve the cataract?

• You are wise to have both eyes done at the same time.

• If you were a non-smoker, you would never have developed cataracts.

• Most patients undergoing cataract surgery do well and enjoy the improved vision.

Answer explanation

Correct Answer:  "Most patients undergoing cataract surgery do well and enjoy the improved vision."

 

 

 

 

Rationale:   Surgical removal is the only treatment used at this time for cataracts; no medical treatment is available to prevent or treat them.

 

Surgical removal of the cataract and lens is indicated when the cataract has developed to the point that vision and activities of daily living are affected.

 

If the patient presents with bilateral cataracts, surgery is only performed on one eye at a time.

 

Complications from cataract surgery are unusual and occur in less than 1% of the surgeries.

The patient with glaucoma has been prescribed travoprost, a prostaglandin analog, to improve the outflow of aqueous humor and reduce ocular pressure. Which symptom will the nurse teach the patient to report immediately to the eye doctor regarding this medication?

• Burning in the eye when the eye drops are used

• Tearing in the eye when the eye drops are used

• Changes in the color of the eyes

• Intolerable pain in the eyes after the drops are used

Answer explanation

Correct Answer:  Intolerable pain in the eyes after the drops are used

 

 

Rationale:  Prostaglandin analogs have some adverse effects, such as blurred vision and stinging, and, when used long-term, cause permanent darkening of the iris of the eye and eyebrows, increased growth of eyelashes, and conjunctival redness.

Which age group has the greatest potential to demonstrate regression when they are sick?

• Infant

• Toddler

• Adolescent

• Young adult

Answer explanation

Correct Answer(s):  Toddler

 

 

Rationale:  Regression is most seen among toddlers and it can be caused by stressful situations such as hospitalization, the arrival of a new sibling, or starting a new school.

 

When a child regresses, he or she appears to be going backward in an earlier stage of development where he or she feels comfortable (e.g. toilet trained toddlers suddenly start wetting their pants when they become sick, thumb sucking).

 

Babies are almost entirely dependent on their caregivers. So it should come as no surprise that how parents interact with their babies has a profound effect on both their physical and mental health. Noticing and responding to these signals, whether they are cries, body movements, coos, or even words, helps them learn to trust the people and the world around them.

 

There’s no doubt the teen years can be a more challenging time to deal with a health condition. In addition to the social pressures to fit in, it’s a time of learning about and understanding their bodies. At a time when it’s natural to be concerned with body image, it can seem hard to feel different. It’s understandable that people can feel just plain sick and tired of dealing with a chronic illness once in a while.

 

Regression may happen in this age group but it is more common in toddler years. Struggling in this stage of life can result in loneliness and isolation. Loneliness can affect overall health in other ways. For example, socially isolated people tend to have unhealthier diets, exercise less, experience greater daytime fatigue, and have poorer sleep.

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization?

 

 

Select all that apply. One, some, or all responses may be correct.

• Mild temperament

• Lack of closeness between parent and child

• Below-average intelligence

• Age

• Gender

Answer explanation

Correct Answer:  Lack of closeness between parent and child
Below-average intelligence
Age
Gender

 

 

 

 

Rationale:   Risk factors for increased stress level of a child to illness or hospitalization: "Difficult" temperament; Lack of closeness between child and parent; Age (especially between 6 months and 5 years old); Male gender; Below-average intelligence; Multiple and continuing stresses (e.g., frequent hospitalizations.

A child is scheduled for a tonsillectomy and is afraid of the surgery. The child asks the nurse, "Will I need another operation when I have a sore throat again?" Which response should the nurse give to the child?

• Once your tonsils are taken out, you will not need the surgery again.

• You will need to repeat the surgery when you have another infection.

• You will need to have another surgery when you turn 14 years old.

• Once your tonsils are fixed, you will not have any more sore throats.

Answer explanation

Correct Answer:  "Once your tonsils are taken out, you will not need the surgery again."

 

 

 

 

 

Rationale:   The child does not have enough knowledge about the tonsillectomy. Therefore, the child may have fear about the surgery.

 

The nurse should explain to the child that once the tonsils are removed, they do not need "fixing" again.

 

It helps relieve the child's fear about the operation, and the child may feel comfortable.

 

Once the tonsillectomy has been done in the child, a second operation is not required after another throat infection.

 

There will actually not be a need for repeating the operation at any age.

 

The child needs to be instructed that there may be other sore throats in the future.