NURS 202 Test 3 Health Assessment Exam 2021 - North Carolina University
1) The nurse is assessing a 20-year-old college student who is experiencing
... [Show More] red, swollen eyes that are oozing a yellowish drainage. The client is complaining of photophobia. What is the most appropriate question for the nurse to ask the client?
A) "Have you had extra caffeine this week?"
B) "Did you get sand in your eye recently?"
C) "Have you been exposed to HIV?"
D) "Have any of your friends experienced these symptoms?" Answer: D
The client is exhibiting signs and symptoms of conjunctivitis. The nurse should explore ways in which the client may have been exposed. Most cases of conjunctivitis are spread by hand to eye contact. Exposure to HIV, sand in the eye, and caffeine are not known causes of conjunctivitis and would not be appropriate questions to ask this client to determine the cause of the symptoms.
4) The nurse is planning care for a client with conjunctivitis. Which client statement supports the nursing diagnosis of Risk for Altered Vision?
A) "I have had this infection for 3 days."
B) "My mother is blind from retinopathy."
C) "This is the fourth eye infection I have had in the last 6 months."
D) "I think I caught the infection from my child." Answer: C
The concern for this client is the repeated infections that could be a chronic form of conjunctivitis that causes eventual blindness. Having the infection for 3 days is concerning but not as much as the potentially chronic form of the disease. Many adults catch "pink eye" from a child, but that is not usually the form that causes blindness. The client's mother has blindness from a source other than conjunctivitis.
6) The nurse is teaching a mother to administer ophthalmic ointment to her infant with conjunctivitis. The nurse determines that learning goals have been met when the mother performs which action?
A) Places the ointment on a swab and spreads it across closed eyelids.
B) Instills the medication to the lacrimal duct.
C) Uses sterile gauze to apply the ointment.
D) Applies the ointment directly to the conjunctival sac. Answer: D
The ointment is applied to the conjunctival sac, not the lids or lacrimal duct, and is applied directly from the medication tube or vial.
7) The nurse is providing care for a pediatric client with bacterial conjunctivitis. Which interventions should the nurse use as part of the collaborative management of the client?
Select all that apply.
A) Dark sunglasses
B) Cold eye compresses
C) Contact the client's school nurse.
D) Careful hand hygiene
E) Antiviral therapy Answer: A, C, D
Dark glasses will help to reduce the photophobia that many clients with conjunctivitis experience. It is often appropriate for the nurse to contact the client's school nurse to discuss increased prevention and student education. A warm compress, not cold, should be used in the management of conjunctivitis.
Warm compresses relieve discomfort and reduce swelling by increasing circulation to the eye. Careful hand hygiene is a standard method for managing the client with conjunctivitis. Antibiotics, not antiviral medications, are prescribed with conjunctivitis. [Show Less]