The following client come to the ophthalmology clinic. Which client needs to be seen first?

Correct Answer: A

Rationale: **Rationale:** **A: Client who had recent cataract surgery and worsening vision** This client is the highest priority due to the risk of **postoperative complications**, such as **endophthalmitis (infection inside the eye)**, **retinal detachment**, or **cystoid macular edema**, which can lead to **permanent vision loss** if not treated urgently. Cataract surgery involves an incision in the eye, making it susceptible to infection or inflammation. Worsening vision postoperatively is a **red flag** requiring **immediate evaluation** to prevent irreversible damage. **B: Client with an absent red reflex** An absent red reflex can indicate serious conditions like **retinoblastoma (in children)**, **cataracts**, or **vitreous hemorrhage**. While concerning, this finding is not **immediately life- or vision-threatening** unless accompanied by acute symptoms (e.g., pain, sudden vision loss). A thorough workup is needed, but it does not take precedence over an acute postoperative complication like worsening vision after surgery. **C: Client with an intraocular pressure (IOP) of 24 mm Hg** An IOP of **24 mm Hg is elevated** (normal range: 10–21 mm Hg) and may suggest **glaucoma**, but it is not an emergency unless accompanied by **acute angle-closure glaucoma symptoms** (severe eye pain, nausea, sudden vision loss, halos around lights). Chronic glaucoma management can wait for routine evaluation, whereas acute postoperative changes demand **urgent intervention**. **D: Client with a tearing, reddened eye with exudate** This presentation suggests **conjunctivitis (viral or bacterial)**, **allergic reaction**, or **blepharitis**. While uncomfortable, these are **not sight-threatening** and can typically be managed with topical treatments. **No immediate intervention** is needed unless signs of **corneal involvement** (e.g., photophobia, severe pain) are present. **Conclusion:** The **postoperative cataract patient with worsening vision (Option A)** is the **highest priority** due to the risk of **surgical complications** that can rapidly progress to **permanent visual impairment**. The other conditions (B, C, D) are either **non-emergent** or require further evaluation but do not pose the same **urgent threat** to vision.

Correct Answer: D

Rationale: Conductive hearing loss occurs when sound waves cannot efficiently travel through the outer or middle ear to reach the inner ear. This can be due to physical blockages, structural abnormalities, or conditions affecting the ear's conductive pathway. **Otitis media (D)**, an infection or inflammation of the middle ear, is a classic cause of conductive hearing loss. Fluid buildup or pus in the middle ear space impedes the movement of the ossicles (tiny bones) and eardrum, disrupting sound conduction. This is particularly common in children due to their shorter, more horizontal Eustachian tubes, which are prone to blockages. The fluid's presence dampens vibrations, leading to temporary hearing impairment until the infection resolves or is treated. **Prolonged exposure to loud noises (A)** typically causes sensorineural hearing loss, not conductive. This type of damage affects the hair cells in the cochlea or the auditory nerve, impairing the conversion of sound vibrations into neural signals. While noise-induced hearing loss is a leading cause of auditory deficits, it doesn’t involve the mechanical obstruction characteristic of conductive loss. **Medications (B)**, particularly ototoxic drugs like certain antibiotics (e.g., gentamicin) or chemotherapy agents, also cause sensorineural hearing loss. These substances damage the inner ear’s delicate structures or the auditory nerve, disrupting neural signal transmission. Unlike conductive loss, this damage is often irreversible and doesn’t involve physical barriers in the outer or middle ear. **Presbycusis (C)** is age-related hearing loss and is exclusively sensorineural. It results from degenerative changes in the cochlea, auditory nerve, or brain’s auditory processing centers over time. While it shares symptoms like difficulty hearing high frequencies with some conductive losses, the underlying mechanism is entirely different—no physical blockage or middle ear dysfunction is involved. The key distinction lies in the affected anatomical region: conductive loss involves the outer/middle ear’s mechanical pathway, while sensorineural loss stems from inner ear or neural damage. Otitis media directly interferes with conduction, making it the only correct choice here. The other options, while significant causes of hearing impairment, belong to a separate category of auditory dysfunction. Understanding these differences is critical for accurate diagnosis and treatment, as conductive losses (e.g., from infections or earwax) are often treatable, whereas sensorineural losses may require hearing aids or cochlear implants.

Correct Answer: C

Rationale: **Rationale:** **Choice C (Tinnitus) is correct** because tinnitus—a ringing, buzzing, or hissing sound in the ears—is a common symptom of hearing loss. It often results from damage to the hair cells in the cochlea or other auditory pathways, which can occur due to noise exposure, aging (presbycusis), or medical conditions. Tinnitus is frequently associated with sensorineural hearing loss, as the brain may compensate for reduced auditory input by generating phantom sounds. While tinnitus can occur independently, its presence alongside other symptoms strongly suggests hearing impairment. **Choice A (Presence of cerumen) is incorrect** because earwax (cerumen) is a normal bodily secretion that protects the ear canal. While excessive cerumen can cause temporary conductive hearing loss by blocking sound waves, its mere presence is not a definitive sign of hearing loss. Many individuals have cerumen without any auditory issues, and the problem is easily resolved with proper ear hygiene or medical removal. **Choice B (Presence of cerumen) is repeated and thus redundant**. It is the same as Choice A, and the rationale for its incorrectness remains identical. Redundant options in a question are typically errors and should not be considered valid distinct choices. **Choice D (Frequent asking of others to repeat statements) is incorrect** in this context because while it is a behavioral sign of hearing difficulty, the question specifies "signs of hearing loss," which typically refer to physiological or sensory indicators (e.g., tinnitus). Behavioral cues like asking for repetitions are secondary manifestations rather than direct signs. However, in clinical practice, this would still be relevant for diagnosing hearing impairment—just not the best fit for this question’s phrasing. The focus on **tinnitus (C)** as the correct answer highlights a primary sensory symptom directly linked to hearing loss mechanisms, whereas the other options either describe normal physiology (cerumen) or indirect behavioral effects (asking for repetitions). The repetition of Choice B further invalidates it as a distinct option. Understanding the distinction between direct symptoms and secondary effects is critical for accurately identifying hearing loss.

Correct Answer: C

Rationale: Immobility significantly increases the risk of pressure injuries (pressure ulcers) due to prolonged pressure on bony prominences, reduced blood flow, and potential shear forces from sliding or improper repositioning. The skin integrity of an immobile client must be inspected frequently—ideally every 2 hours—because early signs of injury (e.g., erythema, blisters, or tissue breakdown) require immediate intervention to prevent progression to severe wounds. Pressure injuries can develop rapidly (within hours) and lead to infections, prolonged hospitalization, or systemic complications. This makes skin inspection the **priority** assessment, as it addresses the most immediate and preventable threat to the client’s well-being. **Why other options are incorrect:** - **A: Palpate for edema** While edema assessment is important (e.g., for detecting DVT or fluid retention), it is not the **priority** for an immobile client. Edema may develop over time and is less immediately life-threatening than skin breakdown. Additionally, edema alone does not guide urgent interventions unless paired with other symptoms (e.g., pain or asymmetry suggesting thrombosis). - **B: Auscultate for bowel sounds** Immobility can slow gastrointestinal motility (leading to constipation or ileus), but bowel sounds are not the **first** priority. Bowel dysfunction typically develops over days and is not as immediately harmful as skin compromise. Monitoring bowel function is important but secondary to preventing pressure injuries. - **D: Auscultation of lung sounds** While immobility increases the risk of atelectasis or pneumonia due to shallow breathing, lung sounds are not the **priority** in the initial assessment. Respiratory complications usually manifest later (e.g., after 48–72 hours of immobility). Skin inspection takes precedence because it can prevent irreversible damage with early detection. In summary, **C** is correct because skin inspection directly addresses the most urgent and preventable complication of immobility (pressure injuries), while the other assessments are important but secondary in the immediate context. The rationale aligns with nursing priorities: preventing harm that is both rapid in onset and high in severity.

Correct Answer: D

Rationale: Administering eye drops correctly is critical to ensuring medication efficacy and preventing contamination or injury. The correct technique involves strict hygiene and avoiding direct contact between the dropper and the eye. **Why D is correct (the action needing further education):** Touching the dropper to the eye introduces a high risk of contamination. The dropper tip can pick up bacteria or debris from the eye, eyelashes, or surrounding skin, which may then contaminate the entire bottle of medication. Additionally, physical contact can cause microabrasions to the cornea or lead to accidental injury if the patient moves suddenly. Proper technique requires holding the dropper slightly above the eye (about 1-2 cm) to allow the drop to fall into the conjunctival sac without contact. **Why A is incorrect (acceptable action):** Setting the cap down in a non-contaminated manner (e.g., placing it on a clean tissue or holding it with the inner side facing upward) prevents exposure to dirt or microbes. Since the cap must be removed to administer drops, ensuring it remains clean is part of proper sterile technique. This action does not require correction. **Why B is incorrect (proper technique):** Instilling drops directly into the conjunctival sac (the pocket between the lower eyelid and eyeball) ensures optimal absorption and minimizes spillage. This area is less sensitive than the cornea, reducing discomfort. Dropping medication onto the cornea directly can cause irritation or reflexive blinking, leading to wasted medication. The client’s action here is correct. **Why C is incorrect (essential step):** Handwashing before handling eye drops is a fundamental infection control measure. Pathogens from unwashed hands can transfer to the eye or dropper, increasing the risk of infection (e.g., conjunctivitis). This step is non-negotiable in eye care and does not indicate a need for further teaching. **Key Takeaways for Proper Eye Drop Administration:** - Avoid dropper-to-eye contact to prevent contamination and injury. - Target the conjunctival sac for comfortable and effective delivery. - Maintain sterility by washing hands and handling the cap carefully. - Never touch the tip of the dropper to any surface, including the eye. Missteps like touching the dropper to the eye (D) compromise both safety and sterility, making it the clear indicator for additional client education. The other options (A, B, C) reflect correct practices that align with standard protocols for ophthalmic medication administration.