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** is the highest priority. Postoperative complications following cataract surgery, such as endophthalmitis (a severe intraocular infection) or retinal detachment, can lead to rapid and irreversible vision loss if not addressed immediately. Worsening vision after cataract surgery is a red flag that demands urgent evaluation to rule out these sight-threatening conditions. Delay in treatment could result in permanent damage, making this client the top priority. **B: Client with an absent red reflex** is concerning but may not always require immediate intervention. An absent red reflex can indicate conditions like retinal detachment, vitreous hemorrhage, or advanced cataracts. While serious, some causes (e.g., dense cataract) may not be emergencies, whereas others (e.g., retinal detachment) would be. However, without additional symptoms like acute vision loss or pain, this finding alone is less urgent than a postoperative complication. **C: Client with an intraocular pressure (IOP) of 24 mmHg** is not the most urgent case. While elevated IOP can suggest glaucoma, 24 mmHg is only mildly elevated and may not cause immediate harm. Acute angle-closure glaucoma (which presents with severe pain, vision loss, and IOP >40 mmHg) would be emergent, but this scenario lacks those symptoms. This client can be seen after more urgent cases. **D: Client with a tearing, reddened eye with exudate** likely has conjunctivitis, which, while uncomfortable, is typically non-vision-threatening and not an emergency. Bacterial or viral conjunctivitis can be managed with topical treatments and does not require immediate attention unless there is corneal involvement or severe pain, which is not indicated here. This client can wait compared to the postoperative case. In summary, **A** is the correct answer because postoperative vision changes after cataract surgery are potentially sight-threatening and require immediate assessment. The other options involve conditions that, while notable, are either less urgent or lack the immediate risk of permanent vision loss.

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 type of hearing loss is often caused by mechanical blockages or malfunctions in the ear's conductive pathway. **Correct Answer: D (Otitis media)** Otitis media, an infection or inflammation of the middle ear, is a leading cause of conductive hearing loss. Fluid accumulation in the middle ear space due to infection or Eustachian tube dysfunction prevents the proper vibration of the ossicles (tiny bones in the ear), hindering sound transmission. This condition is particularly common in children and can be acute or chronic, often resolving with treatment but potentially leading to persistent hearing impairment if left untreated. **Incorrect Answer: A (Prolonged exposure to loud noises)** Prolonged exposure to loud noises typically causes **sensorineural hearing loss**, not conductive. This occurs due to damage to the hair cells in the cochlea (inner ear) or the auditory nerve, impairing the conversion of sound waves into neural signals. While noise-induced hearing loss is a significant concern, it does not involve mechanical obstruction or middle ear dysfunction, which are hallmarks of conductive hearing loss. **Incorrect Answer: B (Medications)** Certain medications, such as ototoxic drugs (e.g., aminoglycoside antibiotics, loop diuretics, chemotherapy agents), are known to cause **sensorineural hearing loss** by damaging the inner ear structures or auditory nerve. They do not affect the external or middle ear's ability to conduct sound, making this choice irrelevant to conductive hearing loss. **Incorrect Answer: C (Presbycusis)** Presbycusis is age-related hearing loss, which is **sensorineural** in nature. It results from the gradual degeneration of hair cells in the cochlea and other age-related changes in the auditory system. Unlike conductive hearing loss, presbycusis is not caused by physical blockages or middle ear issues but rather by the inner ear's diminished capacity to process sound. Conductive hearing loss is distinguished by its mechanical origins, such as earwax impaction, otitis media, or ossicular chain disruption, whereas sensorineural hearing loss involves nerve or cochlear damage. Understanding the anatomical and physiological differences between these types of hearing loss is crucial for accurate diagnosis and appropriate management.

Correct Answer: C

Rationale: **Rationale:** **C: Tinnitus** is a correct answer because it is a well-documented symptom of hearing loss. Tinnitus refers to the perception of ringing, buzzing, or other noises in the ears when no external sound is present. It often occurs due to damage to the hair cells in the cochlea, which are responsible for transmitting sound signals to the brain. This damage can result from prolonged exposure to loud noises, aging (presbycusis), or other underlying health conditions. Tinnitus is not a disease itself but a symptom of an auditory system malfunction, making it a strong indicator of hearing loss. Patients with tinnitus frequently report difficulty hearing external sounds clearly, further supporting its association with hearing impairment. **A: Answering questions correctly** is incorrect because this behavior does not indicate hearing loss. In fact, individuals with hearing loss may often answer questions incorrectly or inappropriately due to mishearing or not hearing the question at all. Those with mild to moderate hearing loss might rely on contextual clues or lip-reading to respond, but this is not a reliable sign of normal hearing. The ability to answer questions correctly is more indicative of cognitive function or comprehension rather than auditory health. Therefore, this option does not align with the signs of hearing loss. **B: Presence of cerumen** is incorrect because while excessive earwax (cerumen) can cause temporary conductive hearing loss by blocking the ear canal, it is not a definitive sign of hearing loss itself. Many people have cerumen buildup without experiencing hearing impairment, and the condition is easily treatable with proper ear cleaning. Hearing loss due to cerumen is usually reversible once the blockage is removed, unlike sensorineural hearing loss, which is permanent. Thus, the mere presence of cerumen is not a reliable or standalone indicator of hearing loss. **D: Frequent asking of others to repeat statements** is actually a correct sign of hearing loss, though it was not marked as such in the provided "correct answer." This behavior is a classic red flag for hearing impairment, as individuals struggling to hear clearly often ask others to repeat themselves. It suggests difficulty perceiving speech, especially in noisy environments or when speaking softly. This symptom is particularly common in age-related or noise-induced hearing loss, where high-frequency sounds (like consonants) become harder to distinguish. However, since the question’s designated correct answer was only C, this explanation highlights a discrepancy in the provided answer key. In summary, tinnitus (C) is a correct sign of hearing loss due to its direct link to auditory system damage, while answering questions correctly (A) is irrelevant, and cerumen (B) is only indirectly related. The exclusion of frequent requests for repetition (D) as a correct answer is inconsistent with clinical evidence, as it is a primary behavioral sign of hearing difficulty.

Correct Answer: C

Rationale: Inspecting the skin for injury is the priority assessment for an immobile client because prolonged immobility significantly increases the risk of pressure injuries (formerly called pressure ulcers or bedsores). These injuries develop due to unrelieved pressure on bony prominences (e.g., sacrum, heels, elbows), which compromises blood flow to the tissues, leading to ischemia, necrosis, and potential infection. Early identification of skin breakdown—such as non-blanchable erythema, blisters, or open wounds—allows for timely interventions like repositioning, pressure-relieving devices, and wound care, preventing further complications. Immobility also reduces sensory feedback, meaning the client may not feel discomfort, making visual inspection critical. Palpating for edema (A) is important but not the priority. Edema can indicate fluid retention or circulatory issues, but it is a secondary concern compared to the immediate risk of skin breakdown. While edema may exacerbate pressure injuries, it does not pose as acute a threat as undetected tissue damage. Similarly, auscultating for bowel sounds (B) assesses gastrointestinal motility, which can be impaired in immobile clients (e.g., due to slowed peristalsis or constipation). However, bowel dysfunction is less urgent than preventing or addressing skin integrity issues, which can rapidly deteriorate and lead to systemic infections like sepsis. Auscultation of lung sounds (D) is crucial for detecting complications like atelectasis or pneumonia, which immobile clients are at higher risk for due to shallow breathing and poor secretion clearance. However, these respiratory issues typically develop over time, whereas skin breakdown can occur within hours of unrelieved pressure. While respiratory assessment is vital, it does not supersede the need for immediate skin inspection, as pressure injuries can progress quickly and are often preventable with prompt action. The incorrect choices (A, B, D) represent important but lower-priority assessments for an immobile client. They address potential complications of immobility but fail to target the most immediate and preventable risk. Skin inspection (C) is the priority because it directly addresses the client’s highest vulnerability—pressure injuries—which require proactive monitoring to avert severe consequences. This prioritization aligns with the nursing principle of addressing the most critical, life-altering risks first.

Correct Answer: D

Rationale: Administering eye drops correctly is critical for both medication efficacy and infection prevention. The action described in **Choice D (touching the dropper to the eye)** clearly indicates a need for further education because it introduces contamination risks. The dropper tip should never contact the eye, eyelids, or any other surface, as this can introduce bacteria or other pathogens into the medication bottle, leading to potential infections like conjunctivitis or keratitis. Proper technique involves holding the dropper close to the eye (about an inch away) without making direct contact to maintain sterility. **Choice A (setting the cap down without contaminating it)** is correct and does not require additional teaching. Placing the cap in a clean, dry location (e.g., upside down on a tissue) prevents contamination, ensuring the medication remains sterile. This demonstrates the client’s understanding of aseptic technique. **Choice B (dropping medication into the conjunctival sac)** is also correct. The conjunctival sac, the pocket formed by pulling down the lower eyelid, is the ideal location for instilling drops. This ensures proper absorption and minimizes spillage. The client’s ability to target this area correctly shows they have been taught the proper administration technique. **Choice C (washing hands before instilling drops)** reflects proper hygiene and is essential to prevent transferring pathogens from the hands to the eye. Handwashing reduces the risk of infection, and the client’s adherence to this step indicates they are following best practices. In summary, **Choice D** is the only option that reveals a critical error in technique, as it compromises sterility and increases infection risk. The other choices (A, B, and C) demonstrate correct practices that align with standard eye drop administration protocols. Clients must be reminded to avoid touching the dropper to the eye or any surface to maintain medication safety and effectiveness. Correcting this behavior is crucial to ensure therapeutic outcomes and prevent complications.