What is correct health promotion education for vision? (Select all that apply)

Correct Answer: D

Rationale: Let’s analyze each choice to understand why **D (All of the Above)** is correct and why the other options, while partially correct, are incomplete on their own. 1. **Wear sunglasses to filter ultraviolet (UV) light (A):** This is a crucial health promotion measure for vision. Prolonged UV exposure can lead to cataracts, macular degeneration, and photokeratitis (sunburn of the cornea). Sunglasses with UV-blocking lenses protect the eyes from these harmful effects. However, this alone does not cover all aspects of eye health promotion. 2. **Avoid nonsteroidal anti-inflammatory drug (NSAID) use (B):** While NSAIDs are generally safe for short-term use, chronic or excessive use can cause ocular side effects, such as dry eye syndrome or, in rare cases, retinal hemorrhages. However, this is a more specific and situational recommendation—not everyone needs to avoid NSAIDs outright. It is a valid point for certain populations, but it’s not universally applicable like other options. 3. **Wash your hands before touching your eyelids (C):** Hand hygiene is essential to prevent infections like conjunctivitis (pink eye) or styes, which can result from transferring bacteria or viruses to the eyes. This is a fundamental practice for maintaining eye health, but similar to the other options, it’s only one part of a comprehensive strategy. **Why D (All of the Above) is correct:** Each option (A, B, and C) represents a valid health promotion measure for vision, but none alone cover all necessary precautions. Sunglasses protect against environmental damage, NSAID avoidance prevents medication-related risks, and handwashing reduces infection risks. Combining these measures ensures a holistic approach to eye health, addressing multiple potential threats. **Why A, B, or C alone are insufficient:** - Choosing **only A** neglects infection prevention (C) and medication risks (B). - Choosing **only B** ignores UV protection (A) and hygiene (C). - Choosing **only C** disregards environmental and medication-related risks (A and B). Thus, the most comprehensive and correct answer is **D**, as it integrates all three critical aspects of vision health promotion.

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: A

Rationale: The rationale for the correct answer and incorrect choices in this scenario is as follows: **Assess the right radial pulse (Correct Answer):** A crushing injury to the arm can lead to **compartment syndrome**, vascular damage, or nerve compression, all of which can compromise circulation and sensation. Numbness in the hand suggests possible **neurovascular impairment**, making immediate assessment of the radial pulse critical. The radial pulse is the most direct way to evaluate blood flow to the affected limb. If the pulse is weak, absent, or asymmetrical compared to the other arm, it indicates **ischemia** or **vascular injury**, requiring urgent intervention (e.g., surgical evaluation or compartment pressure measurement). Additionally, a diminished pulse alongside numbness supports the possibility of **nerve compression secondary to swelling or hematoma**. Thus, assessing circulation first ensures timely detection of life- or limb-threatening complications before proceeding with other interventions. **Call the provider (Incorrect Choice):** While notifying the provider is necessary, it should not be the *first* action without initial assessment data. The nurse must first **gather objective findings** (e.g., pulse strength, capillary refill, motor function) to provide the provider with a complete clinical picture. Calling without assessment risks delays in critical information, potentially leading to miscommunication or inadequate urgency in the provider’s response. For example, if the radial pulse is absent, the nurse can immediately escalate the situation as an emergency; if present, they may instead report stable findings with ongoing monitoring. **Administer pain medication (Incorrect Choice):** Pain management is important but **not the priority** in this case. Numbness, rather than pain, is the primary symptom, signaling potential **neurovascular compromise** rather than just tissue damage. Administering analgesics (especially opioids) could mask worsening symptoms (e.g., increasing pain unrelieved by medication, a red flag for compartment syndrome). Additionally, analgesics do not address the underlying cause of numbness, which could escalate to permanent damage if circulation is not restored promptly. Pain relief should follow *after* ensuring perfusion and nerve function are intact. **Assess the right pedal pulse (Incorrect Choice):** The pedal pulse is irrelevant in this context because the injury is localized to the **arm**. Assessing a lower extremity pulse would not provide information about vascular integrity in the affected limb. While systemic circulation checks (e.g., blood pressure) are part of trauma assessments, the focus here must be on the **right arm’s neurovascular status**. A pedal pulse assessment delays critical evaluation of the injury site and could result in missing signs of **compartment syndrome or arterial occlusion** specific to the arm. In summary, the correct sequence is to **first assess the radial pulse** to determine circulatory integrity, then proceed with provider notification or interventions based on findings. The incorrect choices either delay essential assessment, address non-urgent needs, or focus on unrelated systems, potentially compromising patient outcomes.

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.