While completing a health history the client reports experiencing blurring of vision in both eyes without associated pain. What condition does the nurse suspect?

Correct Answer: B

Rationale: The client's report of bilateral, painless blurred vision strongly suggests cataracts as the most likely condition. Cataracts develop when the lens of the eye becomes cloudy, leading to progressive, painless vision impairment that typically affects both eyes (though often asymmetrically). This clouding scatters light entering the eye, causing blurred vision that may be described as looking through a foggy window. Cataracts are particularly associated with aging (age-related cataracts), but can also result from trauma, medications like steroids, or systemic conditions like diabetes. The bilateral presentation without pain aligns perfectly with cataract symptoms, as they rarely cause discomfort unless they reach an advanced stage. Macular degeneration (A) primarily affects central vision rather than causing generalized blurring, and typically presents with specific distortions like straight lines appearing wavy (metamorphopsia) or central scotomas (blind spots). While it can be bilateral, macular degeneration wouldn't typically cause symmetrical blurring without these distinctive features. Retinal detachment (C) usually presents with unilateral symptoms like sudden flashes of light (photopsia), floaters, or a "curtain" over the visual field rather than gradual bilateral blurring. While painless, retinal detachment is typically an acute event with distinct symptoms that differ from the described presentation. Glaucoma (D) in its most common form (open-angle) is indeed painless, but visual changes typically begin with peripheral vision loss, not generalized blurring. Angle-closure glaucoma can cause sudden blurring but is accompanied by severe pain, nausea, and halos around lights, making it inconsistent with this presentation. The key distinguishing factors here are the bilateral nature of symptoms, absence of pain, and the characteristic blurred (rather than lost) vision. Cataracts progress slowly, explaining why the blurring develops gradually without other symptoms. The lens opacity in cataracts affects all light entering the eye uniformly, unlike macular degeneration which targets central vision or glaucoma that attacks peripheral vision first. None of the other options present with this exact combination of features, making cataract the only plausible explanation among the choices given. Additional supporting evidence would include age (most common in those over 60), possible complaints of glare sensitivity, or difficulty with night vision—all hallmark symptoms of cataracts that further confirm this as the correct answer.

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: Atelectasis refers to the partial or complete collapse of lung tissue, often caused by inadequate lung expansion due to immobility, shallow breathing, or obstruction. Preventing atelectasis in clients with impaired mobility requires interventions that promote lung expansion and ventilation. **Option A (Assist the client to orthopneic position)** is correct because the orthopneic position—sitting upright and leaning slightly forward with arms supported on a table or overbed tray—maximizes lung expansion by reducing pressure on the diaphragm and allowing for deeper breaths. This position is especially beneficial for clients with respiratory compromise, as it improves alveolar ventilation and prevents the pooling of secretions that could lead to atelectasis. By facilitating deeper inhalation, it counteracts the shallow breathing patterns common in immobile clients. **Option B (Offer a protein-rich diet)** is incorrect because while nutrition is important for overall health and tissue repair, a protein-rich diet does not directly address the mechanical issue of lung collapse. Atelectasis is primarily a respiratory complication, not a nutritional one. Although proper nutrition supports immune function and healing, it does not improve lung expansion or secretion clearance, which are the primary mechanisms for preventing atelectasis. **Option C (Offer the client a bedpan for toileting)** is incorrect because using a bedpan does not promote lung expansion. In fact, prolonged bedpan use may contribute to immobility and discomfort, which can exacerbate shallow breathing. Encouraging mobility (e.g., assisting the client to a chair or commode) would be more beneficial for respiratory function, as movement helps stimulate deeper breathing and circulation. **Option D (Turn the client every 4 hours)** is incorrect because turning every 4 hours is insufficient to prevent atelectasis in most cases. While repositioning is important for preventing pressure injuries and improving circulation, it does not guarantee adequate lung expansion. More frequent turning (e.g., every 2 hours) combined with deep breathing exercises or incentive spirometry would be more effective. The orthopneic position is a more targeted intervention for directly addressing lung ventilation. The key to preventing atelectasis lies in interventions that actively promote lung expansion and secretion mobilization. The orthopneic position achieves this by optimizing the mechanics of breathing, whereas the other options either address unrelated needs or are insufficiently targeted to respiratory function.

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.