HESI PN FUNDERMENTAL 3 EXAM

1. Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? 1. Chlorothiazide (Diuril) 2. Acetazolamide (Diamox) 3. Bendroflumethiazide (Naturetin) 4. Demecarium bromide (Humorsol) Acetazolamide is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in acute angle-closure glaucoma attack. Chlorothiazide and bendroflumethiazide have no effect on the eye. Demecarium bromide does not affect production of aqueous humor. 2. A client with a history of closed-angle glaucoma is scheduled for abdominal surgery. Because the client is extremely anxious, surgery is to be performed under general anesthesia. What should the nurse teach the client to do to prevent respiratory complications postoperatively? 1. Deep-breathing techniques 2. Performing productive coughing 3. Turning from side to side frequently 4. Pant breathing while gently closing the eyelids Deep breathing is an intervention to prevent respiratory complications that does not increase intraocular pressure. Coughing is contraindicated because it increases intraocular pressure. Although turning from side to side is permitted, it is not as effective as deep breathing in preventing respiratory complications. Pant breathing is shallow breathing and will not prevent respiratory complications. 3. A health care provider recently made the diagnosis that a client has glaucoma. The nurse is preparing to administer eye drops to the client. Which ophthalmic solution is contraindicated for this client? 1. Timolol 2. Atropine 3. Pilocarpine 4. Epinephrine Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucoma because it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker, decreases aqueous humor production; beta blockers are the preferred initial medications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constricts the pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent, enhances aqueous humor outflow, thereby reducing intraocular pressure. 4. A nurse is assessing a client with a diagnosis of dry age-related macular degeneration. Which ocular symptom should the nurse expect the client to report? 1. Attacks of acute pain 2. Constant blurred vision 3. Loss of central vision 4. Decreased peripheral vision The main characteristic of dry age-related macular degeneration is loss of central vision, which is gradual. Primary closed-angle glaucoma causes pain. Blurred vision may be caused by a refractive error. Loss of peripheral vision does not occur with macular degeneration. 5. The nurse is preparing to administer eardrops to a client that has impacted cerumen. Before administering the drops, the nurse will assess the client for which contraindications? Select all that apply. 1. Allergy to the medication 2. Itching in the ear canal 3. Drainage from the ear canal 4. Tympanic membrane rupture 5. Partial hearing loss in the affected ear Contraindications to eardrops include allergy to the medication, drainage from the ear canal, and tympanic membrane rupture. Partial hearing loss may occur with impacted cerumen and is not a contraindication to the use of eardrops. Itching may occur with some ear conditions and is not a contraindication to the use of eardrops. 6. A client has cataracts in both eyes. The plan is to extract the left cataract. What should the nurse include in the client's postoperative teaching plan? 1. Cover both eyes for 24 hours after surgery 2. Cough and deep breathe every 2 hours for at least 24 hours after surgery 3. Bed rest for 72 to 96 hours after surgery 4. Apply a hard patch over the left eye for six to seven days after surgery The eye shield will prevent injury to the newly operated eye. Only the affected eye will be covered. Coughing is contraindicated in clients who have had cataract surgery because it increases intraocular pressure. Bed rest is not necessary; routine activity and ambulation will not cause injury. 7. A client's relative asks the nurse what a cataract is. What explanation should the nurse provide? 1. An opacity of the lens 2. A thin film over the cornea 3. A crystallinization of the pupil 4. An increase in the density of the conjunctiva A cataract is a clouding of the crystalline lens or its capsule. A thin film over the cornea, a crystallinization of the pupil, and an increase in the density of the conjunctiva are not the pathophysiology related to cataracts. 8. The nurse is providing preoperative teaching for a client who is to have cataract surgery. Which is appropriate for the nurse to include concerning what the client should do after surgery? Select all that apply. 1. Remain flat for 3 hours. 2. Eat a soft diet for 2 days. 3. Breathe and cough deeply. 4. Avoid bending from the waist. 5. Do not blow your nose. The client needs to avoid activities that cause a sudden rise in intraocular pressure, such as bending from the waist, blowing the nose, sneezing, and coughing. It is not necessary to remain flat in bed for 3 hours after surgery, and the diet is not restricted. 9. A client is being prepared for discharge from an ambulatory surgical clinic after a cataract extraction and an intraocular lens implant. Which statement indicates to the nurse that the discharge teaching was effective? 1. "I should call the clinic if my eye begins to hurt." 2. "I am so glad that I can take a shower tomorrow." 3. "There will be bright flashes of light for a few days." 4. "My vision should show some improvement by tomorrow." Pain after a cataract extraction and intraocular lens implant may indicate infection or hemorrhage and should be reported immediately. Soap may irritate the eye, and showers or shampooing of the hair should be avoided as instructed, usually from several days to two weeks. Seeing bright flashes of light is a symptom of retinal detachment and is not expected. Although rapid vision improvement may occur in some people, others may require several weeks to achieve improved visual acuity. 10. After cataract surgery the nurse teaches a client how to self-administer eye drops. The nurse reinforces the use of what technique? 1. Placing the drops on the cornea of the eye 2. Raising the upper eyelid with gentle traction 3. Holding the dropper tip above the conjunctival sac 4. Squeezing the eye shut after instilling the medication Drops are placed within the lower lid (conjunctival sac). To protect against physical injury and infection, the dropper tip should not touch the eye. The lower lid is retracted for placement of eye drops. Squeezing the eyes shut after