Tiêu đề RECALLS 8 - NP4 - SC ✅

48. Which situation makes the nurse suspect the client has glaucoma? A. An automobile accident because the client did not see the car in the next lane B. The cake tasted funny because the client could not read the recipe C. The client has been wearing mismatched clothes and socks D. The client ran a stoplight and hit a pedestrian walking in the crosswalk 49. The client has undergone a bilateral stapedectomy. Which action by the client warrants immediate intervention by the nurse? A. The client is ambulating without assistance B. The client is sneezing with the mouth open C. There is some slight serosanguineous drainage D. The client reports hearing popping in the affected ear 50. The client is diagnosed with glaucoma. Which symptom should the nurse expect the client to report? A. Loss of peripheral vision B. Floating spots in the vision C. A yellow haze around everything D. A curtain coming across vision 51. The nurse is administering eyedrops to the client. You know that no further teaching is needed when the patient states: A. “I will wash my hands before and after using the eye drops.” B. “I will tilt my head back and place the drops directly on my cornea.” C. “I will gently press on the inner corner of my eye after putting in the drops.” D. “I will share my eye drops with my spouse if we have the same symptoms.” 52. The client has had an enucleation of the left eye. Which intervention should the nurse implement? A. Discuss the need for special eyeglasses B. Refer the client for an ocular prosthesis C. Help the client obtain a seeing-eye dog D. Teach the client how to instill eyedrops 53. The client comes to the emergency department after splashing chemicals into the eyes. Which intervention should the nurse implement first? A. Have the client move the eyes in all directions B. Administer a broad-spectrum antibiotic C. Irrigate the eyes with normal saline solution D. Determine when the client had a tetanus shot 54. The client is scheduled for laser-assisted in situ keratomileusis (LASIK) surgery. Which instruction should the nurse discuss prior to the client’s discharge from day surgery? A. Wear bilateral eye patches for three (3) days B. Wear corrective lenses until the follow-up visit C. Do not read any material for at least one (1) week D. Teach the client how to instill corticosteroid ophthalmic drops 55. The nurse is placing patches on both eyes of a client with retinal detachment. What is the expected outcome of patching? A. Reduced rapid eye movements B. Decreased irritation caused by light entering the damaged eye C. Protection of the injured eye from infection D. Minimized eye strain on the uninvolved eye 56. Which statement indicates to the nurse the client is experiencing some hearing loss? A. “I clean my ears every day after I take a shower.” B. “I keep turning up the sound on my television.” C. “My ears hurt, especially when I yawn.” D. “I get dizzy when I get up from the chair.” 57. The client is diagnosed with Ménière’s disease. Which statement indicates the client understands the medical management for this disease? A. “After intravenous antibiotic therapy, I will be cured.” B. “I will have to use a hearing aid for the rest of my life.” C. “I must adhere to a low-sodium diet, 2,000 mg/day.” D. “I should sleep with the head of my bed elevated.” 58. The client is complaining of ringing in the ears. Which data are most appropriate for the nurse to document in the client’s chart? A. Complaints of vertigo B. Complaints of otorrhea C. Complaints of tinnitus D. Complaints of presbycusis 59. The nurse is preparing to administer otic drops into an adult client’s right ear. Which intervention should the nurse implement? A. Grasp the earlobe and pull back and out when putting drops in the ear B. Insert the eardrops without touching the outside of the ear C. Instruct the client to close the mouth and blow prior to instilling drops D. Pull the auricle down and back prior to instilling drops 60. Which ototoxic medication should the nurse recognize as potentially life-altering or threatening to the client? A. An oral calcium channel blocker B. An intravenous aminoglycoside antibiotic C. An intravenous glucocorticoid D. An oral loop diuretic 61. The client has ingested a corrosive solution containing lye. Which intervention should the nurse implement? A. Administer syrup of ipecac to induce vomiting B. Insert a nasogastric tube and connect to wall suction C. Assess for airway compromise D. Immediately administer water or milk 62. The male client was found in a parked car with the motor running. The paramedics brought the client to the ED with complaints of headache, nausea, and dizziness. The client is unable to recall his name or address. On assessment, the nurse notes the buccal mucosa is cherry-red. Which intervention should the nurse implement first? A. Check the client’s oxygenation level with a pulse oximeter B. Apply oxygen via nasal cannula at 100% C. Obtain a psychiatric consult to determine if this was a suicide attempt D. Prepare the client for transfer to a facility with a hyperbaric chamber 63. The nurse is providing first aid to a victim of a poisonous snake bite. Which intervention should be the nurse’s first action? A. Apply a tourniquet to the affected limb B. Cut an “X” across the bite and suck out the venom C. Administer a corticosteroid medication D. Have the client lie still and remove constrictive items 64. A patient was rushed to the OR. The patient’s mother said, “I saw her lying on the floor and I think she took all the Tylenol in the bottle.” As a nurse, you know that the antidote for Tylenol poisoning is: A. N-acetylcysteine (Mucomyst) B. Naloxone (Narcan) C. Flumazenil (Romazicon) D. Activated charcoal 65. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical unit. Which nursing task cannot be delegated to the UAP? A. Obtaining the intake and output on a client diagnosed with food poisoning B. Performing a dressing change on a client with a chemical burn C. Assisting a client who overdosed on morphine to the bedside commode D. Helping a client with carbon monoxide poisoning turn, cough, and deep breathe 66. The female client presents to the emergency department with facial lacerations and contusions. The spouse will not leave the room during the assessment interview. Which intervention should be the nurse’s first action? A. Call the security guard to escort the spouse away B. Discuss the injuries while the spouse is in the room C. Tell the spouse the police will want to talk to him D. Escort the client to the bathroom for a urine specimen 67. The nurse is teaching a class about rape prevention to a group of women at a community center. Which information is not a myth about rape? 4 | Page