A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new treatment regimen of timolol and pilocarpine eye drops. Which of the following instructions should the nurse provide?
Administer the medications 5 minutes apart.
Hold pressure on the conjunctival sac for 2 minutes following application of drops.
It is not necessary to remove contact lenses before administering medications.
Administer the medications by touching the tip of the dropper to the sclera of the eye.
The Correct Answer is A
Choice A: Administer the Medications 5 Minutes Apart
Administering the medications 5 minutes apart is crucial when using multiple eye drops. This practice ensures that each medication has enough time to be absorbed without being washed out by the subsequent drop. This is particularly important for medications like timolol and pilocarpine, which are used to manage intraocular pressure in glaucoma.
Choice B: Hold Pressure on the Conjunctival Sac for 2 Minutes Following Application of Drops
Holding pressure on the conjunctival sac (punctal occlusion) for 2 minutes after applying eye drops can help reduce systemic absorption and increase the local effect of the medication. However, this instruction is not as critical as the timing between administering different eye drops.
Choice C: It Is Not Necessary to Remove Contact Lenses Before Administering Medications
This statement is incorrect. Contact lenses should be removed before administering eye drops to prevent contamination and ensure proper absorption of the medication. The lenses can be reinserted after a sufficient amount of time has passed, usually around 15 minutes.
Choice D: Administer the Medications by Touching the Tip of the Dropper to the Sclera of the Eye
This statement is incorrect. The tip of the dropper should never touch the eye or any other surface to avoid contamination. The correct method is to hold the dropper above the eye and squeeze out the prescribed number of drops into the conjunctival sac.
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Correct Answer is D
Explanation
Choice A reason: Stop taking the pills and switch to a different contraceptive method:
This is not necessary for a single missed dose. Stopping the pills entirely and switching methods would be an overreaction and could lead to unnecessary complications. The standard recommendation for a missed dose is to take it as soon as remembered and continue with the regular schedule.
Choice B reason: Take a home pregnancy test:
Taking a home pregnancy test is not required immediately after missing a single dose of oral contraceptives, especially if it is the first week of the cycle. Pregnancy tests are typically recommended if there is a significant delay in the menstrual cycle or if multiple doses are missed.
Choice C reason: Do not have vaginal intercourse until after your next period:
This advice is overly cautious for a single missed dose. While it is important to use backup contraception if multiple doses are missed, abstaining from intercourse until the next period is not necessary for just one missed pill.
Choice D reason: Take the missed dose now, then continue the medication as ordered:
This is the correct course of action. According to guidelines, if a single hormonal pill is missed, it should be taken as soon as possible, and the next pill should be taken at the usual time. This may mean taking two pills in one day, but it ensures continuous contraceptive protection.
Correct Answer is C
Explanation
Choice A: Veracity
Veracity refers to the ethical principle of truthfulness and honesty. In the context of nursing, it involves providing accurate and complete information to patients. While veracity is crucial in maintaining trust between the nurse and the patient, it is not directly related to the decision to discontinue a medication due to adverse effects.
Choice B: Fidelity
Fidelity involves being faithful to commitments and promises made to patients. It includes maintaining confidentiality and being loyal to the patient’s best interests. Although fidelity is important in the nurse-patient relationship, it does not specifically address the ethical considerations involved in discontinuing a harmful medication.
Choice C: Nonmaleficence
Nonmaleficence is the ethical principle of doing no harm. In this scenario, discontinuing the experimental chemotherapy medication due to evidence of rapidly advancing kidney failure aligns with the principle of nonmaleficence. The nurse and healthcare team are acting to prevent further harm to the patient by stopping a treatment that is causing significant adverse effects.
Choice D: Autonomy
Autonomy refers to respecting the patient’s right to make their own decisions about their healthcare. This includes providing the patient with all necessary information to make informed choices. While autonomy is a fundamental ethical principle, the decision to discontinue the medication in this case is primarily based on preventing harm, which aligns more closely with nonmaleficence.