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A nurse is caring for a client following cataract surgery. Which of the following comments from the client should the nurse report to the client’s provider?

A.

“My eye really itches, but I’m trying not to rub it.”.

B.

“The bright light in this room is really bothering me.”.

C.

“I’m afraid of falling.”.

D.

“I need something for the pain in my eye.

Answer and Explanation

The Correct Answer is D

Choice A rationale

 

Itching is a common symptom after cataract surgery, and the client should be reminded not to rub or place pressure on the eyes. This comment does not indicate a serious complication.

 

Choice B rationale

 

Sensitivity to bright light is also common after cataract surgery. The client can be advised to wear sunglasses to reduce discomfort. This comment does not indicate a serious complication.

 

Choice C rationale

 

Fear of falling is a valid concern, especially if the client has impaired vision or depth perception due to the eye patch. However, this comment does not indicate a serious complication that needs immediate reporting.

 

Choice D rationale

 

Severe pain in the eye after cataract surgery can indicate a complication such as increased intraocular pressure, infection, or hemorrhage. This comment should be reported to the provider immediately for further evaluation and intervention.

 


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View Related questions

Correct Answer is A

Explanation

Choice A rationale

A CD4-T-cell count of 180 cells/mm³ indicates severe immunosuppression in a client with HIV, making them highly susceptible to opportunistic infections. This is a critical value that requires immediate attention to prevent life-threatening complications.

Choice B rationale

A positive Western blot test confirms the presence of HIV antibodies but does not indicate the current immune status or the urgency of the client’s condition.

Choice C rationale

Platelets at 150,000/mm³ are within the normal range and do not indicate an immediate threat to the client’s health.

Choice D rationale

A WBC count of 5,000/mm³ is within the normal range and does not indicate an immediate threat to the client’s health.

Correct Answer is C

Explanation

Choice A rationale

Auscultating for wheezing is important but not the first action. The priority is to administer epinephrine to counteract the severe allergic reaction.

Choice B rationale

Assessing the client’s level of consciousness is important but not the first action. Administering epinephrine takes precedence to stabilize the client’s condition.

Choice C rationale

Administering epinephrine is the first action. It is crucial to counteract the severe allergic reaction and prevent further complications.

Choice D rationale

Monitoring for hypotension is important but not the first action. Administering epinephrine is the priority to stabilize the client’s condition.

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