Eyes
A 68-year-old reports gradual loss of peripheral vision and mild headaches. IOP is 24 mmHg. What is the priority nursing action?
What is administer prescribed eye drops to lower intraocular pressure?
A patient with vertigo, tinnitus, and ear fullness suddenly becomes dizzy while standing. What is the priority nursing action?
What is assist the patient to sit or lie down to prevent injury?
A patient presents with swelling, bruising, and inability to bear weight after twisting their ankle. What is the priority intervention?
What is initiate RICE (rest, ice, compression, elevation)?
A patient receiving a blood transfusion develops fever and chills within 10 minutes. What is the FIRST action?
What is stop the transfusion?
A patient presents with fatigue, pale skin, and PICA. What is the likely diagnosis?
What is iron-deficiency anemia?
A patient suddenly develops severe eye pain, blurred vision, and nausea. The eye appears red with a fixed pupil. What is the priority action?
What is treat as an emergency and prepare for rapid reduction of IOP (closed-angle glaucoma)?
A patient with Meniere’s disease asks what diet change will help reduce symptoms. What is the best answer?
What is reduce sodium intake?
A patient with a fracture reports severe pain unrelieved by medication and numbness in the extremity. What is the priority concern?
What is compartment syndrome?
A patient with thrombocytopenia needs medication. Which route should the nurse question?
What is intramuscular injection?
A patient with B12 deficiency reports numbness and tingling. What complication is the nurse concerned about?
What is neurological damage?
A post-op cataract patient bends over to tie their shoes and reports eye pressure. What is the priority education reinforcement?
What is avoid bending, straining, or lifting to prevent increased intraocular pressure?
A patient reports hearing better in noisy environments but struggles in quiet settings. What type of hearing loss is suspected?
What is conductive hearing loss?
A patient with a dislocated shoulder has absent pulses and pallor. What is the priority action?
What is notify provider immediately due to neurovascular compromise?
A patient with an open fracture arrives in the ED. What is the priority initial action?
What is cover the exposed bone with sterile saline dressing?
A patient with polycythemia has thickened blood. What is the priority intervention?
What is increase fluid intake?
A patient reports “floaters” and a shadow over their vision after eye trauma. What is the priority intervention?
What is prepare for urgent evaluation for retinal detachment?
A patient with sensorineural hearing loss is frustrated with communication. What is the best nursing strategy?
What is speak clearly and lower pitch (not louder)?
A patient with a long bone fracture develops sudden dyspnea, tachypnea, and petechiae. What is the priority intervention?
What is administer oxygen for suspected fat embolism?
A patient with compartment syndrome has the extremity elevated above heart level. What is the priority correction?
What is lower the extremity to heart level (do not elevate)?
A patient with platelet count of 18,000 develops petechiae. What is the priority concern?
What is risk for spontaneous bleeding?
After retinal repair surgery, a patient asks why they must avoid straining. What is the best response?
What is straining can increase pressure and disrupt retinal healing?
A patient with Meniere’s disease continues smoking and eating salty foods. Symptoms worsen. What concept is most important to reinforce?
What is lifestyle modification to prevent attacks?
A post-op hip replacement patient crosses their legs while sitting. What is the priority nursing action?
What is reposition immediately to prevent dislocation?
A patient post-amputation is at risk for hemorrhage. What must be readily available at bedside?
What is a tourniquet?
A patient with acute blood loss initially has normal hemoglobin levels. Why?
What is lab values lag and do not reflect acute loss immediately?