Which finding in an emergency department patient who reports ...

[maegan_martin]

Which finding in an emergency department patient who reports being struck in the right eye with a fist is a priority for the nurse to communicate to the health care provider?
 
  a. The patient complains of a right-sided headache.
  b. The sclera on the right eye has broken blood vessels.
  c. The area around the right eye is bruised and tender to the touch.
  d. The patient complains of a curtain over part of the visual field.

Question 2

The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient for many years. During the initial assessment of the patient, it is most important for the nurse to
 
  a. obtain more information about the cause of the patient's vision loss.
  b. obtain information from the spouse about the patient's special needs.
  c. make eye contact with the patient and ask about any need for assistance.
  d. perform an evaluation of the patient's visual acuity using a Snellen chart.

[mcabuhat]

Answer to Question 1

ANS: D
The patient's sensation that a curtain is coming across the field of vision suggests retinal detachment and the need for rapid action to prevent blindness. The other findings would be expected with the patient's history of being hit in the eye.

Answer to Question 2

ANS: C
Making eye contact with a partially sighted patient allows the patient to hear the nurse more easily and allows the nurse to assess the patient's facial expressions. The patient (rather than the spouse) should be asked about any need for assistance. The information about the cause of the vision loss and assessment of the patient's visual acuity are not priorities during the initial assessment.

[maegan_martin]

Gracias!

Excellent