The nurse is caring for a child who reportedly got a wood chip in their right eye. The nurse should take which appropriate action?
The nurse is caring for a child who reportedly got a wood chip in their right eye. The nurse should take which appropriate action?
A. Rub the eye until the object dislodges
[1%]
B. Irrigate the affected eye with hydrogen peroxide
[13%]
C. Perform a visual acuity exam
[55%]
D. Place a cold compress on the affected eye
[31%]
Statistics
Subject/Lesson
Subject
Child Health
Lesson
Visual/Auditory
Client Need
Test Plan
Physiological Adaptation
Related Topic
Illness Management
Item Type
Item Type
Application
Explanation
Choice C is correct. Most eye injuries require a visual acuity exam which assesses a client's ability to read and identify distant objects. This is a standard assessment for any eye injury.
Choice A is incorrect. Rubbing the eye with a foreign body may cause an injury to the cornea causing further injury and can potentially push the foreign object deeper.
Choice B is incorrect. Hydrogen peroxide should not be used in the eye as it will cause serious injury. If the eye should be irrigated, sterile saline should be used.
Choice D is incorrect. Placing a cold compress on the eye is an intervention for an eye contusion.
Additional Info
✓ Keep the child as calm as possible, as anxiety and movement can worsen the situation. Provide reassurance to both the child and the parents.
✓ Instruct the child and parents not to attempt to remove the foreign object on their own, as this may cause additional harm. The removal should be performed by a healthcare professional.
✓ For a foreign object in the eye, the client should not rub the eye because the object may cause damage to the cornea.
✓A visual acuity examination should be obtained for any client with an ocular injury.
✓ To remove the object, have the client look upward, exposing the lower lid, wet a cotton-tipped applicator with sterile normal saline, gently twist the swab over the particle, and remove it.
✓ If the object has caused a corneal injury, prompt administration of ocular antibiotics will be necessary.
✓ Document all relevant information, including the details of the incident, actions taken, and the child's response. Accurate documentation is essential for continuity of care and communication among healthcare providers.
