ARCHER PRACTICE QUESTIONS #1

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

A nurse at a community clinic is taking care of a 34-year-old patient who has been prescribed oral prednisone to treat respiratory issues. What education should the nurse include concerning the possible side effects of this medication? Select all that apply. Increased susceptibility to infection Weight gain Insomnia Blood glucose elevation

A is correct. Prednisone is a corticosteroid that suppresses the immune system, making the patient more susceptible to infections. B is correct. Prednisone can increase appetite, which can lead to weight gain. It can also cause fluid retention and redistribution of fat, contributing to weight gain. C is correct. Prednisone can affect the sleep-wake cycle, causing difficulty sleeping or insomnia. D is correct. Prednisone can raise blood sugar levels, potentially leading to or exacerbating diabetes. Choice E is incorrect. E is incorrect. Prednisone does not typically increase urine output. This is more commonly associated with diuretics. Prednisone can, however, cause fluid retention.

The nurse in the outpatient clinic is assessing a client with systemic lupus erythematosus (SLE). Which laboratory data is essential for the nurse to monitor to determine if the client is experiencing a complication? A. urine analysis B. hemoglobin A1C (HbA1C) C. thyroid-stimulating hormone (TSH) D. ammonia

Choice A is correct. A common complication associated with SLE is the development of lupus nephritis. Glomerular injury is seen in lupus nephritis because of the significant inflammation caused by this condition. The client with SLE should have routine urine analysis because evidence of lupus nephritis would consist of proteinuria and microscopic hematuria. Other laboratory testing pointing to lupus nephritis would be an elevated creatinine and decreased glomerular filtration rate. Lupus nephritis may be so aggressive that it may cause an individual to need a kidney transplant. Choice B is incorrect. The hemoglobin A1C is not a routine laboratory test monitored for a client with SLE. This test is performed for a client with diabetes mellitus or to determine if a client has diabetes. Choice C is incorrect. Thyroid problems may coexist with SLE, but thyroid problems, such as hypothyroidism, are not categorized as a complication; instead, it is a comorbidity. Additional Info ✓ SLE is a multisystem disease that is highly complex because of its multiorgan involvement. ✓ SLE may cause a client to develop complications such as lupus nephritis, pleuritis, anemia, pericarditis, myocarditis, and vasculitis. ✓ Lupus nephritis is a common complication and can be detected with routine urine analysis (UA). A UA that shows proteinuria and microscopic hematuria requires follow-up. ✓ Increased serum creatinine and decreased glomerular filtration rate also are concerning for lupus nephritis.

The nurse is caring for a client who has developed retinal detachment. Which of the following actions should the nurse take first? A. Instruct the client to restrict activity B. Establish a vascular access device C. Review the client's current medications D. Educate the client about topical eye ointments

Choice A is correct. A retinal detachment is an ocular emergency. The client moving may hasten the detachment. It is important to inform the client to restrict their activity, and the nurse should apply an eye patch to the affected eye. Choices B, C, and D are incorrect. A client with a retinal detachment will likely need surgery. Obtaining the client's current medications, establishing vascular access, and educating the client about topical eye ointments that will be prescribed does not prioritize over instructing the client to restrict their head movements. Delaying the instruction of informing the client to restrict their head movements may worsen the detachment. Additional Info ✓ A retinal detachment is a serious ocular condition that occurs suddenly and is painless. ✓ The client often describes bright flashes of light or floating dark spots in the eye. ✓ Aging and ocular injury are common causes of retinal detachment. ✓ The client should seek emergent medical treatment, as surgery is the remedy.

The nurse is providing teaching to a student nurse about the immune system. Which of the following is the best example of natural adaptive immunity? A. Cell-mediated response B. Lymphocyte creation C. Inflammatory response D. The flu vaccine

Choice A is correct. Cell-mediated immunity is the best illustration of natural adaptive immunity. This immunity is spurred by cytokines and T-lymphocytes and doesn't include antibodies. Choices B and C are incorrect. These involve cytokines and antibodies, and so are often considered non-specific. Choice D is incorrect. Humoral responses to vaccines are referred to as artificially acquired adaptive immunity.

The nurse has received a prescription to administer intramuscular (IM) epinephrine. The nurse understands that this medication effects the A. adrenergic receptors. B. muscarinic receptors. C. cholinergic receptors. D. nicotinic receptors.

Choice A is correct. Epinephrine rapidly affects both alpha and beta-adrenergic receptors, eliciting a sympathetic response. Epinephrine is a hormone secreted by the medulla of the adrenal glands. Strong emotions such as fear or anger cause epinephrine to be released into the bloodstream, which causes an increase in heart rate, muscle strength, blood pressure, and sugar metabolism. Choice B is incorrect. Muscarinic receptors are cholinergic receptors and are primarily located at parasympathetic junctions. Choice C is incorrect. Cholinergic receptors respond to acetylcholine stimulation. Cholinergic receptors include muscarinic and nicotinic receptors. Choice D is incorrect. Nicotinic receptors are cholinergic receptors activated by nicotine and found in autonomic ganglia and somatic neuromuscular junctions.

The nurse is caring for a client receiving mechanical ventilation receiving fentanyl and midazolam. Which of the following assessment findings would indicate fentanyl toxicity? A. Constricted pupils B. Hypertension C. Coarse Tremors D. Diarrhea

Choice A is correct. Fentanyl is an opioid. A clinical feature of opioid toxicity includes central nervous system depression that manifests as lethargy leading to somnolence. Further, the client will have pupillary constriction, bradypnea, and decreased gastrointestinal motility. While opioids cause pupillary constriction, this would also be a finding in toxicity. Since this client receives mechanical ventilation, respiratory depression would not be a reliable finding. Choices B, C, and D are incorrect. Manifestations of opioid toxicity would consist of hypotension, not hypertension, because of the effects of histamine. Tremors and diarrhea are not a finding consistent with opioid toxicity.

The nurse is caring for a client scheduled for surgery who is nothing by mouth (NPO) status. Which of the following prescription should the nurse clarify with the primary healthcare physician (PHCP)? A. Lispro insulin 5 units SubQ TID B. Glargine insulin 15 units SubQ QHS C. Vitamin B12 100 mcg IM Daily D. Clonidine patch transdermal TTS-1 0.1 mg/24 hours q 7 days

Choice A is correct. For a client who is NPO awaiting surgery, they should not receive rapid or short-acting insulin. This insulin is intended to be given before meals, and the client could develop life-threatening hypoglycemia if they are given this type of insulin with no meal. When a client is NPO, while a medication tray may not arrive, the medication order does not get suspended. Thus, this requires follow-up. Choices B, C, and D are incorrect. Glargine insulin is long-acting and has no peak. This basal insulin is appropriate to give to a client who is NPO. It is quite unlikely that the client would develop hypoglycemia with this insulin because it has no peak. Vitamin B12 IM may be given to a client as it is given parenterally. Finally, the clonidine patch may be applied to this client because it is not absorbed orally. This patch is applied for seven days and changed as prescribed thereafter.

The nurse is planning a staff development conference about multimodal analgesia. Which of the following information should the nurse include regarding the purpose of this approach? A. This treatment involves the use of two or more classes of analgesics or interventions B. Drugs that have a primary indication other than pain but are analgesics for some painful condition C. Dosing of analgesics for pain that is of a continuous nature D. Allows clients to treat their pain by self-administering doses of analgesics

Choice A is correct. Multimodal analgesia is when drugs from two or more medication classes target different pain mechanisms. For example, a client has been prescribed gabapentin (anti-convulsant), naproxen (NSAID), and duloxetine (SNRI) to achieve appropriate pain control. The benefit of this approach to pain management is that it reduces the reliance on a single medication. A multimodal approach also provides the same relief as a single agent and may delay medication tolerance. A multimodal approach may also involve nonprescriptive interventions such as biofeedback, yoga, etc. Choice B is incorrect. Adjuvant medications are drugs with a primary indication other than pain but are analgesics for some painful conditions. An example would be a client being prescribed duloxetine (SNRI) for a client with chronic back pain. This is not the purpose of this medication, but it is helpful in individuals with chronic pain. Choice C is incorrect. Dosing of analgesics for pain that is continuous describes around-the-clock pain control (ATC). This approach aims to provide the client with optimal pain control without troughs. An example is extended-release pain medication (fentanyl patch, oxycodone-ER). Choice D is incorrect. Allowing clients to treat their pain by self-administering analgesics would describe patient-controlled analgesia, which delivers a prescribed dose of an analgesic when they press a button.

The nurse is reviewing a care plan for a client with chronic pain receiving morphine sulfate. Which of the following aspects in the plan of care require revision? A. Adjust the physician's order based on the client's pain level B. Ensure naloxone is always available C. Check the client's blood pressure before administering morphine sulfate D. Provide a high-fiber diet

Choice A is correct. Pain medication orders may be titrated based on the client's pain level. However, the nurse cannot adjust the physician's order based on the client's pain level. If the nurse wants to adjust the dosage, the nurse will need the physician to adjust the prescription. Choice B is incorrect. Naloxone, an opioid antagonist, should always be available as an antidote to opioids and to treat opioid overdose, including events occurring with morphine sulfate. Choice C is incorrect. Morphine sulfate has a vasodilation effect, which may, in turn, lower blood pressure. Prior to administering this medication, the nurse should assess the client's blood pressure and respiratory rate. Choice D is incorrect. Morphine sulfate diminishes propulsive peristaltic waves in the gastrointestinal tract, often resulting in constipation. Therefore, a high-fiber diet should be given to prevent this complication.

The nurse is assessing a child with reports of right eye irritation, drainage, and itchiness. This client is at highest risk for developing A. conjunctivitis. B. amblyopia. C. nystagmus. D. ocular herpes.

Choice A is correct. This client is demonstrating classic manifestations of conjunctivitis. Conjunctivitis is characterized by Itching, burning, or scratchy eyelids. Additionally, the client has drainage to the affected eye(s), a common conjunctivitis finding. Choice B is incorrect. Amblyopia, also known as 'lazy eye,' is not an infectious process and is characterized by differences between the two eyes in their ability to focus. Choice C is incorrect. Nystagmus is also a condition that is not infectious and is characterized by repetitive and uncontrolled movements of the eye. Choice D is incorrect. Ocular herpes is a viral infection that does not produce drainage. This infection causes the development of vesicles. Additional Info ✓ The clinical features of conjunctivitis are redness and swelling of the conjunctiva, eyelid edema, and discharge. ✓ Conjunctivitis may be viral (in most cases), bacterial, or allergic. ✓ Treatment is aimed at the underlying cause, which includes ophthalmic antibiotics for bacterial conjunctivitis. ✓ Symptomatic measures that can be taken to mitigate discomfort include intermittent wiping of the eye to remove debris (wipe inner canthus > outer). ✓ Additionally, for viral and bacterial causes, the nurse should stress the importance of meticulous hand hygiene to prevent the spread of the infection. ✓ The client should be instructed not to wear contact lenses during the infection.

The nurse is providing discharge instructions to a client who underwent left eye cataract surgery with a lens implant. Which statement by the client would indicate a correct understanding of the teaching? A. "I should avoid getting water in the eye for 3 to 7 days after surgery." B. "It is okay for me to resume normal chores such as vacuuming." C. "It is okay for me to have green or yellow, thick drainage from the eye." D. "I may take aspirin for any pain I may experience."

Choice A is correct. This statement indicates effective teaching by the nurse. Following cataract surgery, the client should not get water in the affected eye for three to seven days. This measure will reduce the potential for infection. Choices B, C, and D are incorrect. Following cataract surgery, the client may resume light chores, but activities that may increase the intraocular pressure (normal is 10-21 mm Hg), such as vacuuming, should be avoided for several weeks because of the forward flexion involved and the rapid, jerky movements. Other activities that may raise the intraocular pressure that should be suspended include lifting objects heavier than 10 pounds, straining, vomiting, sexual intercourse, and keeping the head in a dependent position. Creamy, white drainage is normal that may cause crusting (especially in the morning); however, yellow or green drainage is suggestive of infection. Aspirin should not be taken because of its impact on blood clotting; acetaminophen is preferred for pain control. Cool compresses and acetaminophen are generally permitted. Additional Info ✓ Following cataract surgery, the nurse should educate the client about the prescribed eye drops they will need. It is helpful to write this information out so it may be later referenced. ✓ The nurse should emphasize the need for appropriate follow-up. ✓ Most clients experience a dramatic improvement in their vision following this procedure. However, the maximum benefit may be delayed for up to several weeks. ✓ The nurse should instruct the client to avoid activities that can raise the IOP, such as sexual intercourse, tight shirt collars, and straining during a bowel movement.

The nurse is teaching a parent of a child with recurrent otitis media. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply. "Keeping my child current on their vaccine schedule will be important." "My child should wash their hands with soap and water or hand sanitizer frequently." "My child should not wear headphones." "I will make sure my child receives annual hearing examinations." "I will have my child wear a cap while swimming in a pool."

Choice A is correct. Vaccinations, such as the pneumococcal conjugate vaccine (PCV) and influenza vaccine, can help reduce the risk of ear infections in children. They are appropriate interventions for a child at risk for recurrent otitis media. Choice B is correct. Good hand hygiene practices, such as washing hands regularly, and teaching proper respiratory etiquette, like covering the mouth and nose when coughing or sneezing, can help prevent the spread of infections, including those that can cause ear infections. Choice C is incorrect. Headphones and prolonged loud music/noise exposure have been linked to sensorineural hearing loss. This has not been linked to otitis media, an infectious condition caused by pathogens such as Streptococcus pneumoniae. Choice D is incorrect. Hearing examinations may detect hearing loss. However, they are not a preventative measure for otitis media. Choice E is incorrect. Swimming caps should be used to prevent contaminated water from entering the ear. This is a preventative measure for this infection, known as "swimmer's ear" or otitis externa, not otitis media.

The nurse is caring for a client newly diagnosed with Cushing's disease. Which of the following client statements requires follow-up? A. "I will need to eat more potassium-rich foods." B. "I will need more steroids during periods of stress." C. "I will be at a higher risk for an infection." D. "I should do weight-bearing exercises."

Choice B is correct. A client with Cushing's disease has too many steroids and will have manifestations such as central obesity, weight gain, hypokalemia, hypernatremia, and hypertension. The client will not need more steroids during periods of stress as this is necessary for a patient with Addison's disease to prevent a crisis. Choices A, C, and D are incorrect. A client with Cushing's disease will need to eat more potassium-rich foods because of the potassium elimination associated with the high aldosterone levels. Excessive cortisol levels may cause immunosuppression thus, enabling opportunistic bacterial infections. The client should be instructed to do weight-bearing exercises because Cushing's may cause loss of bone density.

The nurse is providing discharge instructions to a client who has chronic diabetes insipidus (DI). Which of the following client statements would indicate a correct understanding of the discharge instructions? A. "I will need to drink no more than 800 ml per day." B. "I will need to weigh myself at the same time every day." C. "I should increase salty snacks in my diet." D. "I need to log my daily fluid intake."

Choice B is correct. A client with chronic diabetes insipidus (DI) must weigh themselves daily. This weight should be taken with the same scale and obtained after the first-morning void. Weight is the most accurate assessment relevant to fluid volume status. Choices A, C, and D are incorrect. Fluid restrictions would be appropriate for clients with inappropriate antidiuretic hormone (SIADH) syndrome. This is because, in SIADH, the client has excessive water, which causes dilutional hyponatremia. Restricting fluid intake would not be appropriate for a client with DI, as the client will need to consume more fluids because of the polyuria. Salty snacks are not encouraged because this may hasten the hypernatremia associated with this disease. Intake and output are crude ways of assessing fluid status. Even then, having the client log their fluid intake is incomplete as they must log their intake and output.

A client in the medical ward developed sudden hypotension, difficulty breathing, and cyanosis shortly after receiving an intravenous penicillin infusion. Based on the nurses' understanding of anaphylactic reactions, what can the nurse conclude is the cause of this reaction? A. Potent antibodies formed when the antibiotic was infused into the client during this infusion. B. The client was previously exposed to penicillin, enabling their body to produce antibodies. C. The client developed passive immunity to penicillin. D. Atopic sensitization occurred.

Choice B is correct. Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction occurring in previously sensitized clients following reexposure to the sensitizing antigen. Hypersensitivity reactions occur when antibodies are formed through previous exposure to an allergen. Therefore, based on this information, this client has, at some point (either during this admission or at some point in the past), received penicillin previously. Anaphylactic reactions do not typically occur after the initial exposure to an allergen (i.e., the substance that triggers an allergic reaction). Most often, anaphylaxis occurs following a client's subsequent exposure to the allergen. Of note, many clients do not recall their first exposure to the allergen in question (especially non-medicinal allergens). Choice A is incorrect. Anaphylactic reactions do not typically occur during (or following) the initial exposure to an allergen (i.e., here, the penicillin infusion). Most often, anaphylaxis occurs following a client's subsequent exposure to the allergen. Therefore, this client more than likely formed antibodies during a prior exposure to penicillin, not during the current exposure, causing the reaction following this exposure to the allergen (i.e., the penicillin).

The nurse cares for a client immediately following a shoulder reduction procedure with moderate sedation. The nurse assesses the client as restless and irritable. The nurse should take which priority action? A. Assess the client for pain B. Assess the client's oxygen saturation C. Assess the client with the Glasgow Coma Scale (GCS) D. Assess the client's lung sounds

Choice B is correct. Assessing the client's oxygen saturation is essential because this client is demonstrating manifestations of hypoxia. Early signs of hypoxia include altered mental status and restlessness. Moderate sedation uses multiple medications, such as fentanyl and propofol, to achieve a state of altered consciousness, so procedures like shoulder reductions may be completed with very little pain. These medications are CNS depressants, and during the procedure, the client is often given supplemental oxygen. Post-procedurally, the nurse will monitor the client's vital signs very closely. Choices A, C, and D are incorrect. Assessing the client's pain level, GCS, and lung sounds will not clue the nurse into the most serious problem of hypoxia. These are key assessments but are not the priority when looking at the client's airway, breathing, and circulation.

The nurse is discussing the risk of wound disruption following surgery with another healthcare team member. It would be correct for the nurse to identify which condition is a potential cause of this complication? A. Diabetes insipidus B. Cushing's syndrome C. Hemophilia D. Inflammatory bowel disease

Choice B is correct. Excessive corticosteroids characterize Cushing's syndrome. Exposure to the corticosteroid suppresses the production of white blood cells, which inhibits them from migrating to the wound bed. Cushing's also is characterized by high blood glucose levels, which delay healing. An example of a wound disruption would be dehiscence. Choices A, C, and D are incorrect. Diabetes insipidus would not increase the risk of wound disruption, whereas diabetes mellitus would increase the risk of poor wound healing, especially if the diabetes is uncontrolled. Hemophilia is a genetic blood clotting disorder and does not directly cause poor wound healing. Inflammatory bowel disorder is a broad term for Crohn's or Ulcerative Colitis. These conditions do not directly lead to poor wound healing like Cushing's syndrome.

The nurse is reviewing acetaminophen (APAP) toxicity with students. The nurse should remind students that the maximum acetaminophen dosage for an adult is A. 2,000 mg per day B. 4,000 mg per day C. 5,000 mg per day D. 6,000 mg per day

Choice B is correct. The ceiling for acetaminophen dosing is no more than 4,000 mg every 24 hours. The symptoms of APAP toxicity may peak within 72-96 hours after ingestion. Choices A, C, and D are incorrect. Acetaminophen overdosing requires the support of the poison control center and this agency is often consulted during overdoses. The client needs to be cautioned that unintentional APAP overdoses can be avoided by thoroughly reading the packaging material of over-the-counter medications. Often cough and cold remedies contain APAP as an active ingredient.

The nurse reviews a client's laboratory data before a scheduled surgery. Which laboratory data requires immediate follow-up? See the exhibit. A. Sodium level B. Potassium level C. Blood Urea Nitrogen (BUN) D. Creatinine

Choice B is correct. The client's potassium is considerably low and should be reported to the provider. A client scheduled for surgery must have a complete blood count (CBC) and a complete metabolic panel (CMP) to determine if any abnormalities are evident. The potassium being low requires follow-up. Choice A is incorrect. The client's sodium level is marginally low and does not pose a threat compared to the low potassium. Choice C is incorrect. The BUN of 8 mg/dL (2.856 mmol/L) [10-20 mg/dL, 2.5 to 7.1 mmol/L] does not pose a problem to the client, as an elevation indicates renal insufficiency or dehydration. Choice D is incorrect. The creatinine level is slightly elevated but does not pose a serious concern compared to the low potassium level.

The nurse is caring for a client who is two days postoperative following a right femoral popliteal bypass surgery. The client reports worsening pain, and the assessment showed swelling and ecchymosisat the incision sites. The nurse should initially A. Apply pressure to sites with sandbag B. Palpate pedal pulses C. Assess for signs of claudication D. Apply warm compress to incision sites

Choice B is correct. The most significant postoperative complication includes thrombus, hemorrhage, infection, and arrhythmias. Mild to moderate swelling, bruising, and pain at the surgical site are expected and typically resolve over time as the leaked blood is reabsorbed. The most important action would be to assess the client's pedal pulses (distal to incisions) to assess the client's distal circulation. Choice C is incorrect. Intermittent claudication is a cramp-like pain in the leg or buttock during activity due to poor blood supply. This sign of arterial disease should hopefully be resolved with the surgery. Additional Info ✓ Following a femoral-popliteal bypass graft, the priority is performing frequent neurovascular assessments of the affected extremity ✓ The nurse should assess the distal pulse, the temperature of the extremity, and the client's sensation ✓ A significant complication after this surgery is occlusion of the graft. This may occur within the first 24 hours after surgery. ✓ If the operative leg feels cold, becomes pale, ashen, or cyanotic, or has a decreased or absent pulse, the nurse should notify the rapid response team and contact the surgeon.

The nurse is caring for an infant following a cheiloplasty. Which supply item should the nurse have at the bedside following this procedure? A. Nasogastric tube (NGT) B. Bottle of sterile water C. Suction equipment D. Tracheostomy

Choice C is correct. A cheiloplasty is a procedure to repair a cleft lip (CL). This procedure is typically done by age three to six months. A concern after this procedure is that the child may have excessive secretions that may trigger aspiration. The nurse should have a bulb syringe or some other suction equipment available if the infant begins to choke. While routine suctioning is not done to minimize pain or trauma, this is necessary to have it available to prevent respiratory distress. Choices A, B, and D are incorrect. An NGT is not necessary following this procedure. Following a CL repair, some infants can return to breastfeeding or bottle feeding, where some may have to be fed via a syringe. A bottle of sterile water is necessary if a client has a chest tube and it becomes disconnected from the drainage system. A chest tube is not used in this surgery. A tracheostomy is necessary at the bedside for a client immediately after a thyroidectomy, which may be used if the client gets airway edema.

The nurse is caring for a 1 year old client diagnosed with acute otitis media. The client is experiencing otalgia, has been febrile for 24 hours, and is pulling at his left ear. Which intervention is the priority nursing action? A. Position the child on his left side B. Administer antibiotic ear drops C. Administer acetaminophen as prescribed D. Apply a heat pack to the left ear

Choice C is correct. Administering acetaminophen is the priority nursing action in this scenario. The question states that the patient has been febrile for 24 hours. It is the priority of the nurse to address this concern; the nurse can do so through the administration of the antipyretic acetaminophen. Choice A is incorrect. Positioning the child on his left side is not the priority. This position is appropriate however because the child is pulling at his left ear indicating that is the affected side, so positioning on the left side will promote drainage of fluids from that ear. With that being said, there is another option with a higher priority. Choice B is incorrect. Antibiotic ear drops are not used to treat acute otitis media. Systemic antibiotics are used to treat acute otitis media infections with a bacterial cause. Amoxicillin, erythromycin, and cefixime are all systemic antibiotics that may be utilized, but antibiotic ear drops are not effective.

The nurse is assessing a client with age-related cataracts. Which of the following assessment findings would support this diagnosis of age-related cataracts? A. peripheral vision loss B. central vision loss C. difficulty seeing at night, especially while driving D. blurred vision with headache

Choice C is correct. Age-related cataracts are caused by the formation of opacities in an individual's lens. Almost all individuals who are 75 have some degree of cataracts. Age-related cataracts are painless and include the individual reporting blurred vision, difficulty driving (especially at night), and decreased color perception. Cataracts are progressive and may be treated with an outpatient procedure (phacoemulsification). Choice A is incorrect. Peripheral vision loss is a characteristic of glaucoma. This is not a manifestation consistent with cataracts. Choice B is incorrect. Central vision loss is consistent with macular degeneration. This is not a manifestation consistent with cataracts. Choice D is incorrect. Age-related cataracts are painless, and although the client will have blurring of their vision, headache is not an expected finding.

The nurse has received a prescription for celecoxib. Which finding in the client's medical history should prompt the nurse to question the administration of this medication? A. osteoarthritis B. gout C. recent myocardial infarction D. migraine headaches

Choice C is correct. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) used to treat osteoarthritis, gout, dysmenorrhea, and migraine headaches. NSAIDs cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction (MI) and stroke. Choice A is incorrect. Osteoarthritis and rheumatoid arthritis are approved indications for NSAIDs. This is an appropriate indication for celecoxib and does not require follow-up. Choice B is incorrect. Gout attacks can be managed by administering prescribed antiinflammatories such as naproxen, colchicine, or ibuprofen. This is an appropriate indication for celecoxib and does not require follow-up. Choice D is incorrect. During an acute migraine headache, the client may be prescribed an NSAID, such as celecoxib. This is an appropriate indication for celecoxib and does not require follow-up.

The nurse is caring for a client who is 24 hours postoperative following a left total knee replacement.Which assessment data would indicate that the client is ready for discharge? A. Pulse (P) 102, RR 18, BP 104/72 mm Hg B. Urine output of 200 mL in the past 8 hours C. Lung bases are clear upon auscultation D. The client rates left knee pain as 8/10 on the Numerical Rating Scale

Choice C is correct. Clear lung bases indicate adequate gas perfusion and suggest normal progression of postoperative recovery. Inadequate gas perfusion would increase the risk of complications and slow healing. Choice A is incorrect. The client's heart rate is slightly elevated, whereas the blood pressure is at the lower end of normal. The primary focus is the client's tachycardia. Tachycardia is an early warning sign for dehydration, sepsis, or shock. Choice B is incorrect. Urine output should be at least 30 mL/hour or 240 mL in 8 hours. A urine output of 200 mL for 8 hours would be too low, which indicates that intervention is needed. The provider should be notified so that the potential causes of decreased urinary output (dehydration, acute renal failure) can be explored. Choice D is incorrect. Localized pain is expected following total knee replacement surgery but should not be consistently at the 8/10 level. Such assessment data would indicate ineffective pain management. Pain control should be optimized.

The nurse is preparing to admit a client following lumbar spinal fusion surgery. The nurse should instruct the unlicensed assistive personnel (UAP) to have which equipment at the bedside? A. Overhead trapeze B. Abduction pillow C. Transfer board D. Continuous passive motion (CPM)

Choice C is correct. Following a lumbar spinal fusion, the client will need to be log rolled. A transfer board/sheet, along with an ample amount of staff (at least three), will be necessary to facilitate the log roll. Choices A, B, and D are incorrect. None of this equipment is necessary following a lumbar spinal fusion. A trapeze is helpful if a client were to have a lower extremity amputation. Further, an abduction pillow may be warranted after hip arthroplasty. Finally, a CPM may be indicated following a joint replacement.

The intensive care unit (ICU) nurse is preparing to admit a client with Guillain-Barre syndrome. Which of the following items is essential for the nurse to have at the client's bedside? A. blood pressure cuff B. pulse oximeter C. oral intubation equipment D. arterial blood gas (ABG) supplies

Choice C is correct. For a client with Guillain-Barre syndrome, the nurse is concerned about the paralysis potentially involving the diaphragm. Paralysis of the diaphragm may lead to respiratory failure, and the nurse should ensure that oral intubation equipment is readily available if the paralysis impacts the diaphragm. Choice A is incorrect. A blood pressure cuff is helpful to have on hand but not the highest priority in a client with ascending paralysis related to Guillain-Barre syndrome. Choice B is incorrect. A pulse oximeter is helpful to have on hand but not the highest priority in a client with ascending paralysis related to Guillain-Barre syndrome. Choice D is incorrect. Performing ABGs on a client with GBS is not routine. While this may be done if the client requires ventilatory support, this is not the most essential item to have readily available compared to oral intubation equipment.

The nurse is caring for a client immediately followinghypophysectomy. The nurse should position the client A. Trendelenburg B. Side-lying C. high-Fowler's D. Reverse Trendelenburg

Choice C is correct. Hypophysectomy is generally performed via the transsphenoidal route to remove tumors from the pituitary gland. Semi-Fowler's to Fowler's position is the most appropriate as it facilitates drainage. Choices A, B, and D are incorrect. These positions would be contraindicated after hypophysectomy. The goal of positioning the client semi- of high-Fowlers is to decrease edema and facilitate gas exchange.

The nurse is caring for a client who is immediately postoperative following a colon resection with the placement of a colostomy. Which of the following client problems are of greatest concern? A. Infection B. Thermoregulation C. Hemorrhage D. Altered body image

Choice C is correct. Immediately postoperative clients run the risk of airway, breathing, and circulation compromise. Surgeries often result in a client losing volume and may cause intraoperative and postoperative bleeding. The nurse must be aware that an increased heart rate and low blood pressure are classic indicators of fluid volume deficit, which, if untreated, may cause the client to develop hypovolemic shock. Hypovolemic shock may be caused by hemorrhage, a significant concern immediately post-operative.

The nurse is caring for a client with type 1 diabetes mellitus who is admitted to the hospital with diabetic ketoacidosis (DKA). Which laboratory result is critical for the nurse to monitor closely during the client's treatment? A. Blood urea nitrogen (BUN) B. Serum creatinine C. Serum potassium D. Blood glucose

Choice C is correct. In DKA, there is a risk of hyperkalemia because acidosis causes the shift of potassium from intracellular to extracellular spaces (increasing the serum potassium). Insulin therapy can rapidly decrease serum potassium levels by correcting acidosis and reversing this shift (potassium is driven back into the intracellular space). Therefore, close monitoring of serum potassium is required to prevent hypokalemia complications. Choice A is incorrect. While BUN is a relevant parameter, it is not the most critical in managing DKA. Other laboratory values take precedence. Choice B is incorrect. Monitoring serum creatinine is important to assess renal insufficiency, but it is not more critical than hypokalemia monitoring during the treatment of DKA. Choice D is incorrect. Monitoring blood glucose is important in managing DKA, but it is not the most critical parameter during the treatment phase, where serum potassium takes precedence.

A client suddenly develops syndrome of inappropriate antidiuretic hormone (SIADH) after undergoing cranial surgery. Which of the following would be an expected finding? A. Peripheral edema B. Excessive urine production C. Normal or slightly increased blood pressure D. A low urine specific gravity

Choice C is correct. SIADH is an abnormal release of the antidiuretic hormone (ADH), which causes the client to retain water inappropriately. Because free water is retained, the sodium is diluted in the serum. The antidiuretic effect causes urine and plasma alterations such as:- Lower urine output Higher urine osmolality Higher urine-specific gravity (concentrated urine) Low serum osmolality Low serum sodium (hyponatremia) Physical exam findings often reveal Normal skin turgor (euvolemic) Weight gain without peripheral edema (SIADH causes fluid retention across all of the fluid compartments, not just in the extracellular space. So peripheral edema is absent) Blood pressure is mostly normal (normotensive) or slightly increased (choice C)

The nurse is caring for a client who has impaired hearing, the nurse knows that the best way to approach them is to do which of the following? A. Speak loudly B. Speak quickly C. Speak at a normal volume D. Speak into the impaired ear

Choice C is correct. Speaking at a normal volume is the preferred approach when communicating with a client with impaired hearing. It allows for clear and effective communication without the need for shouting or raising one's voice. This approach respects the client's dignity and promotes understanding. Choice A is incorrect. Speaking loudly is not the best approach when communicating with a client with impaired hearing. It can distort speech and may not necessarily improve comprehension. Shouting can also be perceived as disrespectful and may make the client uncomfortable. Choice B is incorrect. Speaking quickly is not recommended when communicating with a client who has impaired hearing. Rapid speech can make it difficult for the client to follow the conversation and may lead to misunderstandings. Choice D is incorrect. Speaking into the impaired ear may not always be effective, as the extent and nature of hearing impairment can vary among individuals. It's generally best to speak facing the client, allowing them to see your lips and facial expressions, which can aid in comprehension.

The nurse is caring for a client with systemic lupus erythematosus (SLE). Which assessment finding requires follow-up from the nurse? The client reports A. difficulty covering up a butterfly rash present on the nose. B. occasional sensitivity to sunlight while working outdoors. C. foamy urine with a slight reddish tint D. joint stiffness that worsens after daily activities.

Choice C is correct. Systemic lupus erythematosus (SLE) is associated with an elevated risk of lupus nephritis, a severe complication in which the immune system attacks the kidneys. In addition to signs and symptoms associated with SLE, clients with lupus nephritis will often exhibit or report foamy urine (due to the amount of protein in the urine) and possibly hematuria. Once these findings are reported to the nurse, the nurse should perform an additional assessment, assessing the client for possible renal involvement or dysfunction. The nurse should then alert the health care provider (HCP) of these findings and initiate further diagnostic testing as ordered.

Which of the following immunizations is a priority for a client who is 75 years old and has a history of cerebrovascular disease? A. Hepatitis A vaccine B. Hepatitis B vaccine C. Pneumococcal vaccine D. Lyme disease vaccine

Choice C is correct. The pneumococcal vaccine is a priority immunization among elderly clients and those with chronic illnesses. This vaccine should be administered every five years. Choice A is incorrect. The hepatitis A vaccine is not indicated for this patient. Choice B is incorrect. Although the Hepatitis B vaccine is recommended, it is not a priority for the patient in this example. Most Americans are vaccinated against hepatitis B as infants. The liver and its function change as a person ages, which makes hepatitis B more prevalent among older adults. The risk of contracting hepatitis B increases for those with hemophilia, end-stage renal disease (ESRD), diabetes, or other conditions that lower resistance to infection.

The nurse has attended a conference on intraoperative nursing interventions for the older adult. Which of the following statements by the nurse would indicate the need for additional teaching? A. "Warming devices should be used to prevent the client from developing hypothermia." B. "The client's head and feet should be covered during surgery." C. "Clients should be slid, not lifted into the proper position." D. "Providing extra padding for clients with decreased peripheral circulation is important."

Choice C is correct. This statement requires follow-up because clients should be lifted into position instead of sliding. Sliding may cause friction and shearing skin injuries. The older adult is more prone to skin injuries because of the decreased dermal and epidemial blood flow and dryness of the skin. Choices A and B are incorrect. The older adult is at risk for poor thermoregulation, which may cause the client to experience hypothermia. Most heat is lost through the feet and head, and keeping both covered will prevent postoperative hypothermia. Warming devices, such as a Bair hugger, are used to maintain thermoregulation. These are accurate statements. Choice D is incorrect. Because of the decreased epidermal thickness, the client is at risk for pressure injuries. It is appropriate for the nurse to provide extra padding to clients with decreased peripheral circulation as it reduces the risk of injury. This extra padding will support the affected extremities(s) and reduce any injury.

The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. Furosemide for a client with hyperparathyroidism B. Methimazole for a client with hyperthyroidism C. Hydrocortisone for a client with diabetes insipidus D. Prazosin for a client with pheochromocytoma

Choice C is correct. Treatment for diabetes insipidus includes medications such as desmopressin, thiazide diuretics, and anti-inflammatories. Hydrocortisone is a short-acting corticosteroid and is indicated in the treatment of adrenal insufficiency. This requires follow-up because DI is not treated with hydrocortisone. Choices A, B, and D are incorrect. Hyperparathyroidism causes hypercalcemia, and the treatment for hyperparathyroidism is a combination of 0.9% saline infusion followed by furosemide. Hyperthyroidism requires antithyroid medications such as methimazole or propylthiouracil. The classic manifestation of pheochromocytoma is hypertension, and treatment of this condition involves antihypertensive such as prazosin, an alpha-adrenergic blocker.

The nurse is caring for an older adult client undergoing bowel prep for a scheduled colonoscopy. Which nursing diagnosis is the priority to integrate into the care plan? A. Deficient knowledge B. Altered elimination pattern C. Impaired skin integrity D. Risk for falls

Choice D is correct. A bowel prep will cause the client to ambulate to the bathroom frequently. The client is an older adult, and being an older adult is a risk factor for falls. The nurse should consider using a bedside commode to shorten the ambulation distance, mitigating the fall risk. Choices A, B, and C are incorrect. Deficient knowledge is common for any procedure, and the nurse should reinforce any education regarding the procedure and bowel prep process to the client. The bowel prep will likely cause loose stools, altering the elimination pattern. Frequent elimination may cause skin breakdown from the wiping of the peri region. These aspects are pertinent to the care plan but do not prioritize the client's safety regarding falls.

nystagmus

Involuntary rapid eye movements The most common cause of acquired nystagmus is certain drugs or medicines. Phenytoin (Dilantin) - an antiseizure medicine, excessive alcohol, or any sedating medicine can impair the labyrinth's function. Other causes include: Inner ear disorders such as benign positional vertigo, labyrinthitis or Meniere disease.

The nurse is reviewing the diet of the client with hypoparathyroidism. The nurse understands that the client should be on what type of diet? A. High-calorie, low-calcium diet B. Low-calcium, low-phosphorus diet C. High-phosphorus, low-calcium diet D. High-calcium, low-phosphorus diet

Choice D is correct. A client with hypoparathyroidism is at risk of hypocalcemia and should therefore be on a diet high in calcium and low in phosphorus. The high calcium serves to increase the client's serum calcium levels. Since calcium and phosphorus have an inversely proportional relationship, the low phosphorus portion of this diet ensures that the client's phosphorus levels are reduced to the point of not interfering with the client's calcium levels. Choice A is incorrect. Consuming a high-calorie, low-calcium diet would result in a hypoparathyroidism client gaining weight and decreasing serum calcium levels. Choice B is incorrect. Consuming a low-calcium, low-phosphorus diet would result in a hypoparathyroidism client's serum calcium levels slowly falling. Choice C is incorrect. Consuming a high-phosphorus, low-calcium diet would result in a hypoparathyroidism client's serum calcium levels rapidly falling, as calcium and phosphorus have an inversely proportional relationship. Learning Objective When reviewing the diet of the client with hypoparathyroidism, correctly identify the diet this client should be on as a high calcium, low phosphorus diet.

The nurse in the emergency department (ED) is assessing a client with anaphylactic shock. Which of the following findings would support a diagnosis of anaphylactic shock? A. hypertension B. crackles (rales) in the lung fields C. cutaneous cyanosis D. pruritus

Choice D is correct. Anaphylactic shock is a medical emergency caused by a severe antibody-antigen reaction leading to massive vasodilation & rapid loss of volume. Death is imminent if it is not treated promptly. The manifestations of anaphylactic shock include tachycardia, hypotension, chest pain, restlessness, cutaneous erythema, urticaria, itching (pruritus), cough, dysphagia, and wheezing in the lung fields. Choice A is incorrect. Anaphylactic shock causes an individual to have peripheral vasodilation and a loss of capillary permeability. This vasodilation causes an individual to experience hypotension. Intramuscular (IM) epinephrine is administered to restore vascular tone. Choice B is incorrect. The client with anaphylactic shock experiences wheezing in the lung fields because of bronchial smooth muscle constriction. Other pulmonary symptoms of anaphylaxis include edema, stridor, hoarseness, a sensation of fullness or a lump in the throat, and dysphagia. Rales (crackles) are not a feature of bronchoconstriction. Rales are produced when air is forced through airways that have been narrowed by mucus or fluid (e.g., pulmonary edema). Choice C is incorrect. Cutaneous manifestations are often the earliest signs of anaphylactic shock, which include pruritus, erythema, urticaria, angioedema, and a sense of warmth. Cyanosis is not typical of anaphylaxis. Cyanosis, if present, would be a highly concerning finding suggestive of severe hypoxia.

The nurse is reviewing discharge prescriptions for a child postoperative following a tonsillectomy. Which medication requires clarification with the primary healthcare provider? A. tetracaine 0.5% lollipop B. acetaminophen (APAP) C. ibuprofen D. codeine

Choice D is correct. Codeine is contraindicated for children after a tonsillectomy because as it is converted to morphine by the liver, some children are rapid metabolizers, which causes the level of codeine to be lethal, causing bradypnea leading to respiratory arrest. This medication is contraindicated. Choice A is incorrect. Tetracaine 0.5% lollipop is an effective pain medication choice, and the child is instructed to suck on the lollipop for 10-15 seconds and then stop. Pain relief is brought within 1-2 minutes. This provides localized pain relief. Choice B is incorrect. APAP is an appropriate pain reliever and can be given to the child as an elixir versus a pill. This medication is over-the-counter and may be alternated with ibuprofen. Choice C is incorrect. Ibuprofen is an appropriate pain reliever and can be given to the child as an elixir versus a pill. This medication is over-the-counter and may be alternated with APAP.

The nurse is caring for a post-operative client at risk for a pressure ulcer. Which intervention should the nurse include in the plan of care? A. Apply sequential compression devices B. Apply an extra sheet to the bed C. Position the client on a donut pillow D. Encourage the consumption of high-protein foods

Choice D is correct. High-protein foods are encouraged because they promote wound healing and prevent fluid shifting, which may lead to a pressure ulcer. The prevention of fluid shifting (edema) contributes to a pressure ulcer. Optimal protein intake is key to preventing (and healing) a pressure ulcer. Choices A, B, and C are incorrect. Sequential compression devices would be a helpful way to prevent venous thromboembolism, not pressure ulcers. Extra linens are not an effective way to prevent pressure ulcers. The least amount of linen on the bed should be used as it traps moisture which leads to the development of a pressure ulcer. Positioning the client on a donut pillow would be inappropriate because this applies direct pressure to the client's buttocks.

The nurse encounters an infant with irritability from acute otitis media while working in the pediatric clinic. The nurse should know that the infant is at much higher risk than an adult for otitis media due to which of the following? A. Immature cardiac sphincter B. Feeding in a semi-Fowler position C. Introduction of solid foods D. Narrower, shorter, and more horizontal Eustachian tubes

Choice D is correct. Infants have more horizontal, shorter, and narrower eustachian tubes, which makes them more prone to otitis media. The eustachian machine is a conduit from the middle ear to the nasopharynx. An inflammatory swelling in the eustachian tube can cause it to be blocked, trapping the fluid in the middle ear and eventually leading to infection. Several factors, such as allergies, common cold, viral flu, sinus infection, enlarged adenoids, and drinking while lying down (in infants), may predispose to swelling/ blockage of the eustachian tube. In an adult, the eustachian tube typically measures 36 mm and is angled at 45 degrees. In infants, it is shorter (18 mm) and has a more horizontal (angle at 10 degrees). Such a shorter tube predisposes to infection via reflux of bacteria from the nasopharynx

The nurse is caring for a client seven hours postoperative following a subtotal thyroidectomy. The client reports peripheral numbness and tingling, muscle twitching, and spasms.The nurse anticipates a prescription for A. levothyroxine. B. hydrocortisone. C. thiamine. D. calcium chloride.

Choice D is correct. This client is displaying classic signs and symptoms of hypocalcemia (i.e., paresthesia and tetany). If left untreated, symptoms may progress to seizures, encephalopathy, and heart failure. More convincingly, the client's recent thyroidectomy supports a presumptive diagnosis of hypocalcemia. Although the thyroid gland in and of itself does not regulate calcium levels within the body, four parathyroid glands (responsible for releasing parathyroid hormone (PTH) to control calcium levels in your blood) are located within the thyroid. Hypoparathyroidism often results after the accidental removal of or damage to one or more parathyroid glands during thyroidectomy. The nurse should anticipate administering intravenous calcium gluconate (or chloride) to this client. Choice A is incorrect. Levothyroxine would be prescribed following a thyroidectomy because the client will require indefinite thyroid hormone replacement. However, the client's manifestations require calcium repletion. Choice B is incorrect. Hydrocortisone may be used postoperatively following a thyroidectomy to prevent airway edema. This would not be the treatment for the client's hypocalcemia. Choice C is incorrect. Thiamine is the treatment for Wernicke encephalopathy, which may cause an individual to develop delirium, ataxia, and nystagmus. This is commonly caused by alcoholism. Learning Objective Recognize that a nurse caring for a post-thyroidectomy client who has recently developed peripheral numbness and tingling, muscle twitching, and spasms should anticipate administering intravenous calcium gluconate.

The nurse is caring for a client reporting an abrupt onset of severe pain associated with metastatic cancer. The nurse reviews the client's current prescriptions and plans to administer A. Fentanyl via transdermal patch B. Pregabalin C. Ketorolac D. Hydromorphone

Choice D is correct. This type of pain with an abrupt onset would best respond to opioid analgesics. Hydromorphone is a potent opioid (one milligram of hydromorphone equates to six milligrams of morphine) that, when given intravenously, provides rapid onset and relief. Prior to administering any opioid, the nurse should assess the client's level of consciousness, respiratory rate, and blood pressure. Choice A, B, and C are incorrect. Fentanyl via a transdermal patch is applied for 72 hours and establishes a peak effect at 24 hours. This would not be an appropriate choice as the client is experiencing breakthrough pain requiring medication with rapid onset. Pregabalin is a maintenance medication indicated for neuropathic pain. This medication would not be helpful for this type of pain. Ketorolac is an anti-inflammatory medication, and while it is helpful for fever and renal colic. It would not be recommended for breakthrough pain because of its limitations on efficacy (this medication is recommended for mild to moderate pain control).

The nurse is caring for a client who is receiving prescribed fentanyl. Which of the following findings would indicate the client is having a side effect? Select all that apply. Nausea and vomiting Constipation Pruritus Urinary retention Nystagmus

Choices A, B, C, and D are correct. Fentanyl is an opioid analgesic used to manage acute and chronic pain. Common effects associated with this drug include nausea and vomiting, constipation, pruritus, and urinary retention. Choice E is incorrect. Nystagmus is not associated with fentanyl. Ophthalmic effects associated with fentanyl include blurred vision and miosis.

The nurse provides discharge instructions to a client diagnosed with bacterial conjunctivitis. Which of the following statements by the client would indicate effective understanding? Select all that apply. "It is okay for me to wear my contact lenses during this infection." "Swimming during this infection is allowed." "I should not share my towels with family members." "To prevent injury, I should not rub my eye." "I should wash my hands frequently."

Choices C, D, and E are correct. Sharing towels should be discouraged to prevent the spread of infection to other family members. Rubbing the eyes can cause injuries to the eye itself and cause the other eye to become infected. Further, the client should not share linens with others as this may cause disease transmission. Choices A and B are incorrect. These statements are incorrect and require follow-up. Contact lenses should not be worn during the infection. This could cause further irritation as well as cause reinfection if the lens were placed in a holder with other lenses. Swimming during the infection is not recommended because this could cause further eye irritation and transmit the infection to others. Additional Info ✓ Conjunctivitis is most commonly caused by viruses, bacteria, or allergies ✓ Bacterial conjunctivitis typically affects children more frequently than adults ✓ The nurse can recommend symptomatic management, including - Keeping the eye clean and properly administering ophthalmic medication. Remove accumulated secretions by wiping from the inner canthus downward and outward, away from the opposite eye. Warm, moist compresses like a clean washcloth wrung out with hot tap water help remove the crusts. Compresses are not kept on the eye because an occlusive covering promotes bacterial growth. Disposing of any makeup brushes or tools that were used during the infection.

Ocular herpes

How you get herpes simplex eye infections. Most herpes simplex eye infections are caused by the same herpes simplex virus that causes cold sores. You usually get the herpes simplex virus from skin to skin contact from someone with a cold sore. Once you have it, it stays in your body.

The nurse is preparing a client scheduled for hip arthroplasty in two hours. The nurse has received a prescription for tranexamic acid. The nurse understands that this medication has had a therapeutic effect when the client has A. decreased postoperative pain. B. increased postoperative vital capacity. C. less postoperative blood loss. D. no surgical site infection.

Tranexamic acid causes inhibition of fibrinolysis. Thus, it helps reduce blood loss for specific operative procedures and trauma. Orthopedic procedures such as hip arthroplasty cause significant intraoperative and postoperative blood loss. This could cause the client to receive a postoperative blood transfusion. This medication is administered intravenously approximately 30 minutes before the operative procedure.

The nurse is teaching a continuing education course regarding vaccines and pregnancy. It would be appropriate for the nurse to state which vaccines are not recommended to be administered during pregnancy? Select all that apply. \ measles, mumps, and rubella (MMR) varicella hepatitis A inactivated Influenza tdap (Tetanus, Diphtheria, Pertussis) Human papillomavirus (HPV)

Vaccines either not recommended or contraindicated during pregnancy include: ✓ MMR ✓ Varicella ✓ Zoster ✓ HPV ✓ Polio ✓ Any live vaccine

Pruritus

itching

amblyopia

reduced vision in one eye caused by abnormal visual development early in life. The weaker — or lazy — eye often wanders inward or outward. Amblyopia generally develops from birth up to age 7 years. It is the leading cause of decreased vision among children.