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HESI LPN/LVN exit Sample Test

1 of 5

When assessing a client, the nurse notes retinal hemorrhages. The nurse should further assess for which of the following?

Correct Answer:

hypertension
when a nurse observes retinal hemorrhages in a client, it is crucial to further investigate for underlying conditions that might cause such symptoms. among the possible causes, hypertension, or high blood pressure, is a significant concern. here, we will explore why retinal hemorrhages might occur and the relevance of assessing for hypertension in such cases.

retinal hemorrhages refer to bleeding within the retina, which is the light-sensitive layer at the back of the eye responsible for receiving and converting light into neural signals for the brain. these hemorrhages can manifest as dots, blots, or flame-shaped marks in the eye and can be detected through an ophthalmoscopic examination. the presence of these hemorrhages is a concerning sign as it may indicate damage to the retinal blood vessels.

hypertension is a leading cause of retinal hemorrhages. high blood pressure can damage the delicate blood vessels in the retina, causing them to weaken, leak, or burst. this damage can lead to hypertensive retinopathy, a condition marked by retinal vascular changes, including hemorrhages. if left unchecked, it can lead to vision problems, and in severe cases, blindness. therefore, when a nurse identifies retinal hemorrhages, assessing the client's blood pressure is a critical next step. this helps in diagnosing hypertension early, allowing for timely medical intervention to manage blood pressure and prevent further ocular and systemic complications.

while retinal hemorrhages can be indicative of other ocular conditions, they are not commonly associated with cataracts, glaucoma, or a need for corrective lenses. cataracts involve the clouding of the lens and primarily affect visual clarity but do not involve bleeding in the retina. glaucoma is related to increased intraocular pressure that affects the optic nerve and does not typically present with retinal hemorrhages unless complicated by other factors. similarly, the need for corrective lenses is generally due to refractive errors in the eye, such as myopia or hyperopia, and is unrelated to the presence of retinal hemorrhages.

in summary, when a nurse notes retinal hemorrhages during an assessment, the priority is to check for hypertension. this condition is a well-known cause of such hemorrhages and can have significant health implications if not addressed. further investigations may include measuring blood pressure and referring the client for a comprehensive eye examination by an ophthalmologist. this will help in confirming the diagnosis, understanding the extent of eye damage, and implementing appropriate management strategies for hypertension and its ocular effects.

HESI LPN/LVN exit (HesiLVN) Shortcuts

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HESI LPN/LVN exit Aliases Test Name

Here is a list of alternative names used for this exam.

HESI LPN/LVN exit
HESI LPN/LVN exit test
HESI LPN/LVN exit Certification Test
HESI
HESI HesiLVN
HesiLVN test
HESI LPN/LVN exit (HesiLVN)
LPN/LVN exit certification