a nurse is caring for a client in an outpatient clinic.
exhibit 1 exhibit 2 exhibit 3 exhibit 4
nurses notes
3 months ago:
client reports blurred vision and worsening visual acuity during
the past year.
provided client education about newly prescribed medication.
today:
client reports decreased night vision. client reports increased
urinary urgency since their last visit.
the nurse is evaluating the outcomes of medication therapy for the client. for
each potential client finding, click to specify if the finding is expected or
unexpected for the client.
client finding expected unexpected
urinary elimination ○ ○
pupil size ○ ○
night vision ○ ○
heart rate ○ ○
floaters ○ ○

Question

a nurse is caring for a client in an outpatient clinic.
exhibit 1  exhibit 2  exhibit 3  exhibit 4
nurses notes
3 months ago:
client reports blurred vision and worsening visual acuity during
the past year.
provided client education about newly prescribed medication.
today:
client reports decreased night vision. client reports increased
urinary urgency since their last visit.
the nurse is evaluating the outcomes of medication therapy for the client. for
each potential client finding, click to specify if the finding is expected or
unexpected for the client.
client finding  expected  unexpected
urinary elimination  ○  ○
pupil size  ○  ○
night vision  ○  ○
heart rate  ○  ○
floaters  ○  ○

Accepted Answer

# Brief Explanations:
To determine expected/unexpected findings, we analyze the client's history and current reports:
- **Urinary elimination**: Client reports increased urinary urgency (a change), so if the therapy was for a condition (e.g., glaucoma, common in vision issues), some medications (like cholinergics) can cause urinary urgency. If the med affects the urinary system, this could be expected. But without knowing the med, assume based on current report: since client reports increased urgency, if the med is associated with urinary effects, it's expected. However, if the med is for vision (e.g., glaucoma meds like pilocarpine, a cholinergic, which can cause urinary urgency), then urinary elimination changes (urgency) are expected. So mark "Expected" for urinary elimination? Wait, no—urinary elimination as a finding: if the client has increased urgency, that's a change. Wait, the table is "Client Finding" (e.g., urinary elimination—maybe frequency/urgency). Let's re-express:

1. **Urinary elimination**: Client reports increased urinary urgency (a type of urinary elimination change). If the medication (prescribed 3 months ago) has urinary side effects (common in some ocular meds, like cholinergics for glaucoma), then this is expected. So mark "Expected".
2. **Pupil size**: For vision issues (blurred vision, worsening acuity), if the med is a miotic (e.g., pilocarpine) to constrict pupils (for glaucoma), pupil size decrease is expected. But the client's current findings don't mention pupil size, but based on med type (if for glaucoma, miotics constrict pupils). So if the med is a miotic, pupil size change (constriction) is expected. But since we don't have med details, but the client has vision issues, maybe pupil size change is expected. Wait, no—this is ambiguous. Wait, the client's current findings are about night vision, floaters, urinary urgency. Pupil size: if the med is for glaucoma, pupil constriction is expected. So mark "Expected"?
3. **Night vision**: Client reports decreased night vision. If the med is for vision (e.g., glaucoma), some meds can affect night vision (e.g., miotics may cause difficulty in dark adaptation). So if the med has that side effect, decreased night vision is expected. The client now reports decreased night vision, so this is expected.
4. **Heart rate**: For ocular meds (e.g., beta-blockers for glaucoma), heart rate decrease is expected. If the med is a beta-blocker, bradycardia is expected. But the client's findings don't mention heart rate, but if the med is a beta-blocker, heart rate change (decrease) is expected. Wait, but the client's current findings are about vision and urinary. So heart rate: if the med is a beta-blocker (common in glaucoma), heart rate decrease is expected. So mark "Expected"?
5. **Floaters**: Floaters are associated with eye conditions (e.g., vitreous changes). If the client has worsening visual acuity and blurred vision, floaters could be part of the eye condition progression, not the med's effect. So floaters are unexpected (since the med is for vision, not causing floaters—floaters are a sign of eye pathology, not med side effect). So mark "Unexpected".

Wait, this is complex. Let's re-express with the given info:

- **Urinary elimination**: Client reports increased urinary urgency (change from before). If the med (prescribed 3 months ago) has urinary side effects (e.g., cholinergics for glaucoma cause urinary urgency), then this is expected. So "Expected".
- **Pupil size**: If the med is a miotic (for glaucoma), pupil constriction is expected. So "Expected".
- **Night vision**: Client reports decreased night vision. If the med (e.g., miotic) causes difficulty in dark adaptation (since pupils are constricted, less light enters), then decreased night vision is expected. So "Expected".
- **Heart rate**: If the med is a beta-blocker (for glaucoma), heart rate decrease is expected. So "Expected".
- **Floaters**: Floaters are not a side effect of typical ocular meds (miotics, beta-blockers) but a sign of eye disease (e.g., vitreous detachment, retinal issues). The client's vision issues (blurred, worsening) may be progressing to floaters, but the med doesn't cause floaters. So "Unexpected".

But this is speculative. Alternatively, maybe the med is for glaucoma (common in blurred vision, worsening acuity). Let's assume the med is a cholinergic (pilocarpine) for glaucoma:

- Cholinergics (miotics) cause:
  - Urinary urgency (cholinergic stimulation of bladder) → Expected.
  - Pupil constriction → Expected.
  - Decreased night vision (due to pupil constriction, less light in dark) → Expected.
  - Bradycardia (cholinergic stimulation of heart, but pilocarpine is mainly ocular; beta-blockers cause bradycardia). Wait, maybe the med is a beta-blocker (e.g., timolol) for glaucoma:
    - Beta-blockers cause bradycardia → Expected.
    - No urinary effects (timolol is topical, but systemic absorption can cause bradycardia, not urinary urgency). Wait, the client has urinary urgency, which is more consistent with cholinergic (systemic absorption of pilocarpine). So:

- Urinary elimination: Expected (cholinergic causes urgency).
- Pupil size: Expected (miotic, constricted).
- Night vision: Expected (constricted pupils → less light in dark → decreased night vision).
- Heart rate: If pilocarpine (cholinergic), it can cause bradycardia (cholinergic effect on heart), so expected. If beta-blocker, also bradycardia. So expected.
- Floaters: Unexpected (floaters are eye pathology, not med side effect).

But this is all based on assumptions. However, the key is to match the client's current findings with med side effects. Since the client reports decreased night vision (matches med side effect if miotic), increased urinary urgency (matches cholinergic), floaters (unrelated to med, related to eye disease), pupil size (related to med), heart rate (related to med).

So the answers would be:

- Urinary elimination: Expected
- Pupil size: Expected
- Night vision: Expected
- Heart rate: Expected
- Floaters: Unexpected

But I'm not sure. Alternatively, maybe the med is not for glaucoma. Wait, the client has blurred vision and worsening visual acuity (possible glaucoma, cataracts, etc.). The med prescribed 3 months ago—if it's a diuretic (unlikely for vision), no. More likely ocular med. So proceeding with the above.
# Answer:
| Client Finding   | Expected | Unexpected |
|------------------|----------|------------|
| Urinary elimination | ⚫ (Expected) |            |
| Pupil size       | ⚫ (Expected) |            |
| Night vision     | ⚫ (Expected) |            |
| Heart rate       | ⚫ (Expected) |            |
| Floaters         |          | ⚫ (Unexpected) |

(Note: The circles are clicked to mark. In the table, for each row, click the "Expected" or "Unexpected" circle. The above shows which to click.)

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QUESTION IMAGE

Question

Explanation:

Answer:

Client Finding	Expected	Unexpected
Pupil size	⚫ (Expected)
Night vision	⚫ (Expected)
Heart rate	⚫ (Expected)
Floaters		⚫ (Unexpected)