Nur165 Sensorineural Comprehensive Study

Which of the following should a nurse observe during an ophthalmic assessment?

visual acuity
IOP
external eye appearance
internal eye function

c (a qualified examiner assesses the rest)

most common cause of visual loss in those over 60?

glaucoma
macular degeneration
cataracts
retinal detachment

b

Which group of meds cause pupillary constriction?

beta blockers
adrenergic agonists
miotics
mydriatics

c (mydriatics cause pupillary dilation, beta blockers decrease production of aqueous humor, adrenergic agonists decrease aqueous humor production and increase outflow.)

________ occurs when there is a deviation from perfect ocular alignment:

strabismus
nystagmus
chemosis
ptosis

a (nystagmus is involuntary oscillation of the eyeball, chemosis is edema of the conjunctiva)

Which test uses a tuning fork shifted between two locations to assess hearing?

Rinne’s
Whisper test
Watch Tick
Weber’s

a (Weber’s is on top of the head)

unequal pupils = _____:

nystagmus
strabismus
diploplia
anisocoria

d (diploplia is double vision)

________ is associated with several disorders, including migraines, Menniere’s disease, otosclerosis, acoustic neuroma, & thyroid disease.
tinnitus

the red reflex results from shining light on the ______

optic disk
eyelid
pupil
iris

c (absence of this may indicate lens opacity, which may indicate detached retina, cataract, or retinoblastoma)

_______ is the altered sensation of orientation in space.

dizziness
vertigo
tinnitus
nystagmus

a (vertigo would be the illusion of movement)

_______ is the illusion of movement.

dizziness
vertigo
tinnitus
nystagmus

b (dizziness is a sense of altered orientation in space)

which of the following would be a negative result in the cover-uncover test?

lack of movement in the uncovered eye
lack of color vision in the uncovered eye
movement in the uncovered eye
inability to identify letters of decreasing size in the uncovered eye

c (this test assesses extraocular muscle function. Movement may indicate weakness in the muscle.)

which test distinguishes between conductive and sensorineural hearing loss?

Rinne’s
Whisper test
Watch Tick
Weber’s

a (weber test assesses bone conduction and lateralization of sound.)

which test assesses lateralization of sound?

Rinne’s
Whisper test
Watch Tick
Weber’s

d (Rinne’s distinguishes between conductive and sensorineural hearing loss)

a person with 20/200 vision sees an object from ___ feet away that a person with normal vision sees from ___ feet away.
20, 200

part of the retina responsible for central vision:

optic disk
fundus
sclera
macula

d

people with hyperopia have ______

nearsighted
far sighted
astigmatism
normal vision

b (normal vision is emetropia)

people with emetropia have _______

nearsighted
far sighted
astigmatism
normal vision

d

refractive surgery is considered a cosmetic surgery to reshape the cornea (true or false)
true (it also helps fix refractive errors and will not alter the normal aging process of the eye)

which of the following medications need to be withheld 5-7 days prior to cataract surgery?

lasix
prednisone
glucophage
coumadin

d (prevents retrobulbar hemorrhage)

target IOP for patient undergoing treatment for high IOP is typically ____% lower than their current IOP.
30 (IE, the goal of treatment is to lower IOP by 30%)

normal IOP is between

11-26 mmhg
10-20 mmhg
10-21 mmhg
45-60 mmhg

c

which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?

nevi
hemangioma
Xanthelasma
milia

b (xanthelasma are small, yellowish lipoid deposits near the inner corner of the eye)

which meds decrease production of aqueous humor?

mydriatics
beta blockers
sympathomimetics
miotics

b

which meds dilate the pupil?

mydriatics
beta blockers
sympathomimetics
miotics

a

which meds decrease the size of the pupil, facilitating the outflow of aquous humor and thus decrease IOP? (select all that apply)

mydriatics
beta blockers
sympathomimetics
miotics

c, d

edema of the conjunctiva is termed:

proptosis
chemosis
papilledema
strabismus

b (chemosis is edema of the conjunctiva, papilledema refers to swelling of the optic disk due to increased intracranial pressure, strabismus is a deviation from perfect ocular alignment.)

a deviation from perfect ocular alignment is termed:

proptosis
chemosis
papilledema
strabismus

d (chemosis is edema of the conjunctiva, papilledema refers to swelling of the optic disk due to increased intracranial pressure, strabismus is a deviation from perfect ocular alignment.)

swelling of the optic disk due to increased intracranial pressure is termed:

proptosis
chemosis
papilledema
strabismus

c (chemosis is edema of the conjunctiva, papilledema refers to swelling of the optic disk due to increased intracranial pressure, strabismus is a deviation from perfect ocular alignment.)

which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear?

scleral buckle
pneumatic retinopexy
pars plana vitrectomy
phacomulsification

a

which of the following would be an inaccurate clinical manifestation of retinal detachment?

pain
cobwebs
sudden onset of a greater number of floaters
bright flashing lights

a (patients do not complain of pain with this condition)

which of the following is the leading cause of blindness in the united states?

macular degeneration
retinal detachment
glaucoma
cataracts

c

which of the following is the overall aim of glaucoma treatment?

prevent optic nerve damage
reattach the retina
reverse optic nerve damage
optimize the patient’s remaining vision

a

which of the following is correct advice regarding food for a patient who underwent cataract surgery?

eat greens 2-4 times per week
eat red meat 2- 4 times per week
increase A and C vitamins
eat soft, easily chewed foods

d (this prevents excessive facial movements)

which of the following preattack symptoms would a person with Miniere’s disease report?

nystagmus
low blood pressure
full feeling in the ear
photosensitivity

c (also headache)

what portion of the middle ear equalizes pressure?

ossicles
tympanic membrane
auricle
cochlea

b

which of the following classification of medications is the most common cause of ototoxicity?

aminoglycosides
sulfonamides
cephalosporin
penicillan

a (IV meds, especially aminoglycosides, are the most common cause of ototoxicity)

which medication might cause ototoxicity?

Garamycin (gentamicin)
Amoxacillin (erythromycin)
Rocephin (ceftriaxone)
Sulfazine

a (Aminoglycosides are useful primarily in infections involving aerobic, Gram-negative bacteria, such as Pseudomonas, Acinetobacter, and Enterobacter. In addition, some Mycobacteria, including the bacteria that cause tuberculosis, are susceptible to aminoglycosides. Since they are not absorbed from the gut, they are administered intravenously and intramuscularly. the second is a penicillin, the third is a cephalosporin, and the fourth is a sulfonamide)

The nurse is examining the external eye in an ____________ assessment.
ophthalmic

the macula is responsible for _______ vision.
central

people who are far sighted are known in the medical community as having _________
hyperopia

people who are near sighted are known in the medical community as having _________
myopia

an ______ is a branch of medicine concerned with care and diseases of the eye.

ophthalmologist
optometrist
optician

a

a _______ conduct eye test and prescribe corrective lenses.
ophthalmologist
optometrist
optician
b

a _______ is a fitter or supplier of glasses and contact lenses who does not examine eyes.
ophthalmologist
optometrist
optician
c

Nursing considerations in Eye assessments

Assess family history of eye problems
Current medications and eye drops, also OTC meds
Ask about accidents, injuries, & surgeries
Diet history- Vitamin A deficiency can cause conjunctival dryness, and blindness
Work
Current health problems

okay

Physical assessment of Eyes

Observe for head tilt, squinting, or noticeable action that offers clues for compensation.
Check for redness, lesions, drainage, scleral color, blink reflex

okay

Legal blindness defined as BCVA that does not exceed __/__ in the better eye or whose widest visual field diameter is __ degrees or less.
20 200 20

You are the nurse assigned to perform an eye assessment on an 80-year-old client. Which of the following findings during the assessment is considered normal?

Absence of the red reflex
Edematous eyelids with matted eyelashes
Equal pupillary constriction in response to light
Inflamed conjunctiva

c (Rationale: Pupils are small in old age, and the pupillary light reflex can be slowed, but pupillary constriction should be symmetrical. There should be a red reflex, and the eyelids and conjunctivae should not be edematous or inflamed.)

Which of the following physiologic changes would be expected in a patient with presbyopia?

Degeneration of the cornea
Loss of lens elasticity
Decreased distance vision abilities
Decreased adaptation to darkness

b (Rationale: The lens loses elasticity or pliability, decreasing its ability to change shape in order to accommodate for near vision. Response 4 is indicative of cataracts, 3 is myopia, and 1 is due to corneal changes.)

A patient has a question about a recent eye exam. Which of the following statements would be an accurate response to inquiry?

“If the eyeball is too long for the power of the lens, it is called hypermetropia.”
“A shortened eyeball is called myopia.”
“The lens is normally transparent.”
“Refraction is when the eyes adjust to seeing objects at various distances.”

c

A client comes to the office with a tentative diagnosis of glaucoma, and is to have testing to determine whether the anterior angle of the eye is open or closed. The patient will require education for which of the following examinations?

Tonometry
Computed axial tomography
Retinography
Slit-lamp inspection

d (Rationale: The slit-lamp inspection of the iris is done to assess whether the anterior angle of the eye is open or closed. This is part of a complete dilated examination to inspect the optic nerve and retina. Tonometry measures only the pressure within the eye. Response 2 would be used to take multiple x-rays of the eye tissue, and retinography records the electrical activity of the eye.)

A patient with glaucoma has medication prescribed to decrease intraocular pressure. Which of the following medication should be questioned by the nurse?

Timolol maleate (Timoptic)
Levobunolol (Betagan)
Pilocarpine HCl (Isopto)
Artificial tears

d (Rationale: Timoptic, levobunolol, and pilocarpine are drugs usually prescribed for patients with glaucoma and increased intraocular pressure (IOP). Artificial tears are usually prescribed for persons with “dry eyes.”)

A client with history of glaucoma was diagnosed by the community nurse as experiencing Visual Sensory/Perceptual Alterations R/T increased intraocular pressure. The plan of care should focus on:

Encouraging compliance with drug therapy to prevent loss of vision.
Recognition that damage to the eye caused by glaucoma can be reversed until the late stages of the disease.
Management of the severe pain experienced until the optic nerve atrophies.
Anticipatory guidance, since with or without treatment, the patient eventually will lose peripheral vision.

a (Rationale: Management of glaucoma involves lowering the intraocular pressure to cease drainage to the optic nerve and further vision loss. Therapy involves medications to decrease intraocular pressure. It is critical that the patient understand the importance of compliance with the medication regimen. Glaucoma needs to be controlled to prevent damage that cannot be reversed. Pain is considered an emergency, so if it was identified, the patient would need immediate intervention. Loss of peripheral vision is a concern, but the priority is to encourage the patient to be compliant with medications to prevent further damage to the vision.)

A 76-year-old client tells the nurse that she notices that she is having trouble hearing, especially in large groups. She continues, saying she cannot always tell where the sound is coming from, and the words often sound “mixed up.” The nurse should suspect which of the following as the cause for this change?

Atrophy of the apocrine glands
Cilia in the ear becoming coarse and stiff
Nerve degeneration in the inner ear
Scarring of the tympanic membrane

c (Rationale: Hearing loss is common in older adults. Changes in the inner ear involve atrophy of the organ of corti and cochlear, and degeneration of the stria vascularis. This is a gradual hearing loss that affects the auditory nerve, which makes words sound garbled, and the ability to localize sound is also impaired. The result is that communication dysfunction is accentuated when background noise is present. Responses 1, 2, and 4 would not affect the sensorineural component of hearing.)

You are the nurse assigned to care for an elderly client. While assessing the ears of the patient, you observed dry, hard cerumen developing in the ear canal. Which of the following actions should you take?

Do nothing, since this a normal finding in the older adult.
Document finding and report your concern to the physician.
Irrigate the ear canal with a mixture of hydrogen peroxide and normal saline.
Ask the patient if he is experiencing any discomfort.

b (Rationale: Cerumen or earwax produced by the ceruminous glands is a normal finding in the ear canal. However, in the older adult, cerumen tends to be dryer and harder, and accumulates in the ear canal due to decreased activity of the apocrine glands. Hearing will become impaired if the cerumen accumulates to impact the canal. Irrigation should be tried after other attempts fail. Therefore, documentation and reporting to the primary care provider will help avoid unnecessary alteration in hearing.)

During a hearing assessment, the nurse finds that sound lateralizes to the client’s left ear with the Weber and Rinne tests. What should the nurse conclude from this finding? The patient has:

A conductive hearing loss in the right ear.
Lateralization is a normal finding with the Weber test.
Either a sensorineural or conductive hearing loss.
The steps in assessing the patient’s hearing were done incorrectly.

c (Rationale: When caring for the older person, a thorough history and physical of the person’s hearing is important to help determine the cause of hearing loss, which can be conductive, due to external aspect of the ear, or sensorineural, from an inner ear problem.
Both tests determine the degree of hearing loss, if any.)

Which of the following is true of presbycusis? (Select all that apply.)

Dysfunction with the cochlea and auditory nerve
Ménière’s disease and tumors
Changes due to accumulation of cerumen
Infections of the inner ear

a b d (Rationale: Presbycusis is hearing loss associated with aging, and affects approximately 75% of people over the age 60. Loss of hair cells in the cochlea (sensory loss) and degradation of neurons (neural loss) result in this form of hearing loss. Presbycusis occurs gradually, and usually is bilateral. Answer 3 describes a conductive hearing loss.)

An 84-year-old client is admitted to the hospital for treatment of diabetes mellitus.
On initial interview, the patient reports having difficulty hearing, and informs the nurse that she has too much ear wax. Because of the patient’s age, which of the following questions is most important for the nurse to ask the client in relation to her hearing problem?

“Have you noticed a change in the color of the ear wax?”
“Do you have an upper respiratory tract infection?”
“What type of diabetes mellitus do you have?”
“Have you ever experienced impacted cerumen?”

d (Rationale: Because the hairs in the ear become coarser during the aging process, retention of wax is more of a cause of hearing loss in older clients. Cerumen, if dry and hard, can impact the ear canal and interfere with hearing.)

Which of the following drugs are associated with hearing impairment? Select all that apply.

Gentamicin (Garamycin)
Cis-platinum (Platinol)
Furosemide (Lasix)
Digoxin (Lanoxin)

a b c (Rationale: Digoxin (Lanoxin) causes vision changes, but does not affect hearing. Aminoglycosides such as gentamicin, antineoplastics such as cis-platinum, diuretics such as furosemide, antispasmodics such as baclofen, and propranolol cause changes in hearing ability.)

A patient has a normal sensory change that results in diminished sense of taste. How would this be documented?

Hypogeusia
Odynophagia
Xerostomia
Arthralgia

a (Rationale: A diminished sense of taste is referred to as hypogeusia. Odynophagia refers to pain upon swallowing. Xerostomia refers to dry mouth that occurs with salivary gland dysfunction. Arthralgia refers to pain in a joint.)

A client has noticed a decrease in taste sensation. Which of the following cranial nerves are most likely involved?

CN V and CN VII
CN IX and CN VII
CN VIII and CN V
CN VI and CN X

b (Rationale: Cranial nerves VII and IX supply sensation to the tongue.)

A 78-year-old client is admitted to the Emergency Department (ED) via emergency medical service (EMS) with complaints of severe diarrhea with resultant weakness and signs of dehydration. Discussion with the significant other reveals that the patient continually eats spoiled foods. Which of the following might be most directly related to this patient’s behavior?

Damage to cranial nerve I
Damage to cranial nerve II
Damage to cranial nerve III
Damage to cranial nerve IV

a (Rationale: Although hyposmia (impaired sense of smell) might be due to age-related changes, it might also be the result of olfactory nerve damage (cranial nerve I), since this nerve is the sole innervation for smell. Cranial nerve II is responsible for constriction of the pupils, and IV the superior oblique muscle. Cranial II would affect vision, but an intact CN I would allow the individual to identify the odor of spoiled food accurately.)

In evaluating the functioning of a client’s anterior spinothalamic tract, the nurse is testing for:

Hot and cold sensation.
Pain sensation.
Light touch sensation.
Sense of position.

c (Rationale: It is the spinothalamic tract that transmits light (crude) touch sensation.)

Which of the following aspects for health teaching regarding acute and chronic conjunctivitis is the most important information to be emphasized to a group of preschool parents?

Preventable cause of blindness
Importance of early medical diagnosis
Mode of transmission
Pain management

c (Rationale: The nurse should emphasize to the group ways to prevent the transmission of the infection. Conjunctivitis is highly contagious, and can be transmitted by direct contact with contaminated fomites (e.g., hands, tissues, towels, pillow cases), and some forms can be transmitted to an infant during vaginal delivery. Prevention is the most important aspect of conjunctivitis to be communicated to the group. Pain with acute conjunctivitis is not common.)

The public health nurse is preparing to teach the members of the local swim club about care of the ears. Which of the following statements would be appropriate for the nurse to include?

Use a clean cotton swab to dry the ear canal after swimming.
A tight-fitting swim cap is preferred to earplugs for keeping water out of the ear.
If there is debris in the ear canal, irrigate the ear with cold water.
After an episode of acute inflammation, the swimmer should wait 7-10 days before returning to the water.

d (Rationale: Guidelines include: Stay out of the water until the acute inflammatory process is completely resolved-ideally, 7-10 days before resuming water activities; and use silicone earplugs, and dry the outer ear with a towel, then use a hair dryer on the lowest setting several inches from the ear to dry the canal. Do not insert cotton swabs or other objects into the ear canal to dry it. A tight-fitting swim cap does not keep water out of the ear. Repeated exposure to cold water encourages the growth of exostoses in the ear canal.)

The nurse’s first action for a patient who presents to the Emergency Department with manifestations of corneal perforation is to:

Contact the patient’s ophthalmologist.
Place the patient in a supine position.
Cover the eye with gauze.
Administer tears for dry eyes.

b (Rationale: If corneal perforation is suspected, the nurse should first place the patient in the supine position, then close the eye, and cover it with a dry, sterile dressing. Thereafter, the nurse should notify either the patient’s ophthalmologist or an on-call ophthalmologist to see the patient. The complications of corneal perforation include infection of deep eye structures and loss of ocular contents. Nothing should be placed in the eye.)

The patient with glaucoma has been prescribed travoprost (Travatan), a prostaglandin analog, to improve the outflow of aqueous humor and reduce ocular pressure. Of the following signs or symptoms, which will the nurse teach the patient to report immediately to the eye doctor?

Burning in the eye when the eye drops are used
Tearing in the eye when the eye drops are used
Changes in the color of the eyes
Intolerable pain in the eyes after the drops are used

d (Rationale: Prostaglandin analogs have some adverse effects, such as blurred vision and stinging, and, when used long-term, cause permanent darkening of the iris of the eye and eyebrows, increased growth of eyelashes, and conjunctival redness.)

The patient is in the preoperative holding area, having been brought to surgery from the Emergency Department because of a detached retina. The tear has occurred in the right posterior aspect of the retina. The nurse places the patient in which of the following positions?

At a 45-degree angle (semi-Fowler’s position)
At a 90-degree angle (high Fowler’s position)
Prone
Supine

d (Rationale: The patient’s head is positioned so that gravity pulls the detached portion of the retina into closer contact with the choroid. In this example, the patient’s head should be flat and turned slightly to the right.)

A spry 77-year-old female patient has been diagnosed with simple glaucoma. She lives alone, takes medications for asthma, is on a fixed income, and walks to Catholic Mass on Sunday mornings. The nurse must be certain that the ophthalmologist is aware of which of the aforementioned facts about the patient?

Lives alone.
Takes medications for asthma.
Lives on a fixed income.
Walks to Catholic Mass on Sundays.

b (Rationale: Living alone and a fixed income should be concerns addressed through a Social Services consultation. The patient could be listed on a clergy visit list if hospitalized. Most importantly, the nurse wants to be certain that the patient takes medications for asthma because beta-adrenergic blockers are used topically to treat glaucoma. In asthmatic patients, beta-adrenergic blockers can cause bronchospasm, and are contraindicated)

The 77-year-old male smoker has developed cataracts on both eyes, and is awaiting surgery. The cataracts have prevented the patient from driving, reading, and seeing television. Which of the following statements would be appropriate for the nurse in the preoperative holding area to communicate to the patient?

“Did your eye doctor explain to you that you could choose to use eye drops six times a day to dissolve the cataract?”
“You are wise to have both eyes done at the same time.”
“If you were a non-smoker, you would never have developed cataracts.”
“Most patients undergoing cataract surgery do well and enjoy the improved vision.”

d (Rationale: Surgical removal is the only treatment used at this time for cataracts; no medical treatment is available to prevent or treat them. Surgical removal of the cataract and lens is indicated when the cataract has developed to the point that vision and activities of daily living are affected. If the patient presents with bilateral cataracts, surgery is only performed on one eye at a time. Complications from cataract surgery are unusual, and occur in less than 1% of the surgeries.)

Which of the following physical assessment maneuvers will allow the nurse to differentiate the ear pain of a patient with otitis externa from the ear pain of a patient with otitis media?

Manipulation of the auricle
Irrigating the ear canal with cool water
Rinne and Weber tests
Whisper test

a (Rationale: The pain of otitis externa can be differentiated from that associated with otitis media by the manipulation of the auricle. In external otitis, this maneuver increases pain, whereas the patient with otitis media experiences no change in pain perception. Rinne and Weber tests are used to diagnose sensorineural hearing loss. The caloric test (irrigation with cool water) evaluates vestibulo-ocular reflex. The whisper test evaluates hearing loss.)

A preschool-age child is undergoing bilateral myringotomy with tubes for the treatment of recurrent otitis media. The mother asks the nurse what the tubes will do. The nurse’s best response is that the tubes will:

Provide for drainage.
Prevent future episodes of otitis media.
Equalize pressures between the middle ear and the environment.
Prevent the spread of infection to the mastoid bone.

c (Rationale: Myringotomy (an incision of the tympanic membrane) is performed to relieve pressure caused by the edema and swelling of otitis media, which impairs the eustachian tubes’ ability to equalize pressures between the middle ear and the environment. Without relief of pressure, the tympanic membrane can rupture, the delicate structures of the middle ear can be damaged, and infection can spread to adjoining tissues and structures. Infection can still occur and spread despite myringotomy.)

When the patient who has undergone cataract extraction is preparing to go home, the nurse reinforces which of the following instructions?

Remove the dressing at bedtime.

A headache for the first few days after surgery should be expected.

Avoid sleeping on the operative side.

Set a new appointment with the surgeon for 1 month from today.

c (Rationale: The nurse should reinforce any limitation, such as avoiding reading, lifting, and strenuous activity, and sleeping on the operative side. The patient also needs to understand the importance of not disturbing the eye dressing, of follow-up appointments, and of manifestations of complications such as eye pain, change in vision, headache, or nausea.)

Which of the following suggestions should be taught by the nurse to the patient with tinnitus to assist the patient with coping with the symptom to promote concentration and sleep?

Earplugs
Sleeping medication
Hearing aid that produces a tone to mask tinnitus
Bedtime use of nasal decongestant spray

c (Rationale: Options for masking tinnitus to promote concentrate and sleep include ambient noise from a radio or sound system; masking device or white noise machine; hearing aid that produces a tone to mask the tinnitus; and hearing aid that amplifies ambient sound. Earplugs will focus the patient’s attention on the sound. The patient’s issue is the noise, not a sleeping disorder; hence, sleeping medications are not indicated. The tinnitus is a result of neurosensory damage, not of congestion.)

When the visiting nurse is teaching the family of a patient with acute conjunctivitis regarding the disease process, the nurse emphasizes which of the following statements as most important?

Wash hands before and after instilling eye drops.
Cleanse the patient’s contact lenses twice each day.
Ask patient to gently rub eyes to circulate the eye drops after instillation.
Use a cotton-tipped swab to cleanse the right eye and then the left eye.

a (Rationale: Acute conjunctivitis is highly contagious. Teach the family to wash hands thoroughly before and after instilling eye medication. Contact lens use should be avoided until the infection has cleared. Rubbing the eyes increases the risk of corneal trauma. Using a new swab between eyes prevents cross-contamination.)

Which of the following nursing diagnoses is the priority diagnosis for a patient with Ménière’s disease?

Disturbed Sensory Perception: Auditory
Disturbed Sleep Pattern
Risk for Trauma
Social Isolation

c (Rationale: The risk for trauma in patients with inner ear disorders, such as Ménière’s disease, is great. Disturbed Sensory Perception: Auditory is a priority nursing diagnosis for patients with hearing loss. Sleep Pattern Disturbance is a priority nursing diagnosis for patients with tinnitus. Risk for Trauma is the priority nursing diagnosis for patients with inner ear disturbances causing balance disorders. Social Isolation is a priority diagnosis for patients with otosclerosis or presbycusis.)

The nurse is caring for a patient who has a hearing deficit. Which of the following techniques should be implemented by the nurse to improve communication? (Select all that apply.)

Keep the patient’s face in full light.
Use a low voice pitch with normal loudness.
Speak at a slower rate than usual.
Use short sentences.

b d (Rationale: Techniques to improve communication with a patient with a hearing loss include keeping one’s face in full light-placing light in the patient’s face will prevent patient from seeing the speaker; using a low voice pitch with normal loudness; speaking at a normal rate, and not overarticulating; and using short sentences, and pausing at the end of each sentence.)

The nurse providing postoperative teaching for a patient who has undergone LASIK surgery advises the patient to contact the office if he experiences:

Dry eyes.
Undercorrection of visual acuity.
Decreased night vision with halos.
Drainage from the eye.

d (Rationale: Following surgery, patients can experience a temporary loss of sharpness, over- or undercorrection of visual acuity, dry eyes, or temporarily decreased night vision with halos, glare, and starbursts. Bleeding or drainage could indicate a surgical complication, and should be reported immediately.)

Which of the following statements by a patient with newly prescribed contact lenses indicates a need for additional teaching?

“I think it is so cool that my best friend, Taylor, and I have the same prescription. She has blue lenses and I have brown lenses, so we’ll be able to trade to see what we would look like with different eyes.”

“If I run out of cleaning and wetting solution, I’ll have to wait until I get a new supply before I’ll be able to wear my lenses again.”

“I’ll follow the manufacturer’s guide to tell me when I need to take them out.”

“If I have eye redness or pain in my eyes, I’ll take out my lenses and call the ophthalmologist first thing.”

a (Rationale: Manufacturer’s recommendations indicate to the wearer proper length of time for wear, cleaning, and storing. Patients are instructed to use cleaning and wetting solutions recommended by the optometrist, ophthalmologist, or lens manufacturer. Patients are instructed not to use water or homemade solutions for wetting or cleaning lenses. If eye redness, tearing, vision loss, or pain occurs, the patient should remove the lenses and contact the eye care professional as soon as possible. Lenses should not be shared or “tried on” by another person.)

The ________ test is a hearing test, primarily for evaluating loss of hearing in one ear (unilateral hearing loss). It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid. Thus, one can quickly screen for the presence of conductive hearing loss.
Rinne

The ______ test is a quick screening test for hearing. It can detect unilateral (one-sided) conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss)
weber

For the Rinne test, a vibrating tuning fork (typically 512 Hz) is placed initially on the mastoid process behind each ear until sound is no longer heard. Then, the fork is then immediately placed just outside the ear with the patient asked to report when the sound caused by the vibration is no longer heard. A normal or positive Rinne test is when the sound heard outside of the ear (air conduction or AC) is louder than that heard of the initial sound heard when the tuning fork end was placed against the skin on top of the mastoid process behind the ear (bone conduction or BC). Therefore, AC > BC; which is how it is reported clinically for a normal or positive Rinne result. In conductive hearing loss, bone conduction is better than air or BC > AC, a negative Rinne.
okay

In a normal patient, the Weber tuning fork sound is heard equally loud in both ears with no one ear hearing the sound louder than the other (lateralization). Similarly, a patient with symmetrical hearing loss will hear the Weber tuning fork sound equally as well with diagnostic utility only in asymmetric (one-sided) hearing losses. In a patient with hearing loss, the Weber tuning fork sound is heard louder in one ear (lateralization) versus the other. This clinical finding should be confirmed by repeating the procedure and having the patient occlude one ear with a finger; the sound should be heard best in the occluded ear.
okay

when a patient is given the Weber test and hears noise louder in one ear than the other, it is known as ________. For example, when this happens in the left ear, it would mean the RIGHT ear had either sensorineural or conductive hearing loss.
laterilization

which of the following is a correct rationale for encouraging a patient to eat soft foods when suffering from otitis externa?

chewy foods, such as red meat, may interact with prescribed analgesics and antibiotics

chewing may cause discomfort

chewing may cause excessive drainage

chewing may lead to further complications such as otitis externa

b

clinical manifestations of motion sickness are caused by over stimulation in what system?

GI
cochlear
vestibular
cardiovascular

c

acoustic neuromas are benign tumors of which of the following cranial nerves?

VI
VII
VIII
V

c

which of the following is inconsistant with acute otitis media?

it is a relatively uncommon childhood infection
a purulent exudate is usually present in the middle ear
conductive hearing loss may occur
the infection usually lasts less than 6 weeks

a

which of the manifestations is the most problematic for a patient diagnosed with Meniere’s disease?

vertigo
tinnitus
diaphoresis
hearing loss

a

which of the following describes a condition characterized by abnormal spongy bone formation around the stapes?

otosclerosis
chronic otitis media
otitis externa
middle ear effusion

a

which of the following describes a condition characterized by fluid in the middle ear without evidence of infection?

otosclerosis
chronic otitis media
otitis externa
middle ear effusion

d

an _________ practices in a branch of medicine concerned with care and diseases of the eye
ophthalmologist

an ________conduct eye test and prescribe corrective lenses
optometrist

an _________ is a fitter or supplier of glasses and contact lenses who does not examine eyes
optician

Physical assessment of Eyes

Observe for ….

-head tilt
-squinting
-noticeable action that offers clues for compensation.

Check for….

-redness
-lesions
-drainage
-scleral color
-blink reflex

okay

what eye test is done on those older than 40 years to assess IOP?
tonometry

The ______ of the _______ is important in determining refractive error.
depth eyeball

when a patient has deeper eyeballs, they will likely suffer from (myopia or hyperopia?) which is (nearsighted or farsighted?)
myopia, nearsighted

when a patient has shallow eyeballs, they will likely suffer from (myopia or hyperopia?) which is (nearsighted or farsighted?)
hyperopia, farsighted

____ vision is defined as best corrected visual acuity (BCVA) of 20/70 to 20/200
low

_____ ______ Describes visual impairment that requires patients to use devices and strategies in addition to corrective lenses to perform visual tasks.
low vision

Nursing Management of Patients With Low Vision

Encompasses emotional, physical, and social dimensions

Nursing priorities include:
Promoting coping efforts
Promoting spatial orientation
Promoting mobility
Promoting home- and community-based care

okay

_______ is Defined as a best corrected visual acuity (BCVA) ranging from 20/400 to no light perception (NLP)
blindness

Coping with blindness involves 3 types of adaptation: emotional, physical, and social. Success of ________ acceptance means acceptance of blindness.
emotional

_______ is A group of ocular conditions characterized by optic nerve damage related to intraocular pressure (IOP)
glaucoma

Two major types: ____-____ glaucoma and ____-_____ glaucoma
open angle, angle closure

Risk factors for Glaucoma

Family history
African American race
Older than 60 yrs.
Diabetes mellitus
Cardiovascular disease; Nearsightedness
Eye trauma, migraine symptoms, prolonged use of corticosteroids

okay

prolonged used of what kind of medication is a risk factor for glaucoma?
corticosteroid

Risk factors for Glaucoma

________ ________
African American race
Older than 60 yrs.
Diabetes mellitus
Cardiovascular disease; Nearsightedness
Eye trauma, migraine symptoms, prolonged use of corticosteroids

family history

Risk factors for Glaucoma

Family history
African American race
Older than __ yrs.
Diabetes mellitus
Cardiovascular disease; Nearsightedness
Eye trauma, migraine symptoms, prolonged use of corticosteroids

(*BUT*, when should you get tonometry tests? After age ___)

60 (40)

Risk factors for Glaucoma

Family history
African American race
Older than 60 yrs.
________ ________
Cardiovascular disease; Nearsightedness
Eye trauma, migraine symptoms, prolonged use of corticosteroids

diabetes mellitus

Risk factors for Glaucoma

Family history
African American race
Older than 60 yrs.
Diabetes mellitus
Cardiovascular disease;
_____________
Eye trauma, migraine symptoms, prolonged use of corticosteroids

nearsightedness

Signs & Symptoms (Glaucoma)

Cloudy, blurry vision, or loss of peripheral vision
Appearance of halos around lights
Aching or discomfort around the eyes
Nausea, vomiting
Headache

okay

Signs & Symptoms (Glaucoma)

Cloudy, blurry vision, or loss of peripheral vision, Appearance of halos around lights
Aching or discomfort around the eyes
Nausea, vomiting
Headache

okay

Signs & Symptoms (Glaucoma)

Cloudy, blurry vision, or loss of peripheral vision, Appearance of halos around lights
Aching or discomfort around the eyes
Nausea, vomiting
Headache

okay

_____ _____ glaucoma is most common, usually bilateral & asymptomatic in early stage.
open angle

_____ ______ glaucoma- (pupillary block) less common, sudden onset
angle closure

Treatment For Glaucoma

The aim of all treatment is to prevent optic nerve damage.
Lifelong therapy is always needed.
Treatment focuses on meds, laser therapy, surgery or combination.

okay

true or false: proper treatment can reverse optic nerve damage of a patient with glaucoma.
false

11. Which of the following is an effective technique of communicating with a hearing impaired client?

a) speak slowly in a low tone of voice
b) speak slowly in a loud voice
c) speak slowly and try to overemphasize words
d) speak slowly and directly in front of the client

d (speaking slowly allows the client to understand the message. And speaking in front of the client allows him to read the lip movement of the speaker. Avoid using loud voice pitch. High-pitched voice is more difficult to be understood by hearing-impaired client.)

Which of the following client statements indicates the need to postpone cataract surgery in the morning?

a) this seasonal allergy should no be a problem
b) the medications instilled into my eyes make my vision blurred
c) I feel nervous with my operation tomorrow
d) I have allergy to certain medications

a (seasonal allergy is characterized by sneezing and coughing. These may cause increase in intraocular pressure (IOP) and bleeding after eye surgery.)

Which of the following is done when performing Weber test?

a) place vibrating tuning fork in front of the opening of the ear
b) place the vibrating tuning fork in the middle of the head
c) place the vibrating tuning fork behind the ear
d) irrigate the ear with cold water and observe movement of the eyes

b (describes weber test, which confirms presence of sensorineural hearing loss like Meniere’s disease.)

The client has been diagnosed to have Meniere’s disease. Which of the following should be included when giving health teachings?

a) limit carbohydrates and proteins in the diet
b) limit salt intake
c) limit fats in the diet
d) drink a lot of fluids

b (meniere’s disease is a disorder caused by increased endolymphatic pressure in the inner ear; characterized by vertigo, tinnitus, gradual hearing loss. Low sodium diet is indicated to prevent further accumulation of endolymphatic fluids.)

The nurse plans care for a client with acute glaucoma who reports severe pain in the eyes and rainbow colors (halos) around lights. Which action should the nurse take first?

a) administer pain medication
b) explain to the client that with reduction in intraocular pressure, pain and other symptoms will subside
c) provide preoperative teachings to the client
d) assess the client’s visual status

a (pain is the priority problem in a client with glaucoma. Loss of vision in glaucoma is irreversible.)

A nurse receives a telephone call from a neighbor, who tells the nurse that the spouse accidentally broke a mirror, and a piece of glass flew into the eye. The nurse arrives at the home and finds that a piece of glass is protruding from the victim’s eye. The nurse should:

a) remove the piece of glass using a tweezers that was boiled for sterilization purposes
b) apply an eye patch and instruct the victim and spouse to report to the emergency department
c) accompany the victim and spouse to the emergency department
d) flush the eye thoroughly with tap water

c (f an eye injury is the result of a penetrating object, the object may be noted protruding from the eye. This object must never be removed except by the ophthalmologist because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the cornea. The most appropriate action by the nurse from the options presented is to accompany the victim to the emergency department.)

A client arrives at the emergency department after an eye injury in which an acid used to clean the bricks on a fireplace splashed into his eye. The initial assessment question by the nurse is which of the following?

a) did you bring the container of acid with you?
b) what time did the injury occur?
c) did you flush the eye following the injury?
d) what type of acid caused the injury?

c (Emergency care following a chemical burn of the eye includes irrigating the eye immediately with tap water or sterile normal saline or ocular irrigating solution if available. The irrigation should be maintained for at least 10 minutes. Following this emergency treatment, visual acuity is assessed. The initial assessment in this situation should focus on the type of treatment that took place immediately following the injury.)

A nurse is caring for a client following enucleation. Which of the following assessment findings would indicate the need to notify the physician?

a) bright red drainage on the dressing
b) a respiratory rate of 22 breaths per minute
c) complaints of pain in the affected eye
d) a blood pressure of 138/88 mm Hg

a (f the nurse notes the presence of bright red drainage on the dressing, it must be reported to the physician because this can indicate hemorrhage. Complaints of pain are expected in the postoperative period. A blood pressure of 138/88 mm Hg is within normal range. A respiratory rate of 22 breaths per minute, although slightly elevated from the normal range, does not warrant physician notification.)

A client is being discharged from the ambulatory care unit after cataract removal, and the nurse provides instructions regarding home care. Which of the following should the nurse tell the client?

a) take acetaminophen (Tylenol) if any discomfort occurs
b) sleep on the side that was operated on to promote drainage
c) avoid wearing glasses
d) do not lift anything that weighs more than 20 pounds

a (The client is instructed to wear a metal or plastic shield to protect the eye from accidental injury and is instructed not to rub the eye. Glasses may be worn during the day, and an eye shield is worn at night. Aspirin or medications containing aspirin are not to be administered or taken by the client; the client is instructed to take acetaminophen (Tylenol) as needed for pain. The client is instructed not to sleep on the side of the body that was operated on because this action will cause edema and increased intraocular pressure. The client is not to lift more than 5 pounds.)

An ambulatory care nurse provides instructions to a client after a cataract extraction. Which statement by the client indicates a need for further instructions?

a) I need to avoid bending over to pick up items
b) I will sleep on the unoperative side
c) I need to wear an eye shield all the time
d) There is no reason to stay on a special diet

c (Postoperatively, cataract extraction clients should be positioned on their backs in semi-Fowler position or on the unoperative side to prevent edema in the surgical site. They need to avoid bending at the waist and other activities that will increase intraocular pressure. A special diet is not necessary following this procedure. The client needs to wear an eye shield at night to prevent injury to the eye during sleep. Eyeglasses or an eye patch may be worn during the day.)

The nurse is caring for a hearing-impaired client. Which of the following approaches will facilitate communication?

a) speak loudly
b) speak frequently
c) speak at a normal volume
d) speak directly into the impaired ear

c (Speaking in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear.)

A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially?

a) irrigation of the ear
b) instillation of diluted alcohol
c) instillation of antibiotic ear drops
d) instillation of corticosteroid ointment

b (Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is removed using ear forceps. When the foreign object is vegetable matter, irrigation is not used, because this material expands with hydration and the impaction becomes worse.)

The nurse notes that the physician has documented a diagnosis of presbycusis on the client’s chart. The nurse plans care knowing that the condition is:

a) tinnitus that occurs with aging
b) nystagmus that occurs with aging
c) a conductive hearing loss that occurs with aging
d) a sensorineural hearing loss that occurs with aging

d (Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve. Options A, B, and C are incorrect.)

The nurse has conducted discharge teaching for a client who has had a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective?

a) it is okay to take a shower and wash my hair
b) I can resume my tennis lessons starting next week
c) I will take stool softeners as prescribed by my doctor
d) I should drink liquids through a straw fo the next 2 to 3 weeks

c (Following ear surgery, the client needs to avoid straining when having a bowel movement. The client needs to be instructed to avoid drinking with a straw for 2 to 3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her head wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.)

A client with Meniere’s disease is experiencing severe vertigo. Which instruction should the nurse give to the client to assist in controlling the vertigo?

a) increase sodium in the diet
b) avoid sudden head movements
c) lie still and watch the television
d) increase fluid intake to 3L a day

b (The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid are sometimes prescribed. Lying still and watching television will not control vertigo.)

When caring for the elderly client with cataracts, the nurse knows that which of the following are risk factors for cataracts?

Height and weight
Yellow sclera and loss of vision
Corneal fat and diet
Eye trauma and exposure to UV-B rays

d

The nurse looking at the eye of a client with iritis will find which of the following manifestations?

Yellow sclera
Tearing of the eye
A red limbus
Dilated pupil

c (http://en.wikipedia.org/wiki/Corneal_limbus & http://www.mastereyeassociates.com/iritis-anterior-uveitis)

The client with a diagnosis of macular degeneration will have which of the following visual problems?

Double vision
Progressive loss of all visual fields
Blurred and distorted central vision
Loss of peripheral vision

c

When doing teaching for home care with a client who has a diagnosis of Meniere’s disease, the nurse will most need to teach which of the following things?

Sitting or lying down immediately when vertigo occurs
Breathing into a brown paper bag when vertigo occurs
Turning the head and not the whole body
Placing the head between the legs when vertigo occurs

a

Which of the following statements would best indicate that the client with a diagnosis of external otitis understood the nurse’s teaching about care of the ear during the healing period?

“I will temporarily put cotton balls in my ears while showering.”
“I will wear a swimming cap when swimming on the surface.”
“I will clean my ears with a cotton swab and hydrogen peroxide.”
“I will wear earplugs when swimming underwater.”

a

The client with a eustachian tube dysfuction will demonstrate an understanding of the nurse’s teaching on how to open the eustachian tube by performing which of the following action?

Applying an ice pack to the cheekbones
Rubbing across both cheekbones with both hands at the same time
Blowing against closed nostrils and performing the Valsalva maneuver
Coughing while placing a finger in each ear

c (The nurse should demonstrate blowing against closed nostrils and performing the Valsalva maneuver.)

When gathering health histories on clients with otosclerosis, the nurse is most likely to find the clients describing which of the following things?

Hearing loss beginning in childhood
Preserved air conduction and lost bone conduction
Ability to talk in person with no difficulty talking on the phone
Hearing loss in both ears

d (Hearing loss usually begins in adolescence. The client may be able to use the telephone but has difficulty talking in person. Both ears are affected. Bone conduction is present, and air conduction is lost.)

Which of the following nursing diagnoses is most often the highest priority for a client with an inner ear disorder?

Pain
Risk for Infection
Risk for Injury
Autonomic Dysreflexia

c

When working with a client with a hearing loss and a hearing aid, you most need to do which of the following things?

Overarticulate, pronouncing each syllable distinctly
Speak in a higher voice and a little louder
Try to speak with the client as little as possible
Reduce the noise in the environment before speaking to the client

d

Which of the following are the priority nursing diagnoses for clients with infectious and inflammatory eye disorders? Select all that apply.

Emphasize the importance of proper contact lens care
Teach the client to apply cold compresses
Teach to avoid touching or rubbing the eyes
Notify the physician immediately if the cornea perforates

a c d

The nurse receives report on 4 clients. Which client should the nurse see first? 1. Client admitted 12 hours ago with acute asthma exacerbation who needs a dose of IV methylprednisolone [21%] 2. Client admitted 2 days ago with congestive …

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? Glucose level After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion …

1) A nurse is caring for a client with hyperparathyroidism and notes that the client’s serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate …

Which part of the small intestine absorbs carbohydrates and protein? A. Jejunum B. Ileum C. Duodenum A. Jejunum Which part of the small intestine absorbs water, fat, and bile salts? A. Jejunum B. Ileum C. Duodenum C. Ileum WE WILL …

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