460 exam 2 lippincott eye ear disorder questions

11. Which statement would the nurse expect the client to report when looking at an object without wearing corrective glasses or contact lenses? [ ] 1. "I see near objects more clearly." [ ] 2. "I see a blurry area in front of me." [ ] 3. "I see far objects more clearly." [ ] 4. "I see two of the same object."

11. 2. Owing to an irregularly shaped cornea or lens, a person with astigmatism has unequal refraction of images on the retina. Therefore, there will be an area where objects appear more blurred or distorted (wider or taller) than they actually are. People with hyperopia see far objects more clearly. People with myopia can see near objects more clearly. No visual acuity disorder causes objects to appear unusually small.

12. After cleaning a client's prescription eyeglasses with soap and warm water or a commercial glass cleaner, which nursing action is best for drying the moist lenses? [ ] 1. Rub the lenses with a paper tissue. [ ] 2. Wipe the lenses with a soft cloth. [ ] 3. Blot the lenses with a paper towel. [ ] 4. Blow on the lenses to promote air drying.

12. 2. Glasses are washed first and wiped with a soft cloth to avoid scratching the surface with dirt and dust. Paper products such as paper tissues or towels should not be used for drying corrective lenses because they are made from wood pulp that can scratch the lens material. Plastic lenses scratch easily. Blowing to promote air drying is tedious and likely to leave streaks on the lenses.

13. Which nursing intervention is most appropriate to include in the care plan of an anxious client who is blind or has both eyes patched? [ ] 1. Touch the client before speaking. [ ] 2. Explain what you plan to do beforehand. [ ] 3. Stand in front of the client when speaking. [ ] 4. Leave the room lights on at all times.

13. 2. Anxiety occurs because a person feels threatened by an unexpected or unfamiliar situation. Hearing an explanation of care beforehand prepares a person for what is about to take place. The nurse should always speak before touching a blind client or one whose vision is obstructed by eye patches. Standing in front of a person when speaking may help a client who has a hearing disorder but not one who is blind. Having adequate light helps partially sighted clients, not those who cannot see.

14. Which instruction to the nursing assistant is best for maintaining the client's safety and security? [ ] 1. Let the client take your arm while walking. [ ] 2. Take the client's arm while walking. [ ] 3. Position the client in front of you and to your side. [ ] 4. Have the client walk independently by your side.

14. 1. A blind person feels safer and more secure by following the lead of someone who is sighted. This is best accomplished by having the blind person stand slightly behind and to the side while taking the sighted person's arm just above the elbow. Safety is a higher priority than total independence in an unfamiliar environment.

15. Which plan best promotes a blind client's feeling of self-reliance when eating? [ ] 1. Help the client locate food by comparing its placement to clock positions. [ ] 2. Ask a hospital volunteer to feed the client so the client does not have to ask for help. [ ] 3. Order foods that can be sipped from containers rather than eaten with utensils. [ ] 4. Ask the dietary department to serve the client's food on paper plates and in cups.

15. 1. Using the imagery of a clock helps a blind client to locate food and self-feed. Feeding a client who has the ability to self-feed does not promote self-reliance. Ordering liquid forms of nourishment without prior collaboration implies that the client is not capable of eating like an adult and may lower the client's self-esteem. Beverages in paper cups are more likely to spill during the client's attempts to eat independently and may reinforce a feeling of inadequacy.

16. When the nurse reviews the client's health history, which symptom is directly related to the development of cataracts? [ ] 1. Gradual loss of vision [ ] 2. Feeling of fullness within the eye [ ] 3. Ocular pain or discomfort [ ] 4. Flashes of light

16. 1. As cataracts form, they cause progressively diminished vision. The visual change is due to degeneration of the eye lenses as a result of aging. A feeling of fullness and ocular pain or discomfort are more likely due to trauma or an inflammatory process. Seeing flashes of light is a symptom described by someone with a detached retina.

17. When the nurse inspects the client's eyes, which clinical finding is most indicative of cataracts? [ ] 1. Ruptured blood vessels in the eye [ ] 2. An irregularly shaped iris [ ] 3. A white spot behind the pupil [ ] 4. A painless corneal lesion

17. 3. When the eyes of someone with cataracts are examined, the usually black pupil appears white, gray, or yellow. This is due to an opacity of the lens, which lies behind the pupil, the opening in the center of the iris. Ruptured blood vessels on the eye are associated with conditions in which the blood pressure has been suddenly elevated, such as when performing Valsalva's maneuver while vomiting or defecating. An irregularly shaped iris can be the result of surgery performed for the treatment of glaucoma. Abnormal tissue may appear as a growth on the cornea.

19. After reviewing the medical orders, which of the fol lowing is essential for the nurse to assess preoperatively? [ ] 1. The client's face for skin lesions [ ] 2. The time of the last dose of anticoagulant [ ] 3. The client's right eye for drainage [ ] 4. The client's left eye for signs of strain

19. 2. On reviewing the preoperative orders, it is especially important to note the time when anticoagulant medication was stopped. This is essential to reduce the risk of retrobulbar hemorrhage. Reviewing the last dose and time of medication allows the nurse to assess if the client has withheld the medication for the appropriate amount of time. Assessing for facial lesions and right eye drainage is appropriate to document preoperatively, but they are not as critical as documenting the last dose of anticoagulant medication. Eyestrain is a subjective finding that may also be documented preoperatively.

2. Assuming the following solutions are available, which one is best for the school nurse to use at this time? [ ] 1. Tap water [ ] 2. Sodium bicarbonate [ ] 3. Normal saline [ ] 4. Magnesium sulfate

2. 1. Water is typically used in an emergency to flush the eyes and dilute the chemical. Tap water from a faucet or shower is generally available. The other chemical solutions may be appropriate depending on the specific chemical that caused the trauma, but they may need to be diluted to a specific strength to prevent additional damage to the eye. Delaying first-aid measures wastes valuable time. Ideally, the student's eyes should have been flushed in the classroom at an appropriate eye wash station before seeing the nurse.

20. The nurse should instill the eyedrops into which part of the client's eye? [ ] 1. Onto the cornea [ ] 2. At the inner canthus [ ] 3. At the outer canthus [ ] 4. In the lower conjunctival sac

20. 4. Eyedrops and ointments are placed in the exposed lower conjunctival sac. The nurse should pull downward below the eye on the lower eyelid to form the conjunctival sac. If the eyedrops are placed on the cornea, they may cause discomfort and reflex blinking. Medication is systemically absorbed when instilled at the inner canthus. Placing eyedrops and ointments at the outer canthus makes it difficult to distribute them in the eye.

21. Which standing nursing order should be eliminated from this client's care plan? [ ] 1. Keep the client's bed in a low position at all times. [ ] 2. Reapply antiembolism stockings twice daily. [ ] 3. Urge the client to cough every 2 hours while awake. [ ] 4. Assist the client when ambulating in the hall or room.

21. 3. Coughing, vomiting, and other activities, such as straining or squeezing the eyelids together, are avoided to prevent an increase in intraocular pressure. Raising intraocular pressure strains the delicate sutures and may dislodge an implanted intraocular lens. All other interventions are appropriate for this client.

22. After cataract surgery, the client tells the nurse of severe pain in the operative eye. Which nursing action is most appropriate? [ ] 1. Report the finding to the charge nurse. [ ] 2. Give the client a prescribed analgesic. [ ] 3. Assess the client's pupil response with a penlight. [ ] 4. Reposition the client on the operative side.

22. 1. Severe pain is an indication that intraocular hemorrhage is occurring. It is essential to report this finding to the charge nurse or surgeon immediately. Giving an analgesic will mask the symptom, thereby diminishing its significance as a serious complication. Assessing the pupils will not reveal the cause of the symptom. The pupils will most likely be dilated and not respond to light. Postoperatively, cataract clients are not positioned on their operative side.

23. When the client asks the nurse about the purpose of the eye shield, which explanation is best? [ ] 1. The shield keeps foreign substances out of the eye. [ ] 2. The shield protects the eye from accidental trauma. [ ] 3. The shield reduces rapid eye movement when dreaming. [ ] 4. The shield promotes dilation of the pupil at night.

23. 2. A metal eye shield called a Fox shield is applied at night or before naps to prevent accidental injury to the operative eye. Although the shield is a mechanical barrier between the environment and the eye, its primary purpose is to prevent traumatic injury. Patching the eyes will not prevent the rapid eye movements that occur during sleep. If pupil dilation is necessary, drugs will be used to paralyze the ciliary muscle.

24. Which information is most appropriate to include in the discharge instructions for the client who has undergone a cataract extraction? [ ] 1. Avoid bending over from the waist. [ ] 2. Keep both eyes patched at all times. [ ] 3. Sleep with the head slightly elevated. [ ] 4. Expect bleeding to decrease in 1 week.

24. 1. Bending over is contraindicated for approximately 2 weeks after eye surgery because it puts strain on the operative sutures. It is unnecessary to keep both eyes patched at all times. The client may sleep with or without a pillow, but should be instructed to sleep only on the unaffected side for approximately 1 week to prevent pressure on the operative eye and reduce tissue edema. External bleeding is not expected at any time postoperatively. Intraocular bleeding, indicated by sudden eye pain, is considered a complication that necessitates immediate examination.

25. Which common characteristic of open-angle glaucoma is this client most likely to report? [ ] 1. Itching and burning eyes [ ] 2. Headaches while reading [ ] 3. Seeing halos around lights [ ] 4. Loss of peripheral vision

25. 4. Glaucoma is a progressive eye disease characterized by increased intraocular pressure resulting in atrophy of the optic nerve and possibly leading to blindness. The increased pressure is due to excessive fluid accumulation inside the eye. There are two types of glaucoma: angle closure and open angle. Angle-closure glaucoma usually presents suddenly and is painful; open-angle glaucoma has a slower onset and few or no symptoms, until a gradual loss of the visual field occurs. Although open-angle glaucoma is not likely to cause significant symptoms, those who are affected generally describe a decrease in their peripheral vision. Itching and burning are most likely allergic responses. Headaches may occur when a client in need of corrective lenses strains to read. Clients with angle closure glaucoma report seeing halos around lights.

26. If the physician wants to check the client's intraocular pressure (IOP), which instrument should the nurse have available? [ ] 1. Ophthalmoscope [ ] 2. Tonometer [ ] 3. Retinoscope [ ] 4. Speculum

26. 2. The symptoms of glaucoma occur as a result of increased intraocular pressure. This condition is diagnosed using an instrument called a tonometer. There are many types of tonometers; one of the more common types is a Schiotz tonometer, which measures the depth of the impression made when a plunger is placed on the surface of the cornea. An ophthalmoscope is used for viewing the fundus or back portion of the eye. A retinoscope is used to measure visual acuity and determine refractory errors. A speculum is an instrument that widens a cavity.

27. Which symptom related to the chronic progression of untreated glaucoma will a client most likely report to the nurse? [ ] 1. Tunnel vision [ ] 2. Double vision [ ] 3. Bulging eyes [ ] 4. Bloodshot eyes

27. 1. Chronic glaucoma causes a gradual loss of peripheral vision. If untreated, the visual field is reduced to only the image that is focused directly on the macula. Clients typically describe this as looking through a tube or tunnel. Double vision is due to neurologic diseases or a weakness in eye muscles. Bulging eyes, also called exophthalmos, accompanies hyperthyroidism. Inflamed eyes can be attributed to various irritating substances.

29. Which comment made to the nurse strongly suggests that the client with glaucoma needs more teaching? [ ] 1. "I must wash my hands before instilling the drops." [ ] 2. "This drug decreases the formation of fluid in my eye." [ ] 3. "I'll need to take this until my eye pressure is normal." [ ] 4. "The cap on the container should be replaced after use."

29. 3. Glaucoma can potentially lead to blindness and requires lifelong treatment with medication unless the condition is treated surgically. Hand washing and replacing the cap of the prescription container are aseptic measures that prevent the transmission of organisms within the eye. Timolol maleate (Timoptic) is a beta-adrenergic blocker that decreases aqueous humor formation without constricting the pupil.

31. Which assessment finding is commonly noted when the intraocular pressure (IOP) of a client with angle closure glaucoma becomes dangerously high? [ ] 1. Spots in the visual field [ ] 2. Severe eye pain [ ] 3. Pinpoint pupils [ ] 4. Bulging eyes

31. 2. A client who experiences an acute increase in intraocular pressure (IOP) will have severe eye pain, nausea, vomiting, and loss of vision. Dangerously high ocular pressure is an emergency. A client with retinal detachment or hypertension typically describes seeing spots in the visual field. During an acute attack of angle-closure glaucoma, the pupils are widely dilated; treatment involves administering drugs that both constrict the pupils and eliminate intraocular fluid. The eyes appear normal in size even during an acute attack of angle-closure glaucoma, but the cornea and conjunctive become red and steamy in appearance.

32. The nurse compares the characteristics of open-angle glaucoma with those of angle-closure glaucoma. Which o the following statements describe ways they are similar? Select all that apply. [ ] 1. The symptoms appear suddenly. [ ] 2. The visual field examination demonstrates a loss of vision. [ ] 3. Clients are initially treated with medications. [ ] 4. Blurred vision is a common manifestation. [ ] 5. Attacks are self-limited but are more harmful with each episode. [ ] 6. Surgery is often required.

32. 2, 3, 6. In both open-angle glaucoma and angle closure glaucoma, the visual field examination indicates a loss of vision. Also, clients with either type of glaucoma are initially treated with medication. Surgical management is required if medication therapy is unsuccessful. In some cases, clients with open-angle glaucoma (a chronic form of the disease) are asymptomatic and may not realize that they have glaucoma until undergoing a routine eye examination. However, many clients experience eye discomfort, temporary blurred vision, and reduced peripheral vision. Clients with angle-closure glaucoma (an acute condition also known as narrow-angle glaucoma) experience sudden onset of symptoms. The eyes become rock hard and painful, and nausea and vomiting may occur. Each subsequent attack harms the eye.

33. When the nurse assesses the client's operative eye after surgery, which finding is most expected? [ ] 1. The pupil appears cloudy and gray. [ ] 2. The pupil is a fixed size and shape. [ ] 3. The entire iris lacks color. [ ] 4. A section of the iris appears black.

33. 4. An iridectomy involves removing a piece of the iris to allow aqueous fluid to flow from the posterior chamber into the anterior chamber through the trabecular mesh-work and out the canal of Schlemm. Intense heat is used to create this opening for drainage. The iris no longer appears perfectly round postoperatively; the missing section appears black.

34. Of the following information provided by the client to the nurse, which factor is most likely to cause a retinal detachment? [ ] 1. The client is younger than age 40. [ ] 2. The client fell and struck the head. [ ] 3. The client has multiple allergies. [ ] 4. The client is being treated for glaucoma.

34. 2. The retina is the neurosensory layer of tissue on the innermost posterior surface of the eye. The retina contains rods and cones, which are necessary for color and black and white vision. Light that comes into the eye via the lens is focused onto the retina. The retina's photoreceptors convert the light into electrical impulses that are relayed to the optic nerve and ultimately to the brain for interpreta tion. Retinal detachment, the separation of retinal pigment epithelium from the sensory layer, has multiple etiologies. Common causes include trauma (such as occurs with a fall or a blow to the head), myopia, and degenerative changes. Aging is a factor, but the most common period for retinal detachment is between ages 50 and 60. Glaucoma may result in retinal detachment, but the opposite is not generally true. There is no causal relationship between retinal detachment and glaucoma

35. Which of the following would be the most appropriate action for the nurse to take when applying eye patches to the client? [ ] 1. Occluding all sources of room light [ ] 2. Ensuring that both patches exert tight pressure on the eyes [ ] 3. Maintaining the client's eyelids in a closed position [ ] 4. Making sure the client can see while the patches are in place

35. 3. The purpose for patching the eyes of a client with a detached retina is to keep the eyes at rest; therefore, patches are applied to both eyes with the eyelids closed. Keeping the eyelids closed also protects the eyes from contact with dust or fibers and prevents the eyes from becoming dry because blinking is difficult once the eyes are patched. Light is not necessarily harmful, but it may cause the client to look about rather than resting the eyes. Gravity rather than pressure has some therapeutic value when treating a detached retina. Patching the eyes but facilitating vision is a contradiction in therapeutic principles.

36. Before leaving the room, which of the following nursing actions best preserves the client's dignity? [ ] 1. The nurse straightens the client's linens. [ ] 2. The nurse informs the client when leaving the room. [ ] 3. The nurse offers to give the client a back rub. [ ] 4. The nurse shares some current events with the client.

36. 2. It is important for the nurse to indicate when leaving because the client whose eyes are patched has no visual cue as to whether the nurse is still in the room. The client would find it frustrating and embarrassing to carry on a conversation if no one is there to respond. Straightening the client's linens, offering a back rub, and sharing current events are acts of kindness and good nursing care but do not specifically help to maintain the client's dignity.

37. Which response by the nurse is best in this situation? [ ] 1. "Gravity helps to reattach the separated retina." [ ] 2. "You don't want to be permanently blind, do you?" [ ] 3. "I can get you a sedative if it's hard to lie still." [ ] 4. "The doctor knows what's best for you, and you should listen."

37. 1. Bed rest and bilateral patching is a conservative treatment that relies on the principle of gravity to help reattach the separated retina. This approach is common before surgical alternatives are considered. Explaining the purpose of bed rest may help the client to comply with the prescribed therapy. Asking whether the client wants to be permanently blind may heighten anxiety. Although sedatives are sometimes prescribed, this situation does not warrant the added risks caused by sedation. Responding in a superficial, belittling manner, as in the last option, implies that the client's question is frivolous.

38. Postoperatively, which of the following client concerns should be the nurse's highest priority? [ ] 1. Pain [ ] 2. Vomiting [ ] 3. Anxiety [ ] 4. Fatigue

38. 2. Scleral buckling is a surgical procedure that takes a tuck in the sclera, thereby ultimately decreasing the size of the eyeball. This facilitates contact between the choroid and the retina, repairing a detachment. An increase in intraocular pressure, which occurs with vomiting, could damage the surgical repair; therefore, vomiting requires prompt treatment. The client requires an antiemetic; if one was not ordered, the nurse must notify the charge nurse or physician immediately. Pain is expected after surgery for a detached retina. Although pain causes discomfort, its treatment should not affect the outcome of the surgical procedure. Anxiety and fatigue are not physiologic problems and therefore do not rank as high on the list of priorities.

39. Which statement made to the nurse is the best evidence that the client understands the anticipated outcome of this procedure? [ ] 1. "I'll have better night vision." [ ] 2. "I'll correctly identify colors." [ ] 3. "I'll see well without glasses." [ ] 4. "I'll use both eyes when reading."

39. 3. Radial keratotomy is performed to reshape the cornea so visual images converge directly on the retina. If the procedure is successful, the client should no longer require corrective lenses. Radial keratotomy does not improve night vision, correct color blindness, or facilitate binocular vision.

40. On inspecting the client's eye, the nurse will note which symptom of conjunctivitis in addition to erythema? [ ] 1. Dried drainage along the eyelid [ ] 2. Lack of pupil response to light [ ] 3. Bulging of the eye from the orbit [ ] 4. Loss of moisture on the cornea

40. 1. A client with pinkeye, a common name for viral or bacterial conjunctivitis, will have an obviously inflamed conjunctiva, sticky or crusty drainage that collects on the lid, itching or burning of the eyes, and possible edema of the eyelid. The disorder does not affect pupil response. The eyelid may be swollen, but the eye itself should not protrude. Tearing may be excessive.

41. Which health teaching instruction given by the nurse is most important for a client with conjunctivitis? [ ] 1. Eat a well-balanced, nutritious diet with plenty of fluids. [ ] 2. Always wear dark sunglasses when in bright light. [ ] 3. Do not share towels or washcloths with family members. [ ] 4. Avoid all aspirin-containing products.

41. 3. Using individual bath linens and performing frequent hand washing are techniques for preventing the transmission of infectious microorganisms present in the inflammatory secretions of a client with conjunctivitis. Eating a nutritious diet and wearing sunglasses to filter ultraviolet light are healthful behaviors, but they are unrelated to the client's disorder. The use of aspirin is not contraindicated; in fact, a mild analgesic may relieve some of the client's discomfort.

42. The nurse correctly hands the physician which solution? [ ] 1. Povidone-iodine (Betadine) [ ] 2. Gentian violet [ ] 3. Methylene blue [ ] 4. Fluorescein

42. 4. Fluorescein is a tissue-staining substance that is applied topically to assess the condition of the cornea, including the presence of foreign bodies or lesions. Povidone-iodine (Betadine) and gentian violet are used for their antimicrobial properties rather than for diagnostic purposes. Methylene blue is used to stain pathology slides.

43. What images will a client with macular degeneration most likely describe seeing? [ ] 1. Objects that are close to the face [ ] 2. Objects that are at a far distance [ ] 3. Objects that are in outer peripheral fields [ ] 4. Objects that are in the central field of vision

43. 3. The macula is a part of the retina that helps people see images in fine detail. Macular degeneration is an eye disorder that results in a change in blood supply to the macula, the point where light rays converge to provide the clearest and most distinct visual image. Having lost macular function, the client is left with what appears to the client as a bull's eye visual defect. Peripheral vision remains, but it is insufficient to read or perform other activities that require acute vision.

44. To identify problems that may compromise the client's vision, the nurse recommends regular eye examinations by an ophthalmologist to which client? [ ] 1. A client who takes aspirin daily [ ] 2. A client who has diabetes mellitus [ ] 3. A client who is lactose intolerant [ ] 4. A client who has a pacemaker A client with a malignant eye tumor has consented to

44. 2. Clients with diabetes mellitus are at risk for developing vascular pathology in the retina. Their retinal blood vessels tend to weaken and bleed. Loss of vision is delayed or prevented when weakened and bleeding retinal blood vessels are treated early with photocoagulation using a laser or by having a vitrectomy performed. Clients who take aspirin, are lactose intolerant, or have an artificial pacemaker are not at any higher risk for ophthalmologic complications than the general population.

45. Which statement provides the best evidence that the client understands the postoperative outcome of this surgery? [ ] 1. "My vision will be restored with a plastic prosthesis." [ ] 2. "The prosthetic eye will be inserted during surgery." [ ] 3. "I will have to remove my prosthesis for cleaning." [ ] 4. "I will have a permanently empty eye socket."

45. 3. Enucleation is the removal of the eyeball from the eye socket, but the muscles surrounding the eyeball are usually left intact. After an enucleation, clients are taught how to remove, clean, and replace the shell-shaped prosthetic eye. The prosthetic eye is only cosmetic, not functional. A conformer, which is a round implant, is inserted during surgery to maintain the shape of the eye and prevent shrinkage of the surrounding tissue. The conformer remains permanently in place; the prosthesis is not inserted until healing takes place, which typically is approximately 4 to 6 weeks postoperatively.

46. Which symptom, expressed to the nurse, most suggests that a client who had a corneal transplant is experiencing rejection of the donor tissue? [ ] 1. Excessive tearing [ ] 2. Change in vision [ ] 3. Itching of the eye [ ] 4. Frequent blinking

46. 2. The cornea serves the eye in two ways. First, it protects the eye from dust, debris, and pathogens. Second, it controls and focuses the light that enters the eye. Corneal transplants are performed when the cornea is thinning, scarring because of infection or injury is present, or the cornea is cloudy. Signs of corneal transplant rejection include redness, loss of vision, and sensitivity to light. Tearing, blinking, and itching would require medical assessment; however, they are not the most significant symptoms that indicate corneal tissue rejection.

47. On the basis of the anatomic changes in the tone of the eyelid, the nurse would expect the client to experience which problem? [ ] 1. Double vision [ ] 2. Photophobia [ ] 3. Lid spasms [ ] 4. Dry eyes

47. 4. Incomplete closure of the eyelids leads to dry eyes. The tarsal muscles within the lids are generally atonic due to age and loss of superficial fat in the face; consequently, lid spasms are unlikely. Topical medications are used to treat the symptoms, but surgery or injections of botulinum toxin may provide a more permanent cosmetic and functional solution. Neither double vision nor light sensitivity is a common manifestation of structural disorders of the lids.

48. Which recommendation by the nurse is most appropriate if the client's condition is caused by hypersecretion of the sebaceous glands? [ ] 1. Increasing attention to hygiene [ ] 2. Limiting consumption of dietary fat [ ] 3. Switching to fluorescent lighting [ ] 4. Eating more deep yellow vegetables

48. 1. Blepharitis, an inflammation of the eyelid margin, is commonly associated with excessive oiliness of the skin, face, and scalp. In most cases, more frequent washing of the face and hair relieves the symptoms. In chronic or severe conditions, clients improve with the additional use of a topical antibiotic ointment. Limiting dietary fat, using fluorescent lighting, and eating more deep yellow vegetables are good lifestyle choices, but they will not decrease or remove secretions from the sebaceous glands in the eyelids.

49. When a client with a stye (hordeolum) asks a nurse to suggest measures to relieve the discomfort, what is the best advice the nurse can offer? [ ] 1. Squeeze the lesion to express the exudate. [ ] 2. Apply warm, moist compresses to the area. [ ] 3. Pierce the lesion with the tip of a pin. [ ] 4. Cover the lesion with a dry gauze dressing.

49. 2. A stye (hordeolum) is a bacterial infection within a meibomian gland, a special type of sebaceous gland at the rim of the eyelids. Warm, moist heat improves circulation to the area that is inflamed and swollen. Vasodilation relieves the edema and promotes a reduction in exudate via absorption or phagocytosis. Incision and drainage may become necessary, but a physician should do this, not the client. Covering the lesion disguises the appearance of the stye, but it does not provide any therapeutic benefit.

5. After the student has been treated, which one of the fol lowing professionals is best for providing follow-up care? [ ] 1. An optician [ ] 2. An ophthalmologist [ ] 3. An optometrist [ ] 4. An orthoptist

5. 2. An ophthalmologist is a physician who is licensed to diagnose and treat eye diseases and traumatic injuries. An optician fills prescriptions for corrective lenses. An optometrist tests vision and prescribes glasses or contact lenses to correct visual acuity. An orthoptist is a person who helps strengthen the extraocular muscles of the eye.

50. Which of the following is correct information for the nurse to provide the client about the consequences if the tissue continues to proliferate? [ ] 1. Blindness may occur. [ ] 2. Lashes may fall out. [ ] 3. Surgery may be necessary. [ ] 4. Pain may be severe.

50. 3. A chalazion, a cyst that forms in an obstructed meibomian gland within the eyelid, tends to be minor. If gentle massage fails to relieve the obstruction, office surgery is performed to excise the cyst-like growth of tissue. A chalazion is more likely to produce a sensation of pressure than of pain. The eyelashes are lost from seborrheic blepharitis, not a chalazion. Blindness is not commonly associated with a chalazion.

51. If the client worked at the following occupations, which one is most likely to have contributed to the hearing loss? [ ] 1. Telephone operator [ ] 2. Computer programmer [ ] 3. Musician [ ] 4. Teacher

51. 3. Musicians and others who are exposed to excessively loud sounds without ear protection can acquire sensorineural hearing loss. There is no significant evidence that occupations involving computer programming, using the telephone, or teaching in a classroom are associated with impaired hearing.

52. What information is best for the nurse to tell the client about cleaning ears? [ ] 1. "It's best to use the corner of a soapy washcloth." [ ] 2. "Do you prefer a short or long cotton-tipped applicator?" [ ] 3. "Have you ever tried removing earwax with a hairpin?" [ ] 4. "I can refer you to a physician who will clean them."

52. 1. The accumulation of normal cerumen is best removed by washing the ears with soapy water and a soft cloth. Hard and sharp objects can injure the ear canal or tympanic membrane. A medical referral is appropriate only if the cerumen is excessively hard or impacted.

53. Which instrument is most appropriate for the nurse to use to test a client's hearing acuity? [ ] 1. Otoscope [ ] 2. Tuning fork [ ] 3. Reflex hammer [ ] 4. Stethoscope

53. 2. A tuning fork is used to test for conductive and sensorineural hearing loss. Weber's test is performed by striking the tuning fork and placing it centrally on the forehead. The Rinne test is performed by striking the tuning fork and placing it on the mastoid bone and beside the ear. An otoscope is used to inspect the physical structures in the external ear. A reflex hammer is used to test deep tendon responses. A stethoscope is used to auscultate body sounds.

54. Which question is most appropriate for the nurse to ask at this time? [ ] 1. "What childhood diseases have you had?" [ ] 2. "What's your present occupation?" [ ] 3. "Do you eat a well-balanced diet?" [ ] 4. "How much aspirin do you take?"

54. 4. Tinnitus, ringing or buzzing in the ears, is a common symptom experienced by people who take repeated, high dosages of aspirin. Although tinnitus is associated with many ear disorders and a few occupations, the other questions posed by the nurse do not necessarily help to establish a cause-and-effect relationship with the client's symptom.

55. Which nursing action is most helpful for reducing or eliminating feedback from the client's hearing aid? [ ] 1. Repositioning the hearing aid within the ear [ ] 2. Cleaning the hearing aid with a soft cloth [ ] 3. Replacing the battery in the hearing aid [ ] 4. Turning down the volume in the hearing aid

55. 1. Feedback, a loud shrill noise, occurs when a hearing aid is positioned incorrectly within the ear. Cleaning, replacing the battery, and regulating the volume are important considerations for the client with a hearing aid, but they do not affect feedback.

56. If a client who has recently experienced diminished hearing takes medications from each of the following drug categories, which one is most likely to have affected the client's hearing? [ ] 1. Nonsteroidal anti-inflammatory drug [ ] 2. Beta-adrenergic blocker [ ] 3. Aminoglycoside antibiotic [ ] 4. Histamine-2 (H2) antagonist

56. 3. The aminoglycoside family of antibiotics, of which gentamicin sulfate (Garamycin) is one example, is ototoxic and nephrotoxic. Beta-adrenergic blockers cause vertigo but do not affect hearing acuity. Neither nonsteroidal anti-inflammatory drugs nor H2 antagonists are known to be ototoxic.

57. When instilling prescribed medication into the ear of an adult, which is the correct technique for the nurse to use to straighten the ear canal? [ ] 1. Pull the ear upward and backward. [ ] 2. Pull the ear downward and forward. [ ] 3. Pull the ear upward and forward. [ ] 4. Pull the ear downward and backward.

57. 1. The external ear canal is a curved tube that is about 1" (2.5 cm) long and extends from the auricle, the flared end of the ear, to the tympanic membrane. The ear canal lies within the temporal bone, the growth of which is not complete in an infant and child; thus, the angle for straightening the canal differs depending on the client's age. The correct technique for straightening the ear canal of an adult is to pull the ear upward and backward. For a child, the ear is pulled downward and backward.

58. After instilling medication into the client's ear, which nursing instruction is most appropriate? [ ] 1. Keep your head tilted for 5 minutes. [ ] 2. Pack a cotton ball tightly in your ear. [ ] 3. Do not blow your nose for at least 1 hour. [ ] 4. Wipe the excess medication from the ear.

58. 1. Keeping the head tilted to the side for at least 5 minutes or maintaining a side-lying position facilitates the movement of the medication to the lowest area of the ear canal. Cotton is loosely inserted within the ear to collect drainage and any excess volume of medication; therefore, wiping away remnants of the drug is unnecessary. The eustachian tube does connect the middle ear with the pharynx. However, if the tympanic membrane is intact, blowing the nose will not displace the medication.

59. Which other assessment finding is most indicative of an infection in the external ear? [ ] 1. Foul-smelling drainage [ ] 2. Scarred tympanic membrane [ ] 3. Diminished hearing [ ] 4. Enlarged lymph nodes

59. 1. Otitis externa is the medical term for an inflammatory process that involves the external ear. The presence of drainage, called otorrhea, is most suggestive that an inflammation is the underlying problem. Because the drain age is foul-smelling, the inflammation is most likely due to a pathogen. Hearing is diminished from swelling and drain age that block the transmission of sound on air currents, but other preinfectious factors can also cause a loss of hearing. Scarring of the tympanic membrane is not an indication that there is a current infection. It may, however, indicate that the tympanic membrane ruptured during a prior middle ear infection and is now healed. Enlarged lymph nodes are indicative of a systemic inner ear infection.

6. When a foreign body becomes embedded in a client's eye, which nursing action should be taken first before referring the client for emergency treatment? [ ] 1. Remove the object with forceps. [ ] 2. Ask the person to blink rapidly. [ ] 3. Instill antibiotic ointment. [ ] 4. Loosely patch both eyes.

6. 4. The eyes are patched loosely with the lids closed to reduce further injury by blinking and eye movement. Instilling antibiotic ointment interferes with the medical examination, although antibiotic ointment may be prescribed after the object is removed. Attempts to remove an embedded object are left to those with specialized medical training.

60. Which response demonstrates that the parents understand the nurse's explanation of why organisms travel more easily from the nasopharynx to the middle ear in a child? [ ] 1. A child's eustachian tube is shorter and straighter. [ ] 2. A child's eustachian tube is longer and straighter. [ ] 3. A child's eustachian tube is shorter and more curved. [ ] 4. A child's eustachian tube is longer and more curved.

60. 1. Microorganisms travel more easily through a pathway between the nose and eustachian tube that is short and straight, which is the case in infants and young children. With growth, the ear canal changes to a 45-degree angle. This natural curved angle provides a barrier against ascending pathogens.

62. What is the best evidence that the antibiotic the nurse is administering for the treatment of acute otitis media is having a therapeutic effect? [ ] 1. The ear feels less warm to the touch. [ ] 2. Ringing sounds within the ear stop. [ ] 3. Ear drainage is thin and watery. [ ] 4. Ear discomfort is relieved.

62. 4. Antibiotic efficacy is most evident when the client's ear discomfort is relieved. The inflamed area in the middle ear is beyond the reach of the fingers; therefore, assessing the temperature of the tissue by touch is impossible. Tinnitus, or disturbing sounds, is not generally a problem for a person during the acute phase of a middle ear infection. Watery or purulent drainage is an indication that the eardrum is perforated.

63. If a client with a middle ear infection reports the fol lowing symptoms, which one is most indicative that the infection has spread to the inner ear? [ ] 1. Temporal headaches [ ] 2. A sore throat [ ] 3. Nasal congestion [ ] 4. Postural dizziness

63. 4. The labyrinth, which is another name for the inner ear, contains structures that are responsible for both hearing and balance. Balance and equilibrium are maintained by receptors that sense rotation, acceleration, and deceleration of the body as it responds to gravitational changes. Structures in the vestibular pathway of the inner ear carry impulses via the eighth cranial nerve to the cerebellum in the brain. The cerebellum restores balance and postural stability by facilitating a correction from the motor cortex to skeletal muscles. When the labyrinth becomes infected, its functions are disrupted. Signs of labyrinthitis (inflammation of the labyrinth of the inner ear) include dizziness,nausea, vomiting, and nystagmus. Headaches indicate that the infection has extended to the meningeal area of the brain. Sore throat and nasal congestion are more likely caused by the primary upper respiratory infection, which commonly precedes a middle ear infection.

64. When the nurse prepares the client for the myringotomy, which statement best explains the purpose of theprocedure? [ ] 1. A myringotomy prevents permanent hearing loss. [ ] 2. A myringotomy provides a pathway for drainage. [ ] 3. A myringotomy aids in administering medications. [ ] 4. A myringotomy maintains motion of the ear bones.

64. 2. A myringotomy, which is the term for incising the tympanic membrane or eardrum, provides a pathway for drainage from the middle ear. As the exudate drains, the client's discomfort is reduced. A surgical incision is preferable to spontaneous rupture of the eardrum because a surgical incision heals better. In most situations, a tympanoplasty, the insertion of plastic tubes within the incised eardrum, is performed at the same time. The plastic tubes, which may remain in the ear for several months, equalize the air pressure within the middle ear when the natural pathway between the eustachian tube and middle ear is impaired. Although hearing may be permanently diminished by repeated middle ear infections, the potential for infection and the severity of future infections is reduced after the tympanic membrane is incised. Systemic antibiotics rather than topical drugs are more effective in treating a middle ear infection. Incising the eardrum is not done to preserve the motion of the ossicles in the middle ear.

65. When planning the child's discharge, what nursing instruction is most appropriate for the nurse to provide the parent concerning the cotton ball in the client's ear canal? [ ] 1. Leave the cotton ball in place until it is saturated. [ ] 2. Keep the cotton ball placed loosely within the ear canal. [ ] 3. Soak the cotton ball in peroxide before insertion. [ ] 4. Remove the cotton ball when the cotton becomes dry.

65. 2. Loosely packed cotton is more likely to absorb drainage than tightly packed cotton. The cotton ball should be replaced when it is moist, not totally saturated. The ear canal is generally cleaned using soap and water before inserting another dry cotton ball.

66. Which finding in the health history would the nurse expect of a client with otosclerosis? [ ] 1. Hearing loss beginning in childhood [ ] 2. Upper respiratory infections with high fevers [ ] 3. History of tonsils and adenoid removal [ ] 4. One or more relatives similarly diagnosed

66. 4. Otosclerosis is the result of bony overgrowth of the stapes, a bone of the middle ear, and is a common cause of hearing impairments in adults. Although the cause of otosclerosis is unknown, most of those affected have a family history of this condition. The onset of this disorder usually becomes apparent when clients are in their 20s or 30s. High fever and removal of the tonsils or adenoids have no relationship to the development of otosclerosis.

67. Which statement by the nurse most accurately explains the pathophysiology of conductive hearing loss? [ ] 1. Sound waves do not travel to the inner ear. [ ] 2. There is a malfunction of inner ear structures. [ ] 3. The eighth cranial nerve is permanently damaged. [ ] 4. Electric conversion of sound is not produced.

67. 1. A conductive hearing loss occurs when there is a barrier in the transmission of vibrating sound waves from the external and middle ear to the inner ear. Common causes of conductive hearing loss include otosclerosis, otitis media, and a ruptured tympanic membrane. In otosclerosis, if the ossicles (the bones in the middle ear) are fused by a bony overgrowth, they no longer vibrate freely against the oval window (the membrane between the middle and inner ear) to transmit sound. The other options all describe the causes of sensorineural hearing loss.

68. When the team leader asks the admitting nurse to assist with developing a goal for the identified diagnosis, which goal correlates best with the diagnosis? [ ] 1. The client will respond appropriately to communication by staff. [ ] 2. The staff will improve verbal communication techniques. [ ] 3. The client will demonstrate the ability to express emotions. [ ] 4. The client will be able to communicate basic needs

68. 1. Responding appropriately to communication with staff indicates an ability to understand the information that is being discussed despite impaired hearing. Accomplishing this goal indicates that the approaches used by the staff to communicate with the hearing-impaired client are effective. The goal should not indicate what the nursing team hopes to accomplish. The client with normal speech but decreased hearing does not have difficulty verbally communicating to staff or expressing emotions.

69. Which intervention is most appropriate to include in the care plan? [ ] 1. Speak directly into the client's ear. [ ] 2. Face the client directly when speaking. [ ] 3. Drop your voice at the end of each sentence. [ ] 4. Raise the pitch of your voice an octave higher.

69. 2. It is best to face a hearing-impaired client so that lip movements and facial expressions are seen because most hearing-impaired persons learn to adapt by lip reading or speech reading. Speaking into the client's ear distorts the words and masks visual cues. Dropping the voice causes some of the words to be missed. Raising or lowering the voice pitch helps persons with hearing loss in one or the other vocal registers. High tones are generally more difficult to hear.

7. When describing the examination procedure to the client, which statement by the nurse is most accurate? [ ] 1. "You'll read words that are the size of newsprint." [ ] 2. "You'll read letters from a distance of 20 feet (6 meters)." [ ] 3. "You'll look at a color picture and identify an image." [ ] 4. "You'll look at a screen and tell me when an object appears."

7. 2. A Snellen chart is used to test far vision and visual acuity by having the client read a series of block letters from a chart. Visual acuity is the ability to see detail in focus at a certain distance. Typically, clients stand 20 feet (6 meters) from the chart and are asked to read letters that progressively become smaller. Normal visual acuity is 20/20. This means that a client can see an object at a distance of 20 feet that normally can be seen at 20 feet. Jaeger's chart is used to test near vision. Ishihara's plates are used to test color vision. A tangent screen, which is used to assess the peripheral visual field, requires the client to indicate when a stimulus is seen in the peripheral field of vision.

70. Which nursing intervention is the best alternative for helping the client to comprehend the details of the procedure at this time? [ ] 1. Providing the client with a printed pamphlet on the topic [ ] 2. Asking another stapedectomy client to talk with the client [ ] 3. Providing someone proficient in sign language [ ] 4. Writing all the information in longhand

70. 1. As long as the client is literate and not visually impaired, reading a descriptive pamphlet is an appropriate alternative. Another stapedectomy client should not be the primary resource for explaining technical information. The client with otosclerosis probably is not so profoundly deaf that sign language is necessary. Writing short sentences or words is appropriate, but writing lengthy technical information is too tedious and time-consuming.

71. Which response by the nurse is most therapeutic to the client in this situation? [ ] 1. "You've got the best surgeon on the staff." [ ] 2. "Tell me more about how you're feeling." [ ] 3. "Don't worry. Those things hardly ever happen." [ ] 4. "Let's think positively about the outcome."

71. 2. Encouraging a discussion of feelings is therapeutic. Endorsing or defending the surgeon's expertise will not relieve the client's fears about the risks. Giving advice, offering a reassuring cliché, and changing the subject even to positive thoughts are nontherapeutic.

72. After the stapedectomy, which is the most appropriate technique for assessing whether the client's facial nerve function is intact? [ ] 1. Ask the client to identify familiar odors. [ ] 2. Ask the client to smile or raise the eyebrows. [ ] 3. Ask the client to stick out the tongue. [ ] 4. Ask the client to read printed information.

72. 2. The facial nerve, which is cranial nerve VII, is assessed by having the client smile or raise the eyebrows. Facial asymmetry suggests damage to this nerve. The olfactory nerve is assessed by asking the client to identify familiar odors. The hypoglossal nerve is tested by having the client stick out the tongue. The optic nerve is tested by determining if the client can see.

73. How should the client be positioned for the first 24 hours after a stapedectomy? [ ] 1. Flat with the head elevated and tilted toward the nonoperative ear. [ ] 2. Facing forward with the head raised and the knees in a flexed position. [ ] 3. Supine with the head of the bed elevated and the head resting on the occiput. [ ] 4. Prone with the head positioned toward the operated side.

73. 1. Keeping the client flat with the head of the bed elevated and the operative ear up helps to maintain the placement of the prosthetic stapes and reduce the occurrence of vertigo. The client should not lie on the operative ear but should be positioned with the head toward the nonoperative ear. None of the other positional choices accomplishes this goal.

74. Which statement by the nurse most accurately explains the client's hearing loss? [ ] 1. The client will have a temporary hearing loss until edema in the operative ear is relieved. [ ] 2. The client will have a temporary hearing loss until the nerve regenerates. [ ] 3. The client will have a temporary hearing loss until fitted with a molded plastic hearing aid. [ ] 4. The client will have a temporary hearing loss until the prosthesis becomes stabilized with new bone.

74. 1. Both rebound swelling and packing within the ear contribute to diminished hearing acuity after a stapedectomy. This setback is only temporary and eventually subsides in the absence of any complications. The success of the surgery is evident in a matter of weeks. If the surgery is successful, the client will not need a hearing aid. The prosthetic stapes is secured to the incus by a fine wire loop or hook; it moves without any bone formation around it.

75. Which instruction by the nurse is best for preventing the dislodgement of the client's internal prosthesis after a stapedectomy? [ ] 1. When chewing food, keep your mouth closed. [ ] 2. When blowing your nose, use a paper tissue. [ ] 3. When sneezing, keep your mouth wide open. [ ] 4. When coughing, turn your head to the side.

75. 3. To avoid displacing the device that replaces the stapes, the client should keep the mouth widely open when a sneeze is unavoidable. Aesthetically, chewing food with a closed mouth shows good etiquette. To prevent transmitting infectious organisms, it is best to enclose the exudate from the nose in a paper tissue and dispose of it in a lined refuse container. Turning the head also reduces the potential for droplet transmission of pathogens.

76. The nurse correctly advises other staff assigned to care for the client postoperatively that the client is at risk for injury due to which potential development? [ ] 1. Fatigue [ ] 2. Diplopia [ ] 3. Vertigo [ ] 4. Pain

76. 3. Stapedectomy clients commonly experience vertigo due to labyrinthitis or a loss of perilymph. To prevent injury, the nurse should ensure that the client's bedside rails are kept raised and that the client is assisted with ambulation. The client undergoing stapedectomy is generally young or middle-aged and is unlikely to feel exceptionally tired. Diplopia is not associated with the effects of this surgery. Although some discomfort is anticipated after surgery, this is not generally considered a major postoperative problem that predisposes the client to injury.

77. The nurse knows that the client who underwent a stapedectomy understands the discharge instructions when the client identifies which activity to avoid for the next 6 months? [ ] 1. Listening to music [ ] 2. Flying in an airplane [ ] 3. Driving an automobile [ ] 4. Singing in the choir

77. 2. Flying in an airplane is temporarily contraindicated after a stapedectomy because of the potential damaging effects that may occur with changes in air pressure. For the same reason, scuba diving is also avoided. None of the other activities is specifically contraindicated for a client who has had a stapedectomy.

78. Which common ailment should the nurse instruct the client who underwent a stapedectomy to immediately report to the physician? [ ] 1. The common cold [ ] 2. A sore throat [ ] 3. Productive cough [ ] 4. Conjunctivitis

78. 1. The client should be instructed by the nurse to report any signs of a common cold or condition that would contribute to congestion in the ears. A throat infection or productive cough is less likely than a common cold to involve the ears. Conjunctivitis is an infection of the conjunctiva of the eye, which does not include congestion of the ears as a symptom.

79. Which subjective symptom is the client most likely to report to the nurse? [ ] 1. Burning [ ] 2. Pressure [ ] 3. Vertigo [ ] 4. Pain

79. 3. Ménière's disease involves the inner ear, affecting balance and hearing, and is believed to be caused by excessive fluid in the inner ear but can be caused by a variety of conditions. The pressure from the fluid increases and causes the major symptom of Ménière's disease, which is severe vertigo. Typically, the client will describe this as a sensation of seeing and feeling motion or rotation, not just a case of dizziness. Ménière's disease encompasses a group of symptoms that includes progressive deafness, ringing in the ears, dizziness, and a feeling of pressure or fullness in the ears. The other symptoms are unrelated to Ménière's disease.

8. Before the examination can be completed, which type of eye medication would the nurse instill in the client's eye to dilate the pupil and temporarily paralyze the ciliary muscle? [ ] 1. Pilocarpine (Pilocar) [ ] 2. Dipivefrin (Propine) [ ] 3. Gentamicin (Genoptic) [ ] 4. Cyclopentolate solution (Cyclogyl)

8. 4. Cyclopentolate solution (Cyclogyl) is used as a mydriatic (pupil-dilating) and cycloplegic (paralysis of ciliary muscle) drug, which prevents accommodation. Accommodation is the contraction or relaxation of the ciliary muscle to change the shape of the lens to focus on near or far objects. This drug is used for eye examinations or to treat uveal tract inflammatory conditions that benefit from pupillary dilation. Pilocarpine (Pilocar) is a direct-acting parasympathomimetic used to produce miosis (constriction of the pupil). Dipivefrin (Propine) is a sympathomimetic prodrug that is bio-transformed into epinephrine within the eye. It is used to decrease intraocular pressure by enhancing aqueous outflow. Gentamicin (Genoptic) is an ophthalmic antibacterial drug used to treat various infections.

81. Which response will the nurse most likely observe during the caloric test if the client has Ménière's disease? [ ] 1. Onset of severe symptoms [ ] 2. No response or change in symptoms [ ] 3. Nystagmus and slight dizziness [ ] 4. Aphasia and loss of consciousness

81. 1. A client with Ménière's disease will develop a sudden onset of severe symptoms, such as vertigo, nausea, vomiting, and tinnitus, during a caloric test. No response to the instillation of warm or cold solution within the ear indicates an auditory nerve tumor. People without Ménière's disease experience slight dizziness and nystagmus during a caloric test. Aphasia and loss of consciousness are unrelated to the mechanics or physiology of a caloric test.

82. The nurse suspects that the client's anxiety is due to fear that nursing care will intensify symptoms. Which nursing intervention is most appropriate to add to the care plan at this time? [ ] 1. Let the client suggest ways to carry out care. [ ] 2. Discontinue nursing care measures at this time. [ ] 3. Restrict care to nutrition and elimination only. [ ] 4. Carry out nursing activities quickly and efficiently.

82. 1. Allowing the client to participate in the planning and implementation of nursing activities maintains an independent locus of control. The client, more than any one, knows what movement will cause the least discom fort. Discontinuing or restricting nursing activities does not reflect a high standard of care. Performing nursing activities quickly heightens the client's anxiety because unexpected movements can induce or aggravate symptoms.

83. The nurse is most accurate in stating that the cause of Ménière's disease is unknown but that the symptoms are related to which disorder? [ ] 1. An electrolyte deficit [ ] 2. An excess of fluid [ ] 3. A vitamin deficiency [ ] 4. An anatomic defect

83. 2. Ménière's disease seems to be related to an increase in endolymphatic fluid within the spaces of the labyrinth in the inner ear. This may be from a hypersecretion, hypoabsorption, deficient membrane permeability, allergy, viral infection, hormonal balance, inherited abnormality, or mental stress. Electrolyte deficits and vitamin deficiencies do not play a role in the development of Ménière's disease. There are no anatomic differences between clients with Ménière's disease and those who do not have the disease. The pathology lies in the increased accumulation of fluid in the labyrinth, which interferes with neural impulses that regulate balance and hearing sent from the inner ear to the brain.

84. When caring for a client with Ménière's disease, which nursing action is most helpful in preventing nausea and vomiting? [ ] 1. Increasing the client's intake of oral fluids [ ] 2. Changing the client's position frequently [ ] 3. Keeping the room lights dim [ ] 4. Avoiding jarring the bed

84. 4. Sudden movement of the client's head or sudden body movements can precipitate an attack that includes nausea and vomiting. Decreasing the client's fluid intake is beneficial. Frequent changing of positions should be avoided. The intensity of room lights is not a factor in controlling the symptoms of Ménière's disease.

85. The nurse should stress to the client the importance of adhering to which dietary restriction? [ ] 1. Fats [ ] 2. Sodium [ ] 3. Potassium [ ] 4. Cholesterol

85. 2. Most clients with Ménière's disease can be successfully treated with diet and medication therapy. Many clients can control their symptoms by avoiding sodium and adhering to a low-sodium diet. The amount of sodium is one of the many factors that regulate the balance of fluid within the body. Sodium and fluid retention disrupts the delicate balance between endolymph and perilymph in the inner ear. Limiting the amount of fat intake and cholesterol in the diet is a good health practice but is not essential with Ménière's disease. Restriction of potassium is unnecessary.

86. Which statement by the client to the nurse indicates a need for additional teaching about Ménière's disease? [ ] 1. "I'll feel well between attacks." [ ] 2. "Future attacks may last minutes or days." [ ] 3. "My hearing will gradually improve." [ ] 4. "Ménière's disease is incurable."

86. 3. Hearing loss associated with Ménière's disease becomes progressively worse with each subsequent attack. The period of time that symptoms last is unpredictable. Between attacks, the client generally resumes normal activities and feels well. Surgery is performed in advanced cases to eliminate the vertigo, nausea, and vomiting. How ever, permanent deafness is a consequence of most surgical procedures.

9. A client comes to the eye clinic and tells the nurse that glasses have been ordered to correct nearsightedness. Which of the following terms would the eye clinic nurse use to document that a client has nearsightedness? [ ] 1. Presbyopia [ ] 2. Amblyopia [ ] 3. Hyperopia [ ] 4. Myopia

9. 4. The term for nearsightedness is myopia. Clients with myopia hold objects closer to their eyes to see them well. Presbyopia is a type of farsightedness associated with aging. It is caused by loss of elasticity in the lenses. Amblyopia is commonly referred to as lazy eye. Untreated, amblyopia results in the loss of vision in one eye from lack of use. Hyperopia is farsightedness.

1. Which information is most important for the school nurse to obtain from the client initially? [ ] 1. Whether safety glasses were worn [ ] 2. The name of the splashed chemical [ ] 3. The treatment already provided [ ] 4. Whether the client's vision is impaired

1. 3. Immediate action is important when treating chemical injuries to the eyes. Therefore, it is important for the school nurse to determine what treatment was given at the time of injury. This information provides a baseline for further treatment. Diluting and removing the chemical reduces the potential for corneal damage. Identifying the chemical is important; however, taking time to determine what, if anything, will neutralize the chemical does not supersede immediate treatment. Liability is affected if safety glasses are not worn, but the priority is treating the chemical splash if that has not already been done. It is too soon to evaluate the extent of sensory damage.

10. Which organization can the nurse suggest as a community resource to the nursing assistant? [ ] 1. The Loyal Order of Moose [ ] 2. The American Legion [ ] 3. Lions Clubs International [ ] 4. The Knights of Columbus

10. 3. The Lions Clubs International organization has vision and hearing improvements as its major goal. Local or state chapters can provide information and assistance to those who need but cannot afford glasses, a guide dog, hearing aid, or surgery. The other organizations are both fraternal and philanthropic, but they have not named vision or hearing assistance as their projects.

18. Which statement made by the client to the nurse best indicates an understanding of when cataract surgery is needed? [ ] 1. "I'll need surgery when my loss of vision really interferes with my activities." [ ] 2. "I'll need surgery when I can't control the pain anymore with eyedrops." [ ] 3. "I'll need surgery when I start to feel self conscious about my appearance." [ ] 4. "I'll need surgery when my cataracts are at their maximum density."

18. 1. The time for cataract removal is left to the client. It largely depends on the person's tolerance of the condition and the degree to which vision impairment interferes with the quality of life. Cataracts are painless. Feeling self-conscious about one's appearance is not necessarily a medically justifiable reason for pursuing surgery. Postponing surgery until a cataract reaches maximum density or "ripens" is no longer considered a standard of care.

3. The nurse is preparing to irrigate the student's eye. What steps are appropriate in completing the irrigation? Select all that apply. [ ] 1. Place the solution directly into the center of the eye. [ ] 2. Tilt the head toward the opposite eye. [ ] 3. Perform hand hygiene and put on gloves. [ ] 4. Offer the client a paper tissue. [ ] 5. Place the solution into the conjunctival sac. [ ] 6. Continue eye irrigations until all redness is resolved.

3. 3, 4, 5. When irrigating the eyes, the nurse should perform hand hygiene and wear gloves to prevent the transmission of microorganisms. The nurse should offer the client a tissue or pad the shoulder area to absorb solution as it drains from the eye. The solution should not be directed into the center of the eye because this can harm the cornea. Instead, the irrigating solution should be instilled in the conjunctival sac, which is located by pulling the lower lid down. The client's head should be tilted toward the affected eye to facilitate drainage and prevent contamination of the unaffected eye. The eye will remain reddened after irrigation due to the irritant nature of the chemical. In a chemical exposure, the eye should be irrigated for at least 15 minutes.

30. The nurse must withhold medication administration and notify the physician if which drug is ordered for a client with glaucoma? [ ] 1. Atropine sulfate (Sal-Tropine) [ ] 2. Morphine sulfate (Roxanol) [ ] 3. Magnesium sulfate (Epsom salts) [ ] 4. Ferrous sulfate (Feosol)

30. 1. Atropine sulfate (Sal-Tropine) and other anticho linergic drugs dilate the pupil. This blocks the drainage of aqueous fluid. If administered, it may cause an acute attack by precipitating high intraocular pressure (IOP), which if left untreated can cause permanent blindness. Morphine sulfate (Roxanol) is an opioid analgesic. Magnesium sulfate is known as Epsom salts and is used for several purposes, especially to soothe musculoskeletal ailments and for relaxation. Ferrous sulfate (Feosol) is an iron preparation. None of these last three medications is contraindicated for clients with glaucoma.

4. When irrigating the client's eyes, which technique describes the best way to direct the flow of irrigating solution? [ ] 1. Directly onto the corneal surface [ ] 2. Away from the inner canthus [ ] 3. Within the anterior chamber [ ] 4. Toward the nasolacrimal duct

4. 2. The irrigating solution is directed so that it flows from the inner canthus toward the outer canthus. This is an especially important principle to follow so that substances in one eye do not come in contact with the tissue of the other eye. It is best to instill the force of the water on the conjunctiva rather than onto the sensitive cornea, which may cause discomfort or reflex blinking. The anterior chamber is not an external eye structure. The nasolacrimal duct lies in the area of the inner canthus.

80. Which information provided by the nurse will best prepare the client for what to expect with caloric testing? [ ] 1. Cold water and warm water will be instilled into each of the ears. [ ] 2. You will wear earphones through which sounds a transmitted. [ ] 3. The room will be darkened, and scalp electrodes will be attached to the head. [ ] 4. Your blood will be drawn from a vein and exam ined microscopically.

80. 1. A caloric test, used to assess vestibular function, involves instilling cold and warm solutions separately into each ear. An audiometric test requires headphones. Electrodes are used for electroencephalography and electronystagmography. A specimen of blood is not used in a caloric test.