Chp 21 Eye and ear

A patient is being provided with discharge instructions after undergoing cataract extraction and intraocular lens implantation. What should the nurse include in the teaching? 1 Avoid straining during bowel movements. 2 Keep consuming a full-liquid diet for 24 hours. 3 Refrain from reading or watching TV for at least 12 hours. 4 Keep a patch over the affected eye until the follow-up appointment with the surgeon.

1 After cataract surgery, coughing, bending at the waist, and straining during bowel movements should be avoided because these activities increase intraocular pressure. It is not necessary to maintain dietary restrictions, refrain from reading or watching TV, or wear a patch.

The nurse is caring for a patient suspected of having age-related macular degeneration. What symptoms should the nurse document and report regarding this disorder? 1 Blurred, darkened vision 2 Itching, burning, and redness 3 Sudden, excruciating pain in the eye 4 Decreased vision, abnormal color perception

1 Age-related macular degeneration (AMD) is an eye condition that leads to the deterioration of the center of the retina, called the macula, leading to loss of central vision. The patient with AMD has blurred and darkened vision, scotomas, and metamorphopsia. The symptoms of cataract are decreased vision, abnormal color perception, and glare. The symptoms of glaucoma are sudden, excruciating pain in or around the eye. The symptoms of allergic conjunctivitis are itching, burning, and redness.

Which instruction should the nurse give the patient who is prescribed verteporfin for age-related macular degeneration? 1 "You should avoid direct exposure to sunlight while on treatment." 2 "You can wear clothes with short sleeves after receiving treatment." 3 "You should avoid lutein-containing, green, leafy vegetables while on treatment." 4 "You should consume vitamin E-containing foods but avoid vitamin C-containing foods after receiving treatment."

1 Age-related macular degeneration is an eye condition that leads to the deterioration of the macula, leading to loss of central vision. Verteporfin is a photosensitizing drug that becomes active when exposed to a low-level laser light wave or sunlight and may cause thermal burns. Therefore the nurse instructs the patient to avoid direct exposure to sunlight. The patient should cover the body completely, rather than wear short sleeves, because any exposure of the skin to sunlight could activate the medication in that area, resulting in a thermal burn. Lutein-containing, green, leafy vegetables do not react with verteporfin. Therefore there is no need of avoiding lutein-containing, green, leafy vegetables. Vitamins C and E are helpful in reducing the risk of age-related macular degeneration.

A 25-year-old patient reports tinnitus, diminished hearing, and changes in equilibrium. The nurse assesses that the patient, a worker in a rayon fiber-manufacturing unit, has been exposed to carbon disulfide. What would the nurse conclude from this assessment? 1 The patient has ototoxicity. 2 The patient has Ménière's disease. 3 The patient has central hearing loss. 4 The patient has an acoustic neuroma.

1 Chemicals used in industry such as carbon disulfide may damage the inner ear. The patient exposed to ototoxic chemicals may exhibit signs and symptoms of ototoxicity such as tinnitus, diminished hearing, and changes in equilibrium. Ménière's disease is characterized by symptoms caused by inner ear disease that include episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness. However, symptoms usually begin between 30 and 60 years of age. Acoustic neuroma is seen in patients between 40 and 60 years of age. This patient is too young for acoustic neuroma. It is a unilateral benign tumor that occurs where the cranial nerve VIII enters the internal auditory canal. Central hearing loss involves an inability to interpret sound, including speech. It occurs due to a problem in the central nervous system (CNS) but is not manifested as any changes in equilibrium.

The nursing student prepares a chart on the diagnostic tests and treatments associated with different auditory problems. Which disease has the nursing student correctly associated with its diagnostic test and treatment? 1 External otitis 2 Chronic otitis media 3 Endolymphatic hydrops 4 Otitis media with effusion

1 External otitis involves inflammation or infection of the epithelium of the auricle and ear canal. Pseudomonas aeruginosa is the most common bacterial cause of this disease. Culture and sensitivity studies of the drainage can be used to diagnose external otitis. Topical treatments may include antibiotic drops for infection and corticosteroids for inflammation. Chronic otitis media can involve the mastoid bone, so mastoid x-ray is one of the diagnostic tests for this disease. However, a labyrinthectomy is not used for treating chronic otitis media; instead, it can be used as surgical therapy for Ménière's disease. In otosclerosis, tuning fork tests and an audiogram demonstrate a difference of at least 20 to 25 dB between air and bone conduction levels of hearing. Otosclerosis can be treated surgically by replacing the stapes with a metal or Teflon prosthesis. Endolymphatic hydrops, or Ménière's disease, is not diagnosed by the air-bone gap, nor treated with a prosthetic stapes. For the diagnosis of Ménière's disease, tests are done to rule out CNS disease; it is treated with antihistamines and benzodiazepines during an acute attack. This is not how otitis media with effusion is diagnosed or treated.

A patient reports sudden, severe pain in the eye accompanied by nausea and vomiting. The assessment findings of the patient indicated optic nerve atrophy and peripheral visual field loss. Which drug will the nurse expect to be prescribed by the primary health care provider? 1 Betaxolol 2 Besifloxacin 3 Tropicamide 4 Ranibizumab

1 Glaucoma is a group of disorders characterized by increased intraocular pressure and optic nerve atrophy and peripheral visual field loss. The symptoms of glaucoma are pain in or around the eye, nausea, and vomiting. Betaxolol is an antiglaucoma drug that decreases intraocular pressure. Besifloxacin is an antibiotic that is used to treat acute bacterial conjunctivitis. Tropicamide is a cycloplegic that is used to produce pupillary dilation. Ranibizumab is a selective inhibitor of endothelial growth factor that is used to slow vision loss in age-related macular degeneration.

On a home visit to a patient who underwent cataract surgery, the nurse finds that the patient has intense pain in the operated eye. What should be the immediate nursing action? 1 Notify the surgeon. 2 Administer eyedrops. 3 Administer analgesics. 4 Apply a cold compress.

1 In the postoperative period after a cataract surgery, the pain is usually mild. However, if the patient complains of intense pain, it should be immediately communicated to the surgeon because it may indicate hemorrhage, infection, or increased intraocular pressure and thus may need prompt intervention. Analgesics can be administered after receiving a surgeon's prescription. Applying a cold compress or administering eye drops may not decrease the pain.

The nurse is discussing glaucoma prevention with a 52-year-old African American patient. Which statement by the patient reflects a correct understanding of glaucoma prevention? 1 "I will visit my eye doctor every one to two years." 2 "I will wear protective sunglasses while outside." 3 "I will take lutein and vitamin E supplements for eye health." 4 "There is nothing that can be done to prevent vision loss from glaucoma."

1 Loss of vision as a result of glaucoma is a preventable problem. Teach the patient and the caregiver about the risk of glaucoma and that it increases with age. Stress the importance of early detection and treatment in preventing visual impairment. A comprehensive ophthalmic examination is important in identifying persons with glaucoma or those at risk of developing glaucoma. The current recommendation is for an ophthalmologic examination every two to four years for persons between ages 40 and 64 years, and every one to two years for persons age 65 years or older. African Americans in every age category should have examinations more often because of the increased incidence and more aggressive course of glaucoma in these individuals. Wearing protective sunglasses while outside may help to reduce the development of cataracts, not glaucoma. Lutein and vitamin supplements may be helpful for preventing macular degeneration, not glaucoma.

Which condition is caused by a refractive error in the eye? 1 Myopia 2 Cataract 3 Glaucoma 4 Conjunctivitis

1 Myopia is a refractive error of the eye characterized by the ability to see close objects clearly, whereas distant objects appear blurred. A cataract manifests as opacity of the lens, leading to decreased vision. It is not a refractive error. Glaucoma is a group of disorders characterized by increased intraocular pressure; it may lead to permanent blindness. Conjunctivitis is an infection of the conjunctiva caused by bacteria or viruses.

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? 1 Absence of pain or pressure 2 Blurred vision in the morning 3 Seeing colored halos around lights 4 Eye pain accompanied with nausea and vomiting

1 Primary open-angle glaucoma is typically symptom free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed. Primary angle-closure glaucoma manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.

The nurse is assessing four patients with visual problems. Which patient does the nurse determine is exhibiting signs of retinal detachment? 1 Patient A Everything looks like a cobweb to me 2 Patient B I am unable to distinguish colors because there is too much glare 3 Patient C unable to tolerate light and have a sensation of a foreign body in my eyes 4 Patient D I have itching and burning sensation in my reddened eyes

1 Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers. Patients with a detaching retina describe symptoms that include a "cobweb," "hairnet," or ring in the field of vision. Therefore the nurse will expect that Patient A has retinal detachment. For Patient B, abnormal color perception and glares indicate cataracts. Redness, photophobia, and foreign body sensation indicates epidemic keratoconjunctivitis for Patient C. Itching, burning, redness, and tearing indicate allergic conjunctivitis in Patient D.

The nurse is caring for a 25-year-old sexually active woman who was just vaccinated against the rubella virus. Which instruction should the nurse give this patient? 1 "Refrain from becoming pregnant for at least three months after being immunized." 2 "Refrain from exposure to chemicals such as toluene, carbon disulfide, and mercury." 3 "Undertake serological testing for the presence of antibodies against the rubella virus." 4 "Be aware that rubella infection during the first eight weeks of pregnancy is associated with an 85 percent incidence of congenital rubella syndrome."

1 The nurse should instruct the patient to avoid pregnancy for at least three months after being immunized against the rubella virus, which can cause deafness in the fetus and malformations affecting the ear. A patient should be vaccinated against rubella virus only when serological tests for the presence of antibodies for this virus are found positive. Chemicals such as carbon disulfide are ototoxic and may damage the inner ear. Such patients may exhibit signs and symptoms of ototoxicity. However, ototoxicity is not related to rubella infection. Rubella infection during the first eight weeks of pregnancy is associated with an 85 percent incidence of congenital rubella syndrome. This syndrome may cause sensorineural deafness in the child. This information is, however, not significant for a woman who is already vaccinated against rubella virus.

A patient has a prescription to receive timolol two drops to both eyes every 12 hours. The nurse would withhold the dose and question the prescription if the patient had which condition? 1 Asthma 2 Urinary retention 3 Cluster headaches 4 Chronic constipation

1 Timolol is a nonselective beta-adrenergic blocking agent that can cause bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with severe chronic obstructive pulmonary disease (COPD) or asthma. Timolol will not increase urinary retention; that commonly is seen with use of anticholinergics. It will not cause or worsen headaches or constipation.

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. Which surgical procedure will be used to relieve traction on the retina and will the nurse educate the patient? 1 Vitrectomy 2 Cryotherapy 3 Photodynamic therapy 4 Ocular coherence tomography

1 Vitrectomy is the surgical removal of the vitreous and is used to relieve traction on the retina caused especially by proliferative diabetic retinopathy. Cryotherapy is a procedure used to seal retinal breaks. Photodynamic therapy is a procedure used to treat age-related macular degeneration. Ocular coherence tomography is used to identify fluid in the central retina; it determines the need for continued intravitreal injections.

A patient presenting with an itching, burning sensation and redness in the eye is diagnosed with allergic conjunctivitis. What interventions are most important to ease the symptoms? Select all that apply. 1 Administer artificial tears, as prescribed. 2 Instruct the patient to wash hands regularly. 3 Instruct the patient to avoid the allergen if it is known. 4 Administer topical antihistamines and corticosteroids. 5 Instruct the patient to use individual or disposable towels

1,3,4 Allergic conjunctivitis is caused by exposure to any allergen. If the allergen is known, the patient should be instructed to avoid the allergen as much as possible. Artificial tears can be used to dilute the allergen and wash it from the eye. Topical antihistamines and corticosteroids can be used to further decrease the symptoms. Hand washing and using individual or disposable towels are general measures to prevent the spread of infection, but they are not specific to allergic conjunctivitis.

The patient experiences loss of high-pitched sounds but understands speech with good response to sound amplification. Which statement accurately describes the patient's condition? 1 There is loss of sensory hair cells. 2 There is stiffening of the basilar membrane. 3 There are degenerative changes in the cochlea. 4 There is atrophy of the blood vessels in the wall of the cochlea.

1 Presbycusis is hearing loss associated with aging. Loss of sensory hair cells occurs in the case of neural presbycusis; as a result, the patient experiences loss of high-pitched sounds. The patient, however, correctly understands speech and responds well to sound amplification. Stiffening of the basilar membrane occurs with cochlear presbycusis, and this condition interferes with sound transmission in the cochlea. With this disorder, speech discrimination is affected with higher-frequency losses. Degenerative changes in the cochlea, termed as neural presbycusis, results in loss of speech discrimination. In the case of metabolic presbycusis, there is atrophy of the blood vessels in wall of the cochlea. Such patients experience uniform loss for all frequencies accompanied by recruitment.

A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention? 1 Walking behind the patient holding the patient's back 2 Describing the environment to the patient while walking 3 Helping the patient to sit by placing the patient's hand on the seat of the chair 4 Standing slightly in front and to one side of the patient and providing elbow for support

1 While assisting a blind patient using sighted-guide technique, the nurse should walk slightly ahead of the patient, with the patient holding the back of the nurse's arm. This action will help the blind patient to walk easily. The nurse should describe the environment while walking to help orient the patient. The student nurse should help the patient sit by placing one of his or her hands on the seat of the chair. The nurse should stand slightly in front and to one side of the patient and provide an elbow for the patient to hold.

In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder? 1 Pressure damage to the optic nerve may occur because of clogged drainage channels. 2 The retinal nerve is damaged by an abnormal increase in the production of aqueous humor. 3 The pupillary opening is blocked secondary to decreased aqueous humor in the anterior chamber. 4 The lens enlarges with normal aging, pushing the iris forward, blocking the outflow of aqueous humor.

1 With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain properly from the eye. This leads to damage to the optic nerve over time. The iris is not affected, the retinal nerve is not damaged, and the aqueous humor builds up because of blockage.

What instruction should the nurse include when teaching a caregiver ways to communicate better with a patient who has hearing loss? Select all that apply. 1 Maintain eye contact. 2 Speak normally and slowly. 3 Move closer to the better ear. 4 Overenunciate whatever you say. 5 Write out names or difficult words. 6 Do not draw attention with hand movements.

1,2,3,5 The family and caregivers can help the patient with hearing loss by using strategies for improving verbal and nonverbal communication. These strategies include maintaining eye contact when talking, speaking normally and slowly, moving closer to the better ear, and writing out names and words that are difficult to understand. Hand movements can be used to draw attention. Overenunciating should be avoided.

Identify risk factors associated with development of cataracts. Select all that apply. 1 Advanced age 2 History of diabetes mellitus 3 Exposure to ultraviolet light 4 Eating a diet high in lutein 5 History of eye chronic open-angle glaucoma 6 History of prolonged therapy with systemic corticosteroids

1,2,3,6 Risk factors for developing cataracts include advanced age, exposure to ultraviolet light, and conditions in which blood glucose levels are elevated, such as diabetes mellitus, or patients receiving long-term corticosteroid medications. These conditions alter metabolic processes and lead to the lens becoming cloudy and then opaque. A diet high in lutein is thought to decrease the risk of age-related macular degeneration. Patients with chronic glaucoma are not at higher risk for cataracts. However, some patients develop glaucoma after having cataract surgery or having an artificial lens implanted.

The adult child of a patient with macular degeneration asks the nurse how to avoid developing the condition. Which intervention should the nurse include in teaching? Select all that apply. 1 Stop smoking or do not start. 2 Avoid exposure to ultraviolet light. 3 Wash hands before touching face or eyes. 4 Wear eye protection while doing yard work. 5 Eat green leafy vegetables such as spinach or kale daily.

1,2,5 Besides aging and family history, risk factors for macular degeneration include cigarette smoking and long-term exposure to ultraviolet light. A diet rich in lutein, found in green leafy vegetables, may reduce the risk of macular degeneration. Hand hygiene prevents infection. Use of eye protection prevents injury.

A nurse provides education to a group of people about eye health care. Which statements by group indicate that the teaching has been understood? Select all that apply. 1 "Wash hands regularly to prevent the spread of diseases." 2 "Avoid removing contact lenses if there is redness and pain in the eye." 3 "Wear sunglasses and ensure proper nutrition to prevent cataract development." 4 "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." 5 "Regular eye checkups help in early detection of disease and prevent further loss of vision."

1,3,4,5 Proper care of the eye plays a vital role in maintaining eye health. Regular hand washing helps to prevent the spread of disease from one eye to the other. Wearing sunglasses and eating a proper diet help to prevent cataract development and age-related diseases. Wearing eye protection during hazardous work helps to reduce the risk of eye injuries. Regular eye checkups help in the early detection of diseases and prevent further loss of vision. Contact lenses should be removed if there is redness and pain in the eye.

A patient with high amounts of myopia is scheduled for laser-assisted in situ keratomileusis (Lasik). In which order should the primary health care provider perform the procedure? 1. The flap is repositioned carefully. 2. A flap is created in the cornea using a laser or surgical blade. 3. The flap adheres on its own without sutures in a few minutes. 4. The flap is folded back on the middle section, or stroma, of the cornea. 5. Pulses from a computer-controlled laser vaporize a part of the stroma.

1. A flap is created in the cornea using a laser or surgical blade. 2. The flap is folded back on the middle section, or stroma, of the cornea. 3. Pulses from a computer-controlled laser vaporize a part of the stroma. 4. The flap is repositioned carefully. 5. The flap adheres on its own without sutures in a few minutes. Laser-assisted in situ keratomileusis is a surgical procedure considered for patients with low to moderately high amounts of myopia or hyperopia, with or without astigmatism. The procedure first involves using a laser or surgical blade to create a flap in the cornea. Then the flap is folded back on the middle section, or stroma, of the cornea. Next, pulses from a computer-controlled laser vaporize a part of the stroma and then the flap is repositioned. Finally, ensure that the flap adheres on its own without sutures in a few minutes.

The patient calls the clinic about a sty that the patient has had for some time on the upper eyelid. The patient says warm moist compresses have been used, but it is no better. What should the nurse tell the patient to do? 1 "Go to the pharmacy to get some eye drops." 2 "Come in so the ophthalmologist can remove the lesion for you." 3 "The health care provider will need to inject it with an antibiotic." 4 "Wash the lid margins with baby shampoo to remove the crusting."

2 A chalazion may evolve from a sty, or hordeolum, as it did for this patient. Initial treatment is with warm compresses, but when they are ineffective, the lesion may be surgically removed or injected with corticosteroids. Washing the lid margins with baby shampoo is done with blepharitis.

The patient is given an oral dose of glycerol followed by serial audiograms over three hours. Which symptom did the nurse assess in the patient? 1 Presence of positive Schwartz's sign 2 Aural fullness and fluctuating sensorineural hearing loss 3 Reduction in touch sensation in the posterior ear canal 4 A painless condition with hearing loss, nausea, and episodes of dizzines

2 A glycerol test is a diagnostic test aimed to confirm Ménière's disease. The symptoms of this disorder include aural fullness and fluctuating sensorineural hearing loss. A series of audiograms over three hours is done after the patient is given an oral dose of glycerol. Improvement in hearing or speech discrimination occurs due to the osmotic effect of glycerol that pulls fluid from the inner ear. An otoscopic examination, the Rinne test, the Weber test, audiometry, and tympanometry are the diagnostic tests used to confirm otosclerosis. Such patients show positive Schwartz's sign. Patients with acoustic neuroma have reduced touch sensation in the posterior ear canal. Diagnostic tests to confirm acoustic neuroma include neurologic, audiometric, and vestibular tests; CT scans; and MRI. A mastoid x-ray is one of the tests used to diagnose chronic otitis media. This is a painless auditory disorder with hearing loss, nausea, and episodes of dizziness

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, on what should the nurse focus? 1 Giving anticipatory guidance about the eventual loss of central vision that will occur 2 Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision 3 Recognizing that eye damage caused by glaucoma can be reversed in the early stages 4 Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

2 Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, the patient should be encouraged to remain compliant with drug therapy. Glaucoma cannot be reversed. Central vision usually is unaffected with open-angle glaucoma. Pain management is important throughout the course of the disease.

The nurse is assessing four patients with different refractive errors. Which patient will the nurse suspect to have hyperopia? 1 Patient A inability to accommodate for objects at a distance 2 Patient B inability to accommodate for near objects 3 Patient C loss of accommodation which is associated with age 4 Patient D irregular corneal curvature

2 Hyperopia, or farsightedness, is an inability to accommodate near objects. It causes the light rays to focus behind the retina and requires the patient to use accommodation to focus the light rays on the retina for near objects; therefore, patient B is suspected to have hyperopia. Myopia or nearsightedness is an inability to accommodate objects at a distance; therefore, Patient A has myopia. Presbyopia is the loss of accommodation associated with age; therefore, Patient C has presbyopia. Astigmatism is caused by an irregular corneal curvature; therefore, Patient D has astigmatism.

An asthmatic patient is diagnosed with chronic glaucoma. The patient is prescribed timolol (Istalol). In regard to patient safety, what action should the nurse take? 1 Explain to patient that carteolol may cause vomiting. 2 Do not administer istalol, and notify the health care provider. 3 Ask the health care provider to decrease the dose of carteolol. 4 Suggest the patient only use carteolol for a short period of time.

2 In an asthmatic patient, administration of timolol should be avoided because it causes bronchospasm. Decreasing the dose and suggesting that the patient only use the medicine for a short period of time do not reduce the risk of bronchospasm. Vomiting is not a side effect of timolol.B

Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? 1 "You may feel some palpitations after instilling these eye drops." 2 "You may have a temporary headache after instilling these drops." 3 "You should withhold this medication if your blood pressure becomes elevated." 4 "You should keep your eyes closed for 15 minutes after instilling these eye drops."

2 It is common for patients to have a temporary headache when instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow and blood pressure is more likely to decrease if absorbed systemically. asthmatic patient, administration of timolol should be avoided because it causes bronchospasm. Closing the eyes for 15 minutes after instilling the eye drops is not necessary.

A patient experiences an attack of Ménière's disease. Which intervention is most important for the nurse to include in the patient's plan of care? 1 Increased fluid intake 2 Decreased environmental stimuli 3 Provision of the patient's regular diet 4 Assessment for orthostatic hypotension

2 The etiology of Ménière's disease is not well understood, but stress and excessive sensory stimulation are possible causes. Decreasing environmental stimuli is one approach to treatment and controlling the severity of the symptoms. Fluid intake should be decreased; this may ease the symptoms because in Ménière's disease there is an increase in the endolymphatic fluid of the inner ear. It is believed this causes disease symptoms. If there is no nausea and vomiting, the patient may eat a regular diet as tolerated, but this is not as high a priority as decreasing environmental stimuli is. Patients may experience tinnitus and vertigo, but the blood pressure is not affected, so orthostatic hypotension does not occur.

The nurse has completed patient teaching for a patient who had cataract surgery on the left eye. Which statement by the patient indicates a need for further teaching? 1 "I might feel some scratchiness in my left eye." 2 "I should notice an improvement in my vision in a few days." 3 "I will call my health care provider if I notice white drainage or redness in my left eye." 4 "I will call my health care provider if I notice white drainage or redness in my left eye."

2 The patient will notice an improvement in vision after surgery not in a few days. Cataract surgery typically results in little to no pain, but the patient may have some scratchiness in the operative eye. Mild analgesics are usually sufficient to relieve any discomfort, but if the pain is sudden or intense, the patient should notify the health care provider because this may indicate hemorrhage, infection, or increased intraocular pressure (IOP). The patient should be instructed to call the health care provider if redness or drainage occurs in the affected eye. These can be signs of infection.

A patient reports an inability to see near objects. The nurse recalls that which physiologic condition is responsible for this disorder? 1 Cornea having irregular curvature 2 Light rays focusing behind the retina 3 Incoming light rays bending unequally 4 Light rays focusing in front of the retina

2 The patient with an inability to see near objects suffers from hyperopia or farsightedness. In this case, the light rays focus behind the retina. Normally the light rays should focus on the retina for near objects. This type of refractive error occurs when the cornea or lens does not have adequate focusing power or when the eyeball is too short. Irregular corneal curvature and incoming light rays bending unequally are associated with astigmatism. Focusing light rays in front of the retina is the sign of myopia

Which visual problem will the nurse suspect in the patient who has symptoms of itching, irritation, intolerance towards light, with crusts on the lid margins and lashes? 1 Cataract 2 Blepharitis 3 Retinal detachment 4 Allergic conjunctivitis

2 Blepharitis Blepharitis is a common chronic bilateral inflammation of the lid margins associated with crusts on the lid margins. Blepharitis is also associated with itching, irritation, and photophobia. Cataract is a clouding of the lens in the eye, which affects vision by abnormal color perception and glaring. Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium. The symptoms of retinal detachment are photopsia and seeing a ring or cobwebs in the field of vision. Allergic conjunctivitis is caused by exposure to an allergen and is associated with itching and swelling.

While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team? 1 Place the patient in a flat supine position. 2 Stabilize the foreign object within the injury site. 3 Instruct the patient to bend over and take deep breaths. 4 Continuously irrigate the eye with sterile saline solution.

2 The nurse should stabilize the foreign object penetrating the eye to prevent further damage until the injury can be treated by an emergency medicine specialist and ophthalmologist. The head of the patient should be elevated 45 degrees to prevent excessive pressure within the eye. Bending over is avoided as well. Irrigation of the eye is indicated only if the injury is caused by a chemical exposure.

The nurse is preparing a patient for penetrating keratoplasty. What disorder does the nurse determine the patient is being treated for? 1 Retinopathy 2 Corneal scars 3 Chronic open-angle glaucoma 4 Age-related macular degeneration

2 A corneal scar is the chronic inflammation of the corneal stroma. Penetrating keratoplasty is the procedure performed to treat corneal scars. While performing surgery, the ophthalmic surgeon removes the full thickness of the patient's cornea and replaces it with a donor cornea that is sutured into place. Retinopathy is treated by laser photocoagulation. Chronic open-angle glaucoma is treated by argon laser trabeculoplasty. Age-related macular degeneration is treated by photodynamic therapy.

A patient is using dipivefrin (propine) for the treatment of glaucoma. What side effects should the nurse educate the patient to monitor? Select all that apply. 1 Depression 2 Tachycardia 3 Hypertension 4 Bronchospasm 5 Taste alteration

2,3 Dipivefrin is an α-adrenergic agonist and is converted to epinephrine inside the eye. It decreases aqueous humor production and enhances outflow facility. Dipivefrin causes tachycardia and hypertension. Depression and bronchospasm are side effects of the antiglaucoma drug carteolol. Taste alteration is a side effect of carbonic anhydrase inhibitors.

A patient, discharged after eye surgery, is told to avoid activities that will increase intraocular pressure. Which activities should the patient avoid? Select all that apply. 1 Eating 2 Lifting 3 Coughing 4 Bending over 5 Breathing deeply

2,3,4 Activities such as coughing, bending over, and lifting increase the pressure within the eye. Eating and breathing deeply do not involve straining or lowering the head, so the pressure within the eye is not increased.

A patient has undergone cataract surgery. What nursing interventions help to prevent postoperative complications? Select all that apply. 1 Antiviral medications are given to prevent infections. 2 Teach the patient to instill medicine following aseptic techniques. 3 Teach the patient about proper hygiene and eye care techniques. 4 Ask the patient to discontinue all prescribed medicine two days after surgery. 5 Advise the patient to avoid actions that can cause increased intraocular pressure.

2,3,5 Postoperative care of the eye is essential for proper wound healing. Increased intraocular pressure may break the sutures and increases the risk of complications; therefore, it should be prevented. Proper hygiene and eye care techniques prevent contamination of the wound. Medicines should be instilled in the eye using aseptic techniques to prevent infection. The full course of medicine should be completed to obtain the therapeutic effect. Antibiotic drops, not antiviral medications, are given to prevent infections.

What instructions should the nurse include when teaching a patient how to administer ear drops? Select all that apply. 1 Administer cold, not warm, drops. 2 The tip of the dropper should not touch the ear. 3 The ear should be positioned so that the drops can run into the canal. 4 The drops should not be put in using a cotton wick placed in the ear canal. 5 The position of the ear should be maintained for two minutes to let the drops spread.

2,3,5 When administering ear drops, the patient should position the ear so that the drops run into the canal, and this position should be maintained for two minutes to let the drops spread. The dropper should not touch the ear; avoiding contact reduces the spread of infection. The ear drops should be at room temperature when administered. Cold drops can cause vertigo; very warm drops can burn the tympanic membrane. Sometimes the drops are placed onto a wick of cotton that is placed in a canal.

Which criteria should the nurse consider for the placement of an implanted hearing system in a patient to treat moderate to severe sensorineural hearing loss? Select all that apply. 1 Loss of sensory hair cells 2 Normal middle ear anatomy 3 Bilateral hearing impairment 4 Normally functioning Eustachian tube 5 Stable bilateral sensorineural hearing loss

2,4,5 An implanted hearing system treats moderate to severe sensorineural hearing loss. Criteria for placement of this device include normal middle ear anatomy, a normally functioning Eustachian tube, and stable bilateral sensorineural hearing loss. Loss of sensory hair cells leads to sensory presbycusis that responds well to sound amplification. Patients with bilateral hearing impairment require binaural hearing.

Which symptom occurs initially with retinal detachment? 1 Redness of the conjunctiva 2 Increased glare with artificial light 3 Seeing flashes of light and floaters 4 Severe pain when moving the eyes

3 A detached retina involves the separation of the sensory retina from the underlying pigment epithelium. Fluid accumulates in the space and blocks essential nourishment and circulation to retinal cells. Initially symptoms include seeing flashes of light, an increased amount of floaters, or lines in the vision field. If the detachment advances, there is a loss of vision peripherally or centrally, depending where the detachment has occurred. Eye irritation or infection causes redness of the conjunctiva. Increased glare that interferes with visual acuity is noted by patients with cataracts. Inflammation or infection within the eye causes pain with eye movement.

A nurse reviews the medical record for a patient with acute glaucoma for which acetazolamide has been prescribed. The patient has a history of high-dose aspirin therapy. Considering the concomitant use of the medications, the nurse expects what change in medication prescriptions? 1 The dose of acetazolamide will be decreased. 2 There will be no change in prescriptions of either medication. 3 The patient cannot take both medications due to gastric disturbances. 4 The patient will be advised to take acetazolamide at a different time than aspirin.

3 Acetazolamide is a carbonic anhydrase inhibitor used in the treatment of glaucoma. The patient is on high-dose aspirin therapy; therefore, acetazolamide is avoided because it increases the risk of gastric disturbances. Decreasing the dose of acetazolamide may not decrease the risk of developing complications. A combination of acetazolamide and aspirin is not recommended because it can cause GI upset. Taking acetazolamide at a different time than aspirin does not prevent drug interactions and should be avoided.

The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom? 1 Carteolol 2 Dipivefrin 3 Carbachol 4 Latanoprost

3 Carbachol is a cholinergic agent that stimulates iris sphincter contraction and results in miosis. Carteolol is a nonselective beta-adrenergic blocker and decreases intraocular pressure but does not cause miosis. Dipivefrin is a sympathomimetic agent that decreases aqueous humor production but does not cause miosis. Latanoprost is a prostaglandin F2-alpha analog that does not stimulate contraction of the iris sphincter; therefore, it does not cause miosis.

A 68-year-old patient has undergone a total hip replacement and has glaucoma. The nurse forms a nursing diagnosis of disturbed sensory perception related to increased intraocular pressure. The plan of care should focus on which main element? 1 Restriction of driving privileges immediately 2 Use of occupational and physical therapy for visual deficits 3 Encouraging medication compliance to reduce the risk of vision loss 4 Managing the pain using oral antiinflammatories and opioids as needed

3 Drug therapy is necessary to prevent the eventual vision loss that accompanies glaucoma. For this reason, the nurse should encourage the patient to remain compliant with drug therapy. Physical therapy will not improve or treat visual deficits. Glaucoma does not cause pain, and unless the vision is severely impaired, driving restrictions are not necessary.

A patient reports ocular pain, photophobia, decreased visual acuity, headaches, corneal edema, and conjunctiva that is reddened and swollen. The nurse recognizes that the patient is most likely experiencing which type of inflammation? 1 Scotoma 2 Blepharitis 3 Endophthalmitis 4 Cytomegalovirus retinitis 00:00:02 Question Answer Confidence Buttons

3 Endophthalmitis is an extensive intraocular inflammation of the vitreous cavity. Ocular pain, photophobia, decreased visual acuity, headaches, reddened, swollen conjunctiva, and corneal edema are the symptoms of endophthalmitis. Blepharitis is a common chronic bilateral inflammation of the lid margins. Cytomegalovirus retinitis is an opportunistic infection that occurs in patients who are immunocompromised. Scotoma is presence of blind spots in the visual field; it is not an infection.

Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos? 1 Strabismus 2 Keratoconus 3 Exposure keratitis 4 Keratoconjunctivitis sicca

3 Exposure keratitis is an inflammation or infection of the cornea that occurs when the patient has exophthalmos due to thyroid disease or masses behind the globe. Therefore the nurse will suspect exposure keratitis. Strabismus is not associated with inadequately closed eyelids, and there is no inflammation. Instead the patient with strabismus cannot consistently focus the two eyes on same object simultaneously. Keratoconus is a noninflammatory condition in which the patient experiences blurred vision. Keratoconjunctivitis sicca is a condition of dry eyes, particularly seen in older adults and individuals with certain systemic diseases such as scleroderma and systemic lupus erythematosus.

The nurse assesses a patient with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin. What action does the nurse anticipate providing to assist with the relief of discomfort due to this condition? 1 Administration of artificial tears 2 Insertion of intacs on the cornea 3 Application of a warm, moist compress four times a day 4 Administration of nonsteroidal antiinflammatory eye drops

3 Hordeolum is an infection of the sebaceous glands in the lid margin. The symptoms of hordeolum are a red, swollen, circumscribed, and acutely tender area near the eye. The only treatment that may be necessary for this patient is to apply warm, moist compresses four times a day, which will decrease the swelling and redness of the eye. Administering artificial tears is the treatment for allergic conjunctivitis to dilute the allergen and wash it away. Insertion of intacs on the cornea is the treatment for keratoconus. Administration of nonsteroidal antiinflammatory eye drops is the treatment given if the patient has inflammation.

A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient? 1 Glaucoma leads to detachment of the retina. 2 Glaucoma results from chronic eye inflammation. 3 Glaucoma results in increased intraocular pressure. 4 Glaucoma is caused by decreased blood flow to the retina.

3 In chronic open-angle glaucoma the outflow of aqueous humor is obstructed, leading to increased intraocular pressure. The increased intraocular pressure eventually causes destruction of the nerve fibers of the retina and painless vision loss, beginning in the periphery. Glaucoma does not cause detachment of the retina, result from chronic inflammation, or result from decreased retinal blood flow.

The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering? 1 Oral acyclovir 2 Trifluridine drops 3 Topical corticosteroids 4 Topical vidarabine ointment

3 Keratitis is an inflammation or infection of the cornea that can be caused by a variety of microorganisms. Topical corticosteroids are contraindicated in this patient because they may cause deeper ulceration of the cornea on prolonged treatment. Oral acyclovir is an antiviral medication that is effective in the treatment of viral keratitis. Trifluridine drops and topical vidarabine ointment are effective in treating viral keratitis.

Which auditory disorder is caused by an excessive accumulation of endolymph in the membranous labyrinth? 1 Otitis Media 2 Otosclerosis 3 Ménière's disease 4 Acoustic neurom

3 Ménière's disease, also called endolymphatic hydrops, results in an excessive accumulation of endolymph in the membranous labyrinth. The volume of endolymph increases until the membranous labyrinth ruptures. Otitis media is caused by an infection of the tympanum, ossicles, and space of the middle ear. Otosclerosis is a hereditary autosomal dominant disease caused by the vascular and bony changes in the middle ear. Otoscopic examination may reveal Schwartz's sign. Acoustic neuroma is a disorder of cranial nerve VIII, on which a unilateral benign tumor grows.

A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse? 1 To decrease pain 2 To prevent anxiety 3 To minimize photophobia 4 To minimize intraocular pressure

3 Pupil dilation medications enlarge the pupil during eye examinations. After administering pupil dilation medications, patients generally have photophobia. Analgesics are administered to decrease pain. Anxiolytics are given to patients to prevent anxiety. Miotics and oral or intravenous hyperosmotic agents such as glycerin liquid, isosorbide solution, and mannitol solution are useful in lowering the intraocular pressu

A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? 1 "Papilledema is caused by irritants and microorganisms." 2 "Papilledema is fluid accumulation between two layers within the retina." 3 "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." 4 "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

3 Sustained, severe hypertension can cause sudden visual loss from swelling of the optic disc and nerve. This condition is known as papilledema. It is not caused by the development of abnormal blood vessels in or around the macula, nor is it caused by microorganisms. Papilledema is not fluid accumulation between two layers within the retina. The development of abnormal blood vessels in or near the macula is known as macular degeneration.

Which instruction given by the nursing student during ear care training needs correction by the registered nurse? 1 "Do not put anything in your ear canal." 2 "Report itching if it becomes a problem." 3 "Dry the ear with cotton-tipped applicators." 4 "Report chronic excessive cerumen if it impairs your hearing."

3 The ears should be kept as dry as possible. However, cotton-tipped applicators should not be used for drying the ears. Rather, a hair dryer set to low and held at least 6 inches from the ear can be used to evaporate the water from the ear. Unless requested by the health care provider, nothing should be put in the ear canal. The health care provider should be consulted if consistent itching occurs or if excessive cerumen impairs hearing.

A patient has sustained an injury to the cornea. The nurse assists the primary health care provider in rinsing the eye with saline solution and then instilling a dye into the conjunctiva of the injured eye. What is the purpose of the dye? 1 To disinfect the injured tissue 2 To help seal and heal the injured tissue 3 To stain the injured tissue so it can more easily be identified 4 To bind with foreign particles, allowing them to be rinsed away from injured tissue

3 The injured tissue is susceptible to the dye and will remain stained even after the eye is rinsed with saline. Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects and locate foreign objects in the eye. The dye is not used to disinfect the tissue, seal and heal it, or bind with foreign particles.

A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? 1 Use suitable coping strategies to reduce stress 2 Identify patient's strengths and support system 3 Verbalize feelings related to visual impairment 4 Transition successfully to the sudden vision loss

3 The nurse's priority is to help the patient express feelings about vision loss because the patient is not coping effectively with the situation. Until the patient expresses how he or she feels, the patient will be unable to progress in the rehabilitation process, including using suitable coping strategies to reduce stress, developing strengths and a support system, and transitioning successfully to the sudden vision loss.

An otoscopic examination of a patient reveals a positive Schwartz's sign. A tuning fork test and an audiogram demonstrate air-bone gaps. Which statement describes the disorder these tests are used to diagnose? 1 Free-floating debris in the semicircular canal causes vertigo with specific head movements. 2 A unilateral benign tumor grows where the vestibulocochlear nerve enters the internal auditory canal. 3 The spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window. 4 The patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.

3 The patient has otosclerosis, which can be diagnosed with otoscopic examination revealing a positive Schwartz's sign along with tuning fork tests and an audiogram identifying air-bone gaps. In otosclerosis, spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window, thereby reducing the transmission of vibrations to the inner ear fluids. This results in conductive hearing loss. In benign paroxysmal positional vertigo (BPPV), free-floating debris in the semicircular canal causes vertigo with specific head movements, such as getting out of bed, rolling over in bed, and sitting up from lying down. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve enters the internal auditory canal. The tumor can compress the trigeminal and facial nerves and arteries within the internal auditory canal. In Ménière's disease, the patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.

Which hearing-impaired patient is the most ideal candidate for a cochlear implant? 1 The middle-aged patient being treated for benign paroxysmal positional vertigo (BPPV) 2 The older adult with slight hearing loss which does not significantly impact activities 3 The teen with profound sensorineural hearing loss after tympanic membrane (TM) rupture 4 The construction worker with tinnitus after prolonged exposure to excessively loud equipment

3 The teenager with profound sensorineural hearing loss after TM rupture is the ideal candidate for a cochlear implant, as hearing loss occurred after speech development, and this patient will adapt to the implant well. Patients who suffer from BPPV typically do not demonstrate hearing loss. A cochlear implant is not indicated for slight hearing loss at any age. Tinnitus is the perception of sound when no source is present. A cochlear implant would be inappropriate treatment for tinnitus.

The registered nurse is preparing to teach a group of nursing students about the use of verbal aids when communicating with hearing-impaired patients. Which information does the nurse include in the teaching plan? 1 Refrain from having light behind the patient. 2 Speak in a clear voice and shout at the patient. 3 Use simple sentences and rephrase sentences if required. 4 Maintain eye contact and draw the attention of the patient with hand movements.

3 The use of simple sentences is an example of a verbal aid that the nurse can use while communicating with a hearing-impaired patient. If required, the nurse should rephrase the sentence and use different words to help the patient understand. As a nonverbal aid, the nurse should avoid light behind the speaker, not the patient. As a verbal aid, the nurse should speak in a normal voice directly into the better ear. The nurse should not shout to make the patient understand. As a nonverbal aid, the nurse should maintain eye contact and draw attention of the patient with hand movements.

Which nursing intervention is most appropriate for facilitating communication with a patient who has a hearing impairment? 1 Speaking loudly and shouting if necessary 2 Asking the patient questions that can be answered with a yes or no response 3 Standing close to the patient and speaking slowly and clearly in a normal tone 4 Standing to one side of the patient when speaking and directing the voice directly into the patient's ear

3 Standing close to and directly in front of the patient will greatly facilitate communication. The nurse also should ensure that the patient can see the nurse's mouth to help facilitate lip-reading. Shouting at the patient with a hearing impairment distorts the voice and further hinders understanding. Asking yes-or-no questions and standing to one side and speaking directly into the patient's ear are not appropriate or effective means of communicating with the patient who has a hearing impairment.

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? 1 Apply pressure to each eyeball for a few seconds after administration. 2 Have the patient close the eyes and move them back and forth several times. 3 Have the patient put pressure on the inner canthus of the eye after administration. 4 Have the patient try to blink out excess medication immediately after administration.

3 Systemic absorption can be minimized by applying pressure to the inner canthus of the eye. Applying pressure to each eyeball, having the patient close the eyes and move them back and forth, and having the patient try to blink out excess medication will not minimize systemic effects of the medication.

A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching? 1 Restrict activity at home. 2 Wear a nighttime eye shield. 3 Do not bend, stoop, cough, or lift. 4 Wash hands before touching the eye.

3 When teaching postoperative home care for cataract surgery, the nurse should instruct the patient to avoid activities such as bending, stooping, coughing, or lifting because these activities can raise the intraocular pressure, which in turn can adversely affect the newly implanted lens. All other activities are permissible. Wearing a nighttime eye shield is not necessary. Washing hands before touching the eye is a general hygiene practice and not specific to postoperative care.

The nursing instructor is teaching a group of nursing students about the treatment of cerumen and foreign bodies in the external ear canal. Which statements made by the nursing student indicate an understanding regarding the instruction? Select all that apply. 1 "The canal should be irrigated with cold solutions." 2 "The ear canal should be completely occluded with the syringe tip." 3 "Use of cotton-tipped applicators to clean the ears should be avoided." 4 "Mild lubricant drops should be used as initial treatment for cerumen removal." 5 "Mineral oil can be used with microscopic guidance to kill an insect before removal."

3,5 Mineral oil or lidocaine drops can be used to kill an insect before removal with microscope guidance. Ears should be cleaned with a washcloth and finger, and never with cotton-tipped applicators. This is because penetration of the middle ear by a cotton-tipped applicator can cause serious injury to the tympanic membrane (TM) and ossicles, and can also cause cerumen to become impacted against the TM and impair hearing. Management of cerumen involves irrigation of the canal with body temperature solutions to soften the cerumen. When irrigating the ear canal to soften the cerumen, it is important to make sure that the ear canal is not completely occluded with the syringe tip. Mild lubricant drops may be used to soften the earwax only if irrigation does not remove the wax, and not as the initial step for cerumen removal.

The nurse is admitting a patient with glaucoma who states that he or she is allergic to all sulfa drugs. Which medication order should the nurse question and immediately report to the primary care provider? 1 Carteolol 2 Dipivefrin 3 Carbachol 4 Acetazolamide

4 Acetazolamide is an antiglaucoma drug and a carbonic anhydrase inhibitor that may cause immunologically mediated reactions and result in sulfa-type allergic reactions in patients allergic to sulfa. Carteolol is a nonselective beta blocker and may cause blurred vision, photophobia, and bradycardia. Dipivefrin is sympathomimetic and may cause side effects such as ocular discomfort and redness. Carbachol is an antiglaucoma drug and a cholinergic agent that may cause transient ocular discomfort, headache, and blurred vision.

A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms? 1 Itching, burning, irritation, and photophobia 2 Tearing, redness, photophobia, and foreign body sensation 3 Red, swollen, circumscribed, and acutely tender area in the lid margin 4 Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

4 Bacterial conjunctivitis manifests as discomfort, pruritus, redness, and a mucopurulent drainage in the eye. It occurs due to unhygienic conditions. The infection is caused by Staphylococcus aureus. It can be treated with antibiotic drops. Itching, burning, irritation, and photophobia are signs of blepharitis. Tearing, redness, photophobia, and foreign body sensation are symptoms of epidemic keratoconjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum.

While preparing a patient with a visual problem for surgical therapy, the primary health care provider orders the nurse to administer cycloplegics to the patient. What rationale does the nurse identify for this action? 1 To prevent anxiety 2 To reduce inflammation 3 To minimize photophobia 4 To block the effect of acetylcholine on ciliary body muscles

4 Cycloplegics are anticholinergic drugs that block the effect of acetylcholine on the ciliary body muscles and produce paralysis of accommodation. Therefore cycloplegics are given in the preoperative phase of surgical therapy to block the effect of acetylcholine on the iris sphincter muscle. Antianxiety drugs are given to the patient to prevent anxiety. Nonsteroidal antiinflammatory drugs are given to reduce inflammation. The patient is advised to wear dark glasses to minimize photophobia.

A patient complains of a red, swollen, circumscribed, and acutely tender area in the lid margin. After the medical checkup, it is diagnosed as a hordeolum. The nurse should provide what instructions to help the patient care for the affected eye? 1 Advise the patient to not perform lid scrubs for 10 days. 2 Suggest wearing glasses to reduce development of the infection. 3 Advise to avoid any treatment because the condition is a normal body protective mechanism. 4 Suggest applying warm, moist compresses at least four times a day until the condition improves. 00:00:06 Question Answer Confidence Buttons

4 Hordeolum is an infection caused by the bacteria Staphylococcus aureus. It manifests as a red, swollen, circumscribed, and acutely tender area in the lid margin. Treatment involves applying warm, moist compresses at least four times a day until the condition improves. If it recurs, lid scrubs should be performed daily to aid healing. In addition, appropriate antibiotic ointments or drops are prescribed if required. Wearing glasses may not help in treating hordeolum. It is not a normal body protective mechanism; therefore, treatment should not be deferred.

A patient with glaucoma is taking timolol drops. What should the nurse include while reinforcing principles of medication administration with the patient? 1 The patient will notice an improvement in vision within one month. 2 The patient should use these on an as needed basis for eye irritation. 3 The patient should maintain a supine position for 30 minutes after the drops are instilled. 4 The patient may experience blurred vision after administration of the drops lasting several minutes.

4 It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should be no cause for concern to the patient. This medication should be used on a fixed schedule to reduce intraocular pressure. Glaucoma is asymptomatic and may not result in vision loss. It is not necessary to lie flat following eye drop administration.

An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect? 1 Cataract 2 Strabismus 3 Keratoconus 4 Keratoconjunctivitis sicca

4 Keratoconjunctivitis sicca is a dry eye disorder commonly seen in older adults. The patient with keratoconjunctivitis sicca reports irritation and presence of sand in the eye. Cataract is a condition in which there is opacity within the lens and the patient reports decreased vision, abnormal color perception, and glare. Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object and the patient will complain of double vision. Keratoconus is a noninflammatory disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape, and the patient complains of blurred vision.

The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching? 1 "I'll limit my fluid intake." 2 "I'll change positions slowly." 3 "I'll use my eye drops until my vision clears." 4 "I'll check the labels on my nonprescription drugs."

4 Nonprescription drugs, even caffeine, may increase intraocular pressure, resulting in enough pressure to cause damage. Therefore it is important for the patient to check the contents of all drug labels. Limitation of fluid intake and slow position changes will not affect intraocular pressure. Eye drop medications for glaucoma must be taken as prescribed. Stopping these medications could cause a rebound increase in intraocular pressure.

Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention? 1 Tobacco smoking cessation 2 Yearly ophthalmic examination 3 Eating a diet high in green leafy vegetables and lysine 4 Strict adherence to prescribed eye drop medication schedule

4 Strict adherence to prescribed medication regimen to treat glaucoma will keep the intraoptic pressure at safe levels to avoid optic nerve damage. Tobacco cessation is healthy but will not treat glaucoma. Yearly eye examinations are important but will measure only any damage done if the patient does not follow treatment. A diet high in lutein, found in green leafy vegetables, is thought to improve eye health. Lysine is an amino acid that has some antiviral properties.

A nurse is comparing otosclerosis and otitis media with effusion. Which statement is correct regarding these two diseases? 1 Otosclerosis can be caused by changes in air pressure, whereas otitis media with effusion follows chronic sinus infections. 2 Otosclerosis is an inflammation of the middle ear, whereas otitis media with effusion is a hereditary recessive disease. 3 Otosclerosis may be accompanied by a reddish blush of the tympanum, whereas otitis media with effusion is accompanied by purulent discharge from the ear. 4 Otosclerosis is treated by oral administration of sodium fluoride, with vitamin D and calcium carbonate, whereas otitis media with effusion does not require antibiotic therapy.

4 The hearing loss associated with otosclerosis may be stabilized by the oral administration of sodium fluoride, with vitamin D and calcium carbonate. These medications slow bone resorption and encourage the calcification of bony lesions. Otitis media with effusion usually resolves without treatment but may recur. Chronic sinus infections can lead to otitis media with effusion; so can barotrauma caused by pressure change. Otosclerosis is not associated with a change in air pressure. Otosclerosis is a hereditary autosomal dominant disease, whereas otitis media with effusion is an inflammation of the middle ear with a collection of fluid in the middle ear space. In a patient with otosclerosis, an otoscopic examination may reveal a reddish blush of the tympanum known as Schwartz's sign; this is caused by the vascular and bony changes within the middle ear. In otitis media with effusion, the patient does not experience pain, fever, or discharge from the ear.

The patient needs, but does not want, a corneal transplant because of difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this? 1 If the transplant is done soon after the donor dies, there will not be as much trouble recovering vision. 2 The astigmatism the patient is experiencing may be corrected with glasses or rigid contact lenses. 3 Increasing the amount of light and using a magnifier to read will be helpful if a transplant is not wanted. 4 There are newer procedures in which only the damaged cornea's epithelial layer is replaced, and these procedures have a faster recovery.

4 The new procedures are called Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's membrane endothelial keratoplasty (DMEK). Corneal transplants should be done as soon as possible, but this does not affect the rate of visual recovery. Astigmatism is not experienced with corneal scars and opacities requiring a corneal transplant. Increasing light and magnification helps a person with cataracts to read.

Which nonverbal aids can the nurse adopt to effectively communicate with a patient with hearing loss? 1 Refraining from touching the client 2 Having a light source behind the speaker 3 Maintaining equal distance from both ears 4 Refraining from covering the mouth or face with hands

4 The nurse should not cover his or her mouth or face with the hands to communicate effectively with a patient with hearing loss. Using touch can be an effective strategy in this situation. The nurse should refrain from having light behind the speaker. The nurse should move close to the better ear while communicating with the patient with hearing loss.

A patient has undergone kidney transplantation surgery and takes immunosuppressant drugs. The patient comes in contact with a person who has chickenpox. The nurse recognizes that the patient is susceptible to which viral ophthalmic infection? 1 Blepharitis 2 Hordeolum 3 Astigmatism 4 Herpes zoster ophthalmicus

4 The patient is being treated with immunosuppressant drugs to prevent the rejection of a transplanted kidney. The immunosuppressive drugs tend to decrease the patient's immunity. If the patient comes in contact with a patient with chickenpox, there is the possibility of herpes zoster ophthalmicus infection. It may occur due to reactivation of an endogenous infection. The endogenous infection might have persisted in a latent form after an earlier attack of varicella or by contact with a patient with chickenpox or herpes zoster. It occurs most frequently in older adults and immunosuppressed patients. Blepharitis is a common chronic bilateral inflammation of the lid margins. Hordeolum is an infection of the sebaceous glands in the lid margin. Astigmatism is an eye disorder; it is not a viral infection.

A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient? 1 Instruct the patient to quit smoking. 2 Suggest that the patient consider using supplements of vitamins and minerals. 3 Advise the patient to eat lots of dark green, leafy vegetables containing lutein. 4 Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

4 Verteporfin, used for phototherapy, is a photosensitizing drug. It becomes active in the presence of low-level laser light waves. It can be activated by exposure to sunlight or high-intensity light until it is fully excreted. If activated, it can cause thermal burns in the area. The patient should be instructed to avoid direct sunlight and other intense forms of light for five days after treatment. Taking vitamin and mineral supplements, eating green leafy vegetables high in lutein, and cessation of smoking are measures to decrease the risk of AMD.

A patient has lost an eye after an industrial accident. Which action by the nurse is most appropriate during this time? 1 Speak louder when talking to the patient. 2 Avoid making eye contact during a conversation. 3 Introduce the patient to other visually impaired persons. 4 Assist the patient with the same grieving process that is associated with other losses.

4 When the patient has lost visual function or even the entire eye, he or she will grieve the loss. The nurse should help the patient through the grieving process. The patient lost an eye, not an ear, so speaking louder is not necessary. The nurse should still make eye contact with the patient. Introducing the patient to other visually impaired persons is not recommended early in the grieving process.

What is important for the nurse to include in the postoperative care of the patient following a stapedectomy to correct otosclerosis? Select all that apply. 1 Check the gag reflex. 2 Encourage independence. 3 Avoid changing the cotton padding. 4 Instruct patient to refrain from lifting or bending. 5 Inform patient that nausea and dizziness may occur.

4,5 The patient may experience dizziness, nausea, and vomiting as a result of stimulation of the labyrinth during surgery. The patient should take care to avoid sudden movements that may bring on or exacerbate vertigo. Actions that increase inner ear pressure, such as coughing, sneezing, lifting, bending, and straining during bowel movements, should be avoided. Place a cotton ball in the ear canal, and cover the ear with a small dressing. It is not necessary to check a gag reflex. The patient will need assistance early postoperatively for safety reasons, so the nurse should not promote independence. The cotton padding may need to be changed if there is excess drainage. Topics

An elderly patient with a history of bilateral cataracts is admitted to the hospital with pneumonia. What intervention will facilitate the patient's ability to see? Select all that apply. 1 Administer prescribed analgesics. 2 Patch the eye that has less visual acuity. 3 Obtain dark glasses for the patient to wear. 4 Increase the amount of light for near vision. 5 Obtain teaching materials with enlarged print.

4,5 The patient with intact cataracts will see better with the use of increased lighting and magnifiers, including enlarged print. Receiving prescribed analgesics will relieve discomfort. Patching an eye will lessen vision. Wearing dark glasses decreases the patient's visual acuity.

A 75-yr-old patient who lives alone at home tells the nurse, "I am afraid of losing my independence because my eyes don't work as well they used to." Which action should the nurse take first? Discuss the increased risk for falls that is associated with impaired vision. Ask the patient about what type of vision problems are being experienced. Explain that there are many ways to compensate for decreases in visual acuity. Suggest ways of improving the patient's safety, such as using brighter lighting.

Ask the patient about what type of vision problems are being experienced.

A patient with high amounts of myopia is scheduled for laser-assisted in situ keratomileusis (Lasik). In which order should the primary health care provider perform the procedure? 1. The flap is repositioned carefully. 2. A flap is created in the cornea using a laser or surgical blade. 3. The flap adheres on its own without sutures in a few minutes. 4. The flap is folded back on the middle section, or stroma, of the cornea. 5. Pulses from a computer-controlled laser vaporize a part of the stroma.

Correct 1. A flap is created in the cornea using a laser or surgical blade. Correct 2. The flap is folded back on the middle section, or stroma, of the cornea. Correct 3. Pulses from a computer-controlled laser vaporize a part of the stroma. Correct 4. The flap is repositioned carefully. Correct 5. The flap adheres on its own without sutures in a few minutes Laser-assisted in situ keratomileusis is a surgical procedure considered for patients with low to moderately high amounts of myopia or hyperopia, with or without astigmatism. The procedure first involves using a laser or surgical blade to create a flap in the cornea. Then the flap is folded back on the middle section, or stroma, of the cornea. Next, pulses from a computer-controlled laser vaporize a part of the stroma and then the flap is repositioned. Finally, ensure that the flap adheres on its own without sutures in a few minutes.

A patient with Meniere's disease is admitted with vertigo, dizziness, nausea and vomiting. Which nursing intervention will be included in the plan of care Dim the lights in the patient's room. Encourage increased oral fluid intake. Change the patient's position every 2 hours. Keep the head of the bed elevated 45 degrees.

Dim the lights in the patients room

The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient many years. During the initial assessment of the patient, it is most important for the nurse to

Make eye contact with the patient and ask about any need for assistance

Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma? Morphine sulfate 4 mg IV Mannitol (Osmitrol) 100 mg IV Betaxolol (Betoptic) 1 drop in each eye Acetazolamide (Diamox) 250 mg orally

Mannitol (Osmitrol) 100 mg IV

An older patient who is being admitted to the hospital repeatedly asks the nurse to "speak up so that I can hear you." Which action should the nurse take?

Speak more normal but more slowly

The charge nurse observes a newly hired nurse performing all the interventions for a patient who just undergone right cataract removal and intraocular lens implant. Which one requires that the charge nurse intervene?

The nurse encourages the patient to cough

During the preoperative assessment of a patient scheduled for a right cataract extraction and intraocular lens implantation, it is important for the nurse to assess The patient requests a prescription refill for next week. The patient feels uncomfortable wearing an eye patch. The patient complains that the vision has not improved. The patient reports eye pain rated 8 (on a 0 to 10 scale).

The patient reports eye pain rated 8 (on a 0 to 10 scale).

A patient with right retinal detachment had a pneumatic retinopexy procedure. which information will be included in the discharge teaching plan?

The purpose of maintaining the head resting in a prescribed position

Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of corticosteroid eye drops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 1 to 2 days after the surgery

b. Administration of corticosteroid eye drops

The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? a. The patient has had blurred vision for 3 years. b. The patient has not eaten anything for 8 hours. c. The patient takes 2 antihypertensive medications. d. The patient gets nauseated with general anesthesia.

c. The patient takes 2 antihypertensive medications.

To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by

noting any changes in the patient's visual field

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider

the patient reports eye pain rated 5

The safest technique for the nurse when assisting a blind patient in ambulating to the bathroom

walk slightly ahead of the patient, allowing the patient to hold on to the elbow