CHP 52 Sensory Disorder Questions

14. What group of disorders characterizes glaucoma? (1867)

(a) Increased intraocular pressure (IOP) because of obstruction of the outflow of aqueous humor, (b) optic nerve atrophy, and (c) progressive loss of peripheral vision

25. The nurse receives medication orders for a patient with open-angle glaucoma. Which medication order does the nurse anticipate? 1. Atropine, Sulamyd 2. Betoptic, pilocarpine 3. Decadron, Liquifilm 4. Mannitol, Cyclogyl

4(Check back of book if this isnt right) 2 should answer

33. Tonometry is used in the diagnosis of what condition? (1868) 1. Corneal abrasions 2. Blepharitis 3. Glaucoma 4. Retinal detachment

Answer 3: Tonometry is most commonly done using puffs of air forced into the open eye. An increased ocular pressure suggests glaucoma

29. Ectropion is often characterized by: (Select all that apply.) (1860) 1. tearing. 2. redness of sclera. 3. thick eye discharge. 4. corneal dryness. 5. outward turning of eyelid margin.

Answer 1, 2, 4, 5: Ectropion and entropion are characterized by abnormal direction of the eyelid with tearing and corneal dryness. Redness of the sclera may also be present.

36. Based on research, supplemental zinc, beta- carotene, vitamins C and E, and a diet rich in fruits and dark-green leafy vegetables would be recommended for which eye disorder? (1864) 1. Age-related macular degeneration 2. Senile cataracts 3. Retinal detachment 4. Glaucoma

Answer 1: High-dose nutritional supplements of zinc, beta-carotene, and vitamins C and E have been shown to reduce the risk of progression to advanced ARMD by 25% (NEI, NIH, 2008). A diet rich in fruits and darkgreen leafy vegetables is also recommended (NEI, NIH, 2008).

43. Which intervention applies to positioning the patient after a stapedectomy? (1888) 1. Keep the operative side facing upward. 2. Elevate the head of the bed to at least 90 degrees. 3. Turn, cough, and deep-breathe every 2 hours. 4. Use the neck brace for the first 2 hours

Answer 1: Keep the patient flat with the operative side facing upward to maintain the position of the prosthesis and graft; make certain that the patient is not turned.

34. The patient has been diagnosed with a visual disorder. Contact lenses have been prescribed. Which statement indicates the need for further instruction? (1855) 1. "Photophobia, dryness, burning, or tearing are expected symptoms." 2. "I will use proper lens care solutions and a clean lens case." 3. "I will need to be careful not to mix up my left and right lenses." 4. "Washing and drying my hands before handling my lenses is essential."

Answer 1: Photophobia, dryness, burning, or tearing should be reported to the health care provider. The other statements are correct.

27. A patient has recently been diagnosed with keratoconjunctivitis sicca and a dry mouth. Which immune disorder is likely to be associated with this diagnosis and symptom? (1859) 1. Sjögren's syndrome 2. Acquired immunodeficiency syndrome 3. Rheumatoidarthritis 4. Type 1 diabetes mellitus

Answer 1: Sjögren syndrome is an immunologic disorder characterized by deficient fluid production by the lacrimal, salivary, and other glands, resulting in abnormal dryness of the mouth, eyes, and other mucous membranes

32. A 65-yr old patient reports to the office complaining of visual deficits, including disturbances in color vision and visual clarity, and a darkened area in the center of vision. What medical diagnosis does the nurse anticipate will be made? (1865) 1. Macular degeneration 2. Glaucoma 3. Herpetic keratitis 4. Cataracts

Answer 1: This older patient is reporting symptoms of macular degeneration.

20. The nurse is orienting the patient to the hos- pital environment. He is just learning to use a cane as an assistive device for partial blindness. Which interventions would the nurse use? (Select all that apply.) (1852) 1. Walk silently beside the patient, so that he can hear environmental noises. 2. Suggest that the cane be used to identify borders or objects in pathways. 3. Walk behind the patient, so that the path- way is clear for him/her. 4. Advise to walk slowly, especially since the environment is unfamiliar. 5. Describe the general layout of the room and the adjacent hallway.

Answer 2, 4, 5: The purpose of the cane is to determine the boundaries of the walking path and the tip of the cane is used to seek anything obstructing the path. The helper should walk in front of the patient; patient can hold the elbow for security and to detect directionality of helper's movements. Walking slowly is advised so that objects can be detected. Descriptions of surroundings help to create a mental picture for the patient.

41. The nurse's toddler received a prescription for antibiotics to treat acute otitis media. The anti- biotics and acetaminophen where given as recommended, but the toddler is still crying with pain. What should the nurse try first? (1882) 1. Have the toddler swallow cool fluids 2. Place a warm compress over the affected ear. 3. Use distraction until the acetaminophen works. 4. Call the provider and ask for a sedative prescription.

Answer 2: A warm compress over the affected ear will help relieve the pain. Swallowing can relieve the pressure, but sobbing and swallowing increase the chance for vomiting. The acetaminophen will work, but recall that pain medication is not as effective if given during the peak of pain. A prescription for a sedative is possible if the pain and sleeplessness are excessive.

42.The nurse is reviewing the patient's medica- tion list and sees the patient takes meclizine (Antivert). What instructions should be given to the UAP? (1883) 1. Face the patient directly when speaking to him. 2. Assist the patient to ambulate because he gets dizzy. 3. Keep the head of the bed elevated at least 30 degrees. 4. Assist the patient to clean his eyes with a clean washcloth.

Answer 2: Antivert is a medication used in the treatment of vertigo, which causes dizziness and a sensation of spinning.

Lens

u

Cornea

v

15. Sensation of moving or spinning (1878)

vertigo

What type of hearing loss involves normal sound conduction through the external and middle ear, but distortion in the inner ear, making discrimination difficult? 1 Sensorineural hearing loss 2 Conductive hearing loss 3 Mixed hearing loss 4 Functional hearing loss

1 The type of hearing loss that involves normal sound conduction through the external and middle ear, but distortion in the inner ear, making discrimination difficult, is called a sensorineural hearing loss. Trauma, infectious process, presbycusis, congenital factors, or exposure to ototoxic drugs usually causes this type of hearing loss. In conductive hearing loss, sound is inadequately conducted through the external and middle ear to the sensorineural apparatus of the inner ear. A common cause is buildup of cerumen. Sensitivity to sound is diminished, but clarity or interpretation of sound is unchanged. A mixed hearing loss is a combination of sensorineural and conductive hearing loss. A functional hearing loss is a loss of hearing in which there is no organic cause. It is also known as psychogenic or nonorganic hearing loss.REF: Page 1878

What is the visual disorder characterized by slow, progressive loss of central and near vision? 1 Age-related macular degeneration 2 Diabetic retinopathy 3 Retinal detachment 4 Glaucoma

1 The visual disorder characterized by slow, progressive loss of central and near vision is known as age-related macular degeneration (ARMD). The "wet type," accounting for 10% of cases, is related to new blood vessel growth (neovascularization) that occurs suddenly. Vision loss is irreversible. The more common type, the "dry type," is caused by degenerative changes (lipid deposits and atrophy). Diabetic retinopathy is a disorder of retinal blood vessels characterized by capillary microaneurysms, hemorrhage, exudates, and the formation of new vessels and connective tissue. Retinal detachment is a separation of the retina from the choroid in the posterior area of the eye. The patient may see flashes of light, floating spots, and loss of a specific field of vision. Glaucoma is characterized by an increase in intraocular pressure related to an obstruction of outflow of aqueous humor. The patient will experience a gradual loss of peripheral vision.REF: Page 1863

13. The nurse is admitting an adult patient to a walk-in clinic. The patient complains of recent hearing loss. What does the nurse anticipate as the most probable cause of this patient's hearing loss? 1. Cerumen buildup 2. Ossification of the pinna 3. Low batteries in the hearing aid 4. Fluid in the ear

1(Check back of book if this isnt right)

14. A 71-year-old patient complains of being severely dizzy. What instruction should the nurse give the patient? 1. Avoid sudden movements. 2. Avoid noises. 3. Increase fluid intake. 4. Lie on the affected side.

1(Check back of book if this isnt right)

19. The nurse is caring for a patient with vertigo. What is the nurse's priority concern when caring for this patient? 1. Safety 2. Comfort 3. Hygiene 4. Quiet

1(Check back of book if this isnt right)

22. A 78-year-old patient comes into the clinic complaining of progressive loss of vision in the center of the visual field. The nurse is aware that the patient is most likely experiencing symptoms of which disorder? 1. Macular degeneration 2. Primary open-angle glaucoma 3. Color blindness 4. Retinal degeneration

1(Check back of book if this isnt right)

3. A patient has impaired hearing. Which action by the nurse would best facilitate communication? 1. Face the patient when speaking. 2. Overaccentuate words to make the communication more effective. 3. Shout to allow the patient to hear. 4. Use one-word phrases when speaking.

1(Check back of book if this isnt right)

8. Which of the following would be most hazardous in the home of a patient who is visually impaired? 1. Area rugs 2. Room carpeting 3. Tile floor 4. Concrete flooring

1(Check back of book if this isnt right)

2. The parents want to know more about their child's conductive hearing loss. Which is the best explanation by the nurse? 1. "Sound is delivered through the external and middle ear, but a defect in the inner ear results in distortion of sound." 2. "Sound is inadequately delivered through the external or middle ear to the inner ear." 3. "There is no organic cause, but a functional problem exists." 4. "The brain's auditory pathways are damaged."

1(Check back of book if this isnt right) [answer should be 2, conductive hearing loss is an inability to deliver it properly to the inner ear]

10. A patient has just had cataract surgery. What information should the nurse include in the discharge instructions? (Select all that apply.) 1. Wear an eye shield at night on the operative eye. 2. Avoid bending, stooping, coughing, or lifting. 3. Instill prescribed eyedrops into the conjunctival sac. 4. Take an analgesic every 4 hours. 5. Avoid lying on the affected eye for 2 weeks following surgery.

1,2,3(Check back of book if this isnt right)

What factors have been associated with the formation of cataracts? Select all that apply. 1 Aging 2 Ultraviolet light 3 History of eye surgery 4 Exposure to maternal rubella 5 Smoking 6 Loud music 7 Diabetes mellitus

1,2,4,5,7 Advanced age has been associated with the formation of cataracts; in fact, most cataracts are age-related, or "senile cataracts." As a person ages, there is a gradual opacification of the crystalline lens of the eye. Ultraviolet light, exposure to maternal rubella, and smoking also have been associated with the formation of cataracts. Diabetes mellitus has been associated with the formation of cataracts, and the patient with diabetes mellitus tends to develop them at a younger age than a patient without diabetes. Having a history of eye surgery has not been associated with the formation of cataracts. Exposure to loud music has not been associated with the formation of cataracts, although it may lead to hearing damage as a result of damage to the hair cells.REF: Pages 1859-1860

9. A patient with glaucoma tests above the normal range of ___________ mm Hg. (1868)

10 to 22

8. The normal visual field range us _______________ degrees (1852)

180

1. A patient is to have a laser treatment to cauterize hemorrhaging vessels caused by diabetic retinopathy. The patient asks the nurse what this procedure is called. Which response by the nurse is correct? 1. Enucleation 2. Scleral buckle 3. Photocoagulation 4. Trabeculoplasty

3 (Check back of book if this isnt right)

6. The nurse is evaluating a patient's eye as it adjusts to seeing objects at various distances. When documenting, how should the nurse identify this test? 1. PERRLA 2. Refraction 3. Focusing 4. Accommodation

4(Check back of book if this isnt right)

When taking care of a patient with newly diagnosed type 1 diabetes mellitus, the nurse notes the patient is expressing some fears about long-term complications of the disease. She states, "I know I'll go blind within 10 years. Why should I bother controlling my blood sugar?" On what knowledge can the nurse's best response be based? 1 After 10 years with diabetes mellitus, most type 1 patients have advanced diabetic retinopathy. 2 Diabetic retinopathy occurs more frequently in patients with long-standing, poorly controlled diabetes mellitus. 3 The initial stage of diabetic retinopathy only lasts for a couple of months. 4 The initial stage consists of vision loss and the presence of "floaters" in the visual field.

2 Diabetic retinopathy occurs more frequently in patients with long-standing, poorly controlled diabetes mellitus. Although the incidence does increase with length of time one has had the disease, control of blood sugar is an important variable that can delay or reduce the severity of this complication. Therefore, it is important to empower this patient with the knowledge that what he or she does can and will affect the progression of diabetic retinopathy. After 15 years with diabetes mellitus, most type 1 patients and 80% of type 2 patients demonstrate some degree of retinal disease. The initial stage of diabetic retinopathy may last for several years—and this is the stage at which it is most treatable. The patient with diabetes mellitus should be instructed to have regular eye examinations by an ophthalmologist (or specially trained optometrist) for early diagnosis and treatment of retinal disease. The advanced stages of diabetic retinopathy consist of progressive vision loss and the presence of "floaters" (minute products of hemorrhage) in the visual field.REF: Page 1862

What is the ability of the eye to focus on objects at various distances? 1 Refraction 2 Accommodation 3 Constriction 4 Convergence

2 The ability of the eye to focus on objects at various distances is called accommodation. Because of accommodation, the eye is able to focus the image of an object on the retina by changing the curvature of the lens. In refraction, light rays are bent as they pass through the colorless structures of the eye, enabling light from the environment to focus on the retina. Constriction allows the pupil size to decrease. This is regulated by the amount of light entering the eye and controlled by the dilator and constrictor muscles of the iris. In convergence, medial movement of both eyes allows light rays from an object to hit the same point on both retinas.REF: Page 1849

12. While communicating with a patient, you notice a possible hearing deficit in one ear. Which nursing intervention would be appropriate? 1. Shout in the affected ear. 2. Speak clearly and in a slightly louder voice toward the patient's face. 3. Plug the affected ear and shout in the unaffected ear. 4. Speak more softly than usual in the affected ear.

2(Check back of book if this isnt right)

16. A patient has a family history of cataracts. He asks what early symptoms he should watch for that would alert him to the development of cataracts. What is the nurse's best response? 1. Pain in the eyes 2. Blurred vision 3. Loss of peripheral vision 4. Dry eyes

2(Check back of book if this isnt right)

23. After cataract surgery a patient complains of sudden sharp pain in the operative eye. What is the most appropriate nursing action? 1. Remove the metal eye shield to relieve pressure. 2. Call the surgeon. 3. Administer an analgesic. 4. Document complaint of pain on chart.

2(Check back of book if this isnt right)

9. A patient arrives in the emergency room following an accident that resulted in a piece of metal penetrating the eye. What nursing action should be taken initially on the patient's arrival at the hospital? 1. Apply a cool compress immediately. 2. Lightly cover both eyes with an eye shield. 3. Attempt to gently remove the object. 4. Irrigate the eye with tap water.

2(Check back of book if this isnt right)

18. A 15-year-old hearing-impaired patient is having problems communicating with the staff. Which behavior would improve communication? (Select all that apply.) 1. Overaccentuating words 2. Facing the patient when speaking 3. Speaking in conversational tones 4. Asking permission to turn off the television or radio 5. Using written communication for most interactions

2,3,4(Check back of book if this isnt right)

11. Which assessment finding would indicate a need for possible glaucoma testing? (Select all that apply.) 1. Presence of "floaters" 2. Halos around lights 3. Progressive loss of peripheral vision 4. Pruritus and erythema of the conjunctiva 5. Lack of ability to adapt to darkness

2,3,5(Check back of book if this isnt right)

When caring for a patient who has just undergone a corneal transplant (keratoplasty), what is the most important nursing intervention? 1 Preparing written postoperative instructions for the patient to read over 2 Positioning the patient on the operative side 3 Reporting any severe or progressive pain to the surgeon immediately 4 Teaching the patient to avoid bending, lifting, or straining for 1 week

3 Appropriate nursing care for a patient who has just undergone a keratoplasty (corneal transplant) includes reporting any severe or progressive pain to the surgeon immediately, as this can be a sign of complications. Also immediately reportable are complaints of erythema, vision loss, or photophobia, because these can be signs of corneal rejection. Written instructions for the patient to read would be not advisable, because the lateral movement of the eye may loosen the sutures. Written instructions for the spouse or caregiver would be fine, as long as the nurse informs the patient about limitations on reading. Appropriate nursing care for a patient who has just undergone a keratoplasty includes positioning the patient on the nonoperative side or on the back, until the physician allows the patient to be turned onto the operative side. Appropriate nursing care for a patient who has just undergone a keratoplasty includes teaching the patient to avoid bending, lifting, or straining for 1 month to prevent increased intraocular pressure or tension on the sutures.REF: Pages 1872-1873

What is the thick, white, opaque connective tissue that is part of the outermost layer of the eyeball? 1Conjunctiva 2Cornea 3Sclera 4Retina

3 The thick, white, opaque connective tissue that is part of the outermost layer of the eyeball is called the sclera, also known as the white of the eye. The sclera gives shape to the eyeball and protects the inner eye structures. The conjunctiva is a thin mucous membrane that lines the inner aspect of the eyelids and anterior surface of the eyeball to the edge of the cornea. The cornea is the central anterior portion of the sclera. It is transparent and covers the iris. The retina is the innermost tunic of the eye, a 10-layer, delicate, nervous tissue membrane of the eye that receives images of external objects and transmits impulses through the optic nerve to the brain.REF: Page 1847

15. A patient who has been blind for the past 10 years is hospitalized with heart failure. What intervention should the nurse include in the plan of care? 1. Keep all personal care items at a distance so he won't bump into them. 2. Schedule a consultation with an occupational therapist to teach activities of daily living. 3. All personnel announce themselves when entering and leaving the room. 4. Initiate a referral to the Department of Health and Human Services.

3(Check back of book if this isnt right)

21. A patient visits the health care provider to have her vision tested using the Snellen eye chart. What instruction should the nurse provide to the patient? 1. Use both eyes to read the chart. 2. Read the chart from right to left. 3. Cover one eye while testing the other. 4. Use either eye because they will be the same.

3(Check back of book if this isnt right)

5. A patient is diagnosed with an inner ear problem. What symptom should the nurse monitor the patient closely for? 1. Echoing 2. Intense pain 3. Vertigo 4. Loss of hearing

3(Check back of book if this isnt right)

17. A patient is scheduled for a stapedectomy. What postoperative instructions should the nurse include in patient teaching? (Select all that apply.) 1. Change cotton in external ear canal hourly. 2. Gently blow through both nares simultaneously. 3. Teach the patient to open the mouth when sneezing or coughing. 4. Limit exercise or active sports for 3 weeks. 5. Avoid exposure to people with upper respiratory tract infections.

3,4,5(Check back of book if this isnt right)

7. A patient is suspected of having a retinal detachment. What signs/symptoms will provide support to this diagnosis? (Select all that apply.) 1. "I have tunnel vision." 2. "I am having a lot of pain in my eye." 3. "It feels like I'm looking through cobwebs." 4. "I see specks floating around the edges of my vision." 5. "I feel like someone pulled a curtain over my eye."

3,4,5(Check back of book if this isnt right)

What are the most appropriate nursing care and patient teaching for the patient with external otitis? 1 Applying cold compresses to the affected ear 2 Continuing antibiotic therapy until symptoms of the infection are relieved 3 Advising patient to rinse ears out each morning in the shower 4 Washing hands before and after changing cotton plugs

4 Appropriate nursing care and patient teaching for the patient with otitis media includes washing hands before and after changing cotton plugs to prevent a secondary infection. A warm compress applied to the affected ear will help relieve pain. Appropriate patient teaching for the patient with external otitis includes instructing the patient to continue antibiotic therapy for the prescribed number of days, even if symptoms have disappeared. In caring for a patient with external otitis, the ear canal should be protected from water while the patient showers. Cotton with petrolatum and a shower cap may be useful.REF: Pages 1880-1881

The nurse is caring for a patient who has had functional blindness for 10 years. Which statement is true? 1 Pain is not associated with blindness, since the pain receptors have been destroyed. 2 Since this patient has been blind for a number of years, the patient is in the acceptance phase of the illness. 3 Since the patient's blindness is functional, not total, the patient is not considered to be legally blind. 4 A comprehensive approach to patient care is essential with blind patients.

4 A comprehensive approach to patient care is essential with blind individuals. Home health considerations include education about community resources. When a total approach is taken, the patient's successful adjustment to home, work, and society is possible. Blind individuals are capable of leading a full and active life, and need to be treated in such a manner. Pain can be a symptom of blindness. Other symptoms that patients may experience include diplopia, presence of floaters in the visual field, flashes of light, pruritus, and burning of the eyes. Even if a patient with blindness has been blind for a number of years, it is false to assume that he or she is in the acceptance phase. Complications of long-term blindness may result in physical and emotional problems, such as malnutrition, infection, helplessness, hopelessness, and more. The patient who has either total blindness (no light perception and no usable vision) or functional blindness (light perception but no usable vision) is considered to be legally blind.REF: Pages 1851-1852

The nurse is caring for a 75-year-old patient who has experienced some sensory deficits. What change might be explained by age-related changes of the sensory system? 1 Decreased sensitivity to glare 2 Inability to hear low-frequency sounds 3 Difficulty with red/orange color discrimination 4 Increased difficulty focusing on close objects

4 As the individual ages, the crystalline lens of the eye hardens and becomes too large for the eye muscles, thus causing a loss of accommodation. This often results in a need for bifocals or trifocals. Increased difficulty focusing on close objects is considered to be a normal change of aging of the eye. This leads to difficulty with reading or doing close work by the older adult. The older adult has increased sensitivity to glare, as well as problems with dark to light and light to dark adaptation ("night blindness"). For these reasons, many older adults may give up driving at night. The older adult often has difficulty hearing high-frequency sounds, a common condition known as presbycusis. They usually can hear more clearly when sounds are of a decreased pitch. Normal changes of aging of the eye lead to the older adult having difficulty with blue/green color discrimination. This is because aging tends to affect perception of the shorter wavelengths of light. It is sometimes useful to use colors in the environment with longer wavelengths (red/orange) for safety, as the older adult can discriminate these colors more effectively.REF: Page 1853

20. While cleaning the garage a patient splashed a chemical in his eyes. What is the initial action following the chemical burn? 1. Transport to an emergency facility immediately. 2. Cover the eyes with sterile gauze. 3. Lubricate eye with petroleum-based jelly. 4. Irrigate the eye with water for 20 minutes.

4(Check back of book if this isnt right)

24. A patient is asked to sign a surgical consent for treatment of otosclerosis. Which statement indicates correct understanding of the procedure? 1. "It involves surgical repair of the external ear." 2. "It means cutting the nerve in my ear." 3. "It cleans the ear canal of wax." 4. "It will help me hear sounds again."

4(Check back of book if this isnt right)

4. A patient tells the nurse he has dizziness. He states that the health care provider used another term. What term did the health care provider most likely use? 1. Tinnitus 2. Labyrinthitis 3. Sensorineural 4. Vertigo

4(Check back of book if this isnt right)

46.The patient had a car accident and is returning to the nurse's unit from vitrectomy surgery of the right eye. List the appropriate nursing interventions for this patient. (1875

46. Nursing interventions for the patient having a vitrectomy include: • The patient is required to maintain a position on the abdomen or sitting forward resting the nonoperative side of the head on a table to allow air that is in the eye to float against the retina. This position is maintained for 4 to 5 days. • Dark glasses are prescribed postoperatively to decrease the discomfort of photophobia. • Assessing the eye patch • Applying ice packs • Monitoring vital signs • Assessing the dressing for bleeding

47. Refer to Box 52-2 on p. 1877 and identify behaviors that you have noticed for someone you know who may be demonstrating a hearling loss. Has the person you identified admitted that he or she has a hearing loss?

47. It is likely that you have a grandparent, parent, or older aunt or uncle who has demonstrated some of the behaviors associated with hearing loss. The symptoms may have been gradual or only a few may have occurred so far. There may be circumstances where the behaviors are more pronounced. Most people adapt to gradual losses and loss of hearing may be more noticeable to those around who are trying to communicate with that person

48. If you were to suddenly lose your vision or hearing, how would the loss affect your current lifestyle and future plans?

48. A sudden loss of any of the senses would be devastating to anyone. Since you are currently in nursing school, the loss would impact your ability to complete your studies. Moreover, imagine how difficult it would be to conduct an assessment of a patient if you couldn't see or hear. Would you be able to perform patient care if you couldn't see? How would you administer medication if you couldn't read the label? Perhaps you have small children and they rely on you for everything. How would you adapt and cope so that the impact of your loss did not adversely affect them?

Auricle

A

43. Arrange the parts of the eye from the exterior to the most interior. (Separate letters by a comma and space as follows: A, B, C, D) a. Choroid b. Cornea c. Aqueous humor d. Retina e. Lens f. Iris

ANS: B, C, F, E, D, A The cornea is the outermost, followed by the aqueous humor, iris, lens, retina, and the choroid. PTS: 1 DIF: Cognitive Level: Application REF: Page 1840, Figure 52-1 OBJ: 2 TOP: Eye structure KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

44. Place the nursing intervention in appropriate order for the immediate care of a patient with a penetrating wound of the eye. (Separate letters by a comma and space as follows: A, B, C, D) a. Assess eye, do not remove object b. Cover both eyes with an eye shield or cup c. Lay the patient down flat d. Check for the irregularity of the pupil e. Obtain medical attention immediately

ANS: C, A, D, B, E The patient should be placed on his back to prevent loss of the aqueous humor, assessment of the eye for the location of the object and whether the pupil is regular, cover the eye to prevent movement, and obtain medical attention immediately. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1870, Safety Alert OBJ: 10 TOP: Penetrating wound of the eye KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

40. The total removal of an eye is a(n) ___________.

ANS: enucleation The surgical removal of the eyeball is an enucleation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1869 OBJ: 9 TOP: Enucleation KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

39. The nurse explains that a pneumatic retinopexy is a repair of a retinal detachment using a bubble of_________ to put pressure on the damaged retina.

ANS: gas A pneumatic retinopexy uses a bubble of gas to put pressure on the damaged retina. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1866 OBJ: 11 TOP: Pneumatic retinopexy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

41. The surgical incision into the eardrum with either a knife or a heated wire loop to relieve pressure in the middle ear is a(n) ___________.

ANS: myringotomy The opening of the eardrum with a specialized knife or a heated wire loop to relieve pressure in the middle ear is a myringotomy. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1883 OBJ: 17 TOP: Myringotomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

42. Progressive deafness caused by the ankylosis of the stapes is the condition of__________.

ANS: otosclerosis Progressive deafness related to the ankylosis of the stapes is diagnosed as otosclerosis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1885 OBJ: 16 TOP: Otosclerosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

29. Why is otitis media found more frequently in children 6 to 36 months? a. Eustachian tubes in children are shorter and straighter. b. Infection descends via the eustachian tube to the throat. c. Children's eustachian tubes are more vertical and longer. d. Otitis media is seen equally in both children and adults.

ANS: A Children's shorter and straighter eustachian tubes provide easier access of the organisms from the nasopharynx to travel to the middle ear. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1881 OBJ: 16 TOP: Otitis media KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

7. What is a common mistake that hinders communication when communicating with the hearing impaired? a. Overaccentuating words b. Facing the patient when speaking c. Speaking in conversational tones d. Speaking into the ear with the hearing aid

ANS: A Do not overaccentuate words. Speak in a normal tone; do not shout or raise the pitch of voice. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1870, Health Promotion OBJ: 14 TOP: Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

22. What should the nurse include in the plan of care following a tympanoplasty? a. Elevating head of bed with operative side facing upward b. Enforcing bed rest for 72 hours c. Frequent turning, coughing, and deep breathing d. Continuous irrigation of the ear canal with antibiotic solutions

ANS: A Postoperative management for patients who have had a tympanoplasty consists of bed rest until the next morning. The head of the bed is elevated 40 degrees, and the operative side faces upward. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1889 OBJ: 17 TOP: Otitis media KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

14. What does diabetes retinopathy result from? a. Capillaries in retina hemorrhage b. Long-term overdosing of insulin c. Retinal detachment d. Aging

ANS: A Retinopathy is caused when the capillaries in the retina have aneurysms or hemorrhage. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1861 OBJ: 9 TOP: Glaucoma KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

28. Which is a sign of acute angle closure glaucoma (AACG)? a. Large fixed pupil b. Nystagmus c. Bluish color in sclera d. Drooping eyelid

ANS: A Signs of AACG would be eye pain, large fixed pupil with reddened sclera, decreased vision, nausea, and vomiting. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1867 OBJ: 9 TOP: Glaucoma KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. The 62-year-old home health patient who is recovering from eye surgery complains of a feeling of "grittiness" in the eye and is having blurred vision. The eyes are reddened and have stringy mucus. What do these complaints indicate? a. Sjögren syndrome b. Early cataracts c. Macular degeneration d. Retinal detachment

ANS: A The Sjögren syndrome of "dry eye" frequently appears after eye surgery. There is insufficient production of tears. Excessive use of antihistamines, antidepressants, and decongestants may cause this syndrome to appear. PTS: 1 DIF: Cognitive Level: Application REF: Page 1858 OBJ: 8 TOP: Sjögren syndrome KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

8. What is the process when the lens of the eye changes its curvature to focus on the retina? a. Accommodation b. Constriction c. Convergence d. Refraction

ANS: A The ability of the lens to alter its curvature as it focuses on the retina is accommodation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1849 OBJ: 16 TOP: Accommodation KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

30. Why would the nurse encourage a group of teenagers to protect their eyes with dark sunglasses while using a UV lamp? a. The lamp can cause cataracts. b. The lamp can cause presbycusis. c. The lamp can cause keratitis. d. The lamp can cause ectropion.

ANS: A The proteins in the lens of the eye are vulnerable to UV light and can develop cataracts. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1890 OBJ: 9 TOP: Health promotion KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

15. When the patient in the emergency room complains of seeing flashing lights and a curtain down over his right eye, the nurse recognizes this as a symptom of which condition? a. Detached retina b. Macular degeneration c. Early sign of cataract d. Diabetic retinopathy

ANS: A The standard complaint of a detached retina is the report of seeing flashing lights and having a curtain being drawn over the eyes. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1865 OBJ: 9 TOP: Detached retina KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

18. What should the nurse remind the hearing aid wearer to do when the nurse hears a whistling hearing aid? a. Reinsert the ear mold b. Change the battery c. Recharge the hearing aid d. Wash the ear mold with warm water

ANS: A The whistling hearing aid is usually caused by a poor fit of the ear mold. Reinsertion of the ear mold usually stops the whistling. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1880, Box 52-3 OBJ: 13 TOP: Hearing aid KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

4. What does a tympanoplasty correct? a. Conductive hearing loss b. Sensorineural hearing loss c. Congenital hearing loss d. Functional hearing loss

ANS: A Tympanoplasty can correct a conductive hearing loss. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1889 OBJ: 17 TOP: Tympanoplasty KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

33. Which may contribute to otitis media? (Select all that apply.) a. Exposure to cigarette smoke b. Allergies c. Upper respiratory infections d. Swimming e. Trauma f. Prolonged exposure to loud noise

ANS: A, B, C Otitis media is usually caused by an upper respiratory infection with gram-negative bacteria, such as Proteus, Klebsiella, and Pseudomonas. In addition, allergy, exposure to cigarette smoke, mycoplasma, and several viruses may be factors. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1881 OBJ: 16 TOP: Otitis media KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

34. What factors must the nurse consider when assessing readiness to learn when teaching health promotion practices for the visually and hearing impaired? (Select all that apply.) a. Cultural beliefs b. Values c. Habits d. Income e. Occupation

ANS: A, B, C The nurse must consider the patient's culture, beliefs, values, and habits, as well as the special needs of the older adult. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1891 OBJ: N/A TOP: Health promotion KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

32. Select all the conditions that may cause conductive hearing loss. (Select all that apply.) a. Buildup of cerumen b. Foreign bodies c. Otosclerosis of external auditory canal d. Trauma e. Exposure to ototoxic drugs f. Otitis media with effusion

ANS: A, B, C, F Common causes of conductive hearing loss are buildup of cerumen and otitis media with effusion (escape of effusion). Other conditions that may result in conductive hearing loss are foreign bodies, otosclerosis, and stenosis of the external auditory canal. Sensorineural hearing loss is usually due to trauma, infectious processes, or exposure to ototoxic drugs. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1878 OBJ: 12 TOP: Hearing loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

35. Which of the following are causes of cataracts? (Select all that apply.) a. Long-term use of corticosteroids b. Hypotension c. Congenital from exposure to maternal rubella d. Diabetes mellitus e. Exposure to sand and dust f. Smoking

ANS: A, C, D, F Among the many causes of cataracts are long-term corticosteroid use, maternal rubella, diabetes mellitus, and smoking. PTS: 1 DIF: Cognitive Level: Application REF: Page 1859 OBJ: 9 TOP: Cataracts KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

36. What would a nurse do when the patient arrives in the PACU after a left stapedectomy? (Select all that apply.) a. Turn the patient to his right side b. Change dressing as it becomes soiled c. Turn patient every 2 hours d. Leave the bed flat e. Medicate immediately on the complaint of nausea

ANS: A, D, E The bed is left in the flat position and the patient is positioned with the operated side facing up, the patient is not turned, and the dressing is not changed by the nurse. The patient should be medicated immediately on complaint of nausea to prevent vomiting and possible disruption of graft. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1887 OBJ: 17 TOP: Stapedectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

24. A patient who had an enucleation of the right eye has been admitted PACU. What should the nurse include in the plan of care? a. Turn, cough, and deep breathe every 3 hours b. Apply a pressure dressing over the right eye socket c. Document dressing assessment every 2 hours d. Turn on the affected side

ANS: B A pressure dressing will be applied to the right eye socket and the dressing should be checked every hour for the first 24 hours. PTS: 1 DIF: Cognitive Level: Application REF: Page 1872 OBJ: 11 TOP: Infections/inflammatory disorders KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. Which complaint made by a 64-year-old patient during a health interview would alert the nurse to the possibility of cataracts? a. Pain in the eyes b. Difficulty driving at night c. Loss of peripheral vision d. Dry eyes

ANS: B Blurring of vision and difficulty driving at night is often the first subjective symptom reported by a patient who has cataracts. PTS: 1 DIF: Cognitive Level: Application REF: Page 1860 OBJ: 9 TOP: Cataracts KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

25. What must a patient do following a left vitrectomy? a. Remain flat in bed for 48 hours b. Position self in a face-down position for 4 to 5 days c. Assume a side-lying position with the left side down for 3 days d. Keep head upright and cushioned with pillows for 24 hours

ANS: B Following a vitrectomy, the patient must assume a face-down position or turn the face to the right side for 4 to 5 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1874 OBJ: 11 TOP: Vitrectomy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

27. What is the first indication of macular degeneration? a. The loss of peripheral vision b. The loss of central vision c. The loss of color discrimination d. Eye fatigue

ANS: B Macular degeneration is characterized by the slow loss of central and near vision. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1864 OBJ: 9 TOP: Macular degeneration KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. When the newly blind male home health patient asks the nurse how he might get assistance, who might the nurse suggest he contact? a. American Red Cross b. American Foundation for the Blind for a list of agencies c. Local hospital social worker d. The public health department

ANS: B The American Foundation for the Blind has lists of agencies to assist and educate the visually impaired patient. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1852 OBJ: 15 TOP: Medications KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

1. The nurse is aware that the patient has 20/40 vision. This means that the patient can see at 20 feet what the normal eye can see at _______ feet. a. 100 b. 200 c. 300 d. 400

ANS: B The Snellen Eye Chart tests visual acuity. A vision evaluation of 20/40 means that the patient can see at 20 feet what the person with normal vision can see at 200 feet. PTS: 1 DIF: Cognitive Level: Application REF: Page 1850 OBJ: 7 TOP: Snellen evaluation KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

16. The nurse will assess for _____________ when the older adult home health patient complains that the entire right side of his head hurts and he cannot chew without pain. a. mumps b. external otitis c. otitis media d. labyrinthitis

ANS: B The symptoms of painful head, painful chewing, and pain when the auricle is moved all indicate external otitis, frequently caused by compacted cerumen. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1880 OBJ: 16 TOP: External otitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

17. The nurse takes into consideration that the Weber test indicated a conductive hearing loss in a patient because the patient reported hearing the tone: a. equally in both ears. b. as a shrill noise. c. louder in his affected ear. d. very faintly.

ANS: C A conductive hearing loss can be diagnosed by the Weber test. A person with a conductive loss will hear the noise louder in his affected ear. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1885 OBJ: 16 TOP: Weber test KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

23. When the patient stares at the black dot on an Amsler grid, what should the nurse ask him to report? a. Any color visible on the grid b. Fading of the edges of the grid c. Any distortion of the grid d. Movement of the black dot

ANS: C Amsler grid, a diagnostic tool for retinal disorders, requires that the patient look at the dot on the grid and report any distortion in the grid lines. PTS: 1 DIF: Cognitive Level: Application REF: Page 1850, Figure 52-3 OBJ: 9 TOP: Aging KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

19. What should the nurse advise the 20-year-old to do who has been put on cefaclor (Ceclor) for a resistant otitis media? a. Store suspension at room temperature b. Discontinue drug when symptoms abate c. Avoid alcoholic beverages d. Take with meals only

ANS: C Drinking alcohol is discouraged while on Ceclor. The drug should be taken in its entirety and stored in the refrigerator. The drug can be taken with or without meals. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1880, Table 52-5 OBJ: 16 TOP: Ceclor KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

6. Four hours after a stapedectomy the patient complains that hearing has not improved at all. What knowledge would the nurse use to shape a response? a. A large percentage of stapedectomies are not successful b. It will take at least 10 days for the graft to heal c. Hearing will not return until edema subsides d. Hearing will improve after irrigation of the ear

ANS: C Hearing improvement will not be noted until edema subsides and the packing is removed. PTS: 1 DIF: Cognitive Level: Application REF: Page 1887 OBJ: 17 TOP: Stapedectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

31. The nurse counsels the 16-year-old boy that playing his music at high volume can result in impairment in hearing related to: a. damaged tympanic membrane. b. protective buildup of cerumen. c. damage of the fine hair cells in the organ of Corti. d. rupture of the oval window.

ANS: C Long-term exposure to loud noises can damage the fine hair cells in the organ of Corti, which causes a conductive hearing loss. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1890 OBJ: 12 TOP: Health promotion KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

13. What should a patient who has had a cataract repair avoid? a. The use of eye patches b. The use of sunglasses c. The lifting of heavy objects d. Reading for long periods of time

ANS: C Postcataract patients should avoid any activity that increases the intraocular pressure, such as lifting heavy objects, stooping, and bending. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1860 OBJ: 11 TOP: Blindness KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

10. The nurse clarifies that the difference between a photorefractive keratectomy (PRK) and a laser in-situ keratomileusis (LASIK) is that a LASIK: a. reshapes the central cornea. b. makes partial-thickness radial incisions in the cornea. c. removes some internal layers of the cornea. d. implants intracorneal rings.

ANS: C The LASIK procedure removes some of the internal layers of the cornea affecting the central zone of vision. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1853 OBJ: 11 TOP: Visual acuity KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

37. What should the nurse do when assisting a blind person to walk in an unfamiliar hospital environment? (Select all that apply.) a. Discourage the use of the cane b. Advise the patient to walk quickly c. Describe the surroundings d. Encourage the patient to ask for verbal cues e. Place patient hand on nurse's shoulder or elbow

ANS: C, D, E The patient should be given verbal cues about the environment. Allow the patient to hold the nurse's shoulder or elbow while the nurse walks in front, and encourage the use of a cane to let the patient "examine" the boundaries and obstacles. PTS: 1 DIF: Cognitive Level: Application REF: Page 1851 OBJ: N/A TOP: Assisting blind to walk KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

26. How would the nurse explain the purpose of photocoagulation to a diabetic patient with diabetic retinopathy? a. The procedure will destroy the retina, which is not getting enough blood supply. b. The procedure will reduce edema in the macula of the eye. c. The procedure will vaporize fatty deposits that appear in the retina. d. The procedure will destroy new blood vessels, seal leaking vessels, and help prevent retinal edema.

ANS: D Photocoagulation is useful in diabetic retinopathy to cauterize hemorrhaging vessels and to destroy new vessels. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1863 OBJ: 9 TOP: Diabetic retinopathy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

2. The patient tells the nurse that he is legally blind. How would this information impact the nurse's plan of care for this patient? a. The patient would be considered totally blind. b. This patient probably has some light perception, but no usable vision. c. This patient has some usable vision, which enables function at an acceptable level. d. The nurse would need to determine how this patient's visual impairment affects normal functioning.

ANS: D "Legal blindness" refers to individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight capacity reduced by 20 degrees. Categories have been established to help determine the exact extent of the vision loss and what assistive measures are appropriate for the individual. The nurse will need more information as to the exact extent of the vision loss for this patient. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1851 OBJ: N/A TOP: Legal blindness KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. One of the housekeepers splashes a chemical in the eyes. What should be the first priority? a. Transport to a physician immediately b. Cover the eyes with a sterile gauze c. Irrigate with H2O for 5 minutes d. Irrigate with normal saline solution for 20 minutes

ANS: D Burns are medically treated with a prolonged, 15- to 20-minute or longer normal saline flush immediately after burn exposure. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1871 OBJ: 11 TOP: Chemical burn of eye KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

20. How should the nurse advise a patient who has severe vertigo from labyrinthitis? a. Lean against a wall and not head forward until vertigo lessens. b. Bend at the waist and take several deep breaths. c. Drink an iced drink slowly. d. Lie immobile and hold the head in one position until the vertigo lessens.

ANS: D Lying immobile and holding the head in one position will lessen vertigo. PTS: 1 DIF: Cognitive Level: Application REF: Page 1880, Patient Teaching OBJ: 16 TOP: Vertigo KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

21. What do miotic eyedrops do for a patient with glaucoma? a. Dilate the pupil and sharpen vision b. Lubricate and moisten the dry eye c. Irrigate the surface of the eye d. Constrict the pupil and open the canal of Schlemm

ANS: D Miotic eyedrops allow the pupil to constrict and open the canal of Schlemm to drain the excess fluid. PTS: 1 DIF: Cognitive Level: Application REF: Page 1868 OBJ: 4 TOP: Aging KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment

11. What does the cataract treatment of phacoemulsification involve? a. "Drying" the cataract with hypertonic saline b. Removing the lens through the anterior capsule c. The insertion of a new lens d. Breaking the cataract with ultrasound

ANS: D Phacoemulsification uses ultrasound to break up the cataract. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1860 OBJ: 11 TOP: Infectious/inflammatory disorders KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

38. The home health patient complains of tearing and a feeling of dryness in the right eye. The nurse assesses that the eyelid is turned inward and the sclera is red. The nurse documents the presence of a(n)_________________.

ANS: entropion An entropion is the abnormal turning in of the eyelid, causing irritation and tearing of the eye. PTS: 1 DIF: Cognitive Level: Application REF: Page 1859 OBJ: 8 TOP: Entropion KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. A patient with myopia is thinking about having refractory surgery to correct the problem. What should the patient do prior to the surgery? (1855) 1. Arrange to take at least 2 weeks off from work for recuperation. 2. Stop wearing contact lenses for 1 to 2 weeks before surgical evaluation. 3. Stop taking any medications for at least 2 days before the surgery. 4. Use sterile hydrating eyedrops for at least 2 weeks prior to surgery

Answer 2: Contact lenses change the shape of the cornea, so for a week or two prior to the initial evaluation, the health care provider will ask the patient not to wear them. Usually one day is sufficient for rest after surgery. Possibly, anticoagulant medications would be held, but systemic complications related to refractory surgery are unlikely.

19. The nurse hears in the shift report that the patient has diplopia. Which task will be the most difficult for the patient (1852) 1. Sitting upright in bed 2. Reading an information brochure 3. Listening to a radio broadcast 4. Eating a sandwich with fries

Answer 2: Diplopia is double vision, so reading is going to be very difficult, if not impossible. The patient should be instructed to steady self by grasping the bed rail or the arm of the chair when sitting upright. Foods that can be eaten with the fingers will be easier for this patient. Listening to the radio would be a better distraction than watching television.

31. The typical type of visual distortions associated with diabetic retinopathy will include: (1864) 1. tunnel vision that worsens in low lighting. 2. a loss of visual acuity accompanied by "floaters" 3. a sudden onset of peripheral vision loss and eye discomfort. 4. reddened eyes accompanied by a yellow discharge.

Answer 2: In diabetic retinopathy, microhemorrhages will cause floaters.

35. Following cataract surgery, which activity is the ophthalmologist most likely to discourage? (1861) 1. Going to the movies 2. Lifting a grandchild 3. Walking on a sunny day 4. Sleeping with a spouse

Answer 2: Lifting, bending, coughing, or stooping would increase intraocular pressure, which is not desirable in the postoperative period. The surgery should improve the glare that would occur while watching a movie. Sunglasses are recommended. Sexual activity may be unadvisable for a period of time. Sleeping with a spouse would be okay unless he/she tended to thrash around during sleep

37. A patient reports seeing flashing lights and floaters and a dark area in the outer peripheral vision. What is the most important question to ask for suspicion of retinal detachment? (1866) 1. "Are you having severe pain in the affected eye?" 2. "Is the darkened area getting progressively larger?" 3. "Do you have type 1 diabetes mellitus?" 4. "Do you have a family history of eye problems?"

Answer 2: Progressive enlargement of the darkened area means the detachment is worsening and if the retina is not repaired, irreversible blindness will result. Pain is not an expected symptom of detachment. Type 1 diabetics are at risk for diabetic retinopathy and there is an increased risk for cataracts. Retinal detachment can be related to injury, but is mostly related to aging, not heredity.

26. For a patient who is diagnosed with keratitis, which common symptom differentiates this disease from the other inflammatory eye diseases? (1858) 1. Elevated body temperature 2. Severe eye pain 3. Prescene of halos or flashes 4. Low white cell count

Answer 2: Severe eye pain is associated with this disorder.

17. The patient shows loss and deterioration in the automated perimetry test. Which activity is the patient most likely to have difficulty with? (1851) 1. Reading a newspaper or book 2. Driving through the neighborhood 3. Looking at a laptop computer screen 4. Going on a moonlight stroll down the street

Answer 2: The automated perimetry test is a test for peripheral vision. Loss in the outer fields would make driving very dangerous. The other tasks require a more focused view of what is straight ahead.

39. The nurse is on a camping trip and one of the campers gets poked in the eye with a stick. The end of the stick is protruding from the eye. What should the nurse do first ?(1872) 1. Gently remove the stick and then flush the eye with water. 2. Cover the eye and stick with a paper cup and secure with tape. 3. Have the camper sit quietly in the car and drive him to the hospital. 4. Remain calm and control the bleeding with direct pressure.

Answer 2: The eye and stick are covered with a cup to prevent dislodgment (cup should be sufficiently large to cover the stick without touching it). Then the camper is taken to the hospital if 911 is not available to respond to the camping site.

38. The nurse's neighbor is trying to remove an eyelash that has gotten in her eye. The nurse would intervene if the neighbor used which method?(1872) 1. Flushed the eye gently with tap water 2. Tried blinking and crying to stimulate tears 3. Used a clean cotton-tipped swab to wipe the cornea 4. Used a sterile pad to wipe the corner of the eye

Answer 3: Cotton is not used because of potential to scratch the cornea. The other methods are acceptable.

18. Which diagnostic test requires an assessment of allergies to seafood or iodine? (1851) 1.Snellen's test 2. Slit-lamp examination 3. Fluorescein angiography 4. Tonometry

Answer 3: During fluorescein angiography, a dye is injected into a vein. The dye could cause a similar allergic reaction for those who react to seafood or iodine.

23. The nurse's teenage son tells her that his con- tact lens fell out while he was hanging out in the park with his friends, so he used saliva to clean it off. What should the nurse say? (1856) 1. "Did you ask if anybody had contact lens solution or a lens case?" 2. "You know you are not supposed to do that, don't you?" 3. "So, what are you planning to do if that happens again?" 4. "Do you think glasses would be a better option for you?"

Answer 3: People who wear contact lenses know they are not supposed to use saliva to clean the lenses; however, many users forget to carry sterile solution or a spare contact case. The nurse should help contact lens users plan ahead. Borrowing solution or lens cases from others is not recommended because of risk for infection. Adolescents generally prefer not to wear glasses, but possibly for active sports they are preferable.

30. What diagnostic tests are used to confirm the presence of entropion? (1860) 1. Amsler's grid 2. Snellen's examination 3. Ophthalmologic examination 4. Pneumatic retinopexy

Answer 3: The health care provider will use visual inspection and an ophthalmoscopic examination. Amsler's grid assesses for disturbances in central vision. Snellen's test assesses visual acuity. Pneumatic retinopexy is a procedure used to correct retinal detachment.

24. The nurse has a 10-year-old daughter who wants to invite two friends for a sleepover. Part of the entertainment for the night is to do "glamour makeovers." What should the nurse do? (1872) 1. Tell the daughter that sharing eye makeup contributes to eye infections. 2. Call the other parents and see if the friends currently have eye infections. 3. Purchase three makeup kits from the drug- store and supervise the activity. 4. Teach the children how to use a fresh cotton-tip applicator for application.

Answer 3: Use of fresh makeup, individual applicators, and supervising the activity is the best option. This may seem a little costly, but the alternative would be to ban the activity with an explanation about eye infections.

25. The home health nurse is supervising a par- ent who is demonstrating care for her child's conjunctivitis. The nurse would intervene if the mother performed which action? (1858) 1. Used a clean washcloth to wipe away the secretions 2. Applied a warm compress with a clean cloth for comfort 3. Instilled the eyedrops in the lower conjunc- tival sac 4. Taped an eyepad loosely over the affected eye

Answer 4: Eye pads are contraindicated because they facilitate bacterial growth. The other actions are correct.

40. The health care provider informs the nurse that the patient had an abnormal Romberg test. Which safety precaution will the nurse initiate? (1878) 1. Make sure the room has adequate natural lighting. 2. Do a physical demonstration of how to use the call light. 3. Announce self to avoid suddenly startling the patient. 4. Assist the patient to stand and get balance before walking.

Answer 4: If the Romberg test is abnormal, the patient lost his balance when standing erect, feet together, with eyes closed.

21. For which eye condition are patients most likely to report trying to first self treat with over-the-counter eyewear? (1855) 1. Astigmatism 2. Strabismus 3. Myopia 4. Hyperopia

Answer 4: In hyperopia, the patient can see distant objects, but close objects such as fine print are blurry; using over-the-counter eyewear that magnifies fine print may work initially.

28. Patients with Sjögren's syndrome typically re- port: (1859) 1. seeing floaters in the field of vision 2. color blindness. 3. feeling worse in the morning. 4. feeling that their eyes are gritty

Answer 4: The eyes feel gritty because of the deficient fluid production in glands of the mouth, eyes, and other mucous membranes.

6. Defect in curvature of eyeball surface (1854)

Astigmatism

External acoustic meatus

B

Temporal bone

C

3. Crystalline opacity or clouding of the lens (1860)

Cataract

7. Pinkeye (1857)

Conjunctivitis

Tympanic membrane

D

Semicircular canals

E

Oval window

F

5. Central vision damaged by macular degeneration can be restored by photocoagulation. (1865) True or false?

False: Central vision damaged by macular degeneration cannot be restored. Photocoagulation is preventive, not curative.

3. Most cataracts are caused by chronic eye infections. (1860) True or false?

False: Most cataracts are age-related

6. There is a direct relationship between vascular hypertension and ocular hypertension. (1870) True or false?

False: There is no apparent relationship between vascular hypertension and ocular hypertension.

Facial Nerve

G

Vestibular Nerve

H

8. Infection of eyelid margin (1856)

Hordeolum

1. Farsightedness (1854)

Hyperopia

Cochlear Nerve

I

Cochlea

J

Vestibule

K

5. Inflammation of cornea (1854)

Keratits

Round Window

L

18. Inflammation of the labrinthine canals of the inner eyes (1884)

Labyrinthitis

Auditory Tube

M

4. Infection of one of the mastoid bones (1884)

Mastoiditis

13. Agents that cause the pupil to constrict (1869)

Miotics

10. Dilating drops (1851)

Mydriatic

11. Nearsightedness (1854

Myopia

Stapes

N

14. Involuntary, rhythmic movements of the eyes (1878)

Nystagmus

Incus

O

9. Chronic progressive deafness caused by the formation of spongy bone (1886)

Otosclerosis

Malleus

P

12. A hearing deficit secondary to aging

Presbycusis

17. A type of refractory error (1851)

Presbyopia

2. Cross-eyed (1854)

Strabisums

16. Ringing or tinkling sounds in the ear (1882)

Tinnitus

4. The incidence of diabetic retinopathy greatly increases in relation to how long the patient has diabetes mellitus and how well their blood glucose levels are controlled. (1862) True or false?

True

7. The deaf community believes that life without hearing is healthy and functional and that deafness is not a disease that needs to be cured. (1891) True or false?

True

Visual (Optic) axis

a

15. Briefly define the six types of hearing loss (1879).

a. In conductive hearing loss, sound is inadequately conducted through the external or middle ear to the sensorineural apparatus of the inner ear. b. In sensorineural hearing loss, sound is conducted through the external and middle ear in a normal way, but a defect in the inner ear results in distortion, making discrimination difficult. c. Mixed hearing loss is a combined conductive and sensorineural hearing loss. d. Congenital hearing loss is present from birth or early infancy. e. Functional hearing loss may be caused by an emotional or a psychological factor. f. Central hearing loss occurs when the brain's auditory pathways are damaged, as in a stroke or a tumor.

45. A 20-year-old patient reports worsening ear pain. After completing his history, it is determined he re- cently had an ear infection and he failed to take the full course of prescribed medications. His other signs and symptoms include fever, headache, malaise, and purulent exudates. (1884) a. What should the nurse anticipate the patient's medical diagnosis will be? b. How did this condition occur? c. Discuss the treatment and the prognosis of this condition.

a. Mastoiditis b. It is the result of a spreading middle ear infection. The patient's risk was enhanced after not completing the prescribed antibiotic therapy. c. If caught early, treatment will include IV antibiotic therapy and a myringotomy. If the infection has progressed, treatment will include IV antibiotic treatment and a simple mastoidectomy.

44. An 18-year-old patient has just returned from surgery for the enucleation of his right eye after injuries suffered in an automobile accident. (1873) a. Discuss the nursing interventions that will be required over the next 24 hours. b. What findings are indictative of complications and warrant an immediate report to the health care provider? c. The patient expresses concerns about his appearance. How will the nurse address his concerns?

a. Monitor pressure dressing over eye. The dressing should be inspected at least every hour. Assess for pain on the affected side or any headache. Monitor vital signs. b. Excess bleeding from site, headache, signs of excess blood loss c. Encourage verbalization of specific concerns. Provide support. When appropriate, advise patient that with healing, he can be fitted with a prosthetic device in 4-6 weeks.

12. What four basic processes are necessary to form an image? (1850)

a. Refraction: light rays are bent as they pass through the colorless structures of the eye, enabling light from the environment to focus on the retina. b. Accommodation: the eye is able to focus on objects at various distances. It focuses the image of an object on the retina by changing the curvature of the lens. c. Constriction: the size of the pupil, which is controlled by the dilator and constrictor muscles of the iris, regulates the amount of light entering the eye. d. Convergence: medial movement of both eyes allows light rays from an object to hit the same point on both retinas.

13. Define the following types of blindness (1852) a. Total blindness: b.Functional blindness: c. Legal blindness:

a. Total blindness is defined as no light perception and no usable vision. b. Functional blindness is present when the patient has some light perception but no usable vision. It may be congenital or acquired. c. Legal blindness refers to individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight capacity reduced to 20 degrees.

Anterior chamber

b

pupil

c

iris

d

lower (inferior) lid

e

ciliary body

f

suspensory ligaments

g

retina

h

choroid

i

sclera

j

Posterior Chamber

k

Macula

l

Fovea Centralis

m

10. Primary open-angle glaucoma is medically treated by the use of beta blockers, __________________________, and carbonic anhydrase inhibitors. (1869)

miotics

Optic nerve

n

Central artery and vein

o

Optic disk

p

Inner layer

q

Vascular layer

r

Fibrous layer

s

11. The four taste sensations are __________________________, __________________________, __________________________, and __________________________. (1890)

sweet; salt; sour; bitter

Lacrimal caruncle

t