eye and ear disorders

2 a hyphema is the presence of blood in the anterior chamber. hyphema is produced when a force is sufficient to break the integrity of the blood vessels in the eye and can be caused by direct injury, such as a penetrating injury from a BB or pellet, or indirectly, such as from striking the forehead on a steering wheel during an accident. the client is treated by bed rest in a semi-fowler's position to assist gravity in keeping the hyphema away from the optical center of the cornea.

a client arrives in the emergency department following an automobile crash. the client's forehead hit the steering wheel, and a hyphema is diagnosed. the nurse should place the client in which position? 1) flat in bed 2) a semi-fowler's position 3) lateral on the affected side 4) lateral on the unaffected side

c severe pain around the eyes that radiates over the face is a manifestation of acute angle-closure glaucoma.

a nurse in an emergency department is reviewing the medical record of a client who is being evaluated for angle-closure glaucoma. which of the following findings are indicative of this condition? a) insidious onset of painless vision loss b) gradual reduction in peripheral vision c) severe pain around eyes d) intraocular pressure 12 mm Hg

4 applying pressure on the nasolacrimal duct prevents systemic absorption of the medication.

the nurse is providing instructions to a client who will be self-administering eye drops. to minimize systemic absorption of the eye drops, the nurse should instruct the client to take which action? 1) eat before instilling the drops. 2) swallow several times after instilling the drops. 3) blink vigorously to encourage tearing after instilling the drops. 4) occlude the nasolacrimal duct with a finger after instilling the drops.

1 visual acuity is assessed in 1 eye at a time, and then in both eyes together, with the client comfortably standing or sitting. the right eye is tested with the left eye covered; then the left eye is tested with the right eye covered. both eyes are then tested together. visual acuity is measured with or without corrective lenses, and the client stands at a distance of 20 feet from the chart.

the nurse is preparing to test the visual acuity of a client, using a snellen chart. which identifies the accurate procedure for this visual acuity test? 1) the right eye is tested, followed by the left eye, and then both eyes are tested. 2) both eyes are assessed together, followed by an assessment of the right eye and then the left eye. 3) the client is asked to stand at a distance of 40 feet from the chart and to read the largest line on the chart. 4) the client is asked to stand a distance of 40 feet from the chart and to read read the line that can be read 200 feet away by an individual with unimpaired vision.

3 presbycusis is a type of hearing loss that occurs with aging. presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve. when communicating with a a client with this condition, the nurse should speak at a normal tone and pitch, slowly and clearly. it is not appropriate to speak loudly, mumble or slur words, or speak into the client's affected ear.

the nurse notes that the primary health care provider has documented a diagnosis of presbycusis on a client's chart. based on this information, what action should the nurse take? 1) speak loudly but mumble or slur the words. 2) speak loudly and clearly while facing the client. 3) speak at a normal tone and pitch, slowly and clearly. 4) speak loudly and directly into the client's affected ear.

4 atropine sulfate is a mydriatic and cycloplegic medication, and its use is contraindicated in clients with glaucoma. mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

which medication, if prescribed for the client with glaucoma, should the nurse question? 1) betaxolol 2) pilocarpine 3) erythromycin 4) atropine sulfate

2 if the eye injury is the result of a penetrating object, the object may be noted protruding from the eye. this object must never be removed except by the ophthalmologist, because it may be holding ocular structures in place. application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the cornea.

a client arrives in the emergency department with a penetrating eye injury from wood chips that occurred while cutting wood. the nurse assesses the eye and notes a piece of wood protruding from the eye. what is the initial nursing action? 1) apply an eye patch. 2) perform visual acuity tests. 3) irrigate the eye with sterile saline. 4) remove the piece of wood using a sterile eye clamp.

2 tinnitus is the most common complaint of clients with otological problems, especially problems involving the inner ear. symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client's thinking process and attention span.

a client is diagnosed with a problem involving the inner ear. which is the most common client complaint associated with a problem involving this part of the ear? 1) pruritis 2) tinnitus 3) hearing loss 4) burning in the ear

1 when an eye drop and and eye ointment are scheduled to be administered at the same time, the eye drop is administered first. the instillation of two medications is separated by 3 to 5 minutes.

a client is prescribed an eye drop and an eye ointment for the right eye. how should the nurse best administer the medications? 1) administer the eye drop first, followed by the eye ointment. 2) administer the eye ointment first, followed by the eye drop. 3) administer the eye drop, wait 15 minutes, and administer the eye ointment. 4) administer the eye ointment, wait 15 minutes, and administer the eye drop.

3 aspirin is contraindicated for GI bleeding and is potentially ototoxic. the client should be advised. to notify the prescribing primary health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead.

a client was just admitted to the hospital to rule out a gastrointestinal bleed. the client has brought several bottles of medications prescribed by different specialists. during the admission assessment, the client states, "lately, i have been hearing some roaring sounds in my ears, especially when i am alone." which medication would the nurse identify as the cause of the client's complaint? 1) doxycycline 2) atropine sulfate 3) acetylsalicylic acid 4) diltiazem hydrochloride

2 the nurse instructs the client to make slow head movements to prevent worsening of the vertigo. dietary changes such as salt and fluid restrictions that reduce amount of endolymphatic fluid are sometimes prescribed. lying still and watching television will not control vertigo.

a client with menere's disease is experiencing severe vertigo. which instruction should the nurse give to the client to assist in controlling the vertigo? 1) increase sodium in the diet. 2) avoid sudden head movements. 3) lie still and watch the television. 4) increase fluid intake to 3000 mL a day.

2 vision that is 20/20 is normal - that is, the client is able to read from 20 feet what a person with normal vision can read from 20 feet. a client with a visual acuity of 20/60 can only read at a distance of 20 feet what a person with normal vision can read at 60 feet. with this vision, the client may need glasses while driving in order to read signs and to see far ahead. the client should be instructed to sit in the front of the room for lectures to aid in visualization. this is not considered to be legal blindness.

a client's vision is tested with a snellen chart. the results of the tests are documented as 20/60. what action should the nurse implement based on this finding? 1) provide the client with materials on legal blindness. 2) instruct the client that he or she may need glasses when driving. 3) inform the client where he or she can purchase a white cane with a red tip. 4) inform the client that it is best to sit near the back of the room when attending lectures.

3 miotics cause pupillary constriction and are used to treat glaucoma. they lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork.

a miotic medication has been prescribed for the client with glaucoma, and the client asks the nurse about the purpose of the medication. which response should the nurse provide to the client? 1) "the medication will help dilate the eye to prevent pressure from occurring." 2) "the medication will relax the muscles of the eyes and prevent blurred vision." 3) "the medication causes the pupil to constrict and will lower the pressure in the eye." 4) "the medication will help block the responses that are sent to the muscles in the eye."

a, b, c, d the guardian should have the child on the unaffected side to allow access to the affected ear and to promote drainage of the medication by gravity into the ear. the guardian should warm the medication by rolling it between their hands. administering the medication cold can cause dizziness. the guardian should gently shake the medication that is in suspension form to evenly disperse the medication. the guardian should keep the child on their side to promote drainage of the medication by gravity into the ear.

a nurse in a provider's office is instructing a guardian of a toddler how to administer ear drops. which of the following instructions should the nurse include? (select all that apply.) a) "place the child on the unaffected side when you are ready to administer the medication." b) "warm the medication by gently rolling it between your hands for a few minutes." c) "gently shake medication that is in suspension form." d) "keep the child on their side for 5 minutes after instillation of the ear drops." e) "tightly pack the ear with cotton after instillation of the ear drops."

b pressing on the nasolacrimal duct blocks the lacrimal punctum and prevents systemic absorption of the medication.

a nurse is instructing a client who has a new prescription for timolol how to insert eye drops. the nurse should instruct the client to press of which of the following areas to prevent systemic absorption of the medication? a) bony orbit b) nasolacrimal duct c) conjunctival sac d) outer canthus

d the client should remove water from the ear after showering or swimming to reduce the risk for otitis externa.

a nurse is teaching a client about preventing otitis externa. which of the following instructions should the nurse include? a) clean the ear with a cotton-tipped swab daily. b) place earplugs in the ears when sleeping at night. c) use a cool water irrigation solutions to remove earwax. d) tip the head to the side to remove water from the ears after showering.

c brimonidine can absorb into soft contact lenses. the client should remove their contacts then instill the medication and wait at least 15 min before putting the contacts back in.

a nurse is teaching a client who has a new prescription for brimonidine ophthalmic drops and wears soft contact lenses. which of the following instructions should the nurse include in the teaching? a) "this medication can stain your contacts." b) "this medication can cause your pupils to constrict." c) "this medication can absorb into your contacts." d) "this medication can slow your heart rate."

1 in this type of accident, the client is instructed to irrigate the eyes immediately with running water for at least 20 minutes, or until the medical emergency services personnel arrive. in the emergency department, the cleansing agent of choice is usually normal saline. calling the PHCP and going to the emergency department delays necessary intervention. hydrogen peroxide is never placed in the eyes.

a woman was working in her garden. she accidentally sprayed insecticide into her right eye. she calls the emergency department, frantic and screaming for help. the nurse should instruct the woman to take which immediate action? 1) irrigate the eyes with water. 2) come to the emergency department. 3) call the primary health care provider. 4) irrigate the eyes with diluted hydrogen peroxide.

3 hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side and adverse effects of the medication. nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia.

betaxolol hydrochloride eye drops have been prescribed for a client with glaucoma. which nursing action is most appropriate related to monitoring for side and adverse effects of this medication? 1) assessing for edema 2) monitoring temperature 3) monitoring blood pressure 4) assessing blood glucose level

1 severe pain or pain accompanied by nausea following a cataract extraction is an indicator of increased intraocular pressure and should be reported to the surgeon immediately.

during the early postoperative period, a client who has undergone cataract extraction complains of nausea and severe pain over the operative site. what should be the initial nursing action? 1) call the surgeon. 2) reassure the client that this is normal. 3) turn the client onto his operative side. 4) administer the prescribed pain medication and antiemetic.

3 cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. cyclopentolate is used for preoperative mydriasis, not pupil constriction. the nurse should consult with the surgeon about the time of administration of the eye drops, because 15 minutes is not adequate time for dilation to occur.

in preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops at 9:00 a.m. for surgery that is scheduled for 9:15 a.m. what initial action should the nurse take in relation to the characteristics of the medication action? 1) provide lubrication to the operative eye prior to giving the eye drops. 2) call the surgeon, as this medication will further constrict the operative pupil. 3) consult the surgeon, as there is not sufficient time for the dilative effects to occur. 4) give the medication as prescribed; the surgeon needs optimal constriction of the pupil.

1 treatment for a contusion begins at the time of injury. ice is applied immediately. the client then should be seen by a PHCP and receive a thorough eye examination to rule out the presence of other eye injuries.

the client sustains a contusion of the eyeball following a traumatic injury with a blunt object. which intervention should be initiated immediately? 1) apply ice to the affected eye. 2) irrigate the eye with cool water. 3) notify the primary health care provider. 4) accompany the client to the emergency department.

4 an acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear or acoustic nerve enters the internal auditory canal. it is important that an early diagnosis be made, because the tumor can compress the trigeminal and facial nerves and arteries within the internal auditory canal. treatment for acoustic neuroma is surgical removal via a craniotomy. assessment of the trigeminal and facial nerves is important. extreme care is taken to preserve remaining hearing and preserve the function of the facial nerve. acoustic neuromas rarely recur following surgical removal.

the nurse is caring for a client following craniotomy for removal of an acoustic neuroma. assessment of which cranial never would identify a complication specifically associated with this surgery? 1) cranial nerve I, olfactory 2) cranial nerve IV, trochlear 3) cranial nerve III, oculomotor 4) cranial nerve VII, facial nerve

3 if the nurse notes the presence of bright red drainage on the dressing, it must be reported to the PHCP, because this indicates hemorrhage.

the nurse is caring for a client following enucleation to treat an ocular tumor and notes the presence of bright red drainage on the dressing. which action should the nurse take at this time? 1) document the finding. 2) continue to monitor the drainage. 3) notify the primary health care provider. 4) mark the drainage on the dressing and monitor for any increase in bleeding.

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

the nurse is caring for a hearing-impaired client. which approach will facilitate communication? 1) speak loudly. 2) speak frequently. 3) speak at a normal volume. 4) speak directly into the impaired ear.

3 the administration of eye drops is a critical component of the treatment plan for the client with glaucoma. the client needs to be instructed that medications will need to be taken for the rest of his or her life.

the nurse is developing a teaching plan for a client with glaucoma. which instruction should the nurse include in the plan of care? 1) avoid overuse of the eyes. 2) decrease the amount of salt in the diet. 3) eye medications will need to be administered for life. 4) decrease fluid intake to control the intraocular pressure.

4 a characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is falling across the field of vision. no pain is associated with detachment of the retina.

the nurse is performing an admission assessment on a client with a diagnosis of detached retina. which sign or symptom is associated with this eye problem? 1) total loss of vision 2) pain in the affected eye 3) a yellow discoloration of the sclera 4) a sense of a curtain falling across the field of vision

4 a gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. early symptoms include slightly blurred vision and a decrease in color perception.

the nurse is performing an assessment on a client with a suspected diagnosis of cataract. which clinical manifestation should the nurse expect to note in the early stages of cataract formation? 1) diplopia 2) eye pain 3) floating spots 4) blurred vision

4 otoscopic examination in a client with mastoiditis reveals a red, dull, thick, and immobile tympanic membrane, with or without perforation. postauricular lymph nodes are tender and enlarged. clients also have a low-grade fever, malaise, anorexia, swelling behind the ear, and pain with minimal movement of the head.

the nurse is performing an otoscopic examination on a client with mastoiditis. on examination of the tympanic membrane, which finding should the nurse expect to observe? 1) a pink-colored tympanic membrane 2) a pearly colored tympanic membrane 3) a transparent and clear tympanic membrane 4) a red, dull, thick, and immobile tympanic membrane

1, 3, 5, 6 following eye surgery, some scratchiness and mild eye discomfort may occur in the operative eye and usually is relieved by mild analgesics. if the eye pain becomes severe, the client should notify the surgeon, because this may indicate hemorrhage, infection, or increased intraocular pressure. the nurse also would instruct the client to notify the surgeon of increased purulent drainage, increased redness, or any decrease in visual acuity. the client is instructed to place an eye shield over the operative eye at bedtime to protect the eye from injury during sleep and to avoid activities that increase IOP, such as bending over.

the nurse is preparing a teaching plan for a client who had a cataract extraction with intraocular implantation. which home care measures should the nurse include in the plan? select all that apply. 1) avoid activities that require bending over. 2) contact the surgeon if eye scratchiness occurs. 3) take acetaminophen for minor eye discomfort. 4) expect episodes of sudden severe pain in the eye. 5) place an eye shield on the surgical eye at bedtime. 6) contact the surgeon if a decrease in visual acuity occurs.

1, 2, 3, 4 to administer eye medications, the nurse should wash hands and put gloves on. the client is instructed to tilt the head backward, open the eyes, and look up. the nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. holding the bottle, the nurse gently rests the wrist of the hand on the client's cheek and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. the client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent the loss of medication.

the nurse is preparing to administer eye drops. which interventions should the nurse take to administer the drops? select all that apply. 1) wash hands. 2) put gloves on. 3) place the drop in the conjunctival sac. 4) pull the lower lid down against the cheekbone. 5) instruct the client to squeeze the eyes shut after instilling the eye drop. 6) instruct the client to tilt the head forward, open the eyes, and look down.

1 before ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. the irrigating solution should be warmed to 98.6 degrees F, because a solution temperature that is not close to the client's body temperature will cause ear injury, nausea, and vertigo. the nurse should check the temperature of the solution on the inner forearm. the affected side should be down following the irrigation to assist in drainage of the fluid. when irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. the client is positioned sitting, facing forward with the head in a natural position; if the ear is faced upward, the nurse would not be able to visualize the canal.

the nurse prepares a client for ear irrigation as prescribed by the primary health care provider. which action should the nurse take when performing the procedure? 1) warm the irrigating solution to 98.6 degrees F. 2) position the client with the affected side up following the irrigation. 3) direct a slow, steady stream of irrigation solution toward the eardrum. 4) assist the client to turn her or his head so that the ear to be irrigated is facing upward.

2 tonometry is a method of measuring intraocular fluid pressure. pressured between 10 and 21 mm Hg are considered within the normal range. however, IOP is slightly higher in the morning. therefore, the initial action is to check the time the test was performed. normal saline drops are not a specific treatment for glaucoma. it is not necessary to contact the PHCP as an initial action. flat positions may increase the pressure.

tonometry is performed on a client with a suspected diagnosis of glaucoma. the nurse looks at the documented test results and notes an intraocular pressure value of 23. what should be the nurse's initial action? 1) apply normal saline drops. 2) note the time of day the test was done. 3) contact the primary health care provider. 4) instruct the client to sleep with the head of the bed flat.