family test 4

After a mastoidectomy, the most important complication for the nurse to assess for is: 1.vomiting. 2.headache. 3.fever. 4.stiff neck.

ANS: 3 All are complications that can occur following this type of surgery. Fever is of extra importance because of its possible link to infection. The mastoid bone is in direct contact with the brain, and therefore any infection can travel to the brain.

A client is diagnosed with a vision disorder. The nurse realizes that the client will experience an alteration in sensory information because the eyes transmit what percentage of all sensory information to the brain? 1.30% 2.50% 3.70% 4.90%

ANS: 3 Approximately 70% of all sensory information reaches the brain through the eyes.The other percentages are incorrect.

The nurse is conducting a child safety class for new mothers. Which factor places young children at risk for ear infections? a. Family history b. Air conditioning c. Excessive cerumen d. Passive cigarette smoke

ANS: D Exposure to passive and gestational smoke is a risk factor for ear infections in infants and children.

1.A client is diagnosed with strabismus. Which of the following will the client most likely experience with this disorder? 1.Nystagmus 2.Diplopia 3.Aphakic vision 4.Ptosis

2 Diplopia, or double vision, is the primary symptom of strabismus. Nystagmus is a disorder that causes involuntarily rhythmic movements in the eye. Aphakic vision occurs when the lens of the eye is removed. Ptosis is drooping of the eyelid.

Which of the following medications used in the treatment of glaucoma works by constricting the pupils to open the angle and allow aqueous fluid to escape? a. Pilocarpine b. Timolol c. Brinzolamide d. Acetazolamide

A

A client is receiving tests to diagnose glaucoma. Which of the following diagnostic tests will be used to identify this disorder in the client? (Select all that apply.) 1.Visual acuity 2.Visual field test 3.Tonometry 4.Weber test 5.Rinne test 6.Electroencephalogram

ANS: 1, 2, 3 Glaucoma is determined through a comprehensive eye exam including a visual acuity test, visual fields test, dilated eye exam, and tonometry. The Weber and Rinne tests are used in an ear assessment. An electroencephalogram is not used to diagnose glaucoma.

A client is complaining of dizziness, unilateral ringing in the ear, feeling of pressure or fullness in the ear, and unilateral hearing loss. The nurse would suspect the client is experiencing: 1.Mnires disease. 2.osteosclerosis. 3.otitis media. 4.mastoiditis.

ANS: 1 All of the clients complaints are signs and symptoms of Mnires disease. Although hearing disorders may have similar signs and symptoms, they do not include all of them.

A client complains of a slight itching, slight pain, and a scratching sound in the ear. The nurse suspects that an insect may have entered the ear. Which of the following should not be done? 1.Add water to flush out the insect. 2.Add mineral oil to kill the insect. 3.Add lidocaine to kill the insect. 4.Call an otologist for a referral.

ANS: 1 Avoid placing water in the ear canal, which will only make the insect swell, thereby making it more difficult to remove. An otologist should be called for the removal. The audiologist may prescribe mineral oil or lidocaine to be applied to the ear canal.

After surgery to remove a cataract, which of the following should the nurse instruct the client? 1.Be sure to follow the schedule for the prescribed eyedrop medication. 2.Sleep on the right side to promote drainage. 3.It is okay to rub the eye because the surgery was on the inside. 4.This is an outpatient procedure, and there are no instructions for the patient.

ANS: 1 Client education is extremely important in the aftercare of cataract surgery. There is a need to emphasize the postoperative care of eyedrop instillation. The client should not place any pressure near or on the eye. Postoperative instructions are highly important for the client having an outpatient surgical procedure.

The nurse is caring for a client diagnosed with acute sinusitis. Which of the following symptoms is the client most likely experiencing? 1.Anosmia 2.Fever 3.Halitosis 4.Metallic taste

ANS: 1 Clients often complain of unilateral face pain, purulent nasal discharge, pain during mastication, anosmia (absence of smell), and headache. Less common symptoms include fever, nasal congestion, halitosis, toothache, metallic taste, and cough.

The nurse is planning to assess a client diagnosed with conductive hearing loss. When performing the Weber test, the nurse would expect which of the following findings? 1.The sound will be louder in the affected ear. 2.The sound will be louder in the good ear. 3.Air conduction is shorter than bone conduction. 4.No sounds will be heard.

ANS: 1 During a Weber test, which tests bone conduction, a client with a conductive hearing loss hears louder sounds on the affected side. Hearing louder sounds on the unaffected side is sensorineural loss. The Rinne test compares bone with air conduction. The client will hear sounds louder in the affected ear.

A client has been diagnosed as being legally blind. The nurse realizes this clients vision is: 1.20/200 or less in the better eye with correction. 2.20/200 or less in the worse eye without correction. 3.20/100 or less in the better eye without correction. 4.20/100 or less in the worse eye with correction.

ANS: 1 Legal blindness is defined as vision of 20/200 or less on a Snellen chart in the better eye with correction. The eye needs to have correction in order to be diagnosed as legally blind; therefore, the choice of 20/200 in the worse eye without correction would be incorrect. The vision measurements of the other choices can be corrected with lenses and would not be categorized as legal blindness.

When instructing a client on cleaning the ear, the nurse should instruct the client to clean: 1.only the outer ear. 2.all the way to the middle ear. 3.all parts of the ear outer, middle, and inner ear. 4.just the tympanic membrane.

ANS: 1 Only the outer portion of the ear should be cleaned. Inserting different objects into the ear canal may result in injury and damage.

A client is diagnosed with an inability to recognize visual information. The nurse realizes that which of the following cranial nerves is involved in the transmitting of visual stimuli to the brain for interpretation? 1.CN II 2.CN III 3.CN IV 4.CN VI

ANS: 1 The optic nerve is the second cranial nerve and is responsible for the transmitting of visual stimuli. Cranial Nerves III, IV, and VI control extraocular eye movements.

The nurse is planning care for the client diagnosed with viral rhinitis. Which of the following would be the best goal of care for this client? 1.Prevent secondary bacterial infection. 2.Prevent rhinitis medicamentosa. 3.Refrain from use of analgesics. 4.Encourage complete participation in activities.

ANS: 1 Treatment of acute rhinitis, or the common cold, is aimed at decreasing the impact of the symptoms and preventing secondary bacterial infection. Rhinitis medicamentosa occurs from misuse of nasal decongestants. Acetaminophen or a nonsteroidal anti-inflammatory agent is useful for fever, aches, and pain. Rest is encouraged.

Which of the following should the nurse instruct a client diagnosed with type 2 diabetes mellitus regarding vision care? (Select all that apply.) 1.Maintain good glucose control. 2.Stop smoking. 3.Limit exercise. 4.Reduce reading. 5.Frequently rest the eyes. 6.Rub eyes daily.

ANS: 1, 2 To preserve vision and reduce the onset of diabetic retinopathy, the nurse should instruct the client to control blood glucose level, manage other complications, and stop smoking. The client should not be instructed to limit exercise, reduce reading, rest the eyes, or rub the eyes to prevent the onset of diabetic retinopathy.

A patient presents with the following signs and symptoms: gradual onset of low-grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause? a. Gonorrhea b. Mononucleosis c. Influenza d. Herpes zoster

B

A client with a family history of hearing loss asks the nurse what he can do to prevent this disorder as he ages. Which of the following should the nurse instruct this client? (Select all that apply.) 1.Turn down radio and television volume. 2.Avoid noisy areas such as rock concerts. 3.Wear protective devices. 4.Use plain cotton balls in the ears. 5.Avoid sun exposure. 6.Flush the ears daily with mineral oil.

ANS: 1, 2, 3 Measures to prevent hearing loss include turning down the volume on the radio and television, avoiding noisy areas such as rock concerts, and wearing protective devices. Using cotton balls in the ears does not decrease noise from reaching the middle ear. Sun exposure does not impact hearing. Flushing the ears daily with mineral oil might decrease the buildup of cerumen; however, it will not improve hearing.

A client is diagnosed with a congenital hearing loss. Which causes does the nurse realize are reasons for this type of hearing loss? (Select all that apply.) 1.Genetics 2.Natal infections 3.Physical deformities 4.Noise levels 5.Maternal ototoxic drugs 6.Maternal TORCH infections

ANS: 1, 2, 3, 5, 6 Congenital hearing loss can be derived from genetics, natal infections, or physical deformities of the ear in addition to maternal ototoxic drug use and maternal TORCH infections that include toxoplasmosis, rubella, cytomegalovirus, and herpes virus type 2. Noise levels do not cause a congenital hearing loss.

When caring for a client with total hearing loss, the nurse is instructing the client about the many options that are available to function in a hearing world. Which of the following should the nurse include? (Select all that apply.) 1.Flashing lights for alarms 2.TV with closed captions 3.Talking computer 4.Lip reading and sign language 5.Cell phones with headsets 6.Loud ringers on telephones

ANS: 1, 2, 4 Patients who have no hearing have access to various mechanisms to alert them to various sounds. Flashing lights for alarms to phones and doorbells, TV with closed captions for the hearing impaired, and classes in lip reading and sign language are some options. Talking computers and cell phones with headsets are advancements for the hearing, not for the hearing impaired. Loud ringers on telephones would also be helpful to the client with some hearing and not a total hearing loss.

A client tells the nurse that he does not want to develop macular degeneration like his mother. Which of the following should the nurse instruct the client as being risk factors for the development of this disorder? (Select all that apply.) 1.There is greater risk as people age. 2.Women are at greater risk than men. 3.African Americans are at greater risk than Caucasians. 4.Family history of macular degeneration increases risk. 5.Smoking does not increase risk. 6.Alcohol prevents the onset of this disorder.

ANS: 1, 2, 4 Recent statistics show that macular degeneration is age related and that women are at greater risk than men. Family history and smoking are also significant risk factors. Caucasians are at greater risk than African Americans. Alcohol does not prevent the onset of this disorder.

The nurse is instructing a client diagnosed with otitis media on management during the acute phase. Which of the following should the nurse include in the teaching? (Select all that apply.) 1.Take the antibiotics as ordered. 2.Take over-the-counter analgesics for mild pain as recommended. 3.It is okay to go swimming. 4.It is okay to go on vacation and trips that require flying. 5.If excruciating pain develops, seek medical care. 6.Limit fluids.

ANS: 1, 2, 5 Clients must complete the medication as ordered to kill the infection. Mild analgesics for pain are often needed. If excruciating ear pain develops, the client should seek medical care to rule out perforation of the eardrum. It is important to keep the ear dry, so the client should not swim at this time. Flying is not recommended at this time. Limiting fluids is not necessary with otitis media.

A client has been diagnosed with allergic rhinitis. Which of the following should the nurse instruct the client regarding strategies to avoid this disorder? (Select all that apply.) 1.Remove home carpeting 2.Reduce the use of an air conditioner 3.Remove pets from the home 4.Open windows in the spring and summer 5.Use feather pillows 6.Wash bed linens in cold water

ANS: 1, 3 Strategies to reduce the symptoms of allergic rhinitis include removing home carpeting and removing pets from the home. The client should be instructed to use an air conditioner, keep windows closed during allergy season, avoid feather pillows, and wash bed linens in hot water.

The nurse is teaching a client how to use a nasal spray. Which of the following should be included in these instructions? (Select all that apply.) 1.Blow the nose before instilling the spray. 2.Tilt the head back and angle the tip of the bottle to the side of the nostril. 3.Use a finger to occlude the nostril that is not receiving the spray. 4.Inhale gently and evenly while discharging the spray into the nostril. 5.If a second spray is recommended, immediately repeat the procedure. 6.Blow the nose after administration of the spray.

ANS: 1, 3, 4 For the steps to be correct, the head should be slightly forward, the second spray should be given 15 to 20 seconds after the spray, and the client should not blow the nose after the administration of the spray. The client should be instructed to blow the nose before instilling the spray, to use a finger to occlude the nostril that is not receiving the spray, and to gently inhale while the spray is being delivered into the nostril.

A client is diagnosed with ocular cancer. The nurse realizes this client could be treated with: (Select all that apply.) 1.Enucleation 2.Laser surgery 3.Plaque brachytherapy 4.Block incision 5.Trabeculoplasty 6.Trabeculectomy

ANS: 1, 3, 4 Surgical options for a client diagnosed with ocular cancer include enucleation, plaque brachytherapy, or block incision. Laser surgery, trabeculoplasty, and trabeculectomy would be used to treat glaucoma.

A client is demonstrating signs of chronic sinusitis. Which of the following will the nurse most likely assess in this client? (Select all that apply.) 1.Facial pain 2.Fever 3.Headache 4.Toothache 5.Fatigue 6.Swollen neck glands

ANS: 1, 3, 4, 5 Manifestations of chronic sinusitis include facial pain, headache, toothache, and fatigue. Fever and swollen neck glands would indicate the disorder has spread beyond the sinuses.

Which of the following are indications that a client has been exposed to excessive noise? (Select all that apply.) 1.Raising the voice to talk in normal conversation 2.Clear drainage from the ears 3.Inability to hear a conversation 2 feet away 4.Sounds are muffled 5.Ringing of the ears 6.Short periods of pain in the ears

ANS: 1, 3, 4, 5, 6 Warning signs of excessive noise exposure include raising the voice to talk in normal conversation, inability to hear a conversation 2 feet away, muffled sounds, ear ringing, and short periods of ear pain. Clear drainage from the ears does not occur with excessive noise exposure.

With which of the following can the nurse instruct a client who is experiencing pain from a sore throat? (Select all that apply.) 1.Gargle with warm salt water. 2.Eat salty foods. 3.Suck on hard candy. 4.Drink fluids. 5.Avoid citrus fruits. 6.Suck on popsicles.

ANS: 1, 3, 4, 6 Interventions to reduce the pain from a sore throat include gargling with warm salt water, sucking on throat lozenges or hard candy, sucking on flavored frozen desserts or popsicles, using a humidifier in the bedroom, and drinking fluids. The client should not be instructed to eat salty foods or avoid citrus fruits.

The nurse is planning instruction for a client experiencing dry eyes. Which of the following should be included in these instructions? (Select all that apply.) 1.Drink 8 to 10 glasses of water each day. 2.Apply petroleum jelly to the eyelids. 3.Blink more frequently. 4.Avoid sun exposure. 5.Avoid rubbing the eyes. 6.Avoid dry air.

ANS: 1, 3, 5, 6 Interventions to improve dry eyes include drink 8 to 10 glasses of water each day; blink more frequently; avoid rubbing the eyes; and know that dry air makes the condition worse. Petroleum jelly is not a treatment for dry eyes. Avoiding the sun is good advice; however, it is not proven to help with dry eyes.

A client is prescribed a medication that is ototoxic. The nurse realizes that this medication may cause: 1.permanent or temporary vision loss. 2.permanent or temporary hearing loss. 3.nausea and vomiting. 4.central nervous system (CNS) depression.

ANS: 2 Although many drugs cause nausea and vomiting and central nervous system (CNS) depression, ototoxic drugs cause hearing loss and the risks must be considered prior to suggesting these types of medications.

A client is experiencing a gradual blurring of vision in both eyes not associated with any pain. The nurse suspects the client is experiencing: 1.glaucoma. 2.cataracts. 3.macular degeneration. 4.retinal detachment.

ANS: 2 Cataracts occur as the opacity of the lens becomes cloudy, blurring the vision. It occurs in both eyes but is usually worse in one eye. Gradual eye blurring is not associated with glaucoma, macular degeneration, or retinal detachment.

A client is experiencing redness, burning, itching, and pain of the eyes. The nurse suspects the client is experiencing: 1.blepharitis. 2.conjunctivitis. 3.keratitis. 4.iritis.

ANS: 2 Clinical manifestations of conjunctivitis (pink eye) include watery eyes, redness, itching, and burning pain. Blepharitis is associated with a sticky exudate. Keratitis is associated with photophobia. Iritis is associated with blurred vision and photophobia.

A client is diagnosed with a conductive hearing loss. The nurse realizes type of hearing loss is not associated with: 1.cerumen. 2.brain damage. 3.otitis media. 4.otosclerosis.

ANS: 2 Conductive hearing loss results in a blockage of sound waves in the external or middle portions of the ear. Wax (cerumen) buildup and infections are a large part of conductive hearing loss. Otosclerosis is associated with conductive hearing loss. Brain damage is not a cause of conductive hearing loss.

A client is not able to successfully pass the whisper test. Which of the following would be indicated for this client? 1.Head CT scan 2.Audiometry 3.MRI of the brain 4.Electroencephalogram

ANS: 2 Failure to pass the whisper test would indicate the need for formal audiometry testing. The client would not need a head CT or MRI at this time. An electroencephalogram is not necessary.

The nurse should instruct a client, diagnosed with glaucoma, that the purpose of medication is to: 1.help dry up excess secretions. 2.lower the intraocular pressure. 3.strengthen the muscles of the eye. 4.improve the vision in the eye.

ANS: 2 Glaucoma is a disease that relates to the increase of intraocular pressure. The medication given will decrease this intraocular pressure. Medication for glaucoma is not used to help dry up excess secretions, strengthen the eye muscles, or improve vision.

A client was assessed as having normal intraocular pressure. The nurse would document this clients pressure as being: 1. 5 mmHg 3 mmHg. 2. 15 mmHg 3 mmHg. 3. 30 mmHg 3 mmHg. 4. 50 mmHg 3 mmHg.

ANS: 2 Normal intraocular pressure is about 15 mmHg 3 mmHg. An intraocular pressure of 5 mmHg would be too low. A pressure of 30 to 50 mmHg would be considered critical.

A client is having difficulty perceiving different colors. The nurse realizes the client may have a disorder that affects the photosensitive receptor cells of the retina, which makes the perception of color possible, or a disorder that affects the: 1.rods. 2.cones. 3.optic discs. 4.irises.

ANS: 2 Other neurosensory elements located in the retina are cones, which mediate color vision. Rods mediate black-and-white vision. The optic disc and iris are not responsible for color vision.

A client has been diagnosed with cataracts. The nurse realizes that the only treatment for this disorder is? 1.Medical management with eyedrops 2.Surgical removal of the lens 3.Cryopexy 4.Phototherapy

ANS: 2 Surgical treatment for cataracts begins when vision is sufficiently impaired. The lens is removed and the replacement artificial intraocular lens is put in place. Cataracts cannot be treated with medication alone. Cryopexy and phototherapy are not used to treat cataracts.

The hearing of an unresponsive client needs to be assessed. Which of the following will be used to assess the hearing of this client? 1.Audiometer 2.Brainstem auditory evoked responses (BAER) test 3.Rinne test 4.Weber test

ANS: 2 The BAER test calculates the ability to hear in a client who is unresponsive. The BAER measures the sound impulse needed to evoke a brain response, which will indicate the clients ability to hear. The other tests need the cooperation of the client and cannot be done at this time.

The nurse realizes that a client, diagnosed with chronic dry eyes, may have a disorder of the lacrimal gland because it: 1.covers the eye for protection. 2.produces tears to lubricate the eye. 3.helps the eye keep its shape. 4.provides blood to the eye.

ANS: 2 The lacrimal gland moistens the eye by producing and distributing tears to lubricate the eye. The lacrimal gland does not cover the eye for protection, help the eye keep its shape, or provide blood to the eye.

A client, diagnosed with keratoconus, asks the nurse what caused the disorder to develop. The nurse should instruct the client on which of the following as risk factors for the development of this disorder? (Select all that apply.) 1.Sun exposure 2.Ocular allergies 3.Wearing rigid contact lenses 4.Vigorous eye rubbing 5.Herpes simplex virus 6.Dry eyes

ANS: 2, 3, 4 Risk factors for the development of keratoconus include ocular allergies, rigid contact lens wear, and vigorous eye rubbing. Sun exposure, herpes simplex virus, and dry eyes are not risk factors for this disorder.

Which of the following should the nurse instruct a client recovering from a tonsillectomy? 1.Drink milk to promote healing. 2.Gargle with salt water. 3.Maintain good hydration. 4.Use a straw to drink.

ANS: 3 Drinking milk does not promote healing and may encourage production of mucus. Gargling and drinking with a straw may disrupt the clot at the operative site and cause bleeding. Maintaining good hydration and eating soft foods are encouraged.

The nurse is instructing the mother of a client recovering from a tonsillectomy. Which of the following should the nurse instruct the mother to report? 1.Difficulty swallowing 2.Difficulty talking 3.Excessive swallowing 4.Pain

ANS: 3 Excessive swallowing is a sign of bleeding and should be reported. Pain and difficulty talking and swallowing are expected.

The nurse realizes that the best medication treatment for open-angle glaucoma would be: 1.timolol (Timoptic) eyedrops. 2.latanoprost (Xalatan) eyedrops. 3.timolol (Timoptic) and Latanoprost (Xalatan) eyedrops. 4.metoprolol oral medication.

ANS: 3 For the best effect in the treatment of open-angle glaucoma, timolol (Timoptic) and latanoprost (Xalatan) should be prescribed together. Metoprolol is not prescribed for open-angle glaucoma.

A client is experiencing a loss of central vision but not a loss of peripheral vision. The nurse realizes the client should be evaluated for: 1.detached retina syndrome. 2.nystagmus. 3.macular degeneration. 4.conjunctivitis.

ANS: 3 Macular degeneration is a deterioration of part of the retina, causing loss of central vision but not affecting peripheral vision. The loss of central vision is not typically seen in a detached retina, nystagmus, or conjunctivitis.

A client tells the nurse that she experiences a stuffy nose, nasal pain, and postnasal drip every time she works in her companys office. Which of the following types of allergic rhinitis is this client most likely experiencing? 1.Infectious 2.Perennial 3.Occupational 4.Seasonal

ANS: 3 Occupational allergic rhinitis occurs from airborne substances in the workplace. Seasonal allergic rhinitis occurs during a specific time of the year. Perennial allergic rhinitis occurs in response to exposure to environmental allergens that can occur throughout the year. Infectious rhinitis is a nonallergic type of rhinitis.

A client diagnosed with hypertension is experiencing allergic rhinitis. The nurse realizes that the medication that would not be indicated for this client would be: 1.loratadine. 2.montelukast. 3.pseudoephedrine. 4.zafirlukast.

ANS: 3 Pseudoephedrine can be contraindicated for the patient with hypertension. Loratadine, montelukast, and zafirlukast should be used cautiously for patients with hepatic impairment.

A 16-year-old client is being prescribed a medication to treat acute sinusitis. The nurse realizes that this client should not be prescribed: 1.amoxicillin. 2.cefuroxime. 3.ciprofloxacin. 4.erythromycin.

ANS: 3 Quinolones such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) are contraindicated in children younger than 17 years of age.

A client diagnosed with viral rhinitis tells the nurse that she has been using a decongestant nasal spray for several weeks and the symptoms are getting worse. Which of the following does the nurse suspect is occurring with this client? 1.Developing pneumonia 2.Subacute rhinitis 3.Rhinitis medicamentosa 4.Chronic otitis media

ANS: 3 Rhinitis medicamentosa can occur with overuse of decongestant nasal sprays, and it leads to rebound nasal congestion that is often worse that the original nasal congestion. The use of nasal sprays does not cause pneumonia, subacute rhinitis, or chronic otitis media.

A tonometry test has been performed with a client and the results are 25 mmHg. The nurse know that: 1.the reading is low and there is no problem. 2.the reading is normal and nothing needs to be done at this time. 3.the results are high and follow-up readings and tests are needed. 4.the results are high and there is no cure to bring the pressure down.

ANS: 3 Several reading need to be taken throughout the day to establish the highest reading to be the treated pressure. Normal intraocular pressure ranges from 12 to 16 mmHg. The reading of 25 mmHg is not low or normal. Medication can be prescribed to reduce the pressure.

Which of the following would prohibit an elderly client from wanting to obtain and use a hearing aid? 1.Fears sounds will be too loud 2.Thinks not necessary for a temporary problem 3.Fears the cost 4.Prefers silence

ANS: 3 Some of the problems encountered by clients obtaining hearing aids include appearance, cost, education, unrealistic expectations, and difficulty with the care and maintenance of the hearing aids. The other choices are not problems encountered by clients obtaining hearing aids.

A client tells the nurse that she sees a shadow that is slowing getting worse in her left eye. Which of the following should the nurse do? 1.Instruct the client to return home to rest in bed. 2.Encourage the client to continue with normal daily activities. 3.Notify an ophthalmologist. 4.Encourage fluids and normal saline eyedrops.

ANS: 3 The nurse should notify an ophthalmologist with the clients symptoms. The onset of a shadow in the field of vision that will not dissipate is an indication of a detached retina. Retinal detachments rarely self-repair, and the client will need surgery. The nurse should not instruct the client to return home to rest in bed. The client should not be encouraged to continue with normal daily activities. Fluids and saline eyedrops will not help a detached retina.

The nurse is trying to communicate with a hearing-impaired client. The best way to do this is to: 1.write down all of the message. 2.shout in the impaired ear. 3.speak slowly and clearly while facing the client. 4.talk in a regular voice in the good ear.

ANS: 3 When trying to communicate with the hearing-impaired client, the nurse should speak slowly and clearly while facing the client to give her the opportunity to see and hear the words being spoken. The nurse should not write down all of the messages. Shouting in the impaired ear will not improve the clients hearing. Talking in a regular voice into the good ear will not improve hearing.

A client is demonstrating signs of peritonsillar abscess. Which of the following will the nurse most likely assess in this client? (Select all that apply.) 1.Bradypnea 2.Drop in blood pressure 3.Hot potato voice 4.Trismus 5.Dysphagia 6.Sore throat

ANS: 3, 4, 5, 6 Assessment findings consistent with peritonsillar abscess include: hot potato voice; trismus, or difficulty fully opening the mouth; dysphagia, or painful swallowing; and sore throat. Bradypnea and drop in blood pressure are not assessment findings consistent with peritonsillar abscess.

Bones classified as irregular would include: a. skull bones. b. the mandible. c. wrist bones. d. the femur.

B

The nurse is performing an assessment on a client. To test the optic nerves function, what should the nurse do? 1.Check for extraocular movement. 2.Check the pupils for reaction to light. 3.Check to see if the patient can blink. 4.Use a Snellen chart.

ANS: 4 A Snellen chart is used to assess visual acuity of the optic nerve. Extraocular movements assess cranial nerves III, IV, and VI. Pupil reaction to light and eye blinking are not functions of the optic nerve.

The nurse is performing postoperative teaching with a client recovering from a stapedectomy. Which of the following instructions would the nurse want to include in the teaching? 1.It is okay to resume exercise the next day. 2.It is okay to resume work the same day. 3.It is okay to shower and shampoo the next day. 4.It is okay to blow the nose gently one side at a time.

ANS: 4 Care must be taken not to disturb the ossicles from their position, so exercise and work should not be resumed until healing is complete. It is also important to keep the ear dry. The client should be taught to blow the nose gently on one side at a time so as not to increase the pressure in the ear.

A client is recovering from a total laryngectomy with the placement of a tracheostomy. The nurse should include which of the following instructions to this client? 1.Clean the tracheostomy tube with soap and water daily. 2.Limit protein in the diet. 3.Restrict fluids. 4.The nasogastric tube will be in for 2 weeks.

ANS: 4 Clients recovering from a laryngectomy are unable to take nutrition orally for about 10 to 14 days. During this time the client will receive nutrition via intravenous fluids, enteral feedings through a nasogastric tube, or parenteral nutrition. Protein and fluids are not limited. The tracheostomy tube is not cleaned with soap and water.

A client asks the nurse if there is an antihistamine that does not cause drowsiness. Which of the following medications would this client most likely prefer to treat allergic rhinitis? 1.Diphenhydramine 2.Chlorpheniramine maleate 3.Clemastine 4.Fexofenadine

ANS: 4 Fexofenadine (Allegra) is a second-generation antihistamine, and second-generation antihistamines exhibit less sedation than first-generation medications such as diphenhydramine, chlorpheniramine maleate, and clemastine.

A child is diagnosed with severe allergic rhinitis. Which of the following manifestations would the nurse most likely assess in this client? 1.Edematous neck glands 2.Reduced hearing 3.Pruritis 4.Frequent wiping of the nose with the palm of the hand

ANS: 4 Frequent wiping of the nose with the palm of the hand is one symptom seen in the client diagnosed with severe allergic rhinitis. Edematous neck glands, reduced hearing, and pruritis are not manifestations of severe allergic rhinitis.

A client has been diagnosed with stage IV cancer of the larynx. The nurse realizes that which of the following surgeries is recommended for this type of cancer? 1.Hemilaryngectomy 2.Partial laryngectomy 3.Supraglottic laryngectomy 4.Total laryngectomy

ANS: 4 In clients diagnosed with invasive or infiltrating tumors such as those of stage III or stage IV, the entire larynx is removed. The other surgeries only remove portions of the larynx and would be appropriate for lesser stages of the disease.

Which of the following should the nurse assess in a client diagnosed with open-angle glaucoma? 1.Degree of lost vision 2.Severity of headaches 3.Amount of blurred vision 4.Date of onset

ANS: 4 Retinal detachment is clinically manifested by flashes and floaters in the visual field. Flashes of light and floaters are not associated with cataracts, glaucoma, or conjunctivitis.

A client is experiencing epistaxis. Which of the following interventions would the nurse complete? a. Call the doctor. b. Check laboratory test results. c. Obtain an emesis basin. d. Show the patient how to pinch the nose.

ANS: 4 The initial intervention for a client with epistaxis is to show the client how to lean forward and pinch the nose against the nasal septum for about 5 to 10 minutes continuously. The other interventions are not necessary at this time.

Which of the following should the nurse instruct a client who is being fitted for a hearing aid? 1.Keep the appliance turned on at all times. 2.Store the hearing aid in a warm, moist place. 3.Batteries last for at least 1 month. 4.Clean ear molds at least once a week.

ANS: 4 The nurse should instruct the client to turn off the appliance when not in use; store in a cool, dry place; change the batteries at least once per week; and clean ear molds at least once per week.

When assessing the corneal reflex, the nurse realizes this reflex is a function of which cranial nerve (CN)? 1.CN II 2.CN III 3.CN IV 4.CN V

ANS: 4 The stimulation of the trigeminal nerve (CN V) causes the corneal reflex, a protective blink. Cranial nerves II, III, or IV do not control the corneal reflex.

The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal? a. High-tone frequency loss b. Increased elasticity of the pinna c. Thin, translucent membrane d. Shiny, pink tympanic membrane

ANS: A A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging. The pinna loses elasticity, causing earlobes to be pendulous. The eardrum may be whiter in color and more opaque and duller in the older person than in the younger adult.

When performing an otoscopic examination of a 5-year-old child with a history of chronic ear infections, the nurse sees that his right tympanic membrane is amber-yellow in color and that air bubbles are visible behind the tympanic membrane. The child reports occasional hearing loss and a popping sound with swallowing. The preliminary analysis based on this information is that the child: a. Most likely has serous otitis media. b. Has an acute purulent otitis media. c. Has evidence of a resolving cholesteatoma. d. Is experiencing the early stages of perforation.

ANS: A An amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible. The patient may have feelings of fullness, transient hearing loss, and a popping sound with swallowing. These findings most likely suggest that the child has serous otitis media. The other responses are not correct.

A 2-week-old infant can fixate on an object but cannot follow a light or bright toy. The nurse would: a. Consider this a normal finding. b. Assess the pupillary light reflex for possible blindness. c. Continue with the examination, and assess visual fields. d. Expect that a 2-week-old infant should be able to fixate and follow an object.

ANS: A By 2 to 4 weeks an infant can fixate on an object. By the age of 1 month, the infant should fixate and follow a bright light or toy.

While discussing the history of a 6-month-old infant, the mother tells the nurse that she took a significant amount of aspirin while she was pregnant. What question would the nurse want to include in the history? a. Does your baby seem to startle with loud noises? b. Has your baby had any surgeries on her ears? c. Have you noticed any drainage from her ears? d. How many ear infections has your baby had since birth?

ANS: A Children at risk for a hearing deficit include those exposed in utero to a variety of conditions, such as maternal rubella or to maternal ototoxic drugs.

The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which one of these reflects the correct procedure? a. Pulling the pinna down b. Pulling the pinna up and back c. Slightly tilting the childs head toward the examiner d. Instructing the child to touch his chin to his chest

ANS: A For an otoscopic examination on an infant or on a child under 3 years of age, the pinna is pulled down. The other responses are not part of the correct procedure.

A patients vision is recorded as 20/80 in each eye. The nurse interprets this finding to mean that the patient: a. Has poor vision. b. Has acute vision. c. Has normal vision. d. Is presbyopic.

ANS: A Normal visual acuity is 20/20 in each eye; the larger the denominator, the poorer the vision.

A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He says that it does seem to help when people speak louder or if he turns up the volume of a television or radio. The most likely cause of his hearing loss is: a. Otosclerosis. b. Presbycusis. c. Trauma to the bones. d. Frequent ear infections.

ANS: A Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. Presbycusis is a type of hearing loss that occurs with aging. Trauma and frequent ear infections are not a likely cause of his hearing loss.

When performing the corneal light reflex assessment, the nurse notes that the light is reflected at 2 oclock in each eye. The nurse should: a. Consider this a normal finding. b. Refer the individual for further evaluation. c. Document this finding as an asymmetric light reflex. d. Perform the confrontation test to validate the findings.

ANS: A Reflection of the light on the corneas should be in exactly the same spot on each eye, or symmetric. If asymmetry is noted, then the nurse should administer the cover test.

The nurse is performing an external eye examination. Which statement regarding the outer layer of the eye is true? a. The outer layer of the eye is very sensitive to touch. b. The outer layer of the eye is darkly pigmented to prevent light from reflecting internally. c. The trigeminal nerve (CN V) and the trochlear nerve (CN IV) are stimulated when the outer surface of the eye is stimulated. d. The visual receptive layer of the eye in which light waves are changed into nerve impulses is located in the outer layer of the eye.

ANS: A The cornea and the sclera make up the outer layer of the eye. The cornea is very sensitive to touch. The middle layer, the choroid, has dark pigmentation to prevent light from reflecting internally. The trigeminal nerve (CN V) and the facial nerve (CN VII) are stimulated when the outer surface of the eye is stimulated. The retina, in the inner layer of the eye, is where light waves are changed into nerve impulses.

The nurse needs to pull the portion of the ear that consists of movable cartilage and skin down and back when administering eardrops. This portion of the ear is called the: a. Auricle. b. Concha. c. Outer meatus. d. Mastoid process.

ANS: A The external ear is called the auricle or pinna and consists of movable cartilage and skin.

The nurse is testing a patients visual accommodation, which refers to which action? a. Pupillary constriction when looking at a near object b. Pupillary dilation when looking at a far object c. Changes in peripheral vision in response to light d. Involuntary blinking in the presence of bright light

ANS: A The muscle fibers of the iris contract the pupil in bright light and accommodate for near vision, which also results in pupil constriction. The other responses are not correct.

The nurse is examining a patients retina with an ophthalmoscope. Which finding is considered normal? a. Optic disc that is a yellow-orange color b. Optic disc margins that are blurred around the edges c. Presence of pigmented crescents in the macular area d. Presence of the macula located on the nasal side of the retina

ANS: A The optic disc is located on the nasal side of the retina. Its color is a creamy yellow-orange to a pink, and the edges are distinct and sharply demarcated, not blurred. A pigmented crescent is black and is due to the accumulation of pigment in the choroid.

When examining the eye, the nurse notices that the patients eyelid margins approximate completely. The nurse recognizes that this assessment finding: a. Is expected. b. May indicate a problem with extraocular muscles. c. May result in problems with tearing. d. Indicates increased intraocular pressure.

ANS: A The palpebral fissure is the elliptical open space between the eyelids, and, when closed, the lid margins approximate completely, which is a normal finding.

The nurse assesses the hearing of a 7-month-old by clapping hands. What is the expected response? The infant: a. Turns his or her head to localize the sound. b. Shows no obvious response to the noise. c. Shows a startle and acoustic blink reflex. d. Stops any movement, and appears to listen for the sound.

ANS: A With a loud sudden noise, the nurse should notice the infant turning his or her head to localize the sound and to respond to his or her own name. A startle reflex and acoustic blink reflex is expected in newborns; at age 3 to 4 months, the infant stops any movement and appears to listen.

During an examination, the nurse notices that the patient stumbles a little while walking, and, when she sits down, she holds on to the sides of the chair. The patient states, It feels like the room is spinning! The nurse notices that the patient is experiencing: a. Objective vertigo. b. Subjective vertigo. c. Tinnitus. d. Dizziness.

ANS: A With objective vertigo, the patient feels like the room spins; with subjective vertigo, the person feels like he or she is spinning. Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Dizziness is not the same as true vertigo; the person who is dizzy may feel unsteady and lightheaded.

The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? Select all that apply. a. Voice sounds are faint, muffled, and almost inaudible when the patient whispers one, two, three in a very soft voice. b. As the patient repeatedly says ninety-nine, the examiner clearly hears the words ninety- nine. c. When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said. d. As the patient says a long ee-ee-ee sound, the examiner also hears a long ee-ee-ee sound. e. As the patient says a long ee-ee-ee sound, the examiner hears a long aaaaaa sound.

ANS: A, C, D As a patient repeatedly says ninety-nine, normally the examiner hears voice sounds but cannot distinguish what is being said. If a clear ninety-nine is auscultated, then it could indicate increased lung density, which enhances the transmission of voice sounds, which is a measure of bronchophony. When a patient says a long ee-ee-ee sound, normally the examiner also hears a long ee-ee-ee sound through auscultation, which is a measure of egophony. If the examiner hears a long aaaaaa sound instead, this sound could indicate areas of consolidation or compression. With whispered pectoriloquy, as when a patient whispers a phrase such as one-two-three, the normal response when auscultating voice sounds is to hear sounds that are faint, muffled, and almost inaudible. If the examiner clearly hears the whispered voice, as if the patient is speaking through the stethoscope, then consolidation of the lung fields may exist.

A patient comes into the clinic complaining of pain in her right eye. On examination, the nurse sees a pustule at the lid margin that is painful to touch, red, and swollen. The nurse recognizes that this is a: a. Chalazion. b. Hordeolum (stye). c. Dacryocystitis. d. Blepharitis.

ANS: B A hordeolum, or stye, is a painful, red, and swollen pustule at the lid margin. A chalazion is a nodule protruding on the lid, toward the inside, and is nontender, firm, with discrete swelling. Dacryocystitis is an inflammation of the lacrimal sac. Blepharitis is inflammation of the eyelids

The nurse is performing the diagnostic positions test. Normal findings would be which of these results? a. Convergence of the eyes b. Parallel movement of both eyes c. Nystagmus in extreme superior gaze d. Slight amount of lid lag when moving the eyes from a superior to an inferior position

ANS: B A normal response for the diagnostic positions test is parallel tracking of the object with both eyes. Eye movement that is not parallel indicates a weakness of an extraocular muscle or dysfunction of the CN that innervates it.

While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex is not visible. The nurse interprets these findings to indicate a(n): a. Fungal infection. b. Acute otitis media. c. Perforation of the eardrum. d. Cholesteatoma.

ANS: B Absent or distorted light reflex and a bright red color of the eardrum are indicative of acute otitis media. (See Table 15-5 for descriptions of the other conditions.)

The nurse suspects that a patient has otitis media. Early signs of otitis media include which of these findings of the tympanic membrane? a. Red and bulging b. Hypomobility c. Retraction with landmarks clearly visible d. Flat, slightly pulled in at the center, and moves with insufflation

ANS: B An early sign of otitis media is hypomobility of the tympanic membrane. As pressure increases, the tympanic membrane begins to bulge.

Which of these assessment findings would the nurse expect to see when examining the eyes of a black patient? a. Increased night vision b. Dark retinal background c. Increased photosensitivity d. Narrowed palpebral fissures

ANS: B An ethnically based variability in the color of the iris and in retinal pigmentation exists, with darker irides having darker retinas behind them.

The nurse is performing a middle ear assessment on a 15-year-old patient who has had a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 oclock and landmarks visible. The nurse should: a. Refer the patient for the possibility of a fungal infection. b. Know that these are scars caused from frequent ear infections. c. Consider that these findings may represent the presence of blood in the middle ear. d. Be concerned about the ability to hear because of this abnormality on the tympanic membrane.

ANS: B Dense white patches on the tympanic membrane are sequelae of repeated ear infections. They do not necessarily affect hearing.

The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal? a. If the drum has ruptured, then purulent drainage will result. b. Bloody or clear watery drainage can indicate a basal skull fracture. c. The auditory canal many be occluded from increased cerumen. d. Foreign bodies from the accident may cause occlusion of the canal.

ANS: B Frank blood or clear watery drainage (cerebrospinal leak) after a trauma suggests a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media.

A patient in her first trimester of pregnancy is diagnosed with rubella. Which of these statements is correct regarding the significance of this in relation to the infants hearing? a. Rubella may affect the mothers hearing but not the infants. b. Rubella can damage the infants organ of Corti, which will impair hearing. c. Rubella is only dangerous to the infant in the second trimester of pregnancy. d. Rubella can impair the development of CN VIII and thus affect hearing.

ANS: B If maternal rubella infection occurs during the first trimester, then it can damage the organ of Corti and impair hearing.

A woman who is in the second trimester of pregnancy mentions that she has had more nosebleeds than ever since she became pregnant. The nurse recognizes that this is a result of: a. A problem with the patients coagulation system b. Increased vascularity in the upper respiratory tract as a result of the pregnancy c. Increased susceptibility to colds and nasal irritation d. Inappropriate use of nasal sprays.

ANS: B Nasal stuffiness and epistaxis may occur during pregnancy as a result of increased vascularity in the upper respiratory tract.

The nurse is performing an eye assessment on an 80-year-old patient. Which of these findings is considered abnormal? a. Decrease in tear production b. Unequal pupillary constriction in response to light c. Presence of arcus senilis observed around the cornea d. Loss of the outer hair on the eyebrows attributable to a decrease in hair follicles

ANS: B Pupils are small in the older adult, and the pupillary light reflex may be slowed, but pupillary constriction should be symmetric. The assessment findings in the other responses are considered normal in older persons.

A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding: a. Is normal for people of his age. b. Is a characteristic of recruitment. c. May indicate a middle ear infection. d. Indicates that the patient has a cerumen impaction.

ANS: B Recruitment is significant hearing loss occurring when speech is at low intensity, but sound actually becomes painful when the speaker repeats at a louder volume. The other responses are not correct.

The nurse is conducting a visual examination. Which of these statements regarding visual pathways and visual fields is true? a. The right side of the brain interprets the vision for the right eye. b. The image formed on the retina is upside down and reversed from its actual appearance in the outside world. c. Light rays are refracted through the transparent media of the eye before striking the pupil. d. Light impulses are conducted through the optic nerve to the temporal lobes of the brain.

ANS: B The image formed on the retina is upside down and reversed from its actual appearance in the outside world. The light rays are refracted through the transparent media of the eye before striking the retina, and the nerve impulses are conducted through the optic nerve tract to the visual cortex of the occipital lobe of the brain. The left side of the brain interprets vision for the right eye.

The nurse is reviewing in age-related changes in the eye for a class. Which of these physiologic changes is responsible for presbyopia? a. Degeneration of the cornea b. Loss of lens elasticity c. Decreased adaptation to darkness d. Decreased distance vision abilities

ANS: B The lens loses elasticity and decreases its ability to change shape to accommodate for near vision. This condition is called presbyopia.

A patients vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that: a. At 30 feet the patient can read the entire chart. b. The patient can read at 20 feet what a person with normal vision can read at 30 feet. c. The patient can read the chart from 20 feet in the left eye and 30 feet in the right eye. d. The patient can read from 30 feet what a person with normal vision can read from 20 feet.

ANS: B The top number indicates the distance the person is standing from the chart; the denominator gives the distance at which a normal eye can see.

When examining the ear with an otoscope, the nurse notes that the tympanic membrane should appear: a. Light pink with a slight bulge. b. Pearly gray and slightly concave. c. Pulled in at the base of the cone of light. d. Whitish with a small fleck of light in the superior portion.

ANS: B The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles.

A 17-year-old student is a swimmer on her high schools swim team. She has had three bouts of otitis externa this season and wants to know what to do to prevent it. The nurse instructs her to: a. Use a cotton-tipped swab to dry the ear canals thoroughly after each swim. b. Use rubbing alcohol or 2% acetic acid eardrops after every swim. c. Irrigate the ears with warm water and a bulb syringe after each swim. d. Rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.

ANS: B With otitis externa (swimmers ear), swimming causes the external canal to become waterlogged and swell; skinfolds are set up for infection. Otitis externa can be prevented by using rubbing alcohol or 2% acetic acid eardrops after every swim.

A patient comes to the emergency department after a boxing match, and his left eye is swollen almost shut. He has bruises on his face and neck. He says he is worried because he cant see well from his left eye. The physician suspects retinal damage. The nurse recognizes that signs of retinal detachment include: a. Loss of central vision. b. Shadow or diminished vision in one quadrant or one half of the visual field. c. Loss of peripheral vision. d. Sudden loss of pupillary constriction and accommodation.

ANS: B With retinal detachment, the person has shadows or diminished vision in one quadrant or one half of the visual field. The other responses are not signs of retinal detachment.

In performing a voice test to assess hearing, which of these actions would the nurse perform? a. Shield the lips so that the sound is muffled. b. Whisper a set of random numbers and letters, and then ask the patient to repeat them. c. Ask the patient to place his finger in his ear to occlude outside noise. d. Stand approximately 4 feet away to ensure that the patient can really hear at this distance.

ANS: B With the head 30 to 60 cm (1 to 2 feet) from the patients ear, the examiner exhales and slowly whispers a set of random numbers and letters, such as 5, B, 6. Normally, the patient is asked to repeat each number and letter correctly after hearing the examiner say them.

The nurse is testing the hearing of a 78-year-old man and is reminded of the changes in hearing that occur with aging that include which of the following? Select all that apply. a. Hearing loss related to aging begins in the mid 40s. b. Progression of hearing loss is slow. c. The aging person has low-frequency tone loss. d. The aging person may find it harder to hear consonants than vowels. e. Sounds may be garbled and difficult to localize. f. Hearing loss reflects nerve degeneration of the middle ear.

ANS: B, D, E Presbycusis is a type of hearing loss that occurs with aging and is found in 60% of those older than 65 years. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve, and it slowly progresses after the age of 50 years. The person first notices a high-frequency tone loss; it is harder to hear consonants (high-pitched components of speech) than vowels, which makes words sound garbled. The ability to localize sound is also impaired.

A patient has been shown to have a sensorineural hearing loss. During the assessment, it would be important for the nurse to: a. Speak loudly so the patient can hear the questions. b. Assess for middle ear infection as a possible cause. c. Ask the patient what medications he is currently taking. d. Look for the source of the obstruction in the external ear.

ANS: C A simple increase in amplitude may not enable the person to understand spoken words. Sensorineural hearing loss may be caused by presbycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the cochlea.

A patient with a middle ear infection asks the nurse, What does the middle ear do? The nurse responds by telling the patient that the middle ear functions to: a. Maintain balance. b. Interpret sounds as they enter the ear. c. Conduct vibrations of sounds to the inner ear. d. Increase amplitude of sound for the inner ear to function.

ANS: C Among its other functions, the middle ear conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. The other responses are not functions of the middle ear.

The nurse is performing an assessment on a 65-year-old man. He reports a crusty nodule behind the pinna. It intermittently bleeds and has not healed over the past 6 months. On physical assessment, the nurse finds an ulcerated crusted nodule with an indurated base. The preliminary analysis in this situation is that this: a. Is most likely a benign sebaceous cyst. b. Is most likely a keloid. c. Could be a potential carcinoma, and the patient should be referred for a biopsy. d. Is a tophus, which is common in the older adult and is a sign of gout.

ANS: C An ulcerated crusted nodule with an indurated base that fails to heal is characteristic of a carcinoma. These lesions fail to heal and intermittently bleed. Individuals with such symptoms should be referred for a biopsy). The other responses are not correct.

A patient has been admitted after an accident at work. During the assessment, the patient is having trouble hearing and states, I dont know what the matter is. All of a sudden, I cant hear you out of my left ear! What should the nurse do next? a. Make note of this finding for the report to the next shift. b. Prepare to remove cerumen from the patients ear. c. Notify the patients health care provider. d. Irrigate the ear with rubbing alcohol.

ANS: C Any sudden loss of hearing in one or both ears that is not associated with an upper respiratory infection needs to be reported at once to the patients health care provider. Hearing loss associated with trauma is often sudden. Irrigating the ear or removing cerumen is not appropriate at this time.

During an assessment of a 20-year-old Asian patient, the nurse notices that he has dry, flaky cerumen in his canal. What is the significance of this finding? This finding: a. Is probably the result of lesions from eczema in his ear. b. Represents poor hygiene. c. Is a normal finding, and no further follow-up is necessary. d. Could be indicative of change in cilia; the nurse should assess for hearing loss.

ANS: C Asians and Native Americans are more likely to have dry cerumen, whereas Blacks and Whites usually have wet cerumen.

The nurse is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination? a. Immobility of the drum is a normal finding. b. An injected membrane would indicate an infection. c. The normal membrane may appear thick and opaque. d. The appearance of the membrane is identical to that of an adult.

ANS: C During the first few days after the birth, the tympanic membrane of a newborn often appears thickened and opaque. It may look injected and have a mild redness from increased vascularity. The other statements are not correct.

A mother asks when her newborn infants eyesight will be developed. The nurse should reply: a. Vision is not totally developed until 2 years of age. b. Infants develop the ability to focus on an object at approximately 8 months of age. c. By approximately 3 months of age, infants develop more coordinated eye movements and can fixate on an object. d. Most infants have uncoordinated eye movements for the first year of life.

ANS: C Eye movements may be poorly coordinated at birth, but by 3 to 4 months of age, the infant should establish binocularity and should be able to fixate simultaneously on a single image with both eyes.

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of: a. Adventitious sounds and limited chest expansion. b. Increased tactile fremitus and dull percussion tones. c. Muffled voice sounds and symmetric tactile fremitus. d. Absent voice sounds and hyperresonant percussion tones.

ANS: C Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious sounds.

The nurse notices the presence of periorbital edema when performing an eye assessment on a 70- year-old patient. The nurse should: a. Check for the presence of exophthalmos. b. Suspect that the patient has hyperthyroidism. c. Ask the patient if he or she has a history of heart failure. d. Assess for blepharitis, which is often associated with periorbital edema.

ANS: C Periorbital edema occurs with local infections, crying, and systemic conditions such as heart failure, renal failure, allergy, and hypothyroidism. Periorbital edema is not associated with blepharitis.

A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says that he cant always tell where the sound is coming from and the words often sound mixed up. What might the nurse suspect as the cause for this change? a. Atrophy of the apocrine glands b. Cilia becoming coarse and stiff c. Nerve degeneration in the inner ear d. Scarring of the tympanic membrane

ANS: C Presbycusis is a type of hearing loss that occurs in 60% of those older than 65 years of age, even in those living in a quiet environment. This sensorineural loss is gradual and caused by nerve degeneration in the inner ear. Words sound garbled, and the ability to localize sound is also impaired. This communication dysfunction is accentuated when background noise is present.

A 60-year-old man is at the clinic for an eye examination. The nurse suspects that he has ptosis of one eye. How should the nurse check for this? a. Perform the confrontation test. b. Assess the individuals near vision. c. Observe the distance between the palpebral fissures. d. Perform the corneal light test, and look for symmetry of the light reflex.

ANS: C Ptosis is a drooping of the upper eyelid that would be apparent by observing the distance between the upper and lower eyelids. The confrontation test measures peripheral vision. Measuring near vision or the corneal light test does not check for ptosis.

When examining a patients eyes, the nurse recalls that stimulation of the sympathetic branch of the autonomic nervous system: a. Causes pupillary constriction. b. Adjusts the eye for near vision. c. Elevates the eyelid and dilates the pupil. d. Causes contraction of the ciliary body.

ANS: C Stimulation of the sympathetic branch of the autonomic nervous system dilates the pupil and elevates the eyelid. Parasympathetic nervous system stimulation causes the pupil to constrict. The muscle fibers of the iris contract the pupil in bright light to accommodate for near vision. The ciliary body controls the thickness of the lens.

The nurse is assessing color vision of a male child. Which statement is correct? The nurse should: a. Check color vision annually until the age of 18 years. b. Ask the child to identify the color of his or her clothing. c. Test for color vision once between the ages of 4 and 8 years. d. Begin color vision screening at the childs 2-year checkup.

ANS: C Test boys only once for color vision between the ages of 4 and 8 years. Color vision is not tested in girls because it is rare in girls. Testing is performed with the Ishihara test, which is a series of polychromatic cards.

The nurse is preparing to assess the visual acuity of a 16-year-old patient. How should the nurse proceed? a. Perform the confrontation test. b. Ask the patient to read the print on a handheld Jaeger card. c. Use the Snellen chart positioned 20 feet away from the patient. d. Determine the patients ability to read newsprint at a distance of 12 to 14 inches.

ANS: C The Snellen alphabet chart is the most commonly used and most accurate measure of visual acuity. The confrontation test is a gross measure of peripheral vision. The Jaeger card or newspaper tests are used to test near vision.

The articulation of the mandible and the temporal bone is known as the: a. Intervertebral foramen. b. Condyle of the mandible. c. Temporomandibular joint. d. Zygomatic arch of the temporal bone.

ANS: C The articulation of the mandible and the temporal bone is the temporomandibular joint. The other responses are not correct.

The nurse is examining a patients ears and notices cerumen in the external canal. Which of these statements about cerumen is correct? a. Sticky honey-colored cerumen is a sign of infection. b. The presence of cerumen is indicative of poor hygiene. c. The purpose of cerumen is to protect and lubricate the ear. d. Cerumen is necessary for transmitting sound through the auditory canal.

ANS: C The ear is lined with glands that secrete cerumen, which is a yellow waxy material that lubricates and protects the ear.

The nurse is reviewing the function of the cranial nerves (CNs). Which CN is responsible for conducting nerve impulses to the brain from the organ of Corti? a. I b. III c. VIII d. XI

ANS: C The nerve impulses are conducted by the auditory portion of CN VIII to the brain.

The nurse is performing an otoscopic examination on an adult. Which of these actions is correct? a. Tilting the persons head forward during the examination b. Once the speculum is in the ear, releasing the traction c. Pulling the pinna up and back before inserting the speculum d. Using the smallest speculum to decrease the amount of discomfort

ANS: C The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed.

When a light is directed across the iris of a patients eye from the temporal side, the nurse is assessing for: a. Drainage from dacryocystitis. b. Presence of conjunctivitis over the iris. c. Presence of shadows, which may indicate glaucoma. d. Scattered light reflex, which may be indicative of cataracts.

ANS: C The presence of shadows in the anterior chamber may be a sign of acute angle-closure glaucoma. The normal iris is flat and creates no shadows. This method is not correct for the assessment of dacryocystitis, conjunctivitis, or cataracts.

In using the ophthalmoscope to assess a patients eyes, the nurse notices a red glow in the patients pupils. On the basis of this finding, the nurse would: a. Suspect that an opacity is present in the lens or cornea. b. Check the light source of the ophthalmoscope to verify that it is functioning. c. Consider the red glow a normal reflection of the ophthalmoscope light off the inner retina. d. Continue with the ophthalmoscopic examination, and refer the patient for further evaluation.

ANS: C The red glow filling the persons pupil is the red reflex and is a normal finding caused by the reflection of the ophthalmoscope light off the inner retina. The other responses are not correct.

To palpate the temporomandibular joint, the nurses fingers should be placed in the depression __________ of the ear. a. Distal to the helix b. Proximal to the helix c. Anterior to the tragus d. Posterior to the tragus

ANS: C The temporomandibular joint can be felt in the depression anterior to the tragus of the ear. The other locations are not correct.

During an examination, the patient states he is hearing a buzzing sound and says that it is driving me crazy! The nurse recognizes that this symptom indicates: a. Vertigo. b. Pruritus. c. Tinnitus. d. Cholesteatoma.

ANS: C Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders.

When assessing the pupillary light reflex, the nurse should use which technique? a. Shine a penlight from directly in front of the patient, and inspect for pupillary constriction. b. Ask the patient to follow the penlight in eight directions, and observe for bilateral pupil constriction. c. Shine a light across the pupil from the side, and observe for direct and consensual pupillary c. constriction. d. Ask the patient to focus on a distant object. Then ask the patient to follow the penlight to d. approximately 7 cm from the nose.

ANS: C To test the pupillary light reflex, the nurse should advance a light in from the side and note the direct and consensual pupillary constriction.

In a patient who has anisocoria, the nurse would expect to observe: a. Dilated pupils. b. Excessive tearing. c. Pupils of unequal size. d. Uneven curvature of the lens.

ANS: C Unequal pupil size is termed anisocoria. It normally exists in 5% of the population but may also be indicative of central nervous system disease.

During an otoscopic examination, the nurse notices an area of black and white dots on the tympanic membrane and the ear canal wall. What does this finding suggest? a. Malignancy b. Viral infection c. Blood in the middle ear d. Yeast or fungal infection

ANS: D A colony of black or white dots on the drum or canal wall suggests a yeast or fungal infection (otomycosis).

A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The nurse should: a. Examine the retina to determine the number of floaters. b. Presume the patient has glaucoma and refer him for further testing. c. Consider these to be abnormal findings, and refer him to an ophthalmologist. d. Know that floaters are usually insignificant and are caused by condensed vitreous fibers.

ANS: D Floaters are a common sensation with myopia or after middle age and are attributable to condensed vitreous fibers. Floaters or spots are not usually significant, but the acute onset of floaters may occur with retinal detachment.

An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish-blue in color with small vesicles. The nurse would need to know additional information that includes which of these? a. Any change in the ability to hear b. Any recent drainage from the ear c. Recent history of trauma to the ear d. Any prolonged exposure to extreme cold

ANS: D Frostbite causes reddish-blue discoloration and swelling of the auricle after exposure to extreme cold. Vesicles or bullae may develop, and the person feels pain and tenderness.

During an interview, the patient states he has the sensation that everything around him is spinning. The nurse recognizes that the portion of the ear responsible for this sensation is the: a. Cochlea. b. CN VIII. c. Organ of Corti. d. Labyrinth.

ANS: D If the labyrinth ever becomes inflamed, then it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo.

A patient is unable to read even the largest letters on the Snellen chart. The nurse should take which action next? a. Refer the patient to an ophthalmologist or optometrist for further evaluation. b. Assess whether the patient can count the nurses fingers when they are placed in front of his or her eyes. c. Ask the patient to put on his or her reading glasses and attempt to read the Snellen chart c. again. d. Shorten the distance between the patient and the chart until the letters are seen, and record d. that distance.

ANS: D If the person is unable to see even the largest letters when standing 20 feet from the chart, then the nurse should shorten the distance to the chart until the letters are seen, and record that distance (e.g., 10/200). If visual acuity is even lower, then the nurse should assess whether the person can count fingers when they are spread in front of the eyes or can distinguish light perception from a penlight. If vision is poorer than 20/30, then a referral to an ophthalmologist or optometrist is necessary, but the nurse must first assess the visual acuity.

In performing an examination of a 3-year-old child with a suspected ear infection, the nurse would: a. Omit the otoscopic examination if the child has a fever. b. Pull the ear up and back before inserting the speculum. c. Ask the mother to leave the room while examining the child. d. Perform the otoscopic examination at the end of the assessment.

ANS: D In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever. For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination.

The nurse is reviewing causes of increased intraocular pressure. Which of these factors determines intraocular pressure? a. Thickness or bulging of the lens b. Posterior chamber as it accommodates increased fluid c. Contraction of the ciliary body in response to the aqueous within the eye d. Amount of aqueous produced and resistance to its outflow at the angle of the anterior chamber

ANS: D Intraocular pressure is determined by a balance between the amount of aqueous produced and the resistance to its outflow at the angle of the anterior chamber. The other responses are incorrect.

During ocular examinations, the nurse keeps in mind that movement of the extraocular muscles is: a. Decreased in the older adult. b. Impaired in a patient with cataracts. c. Stimulated by cranial nerves (CNs) I and II. d. Stimulated by CNs III, IV, and VI.

ANS: D Movement of the extraocular muscles is stimulated by three CNs: III, IV, and VI.

During an examination of the eye, the nurse would expect what normal finding when assessing the lacrimal apparatus? a. Presence of tears along the inner canthus b. Blocked nasolacrimal duct in a newborn infant c. Slight swelling over the upper lid and along the bony orbit if the individual has a cold d. Absence of drainage from the puncta when pressing against the inner orbital rim

ANS: D No swelling, redness, or drainage from the puncta should be observed when it is pressed. Regurgitation of fluid from the puncta, when pressed, indicates duct blockage. The lacrimal glands are not functional at birth.

During an assessment of the sclera of a black patient, the nurse would consider which of these an expected finding? a. Yellow fatty deposits over the cornea b. Pallor near the outer canthus of the lower lid c. Yellow color of the sclera that extends up to the iris d. Presence of small brown macules on the sclera

ANS: D Normally in dark-skinned people, small brown macules may be observed in the sclera.

The mother of a 2-year-old toddler is concerned about the upcoming placement of tympanostomy tubes in her sons ears. The nurse would include which of these statements in the teaching plan? a. The tubes are placed in the inner ear. b. The tubes are used in children with sensorineural loss. c. The tubes are permanently inserted during a surgical procedure. d. The purpose of the tubes is to decrease the pressure and allow for drainage.

ANS: D Polyethylene tubes are surgically inserted into the eardrum to relieve middle ear pressure and to promote drainage of chronic or recurrent middle ear infections. Tubes spontaneously extrude in 6 months to 1 year.

The nurse is performing an eye-screening clinic at a daycare center. When examining a 2-year- old child, the nurse suspects that the child has a lazy eye and should: a. Examine the external structures of the eye. b. Assess visual acuity with the Snellen eye chart. c. Assess the childs visual fields with the confrontation test. d. Test for strabismus by performing the corneal light reflex test.

ANS: D Testing for strabismus is done by performing the corneal light reflex test and the cover test. The Snellen eye chart and confrontation test are not used to test for strabismus.MSC: Client Needs: Health Promotion and Maintenance

The nurse is assessing a patients eyes for the accommodation response and would expect to see which normal finding? a. Dilation of the pupils b. Consensual light reflex c. Conjugate movement of the eyes d. Convergence of the axes of the eyes

ANS: D The accommodation reaction includes pupillary constriction and convergence of the axes of the eyes. The other responses are not correct.

The nurse is reviewing the structures of the ear. Which of these statements concerning the eustachian tube is true? a. The eustachian tube is responsible for the production of cerumen. b. It remains open except when swallowing or yawning. c. The eustachian tube allows passage of air between the middle and outer ear. d. It helps equalize air pressure on both sides of the tympanic membrane.

ANS: D The eustachian tube allows an equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture during, for example, altitude changes in an airplane. The tube is normally closed, but it opens with swallowing or yawning.

The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse? a. It is unusual for a small child to have frequent ear infections unless something else is wrong. b. We need to check the immune system of your son to determine why he is having so many ear infections. c. Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear. d. Your sons eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.

ANS: D The infants eustachian tube is relatively shorter and wider than the adults eustachian tube, and its position is more horizontal; consequently, pathogens from the nasopharynx can more easily migrate through to the middle ear. The other responses are not appropriate.MSC: Client Needs: Health Promotion and Maintenance

In an individual with otitis externa, which of these signs would the nurse expect to find on assessment? a. Rhinorrhea b. Periorbital edema c. Pain over the maxillary sinuses d. Enlarged superficial cervical nodes

ANS: D The lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes. The signs are severe swelling of the canal, inflammation, and tenderness. Rhinorrhea, periorbital edema, and pain over the maxillary sinuses do not occur with otitis externa.

A patient states, Whenever I open my mouth real wide, I feel this popping sensation in front of my ears. To further examine this, the nurse would: a. Place the stethoscope over the temporomandibular joint, and listen for bruits. b. Place the hands over his ears, and ask him to open his mouth really wide. c. Place one hand on his forehead and the other on his jaw, and ask him to try to open his mouth. d. Place a finger on his temporomandibular joint, and ask him to open and close his mouth.

ANS: D The nurse should palpate the temporomandibular joint by placing his or her fingers over the joint as the person opens and closes the mouth.

A patient has a normal pupillary light reflex. The nurse recognizes that this reflex indicates that: a. The eyes converge to focus on the light. b. Light is reflected at the same spot in both eyes. c. The eye focuses the image in the center of the pupil. d. Constriction of both pupils occurs in response to bright light.

ANS: D The pupillary light reflex is the normal constriction of the pupils when bright light shines on the retina. The other responses are not correct.

The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation? a. Do you ever notice ringing or crackling in your ears? b. When was the last time you had your hearing checked? c. Have you ever been told that you have any type of hearing loss? d. Is there any relationship between the ear pain and the discharge you mentioned?

ANS: D Typically with perforation, ear pain occurs first, stopping with a popping sensation, and then drainage occurs.

You are in the park playing with your children when you see that your friend is screaming for help. Her toddler has fallen and there is a stick lodged in his eye. The child is kicking and screaming and grabbing for the stick. You: a. instruct his mother to hold him securely and not allow him to touch the stick, then carefully remove the stick from the eye. b. stabilize the foreign object and accompany the mother and child to the local ER. c. find a water fountain, hold the child to the water, and flush the eye. d. call 911.

B

A patient presents to the clinician with a sore throat, fever of 100.7, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be? a. The patient should be instructed to rest and increase fluid intake as the infection is most likely viral and will resolve without antibiotic treatment. b. Because the patient does not have strep throat, the clinician should start broad spectrum antibiotics in order to cover the offending pathogen. c. A throat culture should be performed to confirm the results of the rapid strep test. d. The patient should be treated with antibiotics for strep throat as the rapid strep test is not very sensitive.

C

Otitis media is considered chronic when: a. Inflammation persists more than 3 months with intermittent or persistent otic discharge. b. There are more than six occurrences of otitis media in a 1-year period. c. Otitis media does not resolve after two courses of antibiotics. d. All of the above

a

You have a patient who is a positive for Strep on rapid antigen testing (rapid strep test). You order amoxacillin after checking for drug allergies (patient is negative) but he returns 3 days later, reporting that his temperature has gone up, not down (101.5 F in office). You also note significant adenopathy, most notably in the posterior and anterior cervical chains, some hepatomegaly, and a diffuse rash. You decide: a. to refer the patient. b. that he is having an allergic response and needs to be changed to a macrolide antibiotic. c. that his antibiotic dosage is not sufficient and should be changed. d. that he possibly has mononucleosis concurrent with his strep infection.

D

Which subtype of cataracts is characterized by significant nearsightedness and a slow indolent course? a. Nuclear cataracts b. Cortical cataracts c. Posterior cataracts d. Immature cataracts

a

Which type of stomatitis results in necrotic ulceration of the oral mucous membranes? a. Vincent's stomatitis b. Allergic stomatitis c. Apthous stomatitis d. Herpetic stomatitis

a

Severe pain associated with acute otitis media signifies perforation of the tympanic membrane T/F

F

As diabetic retinopathy progresses, the presence of 'cotton wool' spots can be detected. Cotton wool spots refer to: a. Nerve fiber layer infarctions b. Blood vessel proliferation c. V enous beading d. Retinal hemorrhage

a

Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis? a. Vasomotor rhinitis b. Rhinitis medicamentosum c. Atrophic rhinitis d. Viral rhinitis

a

Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure? a. 0 to 7 mm Hg b. 8 to 21 mm Hg c. 22 to 40 mm Hg d. 40 to 80 mm Hg

b

An acutely presenting, erythematous, tender lump within the eyelid is called: a. Blepharitis b. Hordeolum c. Chalazion d. Iritis

b

The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection? a. HSV type 2 b. HIV c. Pneumonia d. Syphilis

b

Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis? a. IgA b. IgE c. IgG d. IgM

b

A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma? a. The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma. b. The clinician can definitively diagnosis open-angle glaucoma based on the subjective complaints of the patient. c. Physical diagnosis relies on gonioscopic evaluation of the angle by an ophthalmologist. d. Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve.

c

Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than: a. 4 weeks b. 8 weeks c. 12 weeks d. 16 weeks

c

The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient's mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test? a. Weber test b. Schwabach test c. Rinne test d. Auditory brainstem response (ABR) test

c

The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis? a. Viral conjunctivitis b. Keratoconjunctivitis c. Bacterial conjunctivitis d. Allergic conjunctivitis

c

The most significant precipitating event leading to otitis media with effusion is: a. Pharyngitis b. Allergies c. Viral upper respiratory infection (URI) d. Perforation of the eardrum

c

Which of the following antibiotics provides the best coverage in acute or chronic sinusitis when gram-negative organisms are suspected? a. Penicillin V b. Amoxicillin c. Levofloxacin d. Clindamycin

c

Which of the following statements is true concerning the use of bilberry as a complementary therapy for cataracts? a. The body converts bilberry to vitamin A, which helps to maintain a healthy lens. b. Bilberry blocks an enzyme that leads to sorbitol accumulation that contributes to cataract formation in diabetes. c. Bilberry boosts oxygen and blood delivery to the eye. d. Bilberry is a good choice for patients with diabetes as it does not interact with antidiabetic drugs.

c

A patient presents to the clinician complaining of ear pain. On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition? a. Otitis media b. Meniere's disease c. Tinnitus d. Otitis externa

d

Heart valve damage resulting from acute rheumatic fever is a long-term sequelae resulting from infection with which of the following pathogens? a. Coxsackievirus b. Cytomegalovirus c. Francisella tularensis d. Group A streptococcus

d

In which of the following situations would referral to a specialist be needed for sinusitis? a. Recurrent sinusitis b. Allergic sinusitis c. Sinusitis that is refractory to antibiotic therapy b. All of the above

d

Patients with acute otitis media should be referred to a specialist in which of the following situations? a. Concurrent vertigo or ataxia b. Failed closure of a ruptured tympanic membrane c. If symptoms worsen after 3 or 4 days of treatment d. All of the above

d

Which of the following is an example of sensorineural hearing loss? a. Perforation of the tympanic membrane b. Otosclerosis c. Cholesteatoma d. Presbycusis

d