Test 2 213

.The patient with a corneal transplant asks how long he must wear the eye shield at night. The nurse instructs the patient that he should wear the shield for at least what period of time?

1 month

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in hours of the onset of symptoms to have maximum benefit

3 hours

Following a LASIK surgery, the nurse should explain to the patient that vision will improve:

4-6 weeks

The nurse is aware that the patient has 20/40 vision. This means the patient can see at 20 ft. What the normal eye can see at ___ ft

40 ft

A patient who had an enucleation of the right eye has been admitted PACU. What should the nurse include in the plan of care?

A pressure dressing will be applied to the right eye socket and the dressing should be checked every hour for the first 24 hours

After instilling an eye drop that has a systemic effect, the nurse should press on which of the following to prevent absorption into the circulation?

apply pressure to the inner canthus

A tonometer reading reflects the amount of pressure exerted by which component of the eye?

aqueous humor

When the patient in the emergency room complains of seeing flashing lights and a curtain down over his right eye, the nurse recognizes this as a symptom of which condition?

detached retina

The nurse is caring for a 40-year-old patient. How often should the nurse recommend that this patient undergo testing for glaucoma?

every 5 years

. How often should eye cosmetics be discarded?

every 6 months

The nurse assess the age-related changes that occur in the eye. Which finding is/are consistent with aging

he age-related changes that occur in the eye. Which finding is/are consistent with aging. The cornea flattens and increases astigmatism. Water loss occurs from the lens. Presbyopia occurs. Ectropion occurs.

What does diabetes retinopathy result from?

high blood sugar levels

Which is a sign of acute closure glaucoma (AACG)?

large fixed pupil

A nurse caring for a patient with macular degeneration knows that the patient requires the greatest amount of assistance with which of the following ADL's?

maybe walk, dress, cook, drive, read

The nurse is caring for a patient who has come to the ambulatory care clinical after experiencing a chemical burn on the eye. The nurse should irrigate the patient's eye with which solution?

normal saline

The nurse is caring for a patient who was presented to an ambulatory care clinic with a large amount of sand in his eyes following an all-terrain vehicle accident. After the nurse completes eye irrigation, patient reports that his eyes still hurt and feel irritated. Which action is most appropriate?

notify the physician

What is a common mistake that hinders communication when communicating with the hearing impaired?

overaccentuating words

The nurse is caring for a patient following a left corneal transplant. when positioning the patient, the nurse correctly assists the patient into which positions (select all that apply)

supine, supine iwht head on a small pillow, right side lying

The patient tells the nurse that he is legally blind. How would this information impact the nurse's plan of care for this patient?

the nurse would need to determine how this patient's visual impairment affects normal functioning

The nurse is performing postoperative teaching for a patient who underwent a left cataract removal. Which information should the nurse include in the teaching plan? (select all that apply)

sleep on the right side. take a stool softener to avoid straining

The nurse interviewing a patient with macular degeneration will inquire about the patient's habits, especially _____, which significant contributor to the disorder

smoking

What should a patient who has had a cataract repair avoid?

sunlight

The nurse is teaching a patient who is scheduled to undergo surgery to manage glaucoma. Which statement indicates that the patient understands the nurse's teaching about the procedure?

the surgery wll increase outflow of aqueous humor

Which medications may cause ototoxicity? (select all apply)

vancomycin, furosemide, ibuprofen

A patient tilts her head to the side while reading a pamphlet. The nurse recognizes that this action may be an attempt to compensate for which problem

Diplopia

A client is newly fitted with a hearing aid. Which of the following client statements indicates a need for intervention by the nurse?

"I should gradually increase the time that I wear the hearing aid."

Which of the following are causes of cataracts?

Aging, eye traume

The nurse is caring for a patient who requires neurologic checks. When performing an assessment, how should the nurse best evaluate the patient's thinking?

Ask the pt to add 3 numbers together in his head

. What is the nurse assessing when asking the patient, who is the president of the United state? During a level of consciousness assessment?

Assessment of knowledge

when performing the otoscopic examination on a patient with a hearing loss, which of the following indicates an unexpected finding?

Black cerumen partially occluding the TM

When the nurse interviewing her patient asks about his vision, he says that the last time he had it tested, it was 20/50. This means

Can read at 20 feet what a person with normal vision can read at 50 feet.

Which of the following would the nurse NOT assess when performing the FOUR (Full Outline of Unresponsiveness) tool assessment?

Eye response, motor response, brain stem response, respiratory function

A patient comes to the ambulatory clinic after getting hay into the eyes while farming. Which action(s) should the nurse implement?

Flush the eye with warm saline, hold the eyelids open, tilt the head back, use a moistened sterile cotton swab

. A nurse is caring for a client who has just been diagnosed with angle-closure glaucoma. Which of the following should the nurse expect?

Gradual loss of peripheral vision

Four hours after a stapedectomy, the patient complains that hearing has not improved at all. What knowledge would the nurse use to shape a response?

Hearing improvement will not be noted until edema subsides, and the packing is removed

The student nurse is ambulating with a blind patient. Which technique indicates that the student nurse requires further instruction?

Holding the patient's dominant arm Instructing the patient to put both hands on his shoulders Holding the patient's hand Walking just behind the patient

The nurse is orienting a visually impaired patient to a meal plate. Which action is most appropriate?

Identify food according to an imaginary clock face

The nurse is caring for a patient who has developed keratitis. When planning care, the nurse should implement which action to improve the patients comfort?

Instill artificial tears

One of the housekeepers splashes a chemical in the eye. What should be the first priority?

Irrigate with normal saline solution for 20 min

Which is a sign of acute angle closure glaucoma? (AACG)?

Large fixed pupils

The nurse is assessing a patient's visual field. Which actions demonstrate correct technique? (select all that apply)

Nurse faces the patient , Nurse moved a finger from an area outside the line of peripheral vision into the line of vision , The nurse directs the patient to look directly into her eyes

A 49-year-old patient tells you that he has to hold the newspaper farther and farther away to read it. The best response by the nurse is

Presbyopia. You have presbyopia non prescription reading glassess will help you

A nurse is caring for a client who has possible hearing loss. Which of the following supports the diagnosis of sensorineural hearing loss in the left ear?

Rinne test showing less time for air and bone conduction

A nurse is preparing a patient for a scleral buckling. The nurse knows that this procedure involves:

Suturing a silicone implant against the sclera

The nurse is caring for a patient with suspected macular degeneration. During the assessment the patient is asked to focus on the image. Which finding supports the diagnosis?

The patient see's a dark spot in the center of what is viewed

The nurse explains that a photorefractive keratectomy (PRK) is a very brief surgery that corrects myopia. Which statement indicates that the nurse's teaching about the procedure has been successful?

This procedure uses a laser to remove a thin layer of the cornea

Which of the following client findings is NOT a possible causative factors for the client's sensorineural hearing loss?

Warfarin and presbyopia

A nurse is collecting subjective data for a patient with a retinal detachment of the left eye. Which of the following will the nurse expect the patient to report?

a sense of a curtain falling across the filed of vision

The patient scheduled for a PET (position emission tomography) scan of the brain asks if there is any special preparation for the test. The nurse correctly responds with which statements (select all that apply)

avoid tranquilizers or sedatives the night before and the day of test. you will have to sign a consent form, you will have 2 IV inserted

What is the first nursing intervention step for the immediate care of a patient with a penetrating wound of the eye?

check for the irregualrity of the pupil

The nurse has completed the assessment of a newly admitted patient. Which findings is/are risk factors in the development of cataracts? (select all that apply)

cigarette smoking long term corticosteroids use

How should the nurse advise a patient who has severe vertigo from labyrinthitis?

Lie mobile and hold the head in one position until the vertigo lessens.