Chapter 21 Review Questions

Antihistamines, antiemetics, and sedatives

are used to decrease the symptoms of acute attacks of Ménière's disease.

Aspirin

can also cause hearing loss, but it is not administered IV. Neither dopamine nor ampicillin is likely to cause hearing loss.

Pilocarpine

causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. It should not cause prolonged eye irritation, and this should be immediately reported to the prescribing care provider. This medication will decrease intraocular pressure.

The triage nurse at an ambulatory clinic receives a call from an individual with possible metal fragments in both eyes. Which instructions would the nurse provide for emergency care of this possible eye injury?

"Apply a loose dressing over your eyes." An initial intervention for a penetrating eye injury includes covering the eye(s) with a dry, sterile patch and protective shield. The fragments should not be removed by the individual or others. Penetrating eye injuries should not be irrigated (only irrigate for chemical eye injuries).

The patient informs the nurse that he has a "sty" that has been present for some time on the upper eyelid and reports using warm moist compresses with no improvement. What is the best response by the nurse?

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

The nurse is preparing to administer timolol eye drops for treatment of glaucoma. What statement made by the patient would cause the nurse to hold the medication and report to the health care provider?

"I have chronic obstructive pulmonary disease."

The nurse is teaching a patient about timolol eye drops for the treatment of glaucoma. What statement made by the patient demonstrates that teaching was effective?

"I may have some temporary blurring of vision after instilling these eye drops." It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow, and blood pressure is more likely to decrease if absorbed systemically.

The nurse is providing discharge teaching to a patient with type 2 diabetes after a scleral buckling procedure. Which statement, if made by the patient, indicates that the discharge teaching is effective?

"I should avoid lifting heavy objects and straining." Patients should avoid heavy lifting (more than 20 lb) and straining. Patients usually have little to no discomfort after scleral buckling. Severe, persistent pain should be reported immediately to the health care provider. Vision is restored in about 90% of retinal detachments. Vision will not be restored immediately and takes days to weeks to improve.

The nurse instructs a patient prescribed dipivefrin eye drops to manage chronic open-angle glaucoma. Which statement, if made by the patient to the nurse, indicates that further teaching is needed?

"I will apply gentle pressure on the inside corner of my eye after each eye drop." To avoid systemic reactions such as tachycardia and hypertension, the patient should apply punctual occlusion after instillation of the eye drops.

The nurse is teaching a patient with glaucoma about administration of pilocarpine. What statement is important for the nurse to include during the instructions?

"It is important not to do activities requiring visual acuity immediately after administration."

The nurse is providing care for a patient with loss of hearing acuity over the past several years. Which statement by the nurse is most accurate?

"Many people experience an age-related decline in their hearing."

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate?

"There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. T his leads to damage to the optic nerve over time. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber.

fluid-filled middle ear

A bulging red or blue eardrum and lack of landmarks The fluid may be pus or blood.

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report?

Absence of pain or pressure Primary open-angle glaucoma is typically symptom free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed.

When using the otoscope, the nurse is unable to see the landmarks or light reflex of the tympanic membrane. The tympanic membrane is bulging and red. What does the nurse determine is most likely occurring in the patient's ear?

Acute otitis media The manifestations of inability to see the landmarks or light reflex of the tympanic membrane and the bulging and redness of the tympanic membrane are those of acute otitis media. With swimmer's ear and chronic otitis media, there is frequently drainage in the external auditory canal. Impacted cerumen would block the visualization of the tympanic membrane.

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing action should be the nurse's priority?

Assess impact of vision on normal functioning. The most important nursing intervention is to assess the patient's ability to function with the visual impairment. The nurse will use this information to plan nursing care, including assessment of the patient's coping strategies and teaching about vision enhancement techniques and nutrition.

A patient with Ménière's disease had decompression of the endolymphatic sac to reduce the frequent and incapacitating attacks being experienced. What should the nurse include in the discharge teaching for this patient?

Avoid sudden head movements or position changes. After ear surgery, the patient should avoid sudden head movements or position changes. The patient should not cough or blow the nose because this increases pressure in the Eustachian tube and middle ear cavity and may disrupt healing. Airplane travel should be avoided at first as increased pressure and ear popping is normally experienced, which will disrupt healing.

The patient has been diagnosed with benign paroxysmal positional vertigo. The nurse knows that which anatomic area of the ear contributes to this disturbance?

Benign paroxysmal positional vertigo occurs when the organ of balance (the three semicircular canals) have debris or excessive pressure within the lymphatic fluid. The oval window is in the middle ear and receives the vibrations of the ossicles. The facial nerve (cranial nerve VII) traverses above the oval window in the middle ear and may be damaged by chronic ear infection or trauma that causes problems related to voluntary facial movements. The cochlea is the coiled structure in the inner ear that is the receptor organ for hearing.

The nurse is providing discharge instructions for a patient using contact lenses who is diagnosed with bacterial conjunctivitis. What is most important for the nurse to include in the instructions?

Discard all opened or used lens care products. The patient who wears contact lenses and develops infections should discard all opened or used lens care products and cosmetics to decrease the risk of reinfection from contaminated products.

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, what nursing action would be a priority?

Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, encourage the patient to remain compliant with drug therapy.

An acoustic neuroma is removed from a patient. The nurse instructs the patient about tumor recurrence. What should the nurse instruct the patient to monitor?

Episodes of dizziness Worsening of hearing Inability to close the eye Clinical manifestations of tumor recurrence including facial nerve (CN VII) paralysis can be manifested by intermittent vertigo, hearing loss, and inability to close the eye. Lack of coordination and clear nasal drainage do not manifest with acoustic neuroma.

A patient is prescribed intravenous (IV) gentamicin after repair of an intestinal perforation. The nurse should assess for which adverse effect of this medication?

Hearing loss Recurrent fever can be related to many issues and is not related to the use of IV gentamicin.

When administering a scheduled dose of pilocarpine, in which area should the nurse place the drops?

Lower conjunctival sac Ocular medications such as pilocarpine should be instilled into the lower conjunctival sac. Never apply eye drops directly to the cornea. Applying the drops to the inner canthus will cause them to be distributed systemically.

open areas of the tympanic membrane

Perforation of the TM that has not healed

A patient is diagnosed with severe myopia. Which type of correction is the patient planning to have if they state, "I can't wait to be able to see after they implant a contact lens over my lens"?

Phakic intraocular lenses (phakic IOLs)

retracted TM

The absence of the cone of light

A patient is scheduled for a corneal transplant and is concerned regarding the difficulty with vision that may last for up to 12 months after the transplant. What is the best response by the nurse?

There are newer procedures in which only the damaged cornea epithelial layer is replaced, and they have a faster recovery. The new procedures are called Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's membrane endothelial keratoplasty (DMEK).

The nurse is examining a patient's ear in the clinic to determine if recent treatment for acute otitis media has been effective. Which assessment finding indicates resolution of the middle ear infection?

Tympanic membrane is gray, shiny, and translucent. The tympanic membrane (TM) is normally pearly gray, white or pink, shiny, and translucent.

A patient with septic shock is receiving multiple medications. Which intravenous (IV) medication is most likely to cause a hearing loss?

Vancomycin The IV medication in use that is most likely to cause a hearing loss is vancomycin (Vancocin) because it is an ototoxic medication. For that reason, serum drug levels are monitored to maintain therapeutic levels and reduce the risk of ototoxicity.

A patient is recovering from a motor vehicle crash that resulted in blindness. The patient is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient?

Verbalize feelings related to visual impairment. The nurse's priority is to help the patient express his feelings about the vision loss resulting from the lack of coping effectively with the situation. Until the patient expresses how they feel, they will be unable to progress in the rehabilitation process.

Increasing light and magnification

helps a person with cataracts to read.

Conjunctivitis

is a bacterial or a viral infection of the conjunctiva.

Presbycusis

is a loss of hearing that is both common and age-related.

Timolol

is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches, and it does not affect sinusitis or chronic urinary tract infections.

An acoustic neuroma

is a unilateral benign tumor that occurs where the vestibulocochlear nerve (cranial nerve [CN] VIII) enters the internal auditory canal.

Refractive IOL

is also for patients with a high degree of myopia or hyperopia and involves removing the natural lens and implanting an intraocular lens

A patient with a detached retina

is at risk for detachment of the other retina.

The risk of conjunctivitis

is increased with not disinfecting lenses properly, wearing contact lenses too long, or using water or homemade solutions to store and clean lenses.

Exophthalmos

is related to a symptom of hyperthyroidism.

LASIK surgery

is similar to PRK except that the epithelium is replaced after surgery.

Phakic intraocular lenses (phakic IOLs)

is the implantation of a contact lens in front of the natural lens.

PRK

is used with low to moderate amounts of myopia, and the epithelium is removed and the laser sculpts the cornea to correct the refractive error.

Primary angle-closure glaucoma

manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.

Corneal transplants

should be done as soon as possible, but this does not affect the rate of visual recovery. Astigmatism is not experienced with corneal scars and opacities requiring a corneal transplant.

Aminoglycosides

such as gentamicin are drugs that are potentially ototoxic and may cause damage to the auditory nerve. When this drug is used, careful monitoring for hearing and balance problems (e.g., hearing loss, tinnitus, vertigo) is essential.

With swimmer's ear and chronic otitis media

there is frequently drainage in the external auditory canal.

Dipivefrin

will control chronic open-angle glaucoma but will not cure the disease. Side effects associated with dipivefrin include ocular discomfort and redness, tachycardia, and hypertension.

Impacted cerumen

would block the visualization of the tympanic membrane.