Chapter 22 - Visual and Auditory Problems
d
A client is seen in the clinic for acute otitis media. The nurse identifies which of the following information is most directly related to the development of otitis media? a. the client smokes one pack of cigarettes per day b. the client had pneumonia as a child c. the client has been swimming in a chlorinated pool d. the client had a cold two weeks ago
c, immediate irrigation is warranted, the shorter the exposure the less the eye tissue will be damaged
A mother accidentally splashes ammonia into her child's eyes. The mother contacts the pediatrician's office. Which of the following instructions should the nurse first give to the mother? a. take your child to the emergency room immediately b. irrigate your child's eyes with a boric acid solution c. flush your child's eyes with lukewarm water d. place patches over both of your child's eyes
c
A preschool-age child is undergoing bilateral myringotomy with tubes for the treatment of recurrent otitis media. The mother asks the nurse what the tubes will do. The nurse's best response is that the tubes will: a. Provide for drainage. b. Prevent future episodes of otitis media. c. Equalize pressures between the middle ear and the environment. d. Prevent the spread of infection to the mastoid bone.
c, maintain aseptic technique and avoid cross contamination
A pt is treated for an infection involving the left eye. The prescribed medications include eye drops and antibiotic ointment. When applying the antibiotic ointment, it is most important for the nurse to take which of the following actions? a. administer the medication precisely at the ordered time b. use a new medication container each time a dose is given c. avoid touching the eyeball with the tip of the tube d. apply a generous amount to the inner canthus.
b
A pt with an eye injury wears a patch over the left eye. The nurse identifies the chief visual disturbance that the pt will experience while wearing the patch includes which of the following? a. an inability to focus on very near or far away objects b. difficulty judging the distance of objects c. impaired accommodation to darkness d. seeing floating spots in the affected eye
b
A spry 77-year-old female patient has been diagnosed with simple glaucoma. She lives alone, takes medications for asthma, is on a fixed income, and walks to Catholic Mass on Sunday mornings. The nurse must be certain that the ophthalmologist is aware of which of the aforementioned facts about the patient? a. Lives alone. b. Takes medications for asthma. c. Lives on a fixed income. d. Walks to Catholic Mass on Sundays.
a, the retina perceives light and transmits impulses from nerve cells to the optic nerve; symptoms include flashes of light or blurred, sooty vision, sensation of particles moving in the line of vision, the visual field may be blank, or have a veil like coating and eventually a loss of vision.
An adolescent is brought to the emergency room after being hit on the head while playing ball. After examination, a diagnosis of detached retina of the left eye is made. Which of the following signs & symptoms does the nurse expect to observe? a. the pt states he sees quick flashes of light b. the pt complains of severe pain in the affected eye c. the pt has decreased peripheral vision d. the nurse observes orbital edema
a
An elderly pt asks the nurse what caused his cataract. The nurse's response should be based on which of the following? a. cataracts are most common in the elderly b. the usual cause of cataracts in elderly people is congenital. c. any type of chronic systemic disease can cause cataracts d. all cataracts result from eye injuries
d, social interaction is important to maintain the pt's self esteem
An older client is admitted to the hospital for treatment of a fractured femur. The client's spouse tells the nurse that the client is very hard of hearing. The nurse should develop a plan of care that provides an opportunity for which of the following? a. intellectual challenge b. learning sign language c. private visits with the client's family d. social interaction
d
Before administration of timolol (Timoptic) eye drops for treatment of glaucoma, the nurse would assess the patient for which of the following contraindications for the use of this medicine? A. Sinusitis B. Migraine headaches C. Chronic urinary tract infection D. Chronic obstructive pulmonary disease
b, bleeding from the outer ear is a postop complication and therefore should be reported asap.
If fresh blood is observed on a pt's ear dressing one hour after ear surgery, which of these nursing actions is indicated? a. apply pressure to stop the bleeding b. notify the physician immediately c. chart the results d. change the dressing and notify the physician if bleeding persists
b
Parents express concern to the nurse about their child's detached retina. The parents ask the nurse if a retinal detachment could be hereditary. Which of the following responses by the nurse is best? a. yes, it is. did any of your other children ever have a detached retina? b. the cause of retinal detachment is not certain, but there are usually a number of contributing factors c. while there may be a hereditary tendency, the immediate cause of your child's retinal detachment was severe trauma d. I think we had better concentrate on how to prevent a detached retina in your child's other eye as there is a strong hereditary tendency.
a, pressure on suture lines should be avoided
Postoperative orders for a pt after cataract surgery state, apply pressure dressing to left eye. Which nursing action is most appropriate? a. call the dr to verify the order because pressure dressing ar usually contraindicated after eye surgery. b. call the dr to verify the order because dressings are usually applied bilaterally after eye surgery c. carry out the order by applying four eye pads and covering them lightly with Elastoplast tape d. ask another nurse to read the order and carry it out
d
The 77-year-old male smoker has developed cataracts on both eyes, and is awaiting surgery. The cataracts have prevented the patient from driving, reading, and seeing television. Which of the following statements would be appropriate for the nurse in the preoperative holding area to communicate to the patient? a. "Did your eye doctor explain to you that you could choose to use eye drops six times a day to dissolve the cataract?" b. "You are wise to have both eyes done at the same time." c. "If you were a non-smoker, you would never have developed cataracts." d. "Most patients undergoing cataract surgery do well and enjoy the improved vision."
a
The nurse assesses a pt diagnosed with Meniere's disease. Which of the following pt statements requires follow-up by the nurse? a. I smoke one pack of cigarettes per day b. When I have vertigo, I keep my eyes open and stare straight ahead c. I have a continuous, low pitched roar in my left ear d. I continue to feel dizzy after the vertigo goes away
b, Compazine is an antiemetic given to prevent nausea (nausea increases intraocular pressure and should be avoided following surgery)
The nurse cares for a pt after undergoing a cataract extraction. The physician has ordered prochlorperazine (Compazine) postoperatively. The nurse's explanation to the family should include which of the following statements? a. the physician ordered Compazine to prevent retinal detachment b. the physician ordered Compazine to prevent pressure on the suture line c. the physician ordered Compazine to help the pt sleep better d. the physician ordered Compazine to increase the pt's nutritional intake
d, movement of the eye should be kept to a minimum, if an impaled object is protruding, it should be immobilized by using a moist normal saline dressing and secured to the persons head and immediately taken to an eye specialist.
The nurse cares for clients in the outpt clinic. A client comes in stating, I think I have a piece of glass in my eye. Which of the following actions should the nurse take first? a. attempt to remove the impales glass using tweezers b. douse the affected eye with artificial tears c. assess visual losses in the affected eye d. cover the eye with a protective shield
c, symptoms include blurred vision, annoying glare, and pupils changing from black to gray to milky white.
The nurse expects a pt with a cataract to complain about which symptom? a. eye pain when doing close work b. double vision c. blurred vision d. halos around lights
a, otosclerosis is a cause of deafness, characteristics are gradual loss of hearing and tinnitus
The nurse expects an elderly pt with otosclerosis to exhibit which of the following symptoms? a. hearing loss and buzzing ear noise b. headache and vertigo c. pain and ringing in the ear d. progressive deafness and excessive cerumen
b
The nurse identifies an elderly patient with a severe hearing deficit is most likely to exhibit which of the following characteristics? a. the pt prefers to be alone b. the patient is suspicious of other people c. the pt communicates best by writing d. the pt is difficult to understand
b
The nurse identifies that which of the following approaches is the proper technique for eyedrop instruction? a. instruct the pt to look down, retract the lower eyelid, and instill drops. b. instruct the pt to look up, retract the lower eyelid, and instill drops c. instruct the pt to look down, retract the lower eyelid, and instill drops, then apply pressure. d. Instruct the pt to look sideways, and instill the drops in the inner canthus.
c, to function independently, a visually impaired person should know where things are...
The nurse identifies which environmental factor is most helpful to maintain independence for a client who is legally blind? a. a radio on the bedside table b. a nurse call light that is easy to reach c. the furniture in the room is consistently arranged. d. a room with a private bathroom.
b
The nurse identifies which of these symptoms are characteristic of acute (closed-angle) glaucoma? a. Eye fatigue, photophobia, loss of peripheral vision b. blurred vision, headache, rainbows around lights c. tunnel vision, malaise, flashing lights d. nausea, orbital edema, blindness
d, mastoiditis is secondary to a middle ear infection, the symptoms described indicate spread of the infection to the brain
The nurse in the outpt clinic performs an assessment on a client diagnosed with mastoiditis. The client reports experiencing chills, fever, nausea, vomiting, and a sore neck. Which of the following questions should the nurse ask first? a. how high has the fever been? b. how long have you had an elevated temp? c. what medication are you currently taking? d. have you reported these symptoms to the physician?
b, d
The nurse is caring for a patient who has a hearing deficit. Which of the following techniques should be implemented by the nurse to improve communication? (Select all that apply.) a. Keep the patient's face in full light. b. Use a low voice pitch with normal loudness. c. Speak at a slower rate than usual. d. Use short sentences.
d
The nurse providing postoperative teaching for a patient who has undergone LASIK surgery advises the patient to contact the office if he experiences: a. Dry eyes. b. Undercorrection of visual acuity. c. Decreased night vision with halos. d. Drainage from the eye.
b, stapedectomy is the removal of otosclerotic lesions and the creation of a tissue implant with a prosthesis to maintain conduction, hearing loss is temporary postop due to edema and packing
The nurse should inform a pt after a stapedectomy that it is normal to experience which of the following? a. severe nausea lasting about 24 hours b. further, but temporary, hearing loss c. vertigo when standing upright d. rapid improvement in hearing
c
The nurse teaches a client diagnosed with an infection of the left eye how to protect vision from further injury. It is most important for the nurse to instruct the pt about which of the following? a. avoid touching the eye with medication droppers b. administer eye care without putting any pressure on the eyeball c. prevent cross contamination between the eyes d. clean each eye separately using a different tissue
c, the mastoid will become inflamed if otitis media is left untreated or is poorly treated
The nurse understands if acute otitis media is not adequately treated, which of the following complications may develop? a. Otosclerosis b. Meniere's disease c. Mastoiditis d. Furuncle
a
The nurse understands that the primary purpose of performing a myringotomy on a pt with acute otitis media is to: a. relieve pressure on the eardrum b. create a pathway for administering medications c. avert the need for analgesia d. remove debris from the outer ear
a
The nurse understands that the snellen chart is used for which of the following purposes? a. assess visual acuity b. measure eye pressure c. determine client's ability to read d. test peripheral vision
b, Rationale: If corneal perforation is suspected, the nurse should first place the patient in the supine position, then close the eye, and cover it with a dry, sterile dressing. Thereafter, the nurse should notify either the patient's ophthalmologist or an on-call ophthalmologist to see the patient. The complications of corneal perforation include infection of deep eye structures and loss of ocular contents. Nothing should be placed in the eye.
The nurse's first action for a patient who presents to the Emergency Department with manifestations of corneal perforation is to: a. Contact the patient's ophthalmologist. b. Place the patient in a supine position. c. Cover the eye with gauze. d. Administer tears for dry eyes.
d
The patient is in the preoperative holding area, having been brought to surgery from the Emergency Department because of a detached retina. The tear has occurred in the right posterior aspect of the retina. The nurse places the patient in which of the following positions? a. At a 45-degree angle (semi-Fowler's position) b. At a 90-degree angle (high Fowler's position) c. Prone d. Supine
d
The patient with glaucoma has been prescribed travoprost (Travatan), a prostaglandin analog, to improve the outflow of aqueous humor and reduce ocular pressure. Of the following signs or symptoms, which will the nurse teach the patient to report immediately to the eye doctor? a. Burning in the eye when the eye drops are used b. Tearing in the eye when the eye drops are used c. Changes in the color of the eyes d. Intolerable pain in the eyes after the drops are used
d
The public health nurse is preparing to teach the members of the local swim club about care of the ears. Which of the following statements would be appropriate for the nurse to include? a. Use a clean cotton swab to dry the ear canal after swimming. b. A tight-fitting swim cap is preferred to earplugs for keeping water out of the ear. c. If there is debris in the ear canal, irrigate the ear with cold water. d. After an episode of acute inflammation, the swimmer should wait 7-10 days before returning to the water.
d
When administering a scheduled dose of pilocarpine, the nurse should place the drops in which of the following areas? A. Inner canthus B. Outer canthus C. Center of the eyeball D. Lower conjunctival sac
c
When administering eye drops to a patient with glaucoma, which of the following nursing measures is most appropriate to minimize systemic effects of the medication? A. Apply pressure to each eyeball for a few seconds after administration. B. Have the patient close the eyes and move them back and forth several times. C. Have the patient put pressure on the inner canthus of the eye after administration. D. Have the patient try to blink out excess medication immediately after administration.
a
When communicating with a person diagnosed with a hearing impairment, it is most important for the nurse to take which action? a. speak using hands, face and eyes b. speak normally c. place the person in good light so that he can see the nurse's mouth d. verify that the person understands the message by asking the person to write what is said
c, bed rest minimizes movement of the eyes and head to facilitate settling of the detached retina
When performing preoperative care for a pt diagnosed with a detached retina, the nurse should take which action? a. apply ice packs to the affected eye b. irrigate the eye with warm normal saline c. maintain the pt on bed rest d. instruct the pt to lay on the unaffected side
d
When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which of the following statements? A. "Prolonged eye irritation is an expected adverse effect of this medication." B. "This medication needs to be continued for at least 5 years after your initial diagnosis." C. "This medication will help to raise intraocular pressure to a near normal level." D. "It is important not to do activities requiring visual acuity immediately after administration."
c
When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, which of the following elements should you focus on? A. Recognizing that eye damage caused by glaucoma can be reversed in the early stages. B. Giving anticipatory guidance about the eventual loss of central vision that will occur. C. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision. D. Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies.
b
When teaching a patient about the pathophysiology related to open-angle glaucoma, which of the following statements is most appropriate? A. "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." B. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." C. "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." D. "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."
c
When the patient who has undergone cataract extraction is preparing to go home, the nurse reinforces which of the following instructions? a. Remove the dressing at bedtime. b. A headache for the first few days after surgery should be expected. c. Avoid sleeping on the operative side. d. Set a new appointment with the surgeon for 1 month from today.
a
When the visiting nurse is teaching the family of a patient with acute conjunctivitis regarding the disease process, the nurse emphasizes which of the following statements as most important? a. Wash hands before and after instilling eye drops. b. Cleanse the patient's contact lenses twice each day. c. Ask patient to gently rub eyes to circulate the eye drops after instillation. d. Use a cotton-tipped swab to cleanse the right eye and then the left eye.
c
Which of the following aspects for health teaching regarding acute and chronic conjunctivitis is the most important information to be emphasized to a group of preschool parents? a. Preventable cause of blindness b. Importance of early medical diagnosis c. Mode of transmission d. Pain management
a
Which of the following findings related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? A. Absence of pain or pressure B. Blurred vision in the morning C. Seeing colored halos around lights D. Eye pain accompanied with nausea and vomiting
a
Which of the following instructions is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? A. Discard all opened or used lens care products. B. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. C. Put all used cosmetics in a plastic bag for 1 week to kill any bacteria before reusing. D. Disinfect all lens care products with the prescribed antibiotics drops for 1 week after infection.
c, Rationale: The risk for trauma in patients with inner ear disorders, such as Ménière's disease, is great. Disturbed Sensory Perception: Auditory is a priority nursing diagnosis for patients with hearing loss. Sleep Pattern Disturbance is a priority nursing diagnosis for patients with tinnitus. Risk for Trauma is the priority nursing diagnosis for patients with inner ear disturbances causing balance disorders. Social Isolation is a priority diagnosis for patients with otosclerosis or presbycusis.
Which of the following nursing diagnoses is the priority diagnosis for a patient with Ménière's disease? a. Disturbed Sensory Perception: Auditory b. Disturbed Sleep Pattern c. Risk for Trauma d. Social Isolation
a, Rationale: The pain of otitis externa can be differentiated from that associated with otitis media by the manipulation of the auricle. In external otitis, this maneuver increases pain, whereas the patient with otitis media experiences no change in pain perception. Rinne and Weber tests are used to diagnose sensorineural hearing loss. The caloric test (irrigation with cool water) evaluates vestibulo-ocular reflex. The whisper test evaluates hearing loss.
Which of the following physical assessment maneuvers will allow the nurse to differentiate the ear pain of a patient with otitis externa from the ear pain of a patient with otitis media? a. Manipulation of the auricle b. Irrigating the ear canal with cool water c. Rinne and Weber tests d. Whisper test
a
Which of the following statements by a patient with newly prescribed contact lenses indicates a need for additional teaching? a. "I think it is so cool that my best friend, Taylor, and I have the same prescription. She has blue lenses and I have brown lenses, so we'll be able to trade to see what we would look like with different eyes." b. "If I run out of cleaning and wetting solution, I'll have to wait until I get a new supply before I'll be able to wear my lenses again." c. "I'll follow the manufacturer's guide to tell me when I need to take them out." d. "If I have eye redness or pain in my eyes, I'll take out my lenses and call the ophthalmologist first thing."
b
Which of the following statements is most appropriate when teaching a patient about timolol (Timoptic) eye drops in the treatment of glaucoma? A. "You may feel some palpitations after instilling these eye drops." B. "You may have some temporary blurring of vision after instilling these eye drops." C. "You should keep your eyes closed for 15 minutes after instilling these eye drops." D. "You should withhold this medication if your blood pressure becomes elevated."
c
Which of the following suggestions should be taught by the nurse to the patient with tinnitus to assist the patient with coping with the symptom to promote concentration and sleep? a. Earplugs b. Sleeping medication c. Hearing aid that produces a tone to mask tinnitus d. Bedtime use of nasal decongestant spray
b
You are providing care for a 73-year-old male patient who has sought care because of a loss in his hearing acuity over the past several years. Which of the following statements is most accurate? A. "This is often due to an infection that will resolve on its own." B. "Many people experience an age-related decline in their hearing." C. "This is likely an effect of your medications; try stopping them for a few days." D. "You can likely accommodate for your hearing loss with a few small changes in your routine."
a
the nurse instructs an elderly pt about the appropriate technique to perform an ear irrigation to remove cerumen. The nurse determines teaching is effective if the pt states which of the following? a. I should stop the irrigation if I become nauseated b. I can inject 50 cc of solution c. I should use cool water d. I can use a cotton swab to dry my ears
