Exam 6 SENSORY
Which type of glaucoma presents an ocular emergency?
Acute angle-closure glaucoma
A client is diagnosed as having serous otitis media. When describing this condition to the client, which of the following would be most accurate?
"You have some fluid that has collected in your middle ear but no infection."
A client's vision is assessed at 20/200. The client asks what that means. Which is the most appropriate response by the nurse?
"You see an object from 20 feet away that a person with normal vision sees from 200 feet away."
Which of the following would be an inaccurate clinical manifestation of a retinal detachment?
Pain
When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of:
10 to 20 mm Hg.
Which term refers to the absence of the natural lens?
Aphakia
The nurse is instructing a client's family members on the most incapacitating symptom of Ménière's disease. Which nursing instruction associated with the symptom is most helpful?
Assist the client when ambulating.
Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?
Coumadin
If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone causing which of the following?
Facial nerve paralysis
An elderly client is scheduled for cataract surgery and asks the nurse, "Will I need to wear pop-bottle lenses after surgery?" Which is the most appropriate response from the nurse?
"An implanted lens has replaced the need for corrective glasses."
A nurse is performing an eye examination. Which question would not be included in the examination?
"Are you able to raise both eyebrows?"
A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?
"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."
The nurse identifies the nursing diagnosis of deficient knowledge related to a new hearing aid for a client. After teaching a client about caring for his new hearing aid, the nurse determines that the outcome has been achieved when the client states which of the following?
"I need to keep my ear canal clean and dry."
Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse?
"It means corrective lenses are required."
Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?
"My eyelids were stuck together this morning."
The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer?
"This test measures peripheral vision and detects gaps in the visual field."
It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye?
20/200
When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following?
20/50-3
A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal?
25 mm Hg
The ophthalmologist tells a patient that he has increased intraocular pressure (IOP). The nurse understands that increased pressure resulting from optic nerve damage is indicated by a reading of:
>21 mm Hg.
A dietary modification for a patient with Ménière's disease would be:
A decrease in sodium intake to 2,000 mg daily.
Which symptoms may a client with Ménière disease report before an attack?
A full feeling in the ear
The nurse is assisting the client in planning care during exacerbations of Ménière's disease. Which diet would the nurse identify as appropriate at this time?
A low-sodium diet
The nurse is teaching a class on diseases of the ear. What would the nurse teach the class is the most characteristic symptom of otosclerosis?
A progressive, bilateral loss of hearing
You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?
A progressive, bilateral loss of hearing
The client has been diagnosed with objective vertigo. Which symptom would the nurse relate to the tentative diagnosis?
A sensation of things moving
The nurse admits a client to the emergency department who has been referred by the eye clinic. Which condition is an emergency where the nurse should refer the client for medical treatment immediately?
Acute angle-closure glaucoma
A nurse is preparing a plan of care for a client with otitis externa. Based on the typical assessment findings, which of the following would the nurse most likely identify as the priority nursing diagnosis?
Acute pain related to inflammation
A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment?
Ask the client where to store his or her self-care items.
The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient?
Blurred vision results after application.
Which instruction regarding swimming should the nurse give to the client who is recovering from otitis externa?
Avoid swimming for 7-10 days
A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography?
BUN and creatinine
A client you are caring for has a hearing loss. The client tells you he is self-conscious about his hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his self-esteem?
Be forthright and inform others about the hearing deficit.
There are several types of hearing loss. Which type of hearing loss benefits most from the use of a hearing aid?
Conductive
Health teaching for a patient who suffers from motion sickness would include recommending the use of which one of the following over-the-counter drugs?
Dramamine
The nurse is caring for a client who just returned from a trip requiring an airline flight. The client commented on how his ears hurt upon descent. The nurse is correct in stating which site as being the pressure equalizer in the ear?
Eustachian tube
Which portion of the middle ear equalizes pressure?
Eustachian tube
A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate?
Explain the therapeutic effect and expected outcome of the medication.
A nurse is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal?
External auditory canal erythema
The nurse asks a client to follow the movement of a pencil up, down, right, left, and both ways diagonally. The nurse is assessing which of the following?
Extraocular muscle function
Which of the following eye disorders is caused by an elevated intraocular pressure (IOP)?
Glaucoma
The nurse should monitor for which manifestation in a client who has had LASIK surgery?
Halos and glare
The nurse should monitor for which manifestation in a client who has undergone LASIK?
Halos and glare
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?
Hemangioma
A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?
Hemorrhage
The client is having a Weber test. During a Weber test, where should the tuning fork be placed?
In the midline of the client's skull or in the center of the forehead
Loud, persistent noise has what effect on the body?
Increased blood pressure
A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother?
Instill a few drops of warmed mineral oil to cover the insect.
A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear?
Instillation of mineral oil
A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention?
Irrigate both eyes.
Which action should the nurse recommend to a client with blepharitis?
Keep lid margins clean
The nurse is preparing a presentation for a local community group comparing photorefractive keratectomy and LASIK refractive surgeries. Which of the following would the nurse include?
LASIK involves working with the cornea on a deeper level.
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer?
Laser-assisted stromal in situ keratomileusis (LASIK)
A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following?
Listening skills
A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing:
Loss of accommodative power in the lens.
A physician is assessing a client's ear and notes excess bone formation around the oval window. Which additional assessment finding should the nurse anticipate?
Low-frequency hearing loss
Hearing aids help with which of the following problems?
Makes sounds louder
Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following?
Myopia
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?
NSAIDs
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treating inflammatory conditions of the eyes?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Which of the following is an involuntary rhythmic movement of the eyes that is also associated with vestibular dysfunction?
Nystagmus
Which condition is characterized by the formation of abnormal spongy bone around the stapes?
Otosclerosis
Which term refers to swelling of the optic disc due to increased intracranial pressure?
Papilledema
A nurse is reviewing the medical records of several patients who have had their intraocular pressure (IOP) measured:Patient A: IOP 12 mm HgPatient B: IOP 15 mm HgPatient C: IOP 21 mm HgPatient D: IOP 24 mm HgWhich patient would the nurse identify as having increased IOP suggesting glaucoma?
Patient D
The nurse is developing a plan of care for a patient with severe vertigo. What expected outcome statement would be a priority for this patient?
Patient will experience no falls due to balance disorder.
Which nursing suggestion would be most helpful to the client with recurrent otitis externa?
Place ear plugs into the ears before swimming
Which condition refers to hearing loss associated with degenerative changes?
Presbycusis
Which terms refers to the progressive hearing loss associated with aging?
Presbycusis
Some clients with acoustic neuromas have vertigo. What is a priority nursing action for clients with vertigo?
Protect the client from injury.
A nurse is practicing within a pediatric medicine group. What can the nurse do to maintain hearing within the pediatric client base?
Reduce frequency and severity of ear infections.
Which of the following is an accurate statement regarding refractive surgery?
Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.
Which nursing diagnosis takes highest priority for a client admitted for evaluation for Ménière's disease?
Risk for injury related to vertigo
Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear?
Scleral buckle
When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision:
Sees an object from 20 feet away that a person with normal vision sees from 200 feet away.
What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids?
Serous otitis media
A client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent:
increased intraocular pressure (IOP).
Which symptom is related to vertigo?
Spinning sensation
A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do?
Stand about 1 to 2 feet away from the ear to be tested.
Which of the following is the treatment of choice for acoustic neuromas?
Surgery
Which phrase defines ossiculoplasty?
Surgical reconstruction of the middle ear bones
The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment?
The power of the lens to accommodate will be decreased.
Which statement describes benign paroxysmal positional vertigo (BPPV)?
The vertigo is usually accompanied by nausea and vomiting; generally, however, hearing is not impaired.
Which term refers to surgical repair of the tympanic membrane?
Tympanoplasty
Acoustic neuromas are benign tumors of which of the following cranial nerves?
VIII
A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following?
Vertigo
A client who comes to the ambulatory care facility states, "It feels like things are moving or spinning around me." The nurse interprets this as indicating which of the following?
Vertigo
Which manifestation is the most problematic for the client diagnosed with Ménière disease?
Vertigo
Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection?
Viral
Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa?
Wear soft plastic earplugs.
A client is color blind. The nurse understands that this client has a problem with:
cones
A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:
demonstrate eyedrop instillation.
Changes in pressure at high altitudes can cause discomfort in the ears. Which structure within the middle ear is instrumental in equalizing pressure?
eustachian tubes
A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included?
eyelids
A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition?
hyperopia
The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client:
pulls the tissue near the cheek downward to instill medication.
After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms?
retinal detachment
A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the
stapes
A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the:
stapes
