Eye & Ear

The nurse is caring for a client who reports excessive tearing. Which disorders does the nurse suspect could be responsible for the client's condition? Select all that apply. A. Chalazion B. Entropion C. Hordeolum D. Conjunctivitis E. Keratoconjunctivitis sicca

A, B, D A chalazion is an inflammation of a sebaceous gland in the eyelid manifested by excessive tearing and light sensitivity. An entropion is a disorder of the eyelid that causes pain and excessive tearing. Conjunctivitis also causes excessive tearing, a bloodshot appearance, and itching. A hordeolum is an infection of the eyelid sweat glands that causes red, swollen, and painful eyes. Keratoconjunctivitis sicca is dry eye syndrome; this disorder causes decreased tear production.

A nurse is caring for an older adult with a hearing loss secondary to aging. What can the nurse expect to identify when assessing this client? Select all that apply. A. Dry cerumen B. Tears in the tympanic membrane C. Difficulty hearing high-pitched voices D. Decrease of hair in the auditory canal E. Overgrowth of the epithelial auditory lining

A, C Cerumen (ear wax) becomes drier and harder as a person ages. Generally, female voices have a higher pitch than male voices; older adults with presbycusis (hearing loss caused by the aging process) have more difficulty hearing higher pitched sounds. There is no greater incidence of tympanic tears caused by the aging process. The hair in the auditory canal increases, not decreases. The epithelium of the lining of the ear becomes thinner and drier.

A client asks for information about glaucoma. How should the nurse explain glaucoma to the client? A. An increase in the pressure within the eyeball B. An opacity of the crystalline lens or its capsule C. A curvature of the cornea that becomes unequal D. A separation of the neural retina from the pigmented retina

A. An increase in the pressure within the eyeball An increase in intraocular pressure (IOP) results from a resistance of aqueous humor outflow. Open-angle glaucoma, the most common type of glaucoma, results from increased resistance to aqueous humor outflow. An opacity of the crystalline lens or its capsule is the description of a cataract. A curvature of the cornea that becomes unequal is the description of astigmatism. A separation of the neural retina from the pigmented retina is the description of a detached retina.

After a left cataract extraction, a client reports severe discomfort in the operated eye. The nurse concludes that this problem may be caused by which condition? A. Hemorrhage into the eye B. Expected pot-op discomfort C. Isolation r/t sensory deprivation D. Pressure on the eye from the protective shield

A. Hemorrhage into the eye Acute postoperative pain is a sign of increased intraocular pressure and is caused by hemorrhaging; this is a medical emergency. Postoperative discomfort usually is minimal. Isolation and sensory deprivation will not occur because only one eye is patched. The shield may be slightly uncomfortable but will not cause severe discomfort.

A nurse is assessing a client with a diagnosis of dry age-related macular degeneration. Which ocular symptom should the nurse expect the client to report? A. Loss of central vision B. Attacks of acute pain C. Constant blurred vision D. Decreased peripheral vision

A. Loss of central vision The main characteristic of dry age-related macular degeneration is loss of central vision, which is gradual. Primary closed-angle glaucoma causes pain. Blurred vision may be caused by a refractive error. Loss of peripheral vision does not occur with macular degeneration; peripheral vision loss can occur with glaucoma.

Which beta-adrenergic blocker is used to reduce a client's intraocular pressure? A. Timolol B. Travopost C. Carbachol D. Apraclonidine

A. Timolol Glaucoma is manifested by increased intraocular pressure. Timolol is a beta-adrenergic blocker used in the treatment of glaucoma. Carbachol is a cholinergic agonist used to treat glaucoma. Travopost is a prostaglandin agonist, and apraclonidine is an adrenergic agonist used in the treatment of glaucoma.

A registered nurse is supervising a student nurse while assessing a 70-year-old client who is receiving aminoglycoside therapy. Which statement about the client's condition requires correction? A. "The client may have deterioration of the cochlea" B. "The client may have thinning of the tympanic membrane" C. "The client may have the inability to hear high-frequency sounds" D. "The client may have an inability to differentiate between consonants"

B. "The client may have thinning of the tympanic membrane" An older adult who is on aminoglycoside antibiotic therapy is at a high risk of developing ototoxicity. The client with ototoxicity may have thickening of the tympanic membrane, but not thinning of the tympanic membrane. Deterioration of the cochlea may cause older adults to gradually lose hearing. They may experience an inability to hear high-frequency sounds and differentiate between consonants.

The nurse frequently provides care for clients with hearing aids. Which condition does the nurse recall responds best to hearing aids? A. Destruction of the auditory nerve B. Diminished sensitivity of the cochlea C. Perforation of the tympanic membrane D. Immobilization of the auditory ossicles

B. Diminished sensitivity of the cochlea Because hearing aids use the person's own middle ear, they increase hearing acuity in cases of diminished sensitivity of the cochlea; the amplified signal from the hearing aid gives the cochlea greater stimulation and promotes hearing. Destruction of the auditory nerve results in deafness because impulses cannot be transmitted to the brain's auditory center. Perforation of the tympanic membrane prevents ossicular conduction, which involves transmission of resonant vibrations from the tympanic membrane to the ossicles to the cochlea. Hearing aids will not correct this type of hearing loss; surgery is preferred. Immobilization of the ossicles prevents conduction of resonant vibrations from the tympanic membrane to the cochlea. Hearing aids may help but will not correct this problem; surgery is preferred.

A client who just has been diagnosed with primary open-angle glaucoma (POAG) refuses therapy. The nurse reinforces that it is important for the client to seek treatment. Which goal is the nurse trying to achieve? A. Prevent cataracts B. Prevent blindness C. Prevent retinal detachment D. Prevent blurred distance vision

B. Prevent blindness POAG progresses gradually without symptoms; if untreated, blindness occurs. Peripheral vision slowly disappears until tunnel vision occurs in which there is only a small center field. Without treatment, eventually all vision is lost. POAG is not related to the development of cataracts, retinal detachment, or blurred distance vision.

A client with diabetes mellitus complains of difficulty seeing. What would the nurse suspect as the causative factor? A. Lack of glucose in the retina B. The growth of new retina blood vessels or "neovascularization" C. Inadequate glucose supply D. Destructive effect of ketones on retinal metabolism

B. The growth of new retina blood vessels or "neovascularization" Proliferative diabetic retinopathy is the growth of new retinal blood vessels, also known as " neovascularization." When retinal blood flow is poor and hypoxia develops, retinal cells secrete growth factors that stimulate the formation of new blood vessels in the eye. These new vessels are thin, fragile, and bleed easily, leading to eye hemorrhage and vision loss. Hemorrhages in the eyes precipitate retinal detachment, resulting in blindness. There is an increase in serum glucose in clients with diabetes mellitus; thickening of the capillary basement membranes can occur, even if the glucose level is maintained within normal limits. Ketones do not affect retinal metabolism; retinopathy is a result of vascular changes, retinal detachment, and hemorrhage within the eye.

Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity should the nurse teach the client to report? Select all that apply. A. Bradycardia B. Joint pain C. Blood in the stool D. Ringing in the ears E. Increased urine output

C, D Blood in the stool indicates gastrointestinal irritation and may have resulted from the anticoagulant effect of aspirin. Salicylates, such as aspirin, can cause ototoxicity (affects eighth cranial nerve), which may manifest as ringing in the ears (tinnitus) or muffled hearing and it should be reported. Joint pain is not a symptom of salicylate toxicity; however, it is related to the disease process and should be minimized by the administration of aspirin. Bradycardia and increased urine output (polyuria) do not indicate salicylate toxicity.

A 62-year-old client reports to the nurse, "My eyes don't feel right and I have a gritty and sandy sensation in my eyes." What condition might this client have? A. Retinal detachment B. Infection of the cornea C. Changes in tear composition D. Hemorrhage in the vitreous humor

C. Changes in tear composition Decreased tear formation or changes in the tear composition because of aging or various systemic diseases may cause dryness in the eye. This may manifest in eye discomfort and a sandy, gritty, or burning sensation. Retinal detachment may cause blurred vision. Infection of the cornea may result in photophobia. A vitreous humor hemorrhage manifests as spots or floaters seen in the field of vision.

After cataract surgery the nurse teaches a client how to self-administer eyedrops. The nurse reinforces the use of what technique? A. Placing the drops on the cornea of the eye B. Raising the upper eyelid with gentle traction C. Holding the dropper tip above the conjunctival sac D. Squeezing the eye shut after instilling the medication

C. Holding the dropper tip above the conjunctival sac Drops are placed within the lower lid (conjunctival sac). To protect against physical injury and infection, the dropper tip should not touch the eye. The lower lid is retracted for placement of eyedrops. Squeezing the eyes shut after administration of the medication should be avoided; this will squeeze medication out of the eye.

The nurse is caring for a client newly diagnosed with diabetes. When preparing the teaching plan about the importance of yearly eye examinations, the nurse should instruct the client on which eye problem most associated with diabetes? A. Cataracts B. Glaucoma C. Retinopathy D. Astigmatism

C. Retinopathy Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.

Which clinical indicator is the nurse most likely to identify when exploring the history of a client with open-angle glaucoma? A. Constant blurring B. Abrupt attacks of acute pain C. Sudden, complete loss of vision D. Impairment of peripheral vision

D. Impairment of peripheral vision Open-angle glaucoma has an insidious onset, with increased intraocular pressure on the retina and blood vessels in the eye. Peripheral vision is decreased as the visual field progressively diminishes. Constant blurring may occur with untreated acute angle-closure glaucoma. Pain occurs in acute angle-closure, not open-angle, glaucoma. Occlusions of the central retinal artery or retinal detachment will cause a sudden loss of vision.