Eye & Ear Practice Questions
The nurse is teaching a client about ear protection. Which statement by the client indicates that teaching was effective? A "I always wear earplugs when I swim." B "It is noisy where I work, so I listen to music with ear buds." C "My ears ring after attending a rock concert, but it goes away." D "The machinery is loud at work, but I get used to it."
A "I always wear earplugs when I swim." Earplugs worn during swimming protect against potential ear infection. If the client's work environment is noisy, the client will have to turn up the volume significantly of music played through ear buds. A ringing in the ears (tinnitus) may be a sign of injury. Clients should wear earplugs in environments with loud music. Not wearing ear protection around noisy machinery will cause damage to the ear. "Getting used to" the noise is a sign that damage has occurred.
The nurse is preparing a client for electronystagmography. Which statement by the client indicates that teaching was effective? A "I can't drink caffeine 24 to 48 hours before the test." B "I should drink more fluids 4 hours before the test." C "I'll be placed in a soundproof booth for the test." D "I'll be sedated for the test."
A "I can't drink caffeine 24 to 48 hours before the test." The client must fast for several hours before electronystagmography and avoid caffeine-containing beverages for 24 to 48 hours before the test. Fluids are carefully introduced after the test is completed to prevent nausea and vomiting. The client is placed in a soundproof booth for an audiometry test. The examiners will ask the client to name names or do simple math problems during the test to ensure that he or she stays alert.
A client has a bilateral corneal disorder and must instill anti-infective eyedrops every hour for the first 24 hours. Which comment by the client indicates a need for further instruction by the nurse? A "I have two bottles of eyedrops because I will require a lot of medication." B "I won't be able to wear my contacts for a while." C "I must apply the drops throughout the night." D "I must wash my hands before and between eye applications and after putting the drops in."
A "I have two bottles of eyedrops because I will require a lot of medication." If both eyes are infected, separate bottles of drugs are needed for each eye. The client should be taught to clearly label the bottles "right eye" and "left eye" and to not switch the drugs from eye to eye. The client should not wear contact lenses during the entire time that these drugs are being used because the eye then has fewer protections against infection or injury. In addition, the drugs can cloud or damage contact lenses. If the drugs are to be instilled every hour for the first 24 hours, the client will have to wake up every hour during the night to apply the drops. The client should completely care for one eye, wash the hands, and by using the drugs for the remaining eye, care for that eye. As always, handwashing should be done before and after eye care.
The nurse is teaching a client who is scheduled for an ultrasonography of the eye. Which statement by the client indicates a need for further instruction? A "I'll have to wear a bandage over my eye after the test." B "I will be awake during this test." C "I won't hear the high-frequency sound waves." D "This test will help determine whether my retina is detached."
A "I'll have to wear a bandage over my eye after the test." No special follow-up care is needed after an ultrasonography of the eye, so the client does not have to wear a bandage after the test. However, the client should be reminded not to rub or touch the eye until the effects of the anesthetic drops have worn off. The test is noninvasive and painless, and the client remains awake during the test. The high-frequency sound waves that are bounced through the eye cannot be heard. Ultrasonography aids in the diagnosis of trauma, intraorbital tumor, proptosis, and choroidal or retinal detachment.
The nurse is teaching a client about visual changes that occur with age. Which statement does the nurse include? A "It may take your eyes longer to adjust in a darkened room." B "Most visual changes occur before age 40." C "When the sclera starts to turn yellow, this means you might have problems with your liver." D "You probably will have to move reading materials closer to your eyes."
A "It may take your eyes longer to adjust in a darkened room." With increasing age, the iris has less ability to dilate, which leads to difficulty in adapting to dark environments. Adults older than 40 years are at increased risk for both glaucoma and cataract formation. Presbyopia also commonly begins in the 40s. The sclera appears yellow or blue as a process of aging, and this condition should not be used to assess for jaundice in the older adult. The near-point of vision (the closest distance at which the eye can see an object clearly) increases with aging. Near objects (especially reading material) must be placed farther from the eye to be seen clearly.
Which clients are at high risk for developing hearing problems? (Select all that apply.) A Airline mechanic B Client with Down syndrome C Drummer in a rock band D Teenager listening to music using ear buds E Telephone operator
A Airline mechanic B Client with Down syndrome C Drummer in a rock band D Teenager listening to music using ear buds An airline mechanic is exposed to excessive noise and is at risk for hearing damage. A client with Down syndrome is at risk for hearing problems because this genetic condition is associated with frequent hearing problems. A drummer in a rock band is at risk for hearing problems due to exposure to loud noise. A teenager listening to music using ear buds is at high risk because ear buds are known risk factors for increasing potential hearing loss among people who use them on a regular basis with elevated noise levels. A telephone operator is not at risk for hearing problems simply because he or she may wear headphones or audio equipment.
A bedridden client with reduced vision has been admitted. Which nursing interventions will ease the client's hospital stay? (Select all that apply.) A Announce name and purpose when entering the client's room. Correct B Explain food positions on the tray using a clock face as the example. Correct C Orient the client to the location of the call light, and keep it in that place. Correct D Orient the client to the room surroundings and equipment. Correct E Speak in a loud, clear voice. Staff should always introduce themselves to clients, with or without visual issues. Using a standard clock face to explain food locations on the tray will assist the client with self-feeding. Providing room orientation to the client is important to improve his or her ability for self-care. Orienting the client to the room and equipment in the room will allow him or her to have increased comfort with surroundings. This client has visual issues, not hearing issues, so speaking louder is not necessary.
A Announce name and purpose when entering the client's room. B Explain food positions on the tray using a clock face as the example. C Orient the client to the location of the call light, and keep it in that place. D Orient the client to the room surroundings and equipment. Staff should always introduce themselves to clients, with or without visual issues. Using a standard clock face to explain food locations on the tray will assist the client with self-feeding. Providing room orientation to the client is important to improve his or her ability for self-care. Orienting the client to the room and equipment in the room will allow him or her to have increased comfort with surroundings. This client has visual issues, not hearing issues, so speaking louder is not necessary.
An older adult client comes in for a routine visit. During the assessment, he irritably exclaims, "Speak up and quit mumbling!" How does the nurse respond? A Apologizes and speaks louder and clearer B Asks whether the client has a hearing loss C Offers the client a stethoscope to use D Suggests that the client move to a soundproof examination room to improve his hearing
A Apologizes and speaks louder and clearer The nurse should speak more clearly first, and then determine whether further assessment is needed. It should not be assumed that the client has a hearing loss; this suggestion may make the client more irritable, especially if the client is in denial. Using a stethoscope will be effective only once a hearing loss diagnosis has been established. Soundproof rooms are used for hearing tests, not to improve hearing.
Which test best determines hearing acuity? A Audioscopy B Electronystagmography C Otoscope D Snellen test
A Audioscopy Audioscopy involves the use of a handheld device to generate tones of varying intensity to test hearing. Electronystagmography is a test that is sensitive for detecting central and peripheral disease of the vestibular system in the ear. An otoscope is used to inspect the ear canal. The Snellen test is a vision acuity test.
A client with new-onset diminished vision is being discharged and is concerned about living independently. Which nursing technique best facilitates independent self-care for the client? A Building on the remaining vision B Keeping the floor free of clutter C Suggesting a seeing-eye animal companion D Teaching Braille
A Building on the remaining vision Using large-print books, talking clocks, and telephones with large, raised block numbers are examples of building on the client's remaining vision, which best facilitates the client's independent self-care. Keeping the floor free of clutter is important but is too specific. A seeing-eye animal companion may be assigned to those who are legally blind, not to those with diminished vision. Braille is used by clients who are legally blind; this client will still be able to read using a magnification device such as a visualizer.
An older adult client reports ear pain. Otoscopic examination by the nurse practitioner (NP) reveals a dull and retracted membrane. What does the NP do next? A Continues further assessment B Irrigates the ear C Prescribes antibiotics for probable otitis media D Tests hearing acuity
A Continues further assessment A dull and retracted membrane should not be the only indication of otitis media for the older adult client. This finding may be a normal age-related change, so further assessment is continued. Irrigating the ear is not indicated for this client. Further assessment is needed to determine whether the client has otitis media; therefore, antibiotics should not be prescribed. Auditory assessment is the last part of an ear examination after the otoscopic examination.
The nurse is performing an otoscopic examination of a client's ear and sees a greenish-white drainage. What does the nurse do next? A Disposes of the otoscope tip and washes the hands before examining the other ear B Reports the finding to the health care provider immediately C Sends a specimen for culture D Suctions out the drainage
A Disposes of the otoscope tip and washes the hands before examining the other ear Contact Precautions must be used with any client who has drainage from the ear canal. To prevent cross-contamination, the nurse should dispose of the otoscope tip and wash the hands before examining the opposite ear. The health care provider will be notified after the ear examination is complete. After an otoscopic examination, the nurse must perform an auditory assessment. A specimen is obtained only if the nurse is examining the external meatus region, but this is not the first step. The nurse must assess the second ear and compare. Suctioning the ear that is infected causes trauma to the tissue.
The client who has tinnitus is taking these drugs daily: 1 multiple vitamin, losartan (Cozaar) 50 mg, aspirin 650 mg, and diphenhydramine (Benadryl) 25 mg. Which drug alerts the nurse to a possible cause of tinnitus? A. Aspirin B. Losartan C. Multiple vitamin D. Diphenhydramine
A. Aspirin Rationale: Many drugs affect the ear and hearing. Aspirin use, when taken daily for long periods of time, is associated with the development of tinnitus.
Which new symptom in a 68-year-old man taking diphenhydramine (Benadryl) for vertigo from Ménière's disease will the nurse report to the prescriber? A. Decreased urination B. Drowsiness C. Dry mouth D. Cough
A. Decreased urination Rationale: Diphenhydramine is an antihistamine that also has anticholinergic effects. Some of these side effects include drowsiness and dry mouth (which are expected in all clients taking the drug). The cough can be related to dry mouth but is most likely not associated with diphenhydramine use. It can also cause urinary retention. In an older man who may also have some degree of prostate enlargement, urinary retention could cause bladder and kidney damage.
Which precaution is most important for the nurse to teach a 62-year-old client newly diagnosed with early-stage dry age-related macular degeneration? A. Quit smoking B. Quit drinking alcoholic beverages C. Eat more dark green, red, and yellow vegetables D. Wear dark glasses whenever he or she is outside or in bright interior lighting environments
A. Quit smoking Rationale: Dry AMD is more common and progresses at a faster rate among smokers than among nonsmokers. Thus, quitting smoking can slow the rate of AMD progression. Avoiding alcohol and bright light (even ultraviolet light) is not related to AMD development or progression. Although increasing long-term dietary intake of antioxidants, vitamin B12, and the carotenoids lutein and zeaxanthin that are found in green, red, and yellow vegetables is thought to help slow the progression of AMD, the effects are not as profound as quitting smoking.
Which lifestyle modification does the nurse suggest to the client with Ménière's disease to reduce the frequency or intensity of acute episodes? A. Quitting cigarette smoking B. Avoid aspirin-containing drugs C. Reduce the amount of saturated fats in the diet D. Avoiding crowds and people who have upper respiratory infections
A. Quitting cigarette smoking Rationale: Ménière's disease is made worse by cigarette smoking and a high sodium intake. Reducing or quitting smoking is associated with fewer and less intense episodes of vertigo and nausea. Although avoiding aspirin-containing drugs can be helpful in reducing tinnitus, this action has no effect on Ménière's. The exacerbation of Ménière's disease appears to be unrelated to an upper respiratory infection.
The nurse is teaching a client about open-angle glaucoma management. Which statement by the client indicates a need for further instruction? A "I must wait 10 to 15 minutes between different eyedrop medications." B "I must press on the inside of my eye to prevent washout." C "It is important to not skip a dose." D "These eyedrops will not cure my glaucoma."
B "I must press on the inside of my eye to prevent washout." Pressing on the inside of the eye after instillation of eye medication prevents systemic absorption of the drug. To avoid washout, the client should wait 10 to 15 minutes between eyedrop medications. Skipping a dose will not exacerbate the client's glaucoma. Medication will not cure glaucoma, but it will control its progression.
The nurse is teaching the mother of a teenage client with conjunctivitis how to administer eye ointment. Which statement by the mother indicates a correct understanding of the nurse's instruction? A "My child should look down at the floor during instillation." B "I will place the ointment in the lower lid." C "My child should rub the eye gently after instillation to increase absorption." D "I will press gently on the inner canthus for 1 minute."
B "I will place the ointment in the lower lid." After the lower lid is gently pulled down to form a small pocket, eye ointment should be placed in the lower lid. For instillation of eye ointment, the client should tilt the head backward and look up at the ceiling. After closing the eye, the client may gently wipe away any excess ointment with a tissue, but the eye should never be rubbed. Pressing on the inner canthus is a technique reserved for the instillation of glaucoma drops.
The nurse is performing preoperative teaching for an older adult client who will be having a cataract removed. Which instructions does the nurse include? (Select all that apply.) A "You will need to wear a patch on your eye for several weeks after the surgery." B "Several different types of eyedrops are requested after surgery, and they have to be taken several times a day for up to 4 weeks." C "You will receive a medication to help you relax. Then you will receive some different eyedrops to dilate your pupils and paralyze the lens." D "Bring sunglasses with you on the day of your procedure." E "You might experience a lot of bruising and swelling around the eye."
B "Several different types of eyedrops are requested after surgery, and they have to be taken several times a day for up to 4 weeks." C "You will receive a medication to help you relax. Then you will receive some different eyedrops to dilate your pupils and paralyze the lens." D "Bring sunglasses with you on the day of your procedure." The client will have multiple eyedrops to use after surgery and should be made aware of this before the procedure to understand the importance. Providing information on what to expect, such as telling the client about the medication that will be administered and the eyedrops that will dilate and paralyze the lens, helps the client prepare for the day of surgery. The client will need to have sun protection after the procedure. A patch is required after surgery only if a risk for injury is present. Cataract surgery does not cause bruising and swelling post-surgery.
Which client is most in need of immediate examination by an ophthalmologist? A A 58-year-old with glasses who reports an inability to see colors well and is feeling as though the glasses are always smudged B A 40-year-old with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights C A 76-year-old with seborrhea of the eyebrows and eyelids who reports burning and itching of the eyes D A 39-year-old with contacts who reports an inability to tolerate bright lights and has visible purulent drainage on eyelids and eyelashes
B A 40-year-old with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights The 40-year-old client with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights is exhibiting signs and symptoms of increased intraocular pressure (IOP). This is a priority because the optic nerve can be damaged, which can cause possible blindness. Acute angle-closure glaucoma can occur in those 40 years of age and older. The 58-year-old client reporting an inability to see colors well is exhibiting early signs of cataracts and will need to be seen, but this is not the priority. The 76-year-old with seborrhea of the eyebrows and eyelids is exhibiting signs and symptoms of blepharitis and will need to be seen, but this is also not the priority. The 39-year-old with contacts is exhibiting signs and symptoms of corneal abrasion, possibly from cataracts, and will need to be seen soon, but the client exhibiting increased IOP is still the priority.
Which systemic disorders may affect the eye and vision and require yearly eye examination by an ophthalmologist? (Select all that apply.) A Anemia B Diabetes mellitus C Hepatitis D Hypertension E Multiple sclerosis (MS)
B Diabetes mellitus D Hypertension E Multiple sclerosis (MS) Clients who are diabetic are at risk for diabetic retinopathy and are in need of annual eye examinations. Clients with elevated blood pressure need to have annual eye examinations because of the increased risk for retinal damage. Clients with MS should have annual examinations because of changes that occur with the neurologic effects of MS that impact visual acuity. Anemia does not require eye examination on a routine basis. Hepatitis does not increase eye risk and is not indicated as a disorder requiring annual examinations.
What is the action of miotics in the client with glaucoma? A Decrease the inflammatory process B Enhance aqueous outflow C Increase the production of vitreous humor D Vasoconstrict the blood vessels in the eye
B Enhance aqueous outflow Miotics are used to improve the flow of fluid (aqueous humor) and decrease intraocular pressure in clients with glaucoma. Steroid drops, not miotics, decrease the inflammatory process. Vitreous humor fills the space between the lens and the retina, is stagnant, and is not replenished as the aqueous humor is. Miotics make the pupil smaller, which creates more room between the iris and the lens.
Which eye procedure requires informed consent from the client? A Eyedrop instillation B Fluorescein angiography C Ophthalmoscopy D Snellen test
B Fluorescein angiography Fluorescein angiography is an invasive test and requires informed consent from the client. Eyedrop instillation, ophthalmoscopy, and the Snellen test are not invasive procedures and do not require informed consent from the client.
A client has sustained damage to cranial nerve II after a traumatic injury. Which intervention does the nurse anticipate to accommodate for this injury? A Artificial tears B Identifying food on the client's plate using the clock method C Daily eye assessment using the six cardinal positions of gaze D Ensuring that the client wears sunglasses when the curtains are open or when the room light is on
B Identifying food on the client's plate using the clock method The optic nerve (cranial nerve [CN] II) controls sight. Using the clock method helps the client with impaired vision or loss of vision locate food on his or her plate. Artificial tears are used when tear production is decreased due to the aging process. The six cardinal positions of gaze assess CN III, IV, and VI. Sunglasses are used when the pupils are artificially dilated for assessment purposes, or when medications are used that cause dilation of the pupil.
A client with visual limitations has been admitted to the intensive care unit (ICU). Which action is most important to implement for this client? A Allowing the client's seeing-eye dog in the unit B Making all health care team members aware of the client's visual limitations C Keeping the client bedridden for safety D Addressing the client in a loud, clear voice
B Making all health care team members aware of the client's visual limitations All health care team members must be made aware of the client's visual limitations and need for assistance. Seeing-eye dogs are not usually allowed in the ICU. It is not necessary to keep the client bedridden. The client should be addressed in a normal tone of voice; the client's hearing is not affected.
Which technique is the correct way to instill eardrops? A Maintain the head in the same position for 2 minutes after instillation. B Place the medication bottle in a bowl of warm water before instillation. C Rinse the ear canal with hydrogen peroxide before instillation. D Check to see whether the eardrum is intact before instillation.
B Place the medication bottle in a bowl of warm water before instillation. To instill eardrops, place the bottle (with the top on tightly) in a bowl of warm water for 5 minutes. This warms the medication and makes instillation more comfortable for the client. The head should be gently moved back and forth five times after instillation to ensure proper distribution. It is not necessary to rinse the ear canal with hydrogen peroxide or check to see whether the eardrum is intact before instillation.
A client has recently been diagnosed with 20/200 vision bilaterally. How does the nurse best offer increased support? A Provides instructions in a loud, clear voice B Refers the family to local services for the blind C Tells the client to find a support group D Writes instructions down in very large print
B Refers the family to local services for the blind Because the client is considered legally blind, referring the family to local services for the blind is the best way for the nurse to offer increased support. Talking in a loud, clear voice demonstrates insensitivity on the part of the nurse because speaking louder does not have any impact on vision. The client needs more specific assistance than just being told to find a support group. The client with 20/200 vision will not be able to distinguish large print.
A client whose sister was just diagnosed with autosomal recessive retinitis pigmentosa is pregnant with a male fetus. The client's husband has no relatives with the disorder. She asks what the chances are that her son could be affected. What is the nurse's best response? A. "Because it is likely that you are a carrier and your husband does not have any affected relatives, only your daughters can develop the disease." B. "Because it is likely that you are a carrier and your husband does not have any affected relatives, none of your children will have the disease but each child will have a 50% risk for being a carrier." C. "Because your sister actually has retinitis pigmentosa, the risk for your children having the disorder is 50% with each pregnancy." D. "Because you are a woman, your daughters will each have a 50% risk for having the disease, and all of your sons will be carriers."
B. "Because it is likely that you are a carrier and your husband does not have any affected relatives, none of your children will have the disease but each child will have a 50% risk for being a carrier." Rationale: Because retinitis pigmentosa is an autosomal recessive disorder, two mutated alleles are needed for disease expression. Males and females have equal risk. The client is at most a carrier, with one mutated gene allele. In fact, she might not even be a carrier. Although her husband does not have any relatives with the disorder, this does not completely exclude the possibility that he is a carrier, but chances are good that he is not. If he is not a carrier, there is no risk for the client's son to have the disorder, although he may be a carrier.
Which comment made by a client 1 week after a corneal transplant indicates to the nurse a need to review postoperative care? A. "I have been feeding my cat on the counter so that I don't have to bend over." B. "I have been using an icepack on my eye to reduce the redness and swelling." C. "My daughter has been helping me inspect my eye and place the eyedrops." D. "Instead of reading a book, I now listen to books on tape."
B. "I have been using an icepack on my eye to reduce the redness and swelling." Rationale: The eye should be protected from any activity that can increase pressure on, around, or inside the eye. An ice pack puts pressure on the eyeball, which can damage the graft. The other statements indicate good understanding of postoperative care.
Which assessment question is most important for the nurse to ask a client with glaucoma who has just been prescribed the drug apraclonidine (Iopidine)? A. "Are you allergic to sulfa drugs?" B. "What other drugs do you currently take?" C. "Do you have any difficulty passing urine?" D. "Do you have asthma or any other respiratory problem?"
B. "What other drugs do you currently take?" Rationale: Apraclonidine is an adrenergic agonist. It should not be taken with certain types of psychiatric drugs, especially monoamine oxidase inhibitors (MAOIs). Before giving this first dose of any drug from the adrenergic agonist class, it is important to determine which other drugs the client takes to avoid a serious drug interaction. The other questions are inconsequential.
Which problem is most important for the nurse to prevent with a client who has any degree of dizziness from an ear disorder? A. Pain B. Falls C. Dehydration D. Hearing loss
B. Falls Rationale: Dizziness alone results in poor balance and an increased risk for falls, even among younger clients. If the client also experiences nausea and vomiting with the dizziness, the possibility of dehydration also exists, which further increases the risk for falls by causing orthostatic hypotension. Ear disorders that cause dizziness may or may not result in temporary hearing loss and are not usually associated with pain.
A client is returning home after cataract surgery with a patch over the affected eye. Which statement by the client's spouse indicates a need for further instruction on providing a safe home environment? A "I will get some books on tape for entertainment." B "I will be sure to pick up all clutter and loose carpets from the floor." C "I will rearrange the furniture for better flow before my spouse gets home." D "I will place a nonslip mat in the bathtub."
C "I will rearrange the furniture for better flow before my spouse gets home." Changes in item location should not be made without input from the client with reduced vision. Books on tape are a good diversion for recuperating clients with reduced vision. Any objects that may present a tripping hazard should be removed at once. A nonslip mat may be used to prevent falls in the bathtub.
The nurse is teaching a client with impaired hearing about audiometric testing. Which statement by the nurse effectively communicates information about the procedure to the client? A "Here is a picture of how the test is done. See how your bad ear will be tested first? You will be alone in the soundproof booth, so you will need to watch for lights flashing on and off as your cues." B "Here is a video of the procedure. Please watch and feel free to ask me any questions." C "I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond." D "You will be in a soundproof booth and the sounds will be piped in. When you first hear the loudest sound, put your hand down. When you stop hearing the sound, put your hand up to stop."
C "I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond." Sitting in front of the hearing-impaired client while providing instructions allows the client to read lips. Pictures help the client with impaired hearing, but the good ear is tested first. The client wears earphones and listens for sounds, not flashing lights. Showing a hearing-impaired client a video is ineffective because of tone and frequency differences in the video, which make it difficult to read lips and understand the instructions. During the test, earphones are placed on the client. The client will raise her or his hand up when hearing the first sound and will lower the hand when the sound first disappears.
The nurse has just received change-of-shift report about these clients. Which client needs to be assessed first? A Client with Ménière's disease who is reporting severe nausea and is requesting an antiemetic B Client who has had removal of an acoustic neuroma and has complete hearing loss on the surgical side C Client with labyrinthitis who has a temperature of 102.4° F (39.1° C) and a headache D Client who has acute otitis media and is reporting drainage from the affected ear
C Client with labyrinthitis who has a temperature of 102.4° F (39.1° C) and a headache Elevated temperature and headache with labyrinthitis may indicate that the client has developed meningitis and requires further immediate assessment and intervention. Severe nausea is an expected finding with Ménière's disease. Complete hearing loss on the surgical side is an expected postoperative finding after an acoustic neuroma. Drainage from the affected ear can be an expected finding with otitis media.
Which type of drug therapy does the nurse anticipate giving to a client with Ménière's disease to decrease endolymph volume? A Antihistamines B Antipyretics C Diuretics D Nicotinic acid
C Diuretics Mild diuretics are prescribed to decrease endolymph volume. Antihistamines help reduce the severity of or stop an acute attack, and antipyretics control fever and pain, but they do not decrease endolymph volume. Nicotinic acid has been found to be useful because of its vasodilatory effect, but it does not decrease endolymph volume.
The nurse is assessing a client with recent changes in hearing. After taking a medication history, which drugs does the nurse identify as possible causes of the client's hearing change? (Select all that apply.) A Acetaminophen (Tylenol) B Beta blockers C Erythromycin D Ibuprofen (Advil) E Insulin F Furosemide (Lasix)
C Erythromycin D Ibuprofen (Advil) F Furosemide (Lasix) Erythromycin, ibuprofen, and furosemide (Lasix) are medications known to increase the risk for ototoxicity and hearing problems. Acetaminophen, beta blockers, and insulin are not known ototoxic drugs.
The nurse is providing postmortem care to a client who has donated a cornea. Which action is appropriate for the nurse to implement? A Apply a warm pack to the eyes. B Elevate the lower extremities. C Instill antibiotic drops into the eyes. D Contact the recipient family.
C Instill antibiotic drops into the eyes. Antibiotic eyedrops, such as Neosporin (polymyxin B, neomycin, bacitracin) or tobramycin, should be instilled into the corneal donor's eyes to prevent infection. Small cold packs should be applied to the donor's closed eyes. Raising the head of the bed 30 degrees prevents blood from pooling in the eye region of the deceased client. The nurse is not the person to contact the recipient family; the donor organization will complete all the communication to the parties involved.
While reading a client's optical chart, the nurse notices that the client has emmetropia. Which corrective equipment does the nurse expect to see this client wearing? A Bilateral eye patches B Contact lenses C Nothing; this is normal D Reading glasses
C Nothing; this is normal Emmetropia is perfect refraction (bending of light rays from the outside world into the eye) of the eye. Emmetropia is a normal (and ideal) condition that does not require any treatment. Bilateral eye patches inhibit the client's vision. Contact lenses are used to correct underrefraction of the eye. Reading glasses are used to correct overrefraction of the eye.
Which proper technique does the nurse use for eyedrop instillation? A Instilling the drops into the inner canthus B Opening the eye by raising the upper eyelid C Placing the eyedrop in the lower lid pocket D Touching the bottle tip to the eyeball
C Placing the eyedrop in the lower lid pocket To instill eyedrops, the lower eyelid is gently pulled down against the cheek to form a pocket, and the medication is instilled. Instilling drops into the inner canthus causes the medication to enter the punctum and be absorbed systemically. The upper eyelid is larger than the lower eyelid and is used to protect the eye and keep the cornea moist; it should not be used to create a pocket to instill medication. Touching the bottle tip to any part of the eye could potentially contaminate the eye.
A client has recently had cataract surgery. About which symptom does the nurse instruct the client to notify the health care provider? A Increased tearing B Itching of the eye C Reduction in vision D Swollen eyelid
C Reduction in vision A reduction in vision after cataract surgery indicates a problem, and the client should notify the provider immediately. Increased tearing, itching of the eye, and a swollen eyelid all are expected after cataract surgery.
An older adult client reports nausea during removal of impacted cerumen from the ear canal. What does the nurse do next? A Administer an antiemetic. B Call the health care provider. C Stop irrigation immediately. D Use less water to irrigate.
C Stop irrigation immediately. The client's nausea may be a sign of vertigo. If nausea, vomiting, or dizziness develop in the client, irrigation should be stopped immediately. Antiemetics should not be administered immediately in this case. The client's nausea may be a symptom of vertigo, and further assessment is required first. The health care provider should not be notified before further assessment of the client is done by the nurse. Using less water will not alleviate the client's nausea.
The nurse is caring for a client who is admitted with mastoiditis. Which assessment data obtained by the nurse requires the most immediate action? A The eardrum is red, thick-appearing, and immobile. B The lymph nodes are swollen and painful to touch. C The client reports a headache and a stiff neck. D The client's oral temperature is 100.1° F (37.8° C).
C The client reports a headache and a stiff neck. A headache and a stiff neck may indicate meningitis, which is a serious illness requiring further assessment and immediate intervention. The eardrum being red, thick-appearing, and immobile is an expected finding for a client with an ear infection. Lymph nodes that are swollen and painful to touch are an expected finding for a client with an active infection of the mastoid area. An oral temperature of 100.1° F (37.8° C) is also an expected finding for a client with an active infection
A client reports "something scratching on the inside of my eyelid." Before examining the eyelid, what does the nurse do first? A Administer a Snellen test. B Obtain an informed consent. C Wash the hands. D Put on sterile gloves.
C Wash the hands. Always wash hands before touching the external eye structures to prevent infection. A Snellen test may be done, but is not the first thing that should be done by the nurse. An informed consent or sterile gloves are not needed for the nurse to examine the client's eye.
For which client does the nurse recommend annual evaluation by an ophthalmologist? A. 35-year-old man with asthma B. 21-year-old man with psoriasis C. 24-year-old woman with diabetes D. 38-year-old woman who has lost 50 pounds
C. 24-year-old woman with diabetes Rationale: Diabetes mellitus increases the risk for a variety of visual sensory perception problems, including early-onset glaucoma and cataract formation. Also, diabetes changes blood vessel quality in the eye, increasing the risk for retinal hemorrhage and overgrowth of new blood vessels in the retina.
Which action by a nurse is most likely to increase accurate communication with a client who has low vision? A. Speaking slowly and loudly B. Enhancing the talk using hand gestures C. Being very specific with descriptions and directions D. Marking the door of the client's room to indicate his or her vision status
C. Being very specific with descriptions and directions Rationale: Because the client cannot see or see well, he or she cannot make sense of hand gestures. Many clients with reduced vision have no difficulty hearing. Thus, speaking slowly and loudly does not enhance communication and may reduce the client's rapport with the nurse. Marking the door to indicate the client's vision status is a good thing to do for staff communication but does not enhance nurse-client communication. Using specific descriptions and clear language help the client who has reduced vision or sensory perception.
Which assessment is most important for the nurse to perform before instilling travoprost (Travatan) into the client's eye? A. Measuring the client's blood pressure B. Measuring the client's intraocular pressure C. Checking the cornea for abrasions or open areas D. Assessing heart rate and rhythm for 1 full minute
C. Checking the cornea for abrasions or open areas Rationale: Travoprost is a prostaglandins agonist. Drugs from this class should not be applied unless the cornea is completely intact. Measuring intraocular pressure is not necessary when a diagnosis of glaucoma has been established. Prostaglandins agonists, even if systemically absorbed, do not affect body blood pressure or heart rate and rhythm.
Which precaution or action is the priority for the nurse to teach the client who is scheduled to undergo tympanometry, pure-tone audiometry, and caloric testing? A. Avoid aspirin and aspirin-containing products for 1 week before testing. B. Shower and wash your hair the night before testing. C. Do not eat or drink within 4 hours before testing. D. Do not smoke for 24 hours before the testing.
C. Do not eat or drink within 4 hours before testing. Rationale: The caloric test can induce nausea and vomiting; therefore the client should fast for 4 to 6 hours before testing. All the tests are noninvasive and do not require showering or hairwashing. The use of aspirin does not affect the results of these tests.
A client with reduced vision who is 1 day postoperative for a non-vision problem expresses concern to the nurse that he is afraid if a hospital fire occurred he would not be able to get out in time. Which nurse response or action is most likely to allay his fears? A. Demonstrating how to close the door and place wet towels at the bottom edge of the door. B. Reminding him that the hospital meets all current fire codes and has never experienced a major fire. C. Helping him count the steps to the stairway exit and reminding him that he is on the second floor. D. Reassuring him that even if a fire broke out, the nurses and other personnel would stay on the unit with him
C. Helping him count the steps to the stairway exit and reminding him that he is on the second floor. Rationale: The client feels very dependent in these unfamiliar surroundings. Although reminding him about the hospital's safety history and telling him he would not be abandoned are helpful, assisting him to feel independent about the ability to escape a fire is more likely to allay his fears. Teaching him to stuff wet towels under the door is not appropriate.
A client who had cataract removal with placement of an intraocular implant 1 week ago now calls in and reports that her eye is more bloodshot than it was yesterday and that a small amount of greenish drainage is present. What is the priority nursing action? A. Reassure the client that these symptoms are normal for this stage of recovery after cataract surgery. B. Explain how to apply a wet compress to the affected eye for 15 minutes four times daily. C. Instruct the client to come to the office immediately to be seen by the ophthalmologist. D. Instruct the client to use the antibiotic eyedrops four times daily instead of twice daily.
C. Instruct the client to come to the office immediately to be seen by the ophthalmologist. Rationale: These symptoms are manifestations of infection, which can lead to blindness or even encephalitis. Immediate medical attention is needed to prevent these serious complications.
Which client assessment finding does the nurse report to the health care provider immediately? A. The left pupil is slightly smaller than the right pupil. B. Both eyes twitch when the client looks to the far lateral gaze position. C. The right pupil does not change size when a light is shined directly at it. D. The lowest line the client can read clearly at 20 feet on the Snellen chart is marked 50 feet.
C. The right pupil does not change size when a light is shined directly at it. Rationale: Constriction of both pupils is the normal response to direct light and accommodation. Constriction of the opposite pupil when light is shined at one right pupil is normal and is known as the consensual response. A pupil that fails to react consensually is abnormal and should be investigated. Often this indicates a serious neurologic condition. Although pupils should be approximately equal in size, about 5% of people normally have a noticeable difference in the size of their pupils.
The nurse is talking to a client about ear hygiene safety. Which statement by the client indicates a need for further teaching? A "After I shower, I dry my ears using my fingertip and a towel." B "I irrigate my ears with tap water." C "I never clean my ears with a cotton swab." D "I use a bobby pin to remove earwax."
D "I use a bobby pin to remove earwax." Nothing smaller than the client's own fingertip should be inserted into the ear canal. Use of a bobby pin or cotton swab can scrape the skin of the canal, push cerumen up against the eardrum, and even puncture the eardrum. Using the fingertip and a towel and irrigating the ear canal with tap water are acceptable.
The nurse is reviewing postoperative instructions with a client undergoing stapedectomy. Which statement by the client indicates a need for further teaching? A "I may have problems with vertigo after the surgery." B "I should not drink from a straw for several weeks." C "I will have to take antibiotics after the surgery." D "I will be able to hear as soon as my dressing is removed."
D "I will be able to hear as soon as my dressing is removed." Hearing is initially worse after a stapedectomy. The client should be informed that improvement in hearing may not occur until 6 weeks after surgery. At first, the ear packing interferes with hearing. Swelling in the ear after surgery reduces hearing, but this condition is temporary. Vertigo, nausea, and vomiting are common after surgery because of the nearness of the surgical site to inner ear structures. Clients should not drink through a straw for 2 to 3 weeks after surgery. Antibiotics are used to reduce the risk for infection.
An older adult client expresses concern about the ability to instill over-the-counter eyedrops, saying, "My vision is getting so bad, I can't even see my own eyes." What is the nurse's best response? A "Don't worry about the eyedrops." B "Getting old isn't fun, is it?" C "Can your daughter help you do it?" D "Let's find a way that will work for you."
D "Let's find a way that will work for you." Assessing the client's ability to self-perform and adjusting the steps of eyedrop instillation to accommodate the client's change in vision promote independence. Telling the client not to worry about the eyedrops falsely reassures the client and blocks communication. Diverting the client's concern over the inability to instill eyedrops with a comment about getting old blocks communication. Suggesting that the client's daughter help does not promote client independence.
The nurse is teaching a client who will soon be fitted for a hearing aid about proper care and use. Which statement by the client indicates that teaching was effective? A "Background noises will be difficult for me to hear." B "I should wear my hearing aid only to work at first." C "I should just get a smaller hearing aid because I don't have much money." D "Listening to the radio and television will help me get used to new sounds."
D "Listening to the radio and television will help me get used to new sounds." Listening to television and the radio and reading aloud can help the client get used to new sounds. With hearing aids, background noises are amplified so the client must learn to concentrate and filter out background noises. The client should start using the hearing aid slowly, at first wearing it only at home and only during part of the day. The cost of smaller hearing aids is actually greater than for larger ones.
When performing an eye or vision assessment, which comment by the client alerts the nurse that immediate care by an ophthalmologist is needed? A "One eye is green and the other eye is blue." B "My eyes are red and itchy." C "My vision has been getting worse gradually." D "Something hit my eye while I was cutting grass."
D "Something hit my eye while I was cutting grass." The client who is experiencing trauma, a foreign body in the eye, sudden ocular pain, or sudden redness should be seen immediately by an ophthalmologist. Heterochromia is an ocular condition, usually genetically inherited, that causes the iris to vary in color; this is not an emergency. Itching and redness can be caused by allergies, irritation, or ocular drug effects, but do not require immediate attention. Gradual vision loss could be caused by uncontrolled hypertension and diabetes, but does not require immediate care by an ophthalmologist.
The nurse is teaching a client with vertigo about safety precautions for fall prevention. Which statement by the client indicates a need for further instruction? A "I may need to use a cane." B "I should keep my grandkids' toys out of the hallway." C "Moving more slowly may help the vertigo subside." D "Taking my medication will allow me to drive my car again."
D "Taking my medication will allow me to drive my car again." Medications for vertigo may cause drowsiness, so the client should not drive or operate machinery while taking these drugs. The client with vertigo may need to use a cane for balance. Clients should maintain a safe, uncluttered environment to prevent accidents during periods of vertigo. Restricting head motion and moving more slowly may help clients reduce occurrences of vertigo.
When preparing to examine an ear with drainage, what does the nurse do first? A Begins testing at 1000 Hz B Reassures the client that the ear drainage is normal C Tilts the client's head away slightly D Dons clean gloves
D Dons clean gloves The nurse should always use Contact Precautions, which include wearing clean gloves, with any client who has drainage from the ear canal to prevent infection. Testing for hearing loss (1000 Hz) is not used when examining an ear for drainage. Ear drainage is not normal and must be investigated. Tilting the client's head is not the first action among the options given that the nurse should do.
Clients with a family history of which eye disorder may have problems with increased intraocular pressure (IOP), requiring additional assessment? A Anisocoria B Presbyopia C Diabetic retinopathy D Glaucoma
D Glaucoma Glaucoma can be caused by increased IOP, which reduces blood flow to the eyes. Adults with a family history of glaucoma should have their IOP measured once or twice a year. Anisocoria is characterized by unequal pupil size, which normally affects about 5% of the population; this condition is not a sign of increased IOP. Presbyopia is a condition related to aging with a progressive loss of the ability to focus on near objects; increased IOP is not a factor. Diabetic retinopathy is microvascular damage caused by uncontrolled diabetes, not by increased IOP.
A client with glaucoma is being assessed for new symptoms. Which symptom indicates a high priority need for reassessment of intraocular pressure? A Burning in the eye B Inability to differentiate colors C Increased sensitivity to light D Gradual vision changes
D Gradual vision changes Gradual vision changes are an indication of increased intraocular pressure. A burning sensation in the eye usually indicates inflammation and/or infection. An inability to differentiate colors is an early sign of cataracts. An increased sensitivity to light might be a sign of a corneal abrasion.
What is the proper technique for assessing an adult client's ear with an otoscope? A Hold the otoscope right side up when inserting it into the ear canal. B Maintain distance between the otoscope and the client's head. C Place the otoscope in the nondominant hand. D Pull the pinna up and back with the nondominant hand.
D Pull the pinna up and back with the nondominant hand. In the adult, pulling the pinna up and back allows the ear canal to straighten. The otoscope should be held upside down, like a large pen. The distance between the otoscope and the client's head is very short. The otoscope should be held in the dominant hand.
A client has a purulent drainage in the inner canthus of the eye. Before examining the eye, what must the nurse do first? A Administer a Snellen test. B Obtain an informed consent. C Instill antibiotic drops. D Put on gloves.
D Put on gloves. Gloves should be worn in the presence of drainage and should be put on before examining the eye. Administering a Snellen test or instilling antibiotic eyedrops is not the first thing that the nurse should do before examining the client's eye. Obtaining informed consent is not necessary for an eye examination.
The nurse providing education on eye protection suggests the special need for protective eyewear for which clients? (Select all that apply.) A Cab driver B College student C Lifeguard Correct D Racquetball player E Registered nurse
D Racquetball player Lifeguards are in need of eye protection from ultraviolet (UV) A and UVB rays because of exposure to the sun. People who play racquetball need to wear protective eyewear to prevent possible eye injury. Cab drivers may require eyewear for corrective purposes, but are not at high risk and in need of protective eyewear. College students are generally not at high risk. Although an RN would need eye protection at times, RNs do not routinely require protective eyewear for general work.
A client recently diagnosed with Ménière's disease is struggling with tinnitus. How does the nurse provide support to this client? A Provide further assessment. B Suggest a quiet environment. C Suggest temporary removal of a hearing aid. D Refer the client to the American Tinnitus Association.
D Refer the client to the American Tinnitus Association. The American Tinnitus Association assists clients in coping with tinnitus when other therapy is unsuccessful. Reassessment of the client's diagnosis is not needed; this will only waste the client's and the nurse's time. Background noise masks the tinnitus while quiet conditions exacerbate it; ear-mold hearing aids can amplify sounds to drown out tinnitus during the day.
An older adult client with a new diagnosis of hearing loss is deeply concerned about not being able to hear at the neighborhood council meetings. Which nursing intervention best addresses the client's concern? A Suggest that the client discuss with the chairperson about asking everyone speaking at the meeting to speak louder. B Refer the client to the Center for the Visually Impaired for support. C Arrange for a sign language specialist to attend the meetings to teach everyone how to communicate with the hearing-impaired member. D Refer the client to the Hearing Loss Association of America.
D Refer the client to the Hearing Loss Association of America. The Hearing Loss Association of America can inform the client about support groups in the area, along with interventions to help improve hearing. Speaking louder raises the frequency of the sound, making it more difficult to hear. The Center for the Visually Impaired is useful for people with vision problems, not hearing problems. The client and members of the neighborhood council must first express an interest in learning sign language before arrangements are made with a sign language specialist.
A client says, "I have problems reading the signs when I am driving." Which test does the nurse use to assess this client's problem? A Confrontation test B Ishihara chart C Rosenbaum Pocket Vision Screener or a Jaeger card D Snellen chart
D Snellen chart The Snellen chart assesses the client's distance vision, which is the type of vision used while driving. The confrontation test assesses the client's visual field. The Ishihara chart assesses the client's color vision. The Rosenbaum Pocket Vision Screener or Jaeger card assess the client's near vision.
An older adult client reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media? A Dry, flaky cerumen B Pain on movement of the tragus C Ringing in the ears D Vertigo
D Vertigo With otitis media, as pressure on the middle ear pushes against the inner ear, the client may develop dizziness or vertigo. Dry, flaky cerumen is normal with aging. Pain on movement of the tragus is indicative of external otitis. Ringing in the ears is more likely with Ménière's disease.
Which assessment finding warrants further investigation by the nurse in the ophthalmology clinic? A Snellen eye examination result is 20/50 for a client who normally wears corrective lenses, but does not have them at the time of the examination. B When six cardinal positions of gaze of the left eye are assessed, the client exhibits nystagmus when looking to the left lower and upper fields. C The pupil exhibits miosis when exposed to light from the ophthalmoscope during examination and mydriasis when the light is removed from the pupil. D When assessing the cornea, the nurse notes cloudiness and the client reports pain when the ophthalmoscope light shines into the pupil.
D When assessing the cornea, the nurse notes cloudiness and the client reports pain when the ophthalmoscope light shines into the pupil. Cloudiness in the cornea and pain from a light shined into the pupil is an abnormal finding that requires further assessment and possible intervention/referral. A Snellen eye examination result of 20/50 for the client who normally wears corrective lenses but does not have them at the time of the examination is normal given the client's baseline and considering that he or she wears corrective lenses. It can be a normal finding for the client to exhibit nystagmus when looking to the left lower and upper fields during assessment of the six cardinal positions of gaze of the left eye. It is normal for the pupil to exhibit miosis when exposed to light from the ophthalmoscope during examination and mydriasis when the light is removed from the pupil.
A client is in the immediate postoperative period after tympanoplasty. How does the nurse position the client? A On the affected side B Supine, with eyes toward the ceiling C With the head elevated 60 degrees D With the affected ear facing up
D With the affected ear facing up Keep the client flat, with the head turned to the side and the operative ear facing up, for at least 12 hours after surgery. Raising the head places undue pressure on the surgical site.
A client is having a stapedectomy. Which form of postoperative communication is most effective for the nurse to use? A Gesturing B Sign language C Speaking D Writing
D Writing Writing is the most effective way to communicate with the client who has undergone a stapedectomy. Gesturing can be vague and imprecise. Sign language requires training. It is hoped that the client will not be hearing-impaired long enough for this to be a viable option. The client will not be able to hear for the first 6 weeks after surgery.
The client who had cataract surgery with a lens implant 1 week ago remarks to the home care nurse that after his daughter left to go to her home in another state yesterday, he combined all of his prescribed eyedrops together in one container so he had fewer drops to administer. What is the nurse's best response? A. "This is not a good idea because not all of the drugs are on the same schedule." B. "That is a good idea; just remember to not touch the dropper to your eye when giving yourself the drops." C. "Call your surgeon immediately and get new prescriptions because together these drugs can lower your blood pressure." D. "Call your surgeon immediately and get new prescriptions to use one at a time because these drugs cannot be mixed together."
D. "Call your surgeon immediately and get new prescriptions to use one at a time because these drugs cannot be mixed together." Rationale: These drugs are not to be mixed together. Not only is the chance for contamination high, but the drug concentrations and effectiveness are also reduced when mixed together. Even when the drugs are administered separately, they should be given 5 to 10 minutes apart.
Which precaution is most important for the nurse to teach a client who is prescribed to use an ophthalmic ointment? A. "Keep the tube in the refrigerator to make the ointment easier to control when you squeeze the tube." B. "Wear gloves when you apply the ointment to prevent absorbing the drug through your skin." C. "Patch your eye at night to prevent ointment from getting on your bedding or in your hair." D. "Do not drive with ointment in your eyes."
D. "Do not drive with ointment in your eyes." Rationale: Eye ointment spreads over the cornea and blurs vision. The client should wipe the ointment out of the eye or eyes before driving or performing any task that requires clear vision for safety. Patching the eye at night, keeping the tube in the refrigerator, and wearing gloves during installation are all unnecessary measures.
The client with external otitis reports reduced hearing in the affected ear and asks whether the hearing loss will be permanent. What is the nurse's best response? A. "Yes, but fortunately the hearing of the other ear remains normal." B. "Yes, but this type of problem can be helped with a hearing aid." C. "No, infection does not lead to any type of permanent hearing loss." D. "No, if the infection does not reach the middle ear, hearing will return."
D. "No, if the infection does not reach the middle ear, hearing will return." Rationale: The hearing loss the client is currently experiencing is related to swelling of the ear canal and mechanical prevention of sound waves from reaching the tympanic membrane. If the infection does not progress beyond the ear canal, there is no danger of hearing loss from external otitis.
The older adult client asks whether the white ring in the iris of both eyes is a cataract that can be removed to improve her vision. What is the nurse's best response? A. "A cataract forms inside the eye, not on the surface. This growth should be assessed for cancer." B. "This type of ring in the eye gets worse as intraocular pressure increases, leading to glaucoma." C. "The ring is a cataract, and it cannot be removed until it reaches and covers over the pupil." D. "The ring is just a buildup of deposits, not a cataract, and never interferes with vision."
D. "The ring is just a buildup of deposits, not a cataract, and never interferes with vision." Rationale: Arcus senilis, an opaque, bluish white ring within the outer edge of the cornea, is caused by fat deposits. Although very common, this change does not affect vision. It is age-related but does not appear to be related to a high-fat diet. It is a cosmetic change only, and surgery does not correct it.
With which client does the nurse avoid performing an otoscopic examination? A. 34-year-old woman who is pregnant B. 90-year-old woman who is visually impaired C. 75-year-old man with dizziness and vertigo D. 70-year-old man with advanced Alzheimer's disease
D. 70-year-old man with advanced Alzheimer's disease Rationale: An otoscopic examination involves inserting a hard speculum into the narrow external ear canal. If not performed carefully, the canal or eardrum can be traumatized. The client must remain still during the examination to prevent trauma. A person with advanced Alzheimer's disease is likely to be confused and not understand the direction to hold his or her head still. A nurse does not perform an otoscopic examination on a client who is confused. None of the other client conditions are contraindications to otoscopic examination.
The client is a 28-year-old woman who reports to the nurse that she has experienced reduced hearing in both ears during the past 2 years. Which health issue or personal factor is most likely to be associated with the reduced hearing? A. Use of cotton-tipped applicators to clean the ears for her entire adult life. B. Use of oral contraceptives as the method of birth control for the past 3 years. C. Participation in a vegetarian diet that permits milk and eggs for the past 5 years. D. Management of chronic joint pain with daily naproxen (Aleve) for the past 3 years.
D. Management of chronic joint pain with daily naproxen (Aleve) for the past 3 years. Rationale: Although the use of cotton-tipped applicators can push ear wax against the tympanic membrane and compromise hearing, the most likely cause of this client's hearing problem is the chronic use of naproxen. This drug is ototoxic, usually first causing tinnitus and then resulting in some degree of hearing loss. Oral contraceptive use and a vegetarian diet are not associated with hearing loss.
The nurse is providing discharge instructions to a client with glaucoma. Which activities does the nurse instruct the client to avoid? (Select all that apply.) A Bending over to tie shoes Correct B Sitting with legs elevated C Sleeping on more than two pillows D Blowing the nose frequently Correct E Lifting objects weighing more than 10 pounds
E Lifting objects weighing more than 10 pounds Any action that would increase pressure in the eye should be avoided, such as bending over, excessive blowing of the nose, and lifting heavy objects. Sitting with the legs elevated or sleeping on more than two pillows is not contraindicated in clients with glaucoma.
