Med Surg Exam 4

A client who is diagnosed with stage II prostate cancer asks the nurse if a transurethral resection of the prostate (TURP) can be done for this disorder. Which is the best response by the nurse?

"A TURP is a removal of only a portion of the prostate gland."

An 80-year-old patient is brought to the clinic by her son. The son asks the nurse why his mother has gotten so many "spots" on her skin. What would be an appropriate response by the nurse?A) As people age, they normally develop uneven pigmentation in their skin. B)These 'spots' are called 'liver spots' or 'age spots.' C)Older skin is more apt to break down and tear, causing sores. D)These are usually the result of nutritional deficits earlier in life.

"Ans: A Feedback: The major changes in the skin of older people include dryness, wrinkling, uneven pigmentation, and various proliferative lesions. Stating the names of these spots and identifying older adults' vulnerability to skin damage do not answer the son's question. These lesions are not normally a result of nutritional imbalances.

A nurse is performing an eye examination. Which question would not be included in the examination?

"Are you able to raise both eyebrows?"

A female patient presents to the health clinical for a routine physical examination. The nurse observes that the patient's urine is bright yellow in color. Which of the following questions is most appropriate for the nurse to ask the patient?

"Do you take multiple vitamin preparations?" Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation. Urine that is orange may be caused by intake of Dilantin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female patient, the use of vaginal creams.

A female patient presents to the health clinical for a routine physical examination. The nurse observes that the patient's urine is bright yellow in color. Which of the following questions is most appropriate for the nurse to ask the patient? a) "Do you take phenytoin (Dilantin) daily?" b) "Do you take multiple vitamin preparations?" c) "Have you noticed any vaginal bleeding?" d) "Have you had a recent urinary tract infection?"

"Do you take multiple vitamin preparations?" Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation. Urine that is orange may be caused by intake of Dilantin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female patient, the use of vaginal creams.

While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question? a) "Is it painful when you urinate?" b) "Do you have a strong desire to void?" c) "Do you urinate while sleeping?" d) "Does it burn when you urinate?"

"Do you urinate while sleeping?" Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the client's voiding pattern.

A nurse is conducting a health interview and is assessing for integumentary conditions that are known to have a genetic component. What assessment question is most appropriate?A) Does anyone in your family have eczema or psoriasis? B)Have any of your family members been diagnosed with malignant melanoma? C)Do you have a family history of vitiligo or port-wine stains? D) Does any member of your family have a history of keloid scarring?

"Does anyone in your family have eczema or psoriasis?"

A nurse in ED is triaging a 5-year-old who has been brought to the ED by her parents for an outbreak of urticaria. What would be the most appropriate question to ask this patient and her family?A) Has she eaten any new foods today? B) Has she bathed in the past 24 hours? C) Did she go to a friend's house today? D) Was she digging in the dirt today?

"Has she eaten any new foods today?"

A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? a) "I have had a test similar to this one in the past." b) "I take medication to help me sleep at night." c) "I am allergic to shrimp." d) "I don't like needles."

"I am allergic to shrimp." The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.

After surgery for removal of cataract, a client is being discharged, and the nurse has completed discharge instruction. Which client statement indicates that the outcome of the teaching plan has been met?

"I should avoid pulling or pushing any object that weighs more than 15 lbs."

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse? You Selected:

"I took my blood pressure medication with my morning coffee an hour ago." The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? a) "I will feel a warm sensation as the dye is injected." b) "I will need to drink all of the dye as quickly as possible." c) "I should remove all jewelry before the test." d) "I should let the staff know if I feel claustrophobic."

"I will feel a warm sensation as the dye is injected." A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)?

"I've had trouble getting started when I urinate, often straining to do so."

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."

The nurse is demonstrating the technique for performing a testicular self examination (TSE) to a group of men for a company health fair. One of the men asks the nurse at what age a man should begin performing TSE. What is the best answer by the nurse? "It should be performed in high-risk males over age 30." "It should begin in adolescence." "It should begin at age 40." "It should begin in men over age 50."

"It should begin in adolescence."

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse?

"Prescriptions of this medication are generally not given because it can cause corneal problems."

The nurse is teaching a young adult male how to perform testicular self-examination (TSE). The nurse determines that the client has understood the instructions when he states which of the following?

"The best time to do it is once a month after I take my warm morning shower."

A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? a) "This medication will relieve your pain." b) "This medication will treat the blood in your urine." c) "This medication prevents infection in your urinary tract" d) "This medication prevents urinary incontinence."

"This medication will relieve your pain." Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.

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."

The nurse is precepting a nursing student when a new client comes to the eye clinic. The client explains that they think they have a corneal abrasion. The nurse should explain what to the student nurse?

"To detect corneal abrasions, a slit lamp is used."

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? a) "You don't need to do any fasting before this noninvasive test." b) "You'll have a pressure dressing on your groin after the test." c) "A contrast medium will be used to help see the structures better." d) "An x-ray will be done to view your kidneys, ureters, and bladder."

"You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

A client with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following would the nurse include in the teaching plan for this client?

"You may experience headache and some flushing with this drug."

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?

"You'll need to use the drops for the rest of your life to control the glaucoma."

Strabismus

"crossed- eyes or wandering- eye" misalignment of eye(s) -can be born w/ or acquire later RF: FHx, genetics, stroke, head injury Pathophysiology: -when eye is misaligned double vision may occur- brain will then "turn off" eye to prevent this S/S: -head turning/tilting -headaches, blurry/double vision

A patient has been brought to the emergency room after being hit in the head with a baseball. The nurse should be alert to which of the following clinical manifestations of a detached retina? Select all that apply.

- Bright flashing lights - Sudden onset of floaters - Cobwebs - Sensation of a curtain coming across vision of one eye

A patient presents to an eye clinic with a number of symptoms related to his diminished vision. An initial history leads the nurse practitioner to suspect that the patient has acute angle-closure glaucoma. Which of the following symptoms would apply to this diagnosis? Select all that apply.

- Severe eye pain - Reddening of the eye - Sudden onset of visual disturbance - Nausea and vomiting

Medical consequences with urinary incontinence

- UTIs, urosepsis - skin irritation, decubitus, ulcers - disrupted sleep - falls (d/t urgency)

what are some nursing diagnosis for skin conditions?

- acute pain - impaired skin integrity - disturbed body image - deficient fluid volume - deficient knowledge

MOA of imipramine (TCA) for urge UI

- anticholinergic and a-agonist activity (may increase tone in the internal spinchter)

Mixed UI

- both urgency and stress incontinence - 32% of pts with UI - more common in women

urge ui and benign prostatic hypertrophy (BPH)

- bph should be treated first - if still symptomatic, use antimuscarinic therapy as long as no urinary retention *bladder scan will help make sure there's no urinary retention

caution using antimuscarinics in these people

- caution in frail elderly, cognitive impairment, dementia, and parkinsons - caution with other drugs with safe effects - reevaluate often!

neurogenic UI

- damage to peripheral/spinal nerves or a cerebral lesion (parkinsons, MS, stroke, paralysis) - multiple factors present

(diagnostic procedures) immunofluorescence

- detects antibodies on skin (direct) - detects antibodies in serum (indirect)

Visual field testing

- determines degree of visual field narrowing

most common adverse effects from antimuscarinics

- dry mouth - constipation - blurred vision - confusion, cognitive impairment - increased heart rate

Pyschological consuquences of UI

- embarrassment - isolation - depression - decreased qol

what are the layers of the skin?

- epidermis (top layer) - dermis (middle layer) - hypodermis or subcutaneous (bottom layer)

what are some skin appearances we might see?

- erythema (redness) - rash - cyanosis (blue color from lack of O2) - jaundice (yellow color, liver disease) - pruritus (itchiness of skin) can see these signs centrally or peripherally - peripheral = fingers & toes - central = mucous membranes, tongue

Which features should a nurse observe during an ophthalmic assessment? Select all that apply.

- external eye appearance - pupil responses

Urge UI - antimuscarinics

- first line - relax detrusor muscle - modest efficacy CI: urinary retention, angle glaucoma, gastric retention

bladder training

- for urge UI - pee q1-2, increase by 15 min each week - most effective in combination with drug tx

Theoretical advantages of selective antimuscarinics in Urge UI

- increases selectivity for bladder muscarinic (M3) receptors - decreases lipophilicity which decreases BBB penetration - decreases adverse effects (cognitive impairment, dry mouth, constipation)

myths of UI

- inevitable part of aging - nothing can be done

urinary incontinence (UI)

- involuntary loss of urine of sufficient volume to cause problems for pt - 1/10 pts - women>men

Glaucoma medications: Prostaglandin analogs

- latanoprost, bimatoprost (-prost) • Increase uveoscleral (aqueous) outflow • Can cause blurred vision and stinging • Long term use can cause darkening of iris and eyebrows - if color change occurs it is usually permanent • Important to assess eye color and for eye pain • Usually take this medication at bedtime

Urge UI

- leakage associated with a sudden, uncontrollable need to pee (void) - 14% of UI pts - overactive bladder/detrusor overactivity (urgency w/ or w/o actual incontinence) - increased daytime frequency and notcuria

Overflow UI

- leakage of urine from a full bladder - common with urinary retention - poor detrusor contractility or bladder outlet obstruction

Stress UI

- leakage with increased abdominal pressure (exercize, sneezing, coughing) - 50% incontinence cases - more common in women (even younger women)

vaginal estrogen in stress ui

- may benefit if urogenital atrophy is present - mixed study results - conjugated estrogen - vaginal ring (Estring) - systemic estrogen NOT recommended b/c can worsen stress ui

Lifestyle modifications

- most helpful - decrease wt if bmi>30 (helps with stress ui in women) - decrease alcohol and caffeine - first line (frequency and stress ui) - restrict fluids in the evening if nocturia (take diuretics in the am) - quit smoking (irritant to urogenital sx and the coughing can trigger ui)

behaviour modifications

- most helpful 1. pelvic floor training - 1st line!! 2. bladder training 3. scheduled/prompted toilet q2-3hrs

mirabegron (Myrbetriq)

- new agent for urge ui - b3 agonist (relaxes detrusor smooth muscle and increases storage capacity) - 25mg daily, may increase 50mg daily - similar modest efficacy as antimuscarinics - no ac SE CI in uncontrolled BP AE: increased bp, tachycardia, ha, constipation, utis

what are some parasitic skin infestations?

- pediculosis (lice) - scabies (mites)

5 alpha reductase inhibitors for bph

- prevent conversion of testosterone to dihyrotestosterone (DHT) which decreases prostate size - takes up to 6 months for effect SE: fatigue, decreased libido, ED, rash, gynecomastia

what are some functions of the skin?

- protection (keratin) - sensation (CNS & ANS, touch, pain, pressure) - fluid balance (sweat, assess skin turgor) - temp regulation (convection, conduction, radiation, evaporation) - vitamin D synthesis (from the sun) - immune response (normal flora on skin) - absorption (medications) - elimination (sweat glands, sebaceous glands) - psychosocial (body image, tattoos, piercings)

non selective alpha antagonists for bph

- rarely used - terazosin, doxazosin, prazosin

pelvic floor muscle training

- recommended for everyone - first line for urge, stress, mixed UI - try for 6-12 weeks - be consistent to see results - kegal - if done properly, most effective

alpha antagonists in tx bph

- relax smooth muscle in bladder neck and prostate - selective blockade reduces hypotension SE: ha, dizziness, orthostatic hypotension

what are normal aging changes of the skin?

- thinning of skin - uneven pigmentation - increased fragility - reduced healing ability decreased collagen (protein), decreased skin turgor (will see tenting), and increase for skin tears & pressure ulcers

what are some integumentary infections?

- tine corpis (ringworm) - shingles (herpes zoster) - herpes simplex - varicella (chicken pox) - urticaria (allergic reaction) - contact dermatitis - erythema gyratum repens (EGR) (lupus) - steven-johnson syndrome (caused by medications) - psoriasis

Names of selective antimuscarinics

- tolterodine (Detrol) - trospium (Trosec) - darifenacin (Enablex) - solifenacin (vesicare) - fesoterodine (Toviaz)

Types of urinary incontinence

- urgency - stress - mixed - overflow - functional - neurogenic

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be: a) 1 to 2 L/day b) 3.5 to 4 L/day c) 0.4 to 0.8 L/day d) 2.5 to 3 L/day

1 to 2 L/day The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text. The significance of the 24-hour result will depend on the patient's medical condition.

Give a reasonable dose for oxybutinin in an exam

1. IR 2.5mg hs, increase to 2.5mg BID or TID Max 10-15mg/d Elderly max 5-10mg/d

meds that cause ui

1. alcohol 2. alpha agonists (pseudoephedrine) 3. alpha antagonists (terazosin) 4. anticholinergics 5. acetylcholinesterase (donepezil) 6. antispsychotics (typical) 7. CCBs 8. GABAergic agents (gabapentin, pregabalin) 9. NSAIDS, thiazolidinediones 10. loop diuretics 11. ACEIs 12. narcotics 13. sedative hypnotics

Drug therapy for BPH

1. alpha antagonists 2. 5 alpha reductase inhibitors

Urge UI drug tx

1. antimuscarinics 2. b-3 adrenergic agonist 3. intravaginal estrogen - if associated with vaginal atrophy - usually more for stress or mixed UI

The science of peeing

1. bladder fills 2. micturition center in the brain is alerted 3. PNS contracts detrusor muscle 4. sympathetic nervous system allows relaxation of internal sphincter 5. individual relaxes external sphincter and pelvic floor-->urination

Relevant anatomy to know

1. detrusor muscle (contraction and responds to cholinergic activity) 2. internal sphincter (activated by sympathetic nervous system - alpha-adrenergic stimulation to contract) 3. external sphincter - voluntary control 4. pelvic floor muscle - voluntary control

Know a dose for a selective antimuscarinic for exam

1. fesoterodine (toviaz) 4-8mg daily 2. darifenacin (enablex) 7.5-15mg daily; doesn't need to be readjusted in renal because it's metabolized by the liver

5 alpha reductase inhibitor drugs and doses

1. finasteride 5mg daily 2. dutasteride 0.5mg daily

What investigations for UI?

1. hx and physical - type of incontinence - reversible cause? 2. lab tests - urinalysis - urine culture 3. bladder diary 4. post void urinary residual test (bladder scan) 5. urodynamic tests

UI stepwise approach to tx

1. lifestyle modifications* 2. behaviour modifications* 3. meds 4. minimally invasive procedures, surgery *most helpful

Stress UI drug therapy

1. vaginal estrogen 2. duloxetine - not well studied, occasionally used off label

When fluid intake is normal, the specific gravity of urine should be which of the following? a) >1.025. b) 1.000. c) <1.010. d) 1.010 to 1.025.

1.010 to 1.025. Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of <1.010 may indicate overhydration. A urine specific gravity >1.025 may indicate dehydration.

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.

Conductive Hearing Loss

10% problem w/ sound waves transferring from outer ear to middle ear Symptoms: -difficulty hearing speech -sense own voice difference -easier to hear out of one ear -pain/pressure in ear(s) Causes: -cerumen (build up of wax) -otitis media -otitis externa -fluid in middle ear -perforated ear drum -foreign object

The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio? a) 10:1 b) 8:1 c) 4:1 d) 6:1

10:1 A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.

What is the average age of puberty in girls

13

What is the average age of puberty in boys

14

at what age should you investigate delay in puberty

15 or 16

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150 The urinary drainage bag contains both the contrast agent and urine at the conclusion of the procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and 150 ml of urine.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 10 b) 30 c) 20 d) 40

20 Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 liters per day of filtrate.

A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage?

21 mm Hg or higher

A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal?

25 mm Hg

how often do you need to give oral testosterone

3-4 times daily

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 20% b) 40% c) 50% d) 30%

50% Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.

Open Angle Glaucoma

90% PAINLESS- some kind of blockage but still open -gradual loss of vision over years RF: DM, hypertension, age, African Amer., FHx Diagnosis: Ophthalmoscope Exam -optic nerve cupping - increase intra-ocular pressure

Dry Macular Degeneration

90% blurry/wavy central vision, normal peripheral vision SLOW, GRADUAL ONSET -drusen (yellow spots) >metabolic waste product build up under retina >scarring of retina

Sensorineural Hearing Loss

90% issue w/ inner ear (cochlea assoc. structures) OR vestibulocochlear nerve (CN VIII) -slowly develops overtime Symptoms: -difficulty hearing voices w/ background noise -difficulty hearing quieter noises Causes: -aging, genetic -exposure to loud noises -rubella during pregnancy -low birth weight -head & ear injuries -illness, medications

A 6-year-old child is brought to the pediatric clinic for the assessment of redness and discharge from the eye and is diagnosed with viral conjunctivitis. What is the most important information to discuss with the parents and child? A) hand washing can prevent the spread of the disease to others B) the importance of compliance with antibiotic therapy C) signs and symptoms of complications, such as meningitis and septicemia D) the likely need for surgery to prevent scarring of the conductive

A

A hearing-impaired patient is scheduled to have an MRI. What would be important for the nurse to remember when caring for this patient? A) Patient is likely unable to hear the nurse during test. B) A person adept in sign language must be present during test. C) Lip reading will be the method of communication that is necessary. D) The nurse should interact with the patient like any other patient.

A

A nurse is teaching a patient with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the patient to perform what action? A) Instill the medication in the conjunctival sac. B) Maintain a supine position for 10 minutes after administration. C) Keep the eyes closed for 1 to 2 minutes after administration. D) Apply the medication evenly to the sclera

A

A patient comes to the ophthalmology clinic for an eye examination. The patient tells the nurse that he often sees floaters in his vision. How should the nurse best interpret this subjective assessment finding? A) This is a normal aging process of the eye. B) Glasses will minimize this phenomenon. C) The patient may be exhibiting signs of glaucoma. D) This may be a result of weakened ciliary muscles.

A

A patient diagnosed with arthritis has been taking aspirin and now reports experiencing tinnitus and hearing loss. What should the nurse teach this patient? A) The hearing loss will likely resolve with time after the drug is discontinued. B) The patients hearing loss and tinnitus are irreversible at this point. C) The patients tinnitus is likely multifactorial, and not directly related to aspirin use. D) The patients tinnitus will abate as tolerance to aspirin develops.

A

A patient got a sliver of glass in his eye when a glass container at work fell and shattered. The glass had to be surgically removed and the patient is about to be discharged home. The patient asks the nurse for a topical anesthetic for the pain in his eye. What should the nurse respond? A) Overuse of these drops could soften your cornea and damage your eye. B) You could lose the peripheral vision in your eye if you used these drops too much. C) Im sorry, this medication is considered a controlled substance and patients cannot take it home. D) I know these drops will make your eye feel better, but I cant let you take them home.

A

A patient has had a sudden loss of vision after head trauma. How should the nurse best describe the placement of items on the dinner tray? A) Explain the location of items using clock cues. B) Explain that each of the items on the tray is clearly separated. C) Describe the location of items from the bottom of the plate to the top. D) Ask the patient to describe the location of items before confirming their location.

A

A patient is postoperative day 6 following tympanoplasty and mastoidectomy. The patient has phoned the surgical unit and states that she is experiencing occasional sharp, shooting pains in her affected ear. How should the nurse best interpret this patients complaint? A) These pains are an expected finding during the first few weeks of recovery. B) The patients complaints are suggestive of a postoperative infection. C) The patient may have experienced a spontaneous rupture of the tympanic membrane. D) The patients surgery may have been unsuccessful.

A

A patient with glaucoma has presented for a scheduled clinic visit and tells the nurse that she has begun taking an herbal remedy for her condition that was recommended by a work colleague. What instruction should the nurse provide to the patient? A) The patient should discuss this new remedy with her ophthalmologist promptly. B) The patient should monitor her IOP closely for the next several weeks. C) The patient should do further research on the herbal remedy. D) The patient should report any adverse effects to her pharmacist

A

A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient? A) Sit or stand in front of the patient when speaking. B) Use exaggerated lip and mouth movements when talking. C) Stand in front of a light or window when speaking. D) Say the patients name loudly before starting to talk.

A

A patients ocular tumor has necessitated enucleation and the patient will be fitted with a prosthesis. The nurse should address what nursing diagnosis when planning the patients discharge education? A) Disturbed body image B) Chronic pain C) Ineffective protection D) Unilateral neglect

A

An advanced practice nurse has performed a Rinne test on a new patient. During the test, the patient reports that air-conducted sound is louder than bone-conducted sound. How should the nurse best interpret this assessment finding? A) The patients hearing is likely normal. B) The patient is at risk for tinnitus. C) The patient likely has otosclerosis. D) The patient likely has sensorineural hearing loss.

A

The advanced practice nurse is attempting to examine the patients ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the patients ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure? A) Maintain the irrigation fluid at a warm temperature. B) Instill short, sharp bursts of fluid into the ear canal. C) Follow the procedure with insertion of a cerumen curette to extract missed ear wax. D) Have the patient stand during the procedure.

A

The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis? A) External otitis is characterized by aural tenderness. B) External otitis is usually accompanied by a high fever. C) External otitis is usually related to an upper respiratory infection. D) External otitis can be prevented by using cotton-tipped applicators to clean the ear.

A

The nurse is admitting a 55-year-old male patient diagnosed with a retinal detachment in his left eye. While assessing this patient, what characteristic symptom would the nurse expect to find? A) flashing lights in the visual field B) sudden eye pain C) loss of color vision D) colored halos around lights

A

The nurse is discussing the results of a patients diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss? A) The sound is heard better in the ear in which hearing is better. B) The sound is heard equally in both ears. C) The sound is heard better in the ear in which hearing is poorer. D) The sound is heard longer in the ear in which hearing is better.

A

The nurse is providing discharge education for a patient with a new diagnosis of Mnires disease. What food should the patient be instructed to limit or avoid? A) Sweet pickles B) Frozen yogurt C) Shellfish D) Red meat

A

The nurse should recognize the greatest risk for the development of blindness in which of the following patients? A) A 58-year-old Caucasian woman with macular degeneration B) 28 year old caucasian man with astigmatism C) a 58 year old african american woman with hyperopia D) a 28 year old african american man with myopia

A

A patient with mastoiditis is admitted to the post-surgical unit after undergoing a radical mastoidectomy. The nurse should identify what priority of postoperative care? A) assessing for mouth droop and decreased lateral eye gaze B) assessing for increased middle ear pressure and perforated ear drum C) assessing for gradual onset of conductive hearing loss and nystagmus D) assessing for scar tissue and cerumen obstructing the auditory canal

A (The facial nerve runs through the middle ear and the mastoid; therefore, there is risk of injuring this nerve during a mastoidectomy. When injury occurs, the patient may display mouth droop and decreased lateral gaze on the operative side.)

The nurse has taken shift report on her patients and has been told that one patient has an ocular condition that has primarily affected the rods in his eyes. Considering this information, what should the nurse do while caring for the patient? A) Ensure adequate lighting in the patients room. B) Provide a dimly lit room to aid vision by limiting contrast. C) Carefully point out color differences for the patient. D) Carefully point out fine details for the patient.

A (The nurse should provide adequate lighting in the patients room, as the rods are mainly responsible for night vision or vision in low light. If the patients rods are impaired, the patient will have difficulty seeing in dim light. The cones in the eyes provide best vision for bright light, color vision, and fine detail.)

Which client would the nurse identify as being at highest risk for the development of testicular cancer?

A 25-year-old male with a history of cryptorchidism

Which of the following patients is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall? A 17-year-old Caucasian man A 60-year-old Asian American man A 56-year-old African American man A 35-year-old African American man

A 56-year-old African American man

The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom? a) The ingestion of 8 oz of water b) A dull sound when percussing over the bladder c) Tenderness over the kidneys d) Bruits noted over the abdominal area

A dull sound when percussing over the bladder A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.

While waiting to see the physician, a patient shows the nurse skin areas that are flat, nonpalpable, and have had a change of color. The nurse recognizes that the patient is demonstrating what? Macules

A macule is a flat, nonpalpable skin color change

A nurse in a dermatology clinic is reading the electronic health record of a new patient. The nurse notes that the patient has a history of a primary skin lesion. What is an example of a primary skin lesion? A)Crust B)Keloid C)Pustule D)Ulcer

A pustule is an example of a primary skin lesion. Primary skin lesions are original lesions arising from previously normal skin.

A patient with human immunodeficiency virus (HIV) has sought care because of the recent development of new skin lesions. The nurse should interpret these lesions as most likely suggestive of what?A) A reduction in the patient's CD4 count B)A reduction in the patient's viral load C)An adverse effect of antiretroviral therapy D)Virus-induced changes in allergy status

A reduction in the patient's CD4 count

A patient with a suspected malignant melanoma is referred to the dermatology clinic. The nurse knows to facilitate what diagnostic test to rule out a skin malignancy?A) Tzanck smear B)Skin biopsy C)Patch testing D)Skin scrapings

A skin biopsy is done to rule out malignancies of skin lesions.

A young student comes to the school nurse and shows the nurse a mosquito bite. As the nurse expects, the bite is elevated and has serous fluid contained in the dermis. How would the nurse classify this lesion?

A wheal is a primary skin lesion that is elevated and has fluid contained in the dermis. An example of a wheal would be an insect bite or hives.

Which of the following terms refers to the absence of the natural lens? A)Aphakia B)Scotoma C)Keratoconus D)Hyphema

A)Aphakia When a cataract is extracted, and an interocular lens implant is not used, the "PT" demonstrated aphakia. *Scotma refers to a blind or partially blind area in the visual field *Keratoconus refers to a cone-shaped deformity of the cornea *Hyphema refers to blood in the anterior chamber of the eye

The nurse knows that a postoperative vision-threatening complication of LASIK refractive surgery, diffuse lamellar keratitis (DLK), occurs A)In the first week after the surgery B)1 month after the surgery C)2 to 3 months after surgery D)6 month after surgery

A)In the first week after the surgery DLK is a peculiar, noninfectious inflammatory reaction in the lamellar interface after LASIK. It is characterized by a white granular, diffuse culture-negative lamellar keratitis occurring in the first week after surgery

Which of the following occurs when there is deviation from perfect ocular alignment? A)Strabismus B)Ptosis C)Chemosis D)Nystagmus

A)Strabismus Is a condition in which there is deviation from perfect ocular alignment.

For which of the following categories of "PT" are contact lenses contraindicated? A)Those with a history of recurrent eye infections B)Those with severe allergic reactions C)Those with inflammation of the Zeis gland D)Those with low tear production E)Those with conjunctivitis

A)Those with a history of recurrent eye infections B)Those with severe allergic reactions D)Those with low tear production

Which of the following is indicated when asymmetrical movement is noted during a positions test? A)Weakness in the extraocular muscles B)Retinal tears and detachment C)Cataract D)Glaucoma

A)Weakness in the extraocular muscles The position test is done to asses the eye muscle strength and the cranial nerve function

The nurse is providing care for a patient who has benefited from a cochlear implant. The nurse should understand that this patients health history likely includes which of the following? Select all that apply. A) The patient was diagnosed with sensorineural hearing loss. B) The patients hearing did not improve appreciably with the use of hearing aids. C) The patient has deficits in peripheral nervous function. D) The patients hearing deficit is likely accompanied by a cognitive deficit. E) The patient is unable to lip-read.

A, B

A public health nurse is teaching a health promotion workshop that focuses on vision and eye health. What should this nurse cite as the most common causes of blindness and visual impairment among adults over the age of 40? Select all that apply. A) diabetic retinopathy B) trauma C) macular degeneration D) cytomegalovirus E) glaucoma

A, C, E

A patient is scheduled for enucleation and the nurse is providing anticipatory guidance about postoperative care. What aspects of care should the nurse describe to the patient? Select all that apply. A) Application of topical antibiotic ointment B) Maintenance of a supine position for the first 48 hours postoperative C) Fluid restriction to prevent orbital edema D) Administration of loop diuretics to prevent orbital edema E) Use of an ocular pressure dressing

A, E (Patients who undergo eye removal need to know that they will usually have a large ocular pressure dressing, which is typically removed after a week, and that an ophthalmic topical antibiotic ointment is applied in the socket three times daily. Fluid restriction, supine positioning, and diuretics are not indicated.)

Which type of glaucoma presents an ocular emergency?

Acute angle-closure glaucoma

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of?

Adhere to the medication regimen.

The nurse is educating a patient about performing testicular self-examination (TSE). The nurse informs the patient that the best time to perform the exam is when?

After a warm bath or shower

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a) With the first specimen voided after 8:00 am b) After discarding the 8:00 am specimen c) At 8:00 am, with or without a specimen d) 6 hours after the urine is discarded

After discarding the 8:00 am specimen A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

A 51-year-old client is being seen by an urologist for perineal pain, low back pain, fever lasting 5 days, and painful urination. The physician confirms a diagnosis of prostatitis and orders treatment. During your client education session, which of the following recommendations do you make?

All options are correct.

An 80-year-old client is being seen by the urologist because of erectile dysfunction. This client has a history of hypertension and heart disease. Which of the following would be the most likely cause of his erectile dysfunction? hypertension medication depression atherosclerosis All options are correct.

All options are correct.

A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. What postprocedural assessment will the nurse perform on the client? a) Monitor hypersensitivity response. b) Palpate pedal pulses. c) All options are correct. d) Monitor site condition.

All options are correct. After the procedure, the physician applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.

Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis?

Alpha-adrenergic blocker

Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true. a) All statements are true. b Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear. c) Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. d) Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy.

Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear. Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.

The nurse is caring for a patient who has been NPO for 2 days pending a diagnostic procedure that has been repeated cancelled. When evaluating this patient's urinalysis, what would the nurse anticipate? a) A fluctuating urine specific gravity b) A decreased urine specific gravity c) An increased urine specific gravity d) A fixed urine specific gravity

An increased urine specific gravity Urine specific gravity depends largely on hydration status. A decrease in fluid intake (such as a "nothing by mouth" status) will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with kidney disease, urine specific gravity does not vary with fluid intake, and the patient's urine is said to have a fixed specific gravity.

Assessment of a patient's leg reveals the presence of a 1.5-cm circular region of necrotic tissue that is deeper than the epidermis. The nurse should document the presence of what type of skin lesion?A)Keloid B)Ulcer C)Fissure D)Erosion

An ulcer is skin loss extending past the epidermis with the involvement of necrotic tissue.

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? a) Cystoscopy b) Radiography c) Computed tomography (CT scan) d) Angiography

Angiography Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

In Fabry disease, most male patients and 30% of female heterozygotes will have what?

Angiokeratomas Small, dark spots appear on the skin. In Fabry usually concentrated between the umbilicus and knees.

The nurse in an ambulatory care center is admitting an older adult patient who has bright red moles on the skin. Benign changes in elderly skin that appear as bright red moles are termed what?A) Cherry angiomas B) Solar lentigo C) Seborrheickeratoses D) Xanthelasma

Ans: A Feedback: Cherry angiomas appear as bright red moles, while solar lentigo are commonly called liver spots. Seborrheickeratoses are described as crusty brown stuck on patches, while xanthelasma appears as yellowish, waxy deposits on the upper eyelids.

A gerontologic nurse is teaching a group of nursing students about integumentary changes that occur in older adults. How should these students best integrate these changes into care planning? A) By avoiding the use of moisturizing lotions on older adults' skin B)By protecting older adults against shearing injuries C)By avoiding the use of ice packs to treat muscle pain D)By protecting older adults against excessive sweat accumulation

Ans: B Feedback: Cellular changes associated with aging include thinning at the junction of the dermis and epidermis, which creates a risk for shearing injuries. Moisturizing lotions can be safely used to address the increased dryness of older adults' skin. Ice packs can be used, provided skin is assessed regularly and the patient possesses normal sensation. Older adults perspire much less than younger adults, thus sweat accumulation is rarely an issue.

A patient is diagnosed with atrial fibrillation and the physician orders Coumadin (warfarin). For what skin lesion should the nurse monitor this patient? A) Ulcer B)Ecchymosis C)Scar D)Erosion

Ans: B Feedback: Ecchymosis refers to a round or irregular macular lesion, which is larger than petechiae. This occurs secondary to blood extravasation. It is important to watch for ecchymosis in a patient receiving any type of anticoagulant. An ulcer is an open lesion eroded into the patient's flesh. A scar is an area on the skin caused by the healing of an injury. Erosion is loss of superficial epidermis that does not extend to the dermisa depressed, moist area.

student is brought to the nurse after falling off a swing. nurse is documenting that the child has bruising on the lateral aspect of the right arm. What term will the nurse use to describe bruising on the skin in documentation? A) Telangiectasias B) Ecchymoses C) Purpura D) Urticaria

Ans: B Feedback: Telangiectasias consists of red marks on the skin caused by stretching of superficial blood vessels. Ecchymoses are bruises, and purpura consists of pinpoint hemorrhages into the skin. Urticariais wheals or hives.

A patient is suspected of developing an allergy to an environmental substance and has been given a patch test. During the test, the patient develops fine blisters, papules, and severe itching. The nurse knows that thisA) Weak positive B)Moderately positive C)Strong positive D)Severely positive

Ans: B Feedback: The development of redness, fine elevations, or itching is considered a weak positive reaction; fine blisters, papules, and severe itching indicate a moderately positive reaction; and blisters, pain, and ulceration indicate a strong positive reaction.

A nurse is doing a shift assessment on a group of patients after first taking report. An elderly patient is having her second dose of IV antibiotics for a diagnosis of pneumonia. The nurse notices a new rash on the patient's chest. The nurse should ask what priority question regarding the presence of a reddened rash? A) Is the rash worse at a particular time or season? B)Are you allergic to any foods or medication? C)Are you having any loss of sensation in that area? D)Is your rash painful?

Ans: B Feedback: The nurse should suspect an allergic reaction to the antibiotic therapy. Allergies can be a significant threat to the patient's immediate health, thus questions addressing this possibility would be prioritized over those addressing sensation. Asking about previous rashes is important, but this should likely be framed in the context of an allergy assessment.

The nurse is performing an initial assessment of a patient who has a raised, pruritic rash. The patient denies taking any prescription medication and denies any allergies. What would be an appropriate question A)Is anyone in your family allergic to anything? B)How long have you had this abrasion? C)Do you take any over-the-counter drugs or herbal preparations? D)What do you do for a living?

Ans: C Feedback: If suspicious areas are noted, the patient is questioned about nonprescription or herbal preparations that might be in use. Ascertaining a family history of allergies would not give helpful information at this time. The patient's lesion is not described as an abrasion. The patient's occupation may or may not be relevant; it is more important to assess for herb or drug reactions.

A new patient has come to the dermatology clinic to be assessed for a reddened rash on his abdomen. What diagnostic test would most likely be ordered to identify the causative allergen?A) Skin scrapings B)Skin biopsy C)Patch testing D) Tzanck smear

Ans: C Feedback: Patch testing is performed to identify substances to which the patient has developed an allergy. Skin scrapings are done for suspected fungal lesions. A skin biopsy is completed to rule out malignancy and to establish an exact diagnosis of skin lesions. A Tzanck smear is used to examine cells from blistering skin conditions, such as herpes zoster.

A new patient presents at the clinic and the nurse performs a comprehensive health assessment. The nurse notes that the patient's fingernail surfaces are pitted. The nurse should suspect the presence of what A) Eczema B) Systemic lupus erythematosus (SLE) C) Psoriasis D) Chronic obstructive pulmonary disease (COPD)

Ans: C Feedback: Pitted surface of the nails is a definite indication of psoriasis. Pitting of the nails does not indicate eczema, SLE, or COPD.

While assessing a 25-year-old female, nurse notes the patient has hair on her lower abdomen. Earlier in the health interview, the patient stated that her menses are irregular. nurse should suspect what type of health problem?A) A metabolic disorder B)A malignancy C)A hormonal imbalance D)An infectious process

Ans: C Feedback: Some women with higher levels of testosterone have hair in the areas generally thought of as masculine, such as the face, chest, and lower abdomen. This is often a normal genetic variation, but if it appears along with irregular menses and weight changes, it may indicate a hormonal imbalance. This combination of irregular menses and hair distribution is inconsistent with metabolic disorders, malignancy, or infection.

When planning the skin care of a patient with decreased mobility, the nurse is aware of the varying thickness of the epidermis. At what location is the epidermal layer thickest?A) The scalp B) The elbows C) The palms of the hands D) The knees

Ans: C Feedback: The epidermis is the thickest over the palms of the hands and the soles of the feet.

A nurse is preparing to perform the physical assessment of a newly admitted patient. During which of the following components of the assessment should the nurse wear gloves?A) Palpation of the patient's scalp B)Palpation of the patient's upper extremities C)Palpation of a rash on the patient's trunk D)Palpation of a lesion on the patient's upper back E)Palpation of the patient's fingers

Ans: C, D Feedback: Gloves are worn during skin examination if a rash or lesions are to be palpated. It is not normally necessary to wear gloves to palpate a patient's scalp, extremities, or fingers unless contact with body fluids is reasonably foreseeable.

33. A nurse is assessing the skin of a patient who has been diagnosed with bacterial cellulitis on the dorsal portion of the great toe. When reviewing the patient's health history, the nurse should identify what comorbidity as increasing the patient's vulnerability to skin infections? A Chronic obstructive pulmonary disease B Rheumatoid arthritis C) Gout D)Diabetes

Ans: D Feedback: Patients with diabetes are particularly susceptible to skin infections. COPD, RA, and gout are less commonly associated with integumentary manifestations.

A patient with an exceptionally low body mass index has been admitted to the emergency department with signs and symptoms of hypothermia. The nurse should know that this patient's susceptibility A)Epidermis B)Merkel cells C)Dermis D)Subcutaneous tissue

Ans: D Feedback: The subcutaneous tissues and the amount of fat deposits are important factors in body temperature regulation. The epidermis is an outermost layer of stratified epithelial cells. Merkel cells are receptors that transmit stimuli to the axon through a chemical synapse. The dermis makes up the largest portion of the skin, providing strength and structure. It is composed of two layers: papillary and reticular.

An 82-year-old patient is being treated in the hospital for a sacral pressure ulcer. What age-related change is most likely to affect the patient's course of treatment? A) Increased thickness of the subcutaneous skin layer B) Increased vascular supply to superficial skin layers C) Changes in the character and quantity of bacterial skin flora D) Increased time required for wound healing

Ans: D Feedback: Wound healing becomes slower with age, requiring more time for older adults to recover from surgical and traumatic wounds. There are no changes in skin flora with increased age. Vascular supply and skin thickness both decrease with age.

A nurse is aware that the outer layer of the skin consists of dead cells that contain large amounts of keratin. The physiologic functions of keratin include which of the following? A)Producing antibodies B)Absorbing electrolytes C)Maintaining acidbase balance D)Physically repelling pathogens E)Preventing fluid loss

Ans: D, E Feedback: The dead cells of the epidermis contain large amounts of keratin, an insoluble, fibrous protein that forms the outer barrier of the skin. Keratin has the capacity to repel pathogens and prevent excessive fluid loss from the body. It does not contribute directly to antibody production, acidbase balance, or electrolyte levels.

The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform?

Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye

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.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? a) Asses the patient's back and shoulder areas for signs of internal bleeding. b) Distract the patient's attention from the pain. c) Provide analgesics to the patient. d) Enable the patient to sit up and ambulate.

Asses the patient's back and shoulder areas for signs of internal bleeding. After a renal biopsy, the patient is on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first? a) Exercise the leg and foot. b) Assess for anaphylaxis. c) Place cool compresses on the calf. d) Assess peripheral pulses in the left leg.

Assess peripheral pulses in the left leg. The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom of anaphylaxis.

A nurse practitioner working in a dermatology clinic finds an open lesion on a patient who is being assessed. What should the nurse do next?A) Obtain a swab for culture. B) Assess the characteristics of the lesion. C) Obtain a swab for pH testing. D) Apply a test dose of broad-spectrum topical antibiotic.

Assess the characteristics of the lesion.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important?

Avoid any activity that can increase intraocular pressure.

A group of high school students is attending a concert, which will be at a volume of 80 to 90 dB. What is a health consequence of this sound level? A) hearing will not be affected by a decibel level in this range B) hearing loss may occur with a decibel level in this range C) sounds in this decibel level are not perceived to be harsh to the ear D) ear plugs will have no effect these decibel levels

B

A hospitalized patient with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the patients room? A) That a commode is always available at the bedside B) That all furniture remains in the same position C) That visitors do not leave items on the bedside table D) That the patients slippers stay under the bed

B

A nurse is planning preoperative teaching for a patient with hearing loss due to otosclerosis. The patient is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the patients preoperative teaching? A) The procedure is an effective, time-tested treatment for sensory hearing loss. B) The patient is likely to experience resolution of conductive hearing loss after the procedure. C) Several months of post-procedure rehabilitation will be needed to maximize benefits. D) The procedure is experimental, but early indications suggest great therapeutic benefits.

B

A patient has been diagnosed with glaucoma and the nurse is preparing health education regarding the patients medication regimen. The patient states that she is eager to beat this disease and looks forward to the time that she will no longer require medication. How should the nurse best respond? A) You have a great attitude. This will likely shorten the amount of time that you need medications. B) In fact, glaucoma usually requires lifelong treatment with medications. C) Most people are treated until their intraocular pressure goes below 50 mm Hg. D) You can likely expect a minimum of 6 months of treatment.

B

A patient has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the patient should be kept in a prone position until otherwise ordered. What should the nurse do? A) Call the physician and ask for the order to be confirmed. B) Follow the order because this position will help keep the retinal repair intact. C) Instruct the patient to maintain this position to prevent bleeding. D) Reposition the patient after the first dressing change.

B

A patient has lost most of her vision as a result of macular degeneration. When attempting to meet this patients psychosocial needs, what nursing action is most appropriate? A) Encourage the patient to focus on her use of her other senses. B) Assess and promote the patients coping skills during interactions with the patient. C) Emphasize that her lifestyle will be unchanged once she adapts to her vision loss. D) Promote the patients hope for recovery.

B

A patient has undergone diagnostic testing and has been diagnosed with otosclerosis? What ear structure is primarily affected by this diagnosis? A) malleus B) stapes C) incus D) tympanic membrane

B

A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Mnires disease. What question is it most important for the nurse to ask the patient in preparation for this test? A) Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces? B) Do you currently take any tranquilizers or stimulants on a regular basis? C) do you have a history of falls or problems with loss of balance D) do you have a history of either high or low bloodp ressure

B

A patient presents at the ED after receiving a chemical burn to the eye. What would be the nurses initial intervention for this patient? A) Generously flush the affected eye with a dilute antibiotic solution. B) Generously flush the affected eye with normal saline or water. C) Apply a patch to the affected eye. D) Apply direct pressure to the affected eye.

B

A patient who presents for an eye examination is diagnosed as having a visual acuity of 20/40. The patient asks the nurse what these numbers specifically mean. What is a correct response by the nurse? A) A person whose vision is 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away. B) A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away. C) A person whose vision is 20/40 can see an object from 40 inches away that a person with 20/20 vision can see from 20 inches away. D) A person whose vision is 20/40 can see an object from 20 inches away that a person with 20/20 vision can see from 40 inches away.

B

During discharge teaching the nurse realizes that the patient is not able to read medication bottles accurately and has not been taking her medications consistently at home. How should the nurse intervene most appropriately in this situation? A) Ask the social worker to investigate alternative housing arrangements. B) Ask the social worker to investigate community support agencies. C) Encourage the patient to explore surgical corrections for the vision problem. D) Arrange for referral to a rehabilitation facility for vision training.

B

The nurse is caring for a patient who has undergone a mastoidectomy. In an effort to prevent postoperative infection, what intervention should the nurse implement? A) Teach the patient about the risks of ototoxic medications. B) Instruct the patient to protect the ear from water for several weeks. C) Teach the patient to remove cerumen safely at least once per week. D) Instruct the patient to protect the ear from temperature extremes until healing is complete.

B

The nurse is planning the care of a patient who is adapting to the use of a hearing aid for the first time. What is the most significant challenge experienced by a patient with hearing loss who is adapting to using a hearing aid for the first time? A) regulating the tone and volume B) learning to cope with amplicification of background noise C) constant irritation of the external auditory canal D) challenges in keeping the hearing aid clean while minimizing exposure to moisture

B

The nurse is providing discharge education to an adult patient who will begin a regimen of ocular medications for the treatment of glaucoma. How can the nurse best determine if the patient is able to self-administer these medications safely and effectively? A) assess the patient for any previous inability to self-manage medications B) ask the patient to demonstrate the instillation of her medications C) determine whether the patient can accurately describe the appropriate method of administering her medications D) assess the patients functional status

B

The nurse is providing health education to a patient newly diagnosed with glaucoma. The nurse teaches the patient that this disease has a familial tendency. The nurse should encourage the patients immediate family members to undergo clinical examinations how often? A) At least monthly B) At least once every 2 years C) At least once every 5 years D) At least once every 10 years

B

The nurse on the medicalsurgical unit is reviewing discharge instructions with a patient who has a history of glaucoma. The nurse should anticipate the use of what medications? A) Potassium-sparing diuretics B) Cholinergics C) Antibiotics D) Loop diuretics

B

The nurses assessment of a patient with significant visual losses reveals that the patient cannot count fingers. How should the nurse proceed with assessment of the patients visual acuity? A) Assess the patients vision using a Snellen chart. B) Determine whether the patient is able to see the nurses hand motion. C) Perform a detailed examination of the patients external eye structures. D) Palpate the patients periocular regions.

B

While reviewing the health history of an older adult experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What aspect of this patients health history is most likely to be linked to the patients hearing deficit? A) Recent completion of radiation therapy for treatment of thyroid cancer B) Routine use of quinine for management of leg cramps C) Allergy to hair coloring and hair spray D) Previous perforation of the eardrum

B

The nurse is admitting a patient to the unit who is scheduled to have an ossiculoplasty. What postoperative assessment will best determine whether the procedure has been successful? A) Otoscopy B) Audiometry C) Balance testing D) Culture and sensitivity testing of ear discharge

B (Ossiculoplasty is the surgical reconstruction of the middle ear bones to restore hearing. Consequently, results are assessed by testing hearing, not by visualizing the ear, testing balance, or culturing ear discharge.)

The nurse and a colleague are performing the Epley maneuver with a patient who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action? A) Placing the patient in a prone position B) Assisting the patient into a sitting position C) Instilling 15 mL of warm normal saline into one of the patients ears D) Assessing the patients baseline hearing by performing the whisper test

B (The Epley maneuver is performed by placing the patient in a sitting position, turning the head to a 45- degree angle on the affected side, and then quickly moving the patient to the supine position. Saline is not instilled into the ears and there is no need to assess hearing before the test.)

Edema of the conjunctive is termed? A)Papilledema B)Chemosis C)Proptosis D)Strabismus

B)Chemosis Chemosis is a common manifestation of pinkeye. *Papilledema refers to swelling of the optic disk due to increased intracranial pressure *Proptosis is the downward placement of the eyeball *Strabismus is a condition in which there is a deviation from perfect ocular alignment

Which of the following is the correct advice regarding food for a "PT" who underwent a cataract surgery? A)Eat spinach or collard green two to four time per week B)Eat soft, easily chewed foods C)Eat red meat two to four times per week D)Increase intake of vitamins A and C

B)Eat soft, easily chewed foods The nurse should advise "PT" recovering from cataract surgery to eat soft, easily chewed food until healing is complete to avoid tearing from excessive facial movements

Which of the following is the role of the nurse towards a "PT" who is undergoing eye examination and test? A)Conducting various test to determine the function and the structure of the eyes B)Ensuring that the "PT" receives eye care in order to preserve his or her eye function and prevent further visual loss C)Determining if further action is warranted D)Advising the patient on the diet and the exercise regimen to be followed

B)Ensuring that the "PT" receives eye care in order to preserve his or her eye function and prevent further visual loss Although nurses may not be directly involved in caring for "PT" who are undergoing eye exams and test, it is essential they they ensure the "PT" receive eye care in order to preserve their eye function and/pr prevent further loss

Which is the following features should a nurse observe during an ophthalmic assessment? A)Internal eye function B)External eye appearance C)Visual acuity D)Intraocular pressure

B)External eye appearance During an ophthalmic assessment, the nurse should examine the external eye appearance and the pupil responses of the "PT". A qualified examiner determine the internal eye function, the visual acuity, and the intraocular pressure

Which of the following is the most common cause of visual loss in people older then 60 years of age? A)Glaucoma B)Macular Degeneration C)Cataracts D)Retinal Detachment

B)Macular Degeneration

Which groups of medications causes pupillary constriction? A)Mydriatics B)Miotics C)Beta-blockers D)Adrenergic agonists

B)Miotics

To avoid the side effect of corticosteriods which medication classification is used as an alternative to treating inflammatory condition of the eyes? A)Miotics B)NSAIDS C)Mydriatics D)Cyclopegics

B)NSAIDS NSAIDS are use as an alternative in controlling informatory eye condition and to reduce postoperative inflammation. *Miotics are used to cause pupils to constrict *Mydriatics cause the pupil to dilate *Cyclopelgics cause paralysis of the iris sphincter

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

The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects?

BUN and serum creatinine the client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.

What condition is this? • PTCH1 (AD) • Multiple basal cell carcinoma • Musculoskeletal: Jaw cysts, frontal bossing, bifid ribs, scoliosis • CNS: Medulloblastoma • Eyes: Hypertelorism, Cataracts • GU: Ovarian fibromas

Basal Cell Nevus syndrome

What condition is this? • Multiple fibrofolliculomas • Pulmonary cysts (increased risk for spontaneous pneumothoraces) • Renal tumors: Oncocytoma and renal cell carcinomas

Birt-Hogg-Dube syndrome BHD (AD)

The nurse is providing care to a client who has had a renal (kidney) biopsy. The nurse would need to be alert for signs and symptoms of which of the following? a) Infection b) Dehydration c) Allergic reaction d) Bleeding

Bleeding Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale?

Blinking causes the eye drop to be expelled from the conjunctival sac.

The nurse is caring for a patient following a cystoscopic examination. Following the procedure, the nurse informs the patient that which of the following may occur? a) Blood-tinged urine b) Diarrhea c) Nausea and emesis d) Severe abdominal pain

Blood-tinged urine Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The patient should not experience severe abdominal pain.

Which of the following involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer? -Hormone therapy -Chemotherapy -Brachytherapy -Teletherapy

Brachytherapy

A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?

Breast tenderness

Medical management: Thermal injury

Burns related to heat or reflections from snow, sun gazing, etc. o Can cause corneal epithelial defect, corneal opacity, conjunctival chemosis and injection (congestion of blood vessels), and burns of the eyelids and periocular region o Antibiotic agents and a pressure patch for 24 hours constitute the treatment of mild injuries

The nurse is performing a comprehensive assessment of a patient's skin surfaces and intends to assess moisture, temperature, and texture. The nurse should perform this component of assessment in what way?A) By examining the patient under a Wood's light B) By inspecting the patient's skin in direct sunlight C) By palpating the patient's skin D) By performing percussion of major skin surfaces

By palpating the patient's skin

A 56-year-old patient has come to the clinic for his routine eye examination and is told he needs bifocals. The patient asks the nurse what change in his eyes has caused his need for bifocals. How should the nurse respond? A) You know, you are getting older now and we change as we get older. B) The parts of our eyes age, just like the rest of us, and this is nothing to cause you to worry. C) There is a gradual thickening of the lens of the eye and it can limit the eyes ability for accommodation. D) The eye gets shorter, back to front, as we age and it changes how we see things.

C

A 6-month-old infant is brought to the ED by his parents for inconsolable crying and pulling at his right ear. When assessing this infant, the advanced practice nurse is aware that the tympanic membrane should be what color in a healthy ear? A) Yellowish-white B) pink C) gray D) bluish white

C

A child goes to the school nurse and complains of not being able to hear the teacher. What test could the school nurse perform that would preliminarily indicate hearing loss? A) Audiometry B) Rinne test C) Whisper test D) Weber test

C

A patient has been diagnosed with hearing loss related to damage of the end organ for hearing or cranial nerve VIII. What term is used to describe this condition? A) Exostoses B) otalgia C) sensorineural hearing loss D) presbycusis

C

A patient has been diagnosed with serous otitis media for the third time in the past year. How should the nurse best interpret this patients health status? A) For some patients, these recurrent infections constitute an age-related physiologic change. B) The patient would benefit from a temporary mobility restriction to facilitate healing. C) The patient needs to be assessed for nasopharyngeal cancer. D) Blood cultures should be drawn to rule out a systemic infection.

C

A patient has informed the home health nurse that she has recently noticed distortions when she looks at the Amsler grid that she has mounted on her refrigerator. What is the nurses most appropriate action? A) Reassure the patient that this is an age-related change in vision. B) Arrange for the patient to have her visual acuity assessed. C) Arrange for the patient to be assessed for macular degeneration. D) Facilitate tonometry testing.

C

A patient has just arrived to the floor after an enucleation procedure following a workplace accident in which his left eye was irreparably damaged. Which of the following should the nurse prioritize during the patients immediate postoperative recovery? A) Teaching the patient about options for eye prostheses B) Teaching the patient to estimate depth and distance with the use of one eye C) Assessing and addressing the patients emotional needs D) Teaching the patient about his post-discharge medication regimen

C

A patient is being discharged home after mastoid surgery. What topic should the nurse address in the patients discharge education? A) Expected changes in facial nerve function B) The need for audiometry testing every 6 months following recovery C) Safe use of analgesics and antivertiginous agents D) Appropriate use of OTC ear drops

C

A patient with low vision has called the clinic and asked the nurse for help with acquiring some low- vision aids. What else can the nurse offer to help this patient manage his low vision? A) The patient uses OTC NSAIDs. B) The patient has a history of stroke. C) The patient has diabetes. D) The patient has Asian ancestry.

C

An older adult patient has been diagnosed with macular degeneration and the nurse is assessing him for changes in visual acuity since his last clinic visit. When assessing the patient for recent changes in visual acuity, the patient states that he sees the lines on an Amsler grid as being distorted. What is the nurses most appropriate response? A) Ask if the patient has been using OTC vasoconstrictors. B) Instruct the patient to repeat the test at different times of the day when at home. C) arrange for the patient to visit his ophthalmologist D) encourage the patient to adhere to his prescribed drug regimen

C

Cytomegalovirus (CMV) is the most common cause of retinal inflammation in patients with AIDS. What drug, surgically implanted, is used for the acute stage of CMV retinitis? A) Pilocarpine B) Penicillin C) Ganciclovir D) Gentamicin

C

The nurse is assessing a patient with multiple sclerosis who is demonstrating involuntary, rhythmic eye movements. What term will the nurse use when documenting these eye movements? A) V ertigo B) Tinnitus C) Nystagmus D) Astigmatism

C

The nurse is planning the care of a patient with a diagnosis of vertigo. What nursing diagnosis risk should the nurse prioritize in this patients care? A) Risk for disturbed sensory perception B) Risk for unilateral neglect C) Risk for falls D) Risk for ineffective health maintenance

C

The nurse is teaching a patient to care for her new ocular prosthesis. What should the nurse emphasize during the patients health education? A) The need to limit exposure to bright light B) The need to maintain a low Fowlers position when removing the prosthesis C) The need to perform thorough hand hygiene before handling the prosthesis D) The need to apply antiviral ointment to the prosthesis daily

C

When administering a patients eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal? A) Ensure that the patient is well hydrated at all times. B) Encourage self-administration of eye drops. C) Occlude the puncta after applying the medication. D) Position the patient supine before administering eye drops.

C

Which of the following nursing interventions would most likely facilitate effective communication with a hearing-impaired patient? A) Ask the patient to repeat what was said in order to evaluate understanding. B) Stand directly in front of the patient to facilitate lip reading. C) Reduce environmental noise and distractions before communicating. D) Raise the voice to project sound at a higher frequency

C

The clinic nurse is assessing a child who has been brought to the clinic with signs and symptoms that are suggestive of otitis externa. What assessment finding is characteristic of otitis externa? A) Tophi on the pinna and ear lobe B) Dark yellow cerumen in the external auditory canal C) Pain on manipulation of the auricle D) Air bubbles visible in the middle ear

C (Pain when the nurse pulls gently on the auricle in preparation for an otoscopic examination of the ear canal is a characteristic finding in patients with otitis externa)

Which type of glaucoma present an ocular emergency? A)Normal tension glaucoma B)Ocular hypertension C)Acute angle-closure glaucoma D)Chronic open-angle glaucoma

C)Acute angle-closure glaucoma Acute angle-closure glaucoma results in rapid progressive visual impairment. *Normal tension glaucoma is treated with topical med *Ocular hypertension is treated with topical meds *Chronic open0angle glaucoma is treated initially with topical meds, with oral meds added at a later time

The nurse should monitor for which of the following manifestations in a "PT" who has undergone LASIK or PRK? A)Excessive tearing B)Cataract formation C)Epithelial abrasion D)Sty formation

C)Epithelial abrasion

Which of the following is the term for swelling of the optic disc due to increased IOP? A)Ptosis B)Chemosis C)Papilledema D)Photophobia

C)Papilledema

An older adult with a recent history of mixed hearing loss has been diagnosed with a cholesteatoma. What should this patient be taught about this diagnosis? Select all that apply A) cholesteatomas are benign and self limiting and hearing loss will resolve spontaneously B) cholesteatomas are usually the result of metastasis from a distant tumor site C) cholesteatomas are often the result of chronic otitis media d_ cholesteatomas, if left untreated, result n intractable neuropathic pain E) cholesteatomas usually was be removed surgically

C, E

An unresponsive Caucasian patient has been brought to the emergency room by EMS. While assessing this patient, the nurse notes that the patient's face is a cherry-red color. What should the nurse suspect? A) Carbon monoxide poisoning B)Anemia C)Jaundice D)Uremia

Carbon monoxide poisoning causes a bright cherry red color in the face and upper torso in light-skinned persons. In dark-skinned persons, there will be a cherry red color to nail beds, lips, and oral mucosa.

Which of the following patient populations have the highest risk for developing testicular cancer?

Caucasian American

Non- Proliferative Diabetic Retinopathy (NPDR)

Causes: -MCC: prolonged hyperglycemia -Microaneurysms- leaks blood & fluid >blood- retinal hemorrhages >fluid- macular edema >lipids & proteins leaked out form hard exudates -cotton wool spots- retinal nerve fiber swelling can progress to PDR

Proliferative Diabetic Retinopathy (PDR)

Causes: -Neovascularization (abnormal blood vessel growth) >can grow into retina (decrease vision) >can grow into iris angle (neovascular glaucoma)

Terms relating to malignant lesions: Define Squamous cell carcinoma

Characterized by abnormal, accelerated growth of squamous cells. Squamous meaning scale, so this condition tends to have extra scale on the surface.

A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions? a) Keep the patient on bed rest for 72 hours. b) Apply moist heat, every 4 hours for the first 48 hours to aid healing. c) Place a bed board under the mattress to add support. d) Check the patient's urine for hematuria.

Check the patient's urine for hematuria. The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae. Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed rest is not necessary.

What is this condition? • LYST (AR) • Skin colon is slate-ray and hair has silver sheen color. • Eye findings similar to OCA, but acuity is usually normal • Recurrent bacterial infections • Mild bleeding diathesis with easy bruising • Progressive neurologic deterioration • Accelerated lymphoma-like phase • Early death without bone marrow transplantation

Chediak-Higashi syndrome

A patient has been diagnosed with bacterial conjunctivitis that was sexually transmitted. The nurse informs the patient that the isolated organism is which of the following?

Chlamydia trachomatis

A group of students are reviewing information about the classifications of testicular cancer. The students demonstrate understanding of the information when they describe which of the following?

Choriocarcinoma is an example of a nonseminoma.

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Proteinuria d) Chronic kidney disease

Chronic kidney disease A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? a) Client reports increasing fatigue. b) Urine output is 100 ml/hr. c) Client rates pain at a 3 on a scale of 0 to 10. d) Client denies frequency and urgency.

Client reports increasing fatigue. Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? a) Bladder ultrasonography b) Computed tomography with contrast c) Cystoscopy d) Radiography

Computed tomography with contrast The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.

When describing the functions of the kidney to a client, which of the following would the nurse include? a) Synthesis of vitamin K b) Control of water balance c) Regulation of white blood cell production d) Secretion of enzymes

Control of water balance Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.

A client is being discharged after successful same-day cataract surgery. The nurse instructs the client about permitted activities and which activities to avoid. Which of the following activities would be permitted in the postoperative instructions by the client?

Cooking.

Which of the following is the main refracting surface of the eye?

Cornea

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? a) Pain after voiding b) Suprapubic pain c) Costovertebal angle tenderness d) Perineal pain

Costovertebal angle tenderness Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

What condition is this? • Facial tricholemmomas • Thyroid goiters • Lipoma • Hamartomatous polyps • Macrocephaly

Cowden syndrome (PTEN hamartoma syndrome)

Which of the following does the nurse recognize is the best clinical measure of renal function? a) Volume of urine output b) Creatinine clearance c) Urine-specific gravity d) Circulating ADH levels

Creatinine clearance Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decreases.

client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?

Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? a) Creatinine clearance level b) Uric acid level c) Blood urea nitrogen level d) Serum potassium level

Creatinine clearance level Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example?

Cryptorchidism

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? a) Excretory urogram b) Cystoscopy c) Intravenous pyelography d) Renal angiography

Cystoscopy Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered? A) ossiculoplasty B) insertion of a cochlear implant C) stapedectomy D) insertion of a ventilation tube

D

A nurse is teaching preventative measures for otitis externa to a group of older adults. What action should the nurse encourage? A) Rinsing the ears with normal saline after swimming B) Avoiding loud environmental noises C) Instilling antibiotic ointments on a regular basis D) avoiding the use fo cotton swabs

D

A patient is being discharged home from the ambulatory surgical center after cataract surgery. In reviewing the discharge instructions with the patient, the nurse instructs the patient to immediately call the office if the patient experiences what? A) Slight morning discharge from the eye B) Any appearance of redness of the eye C) A scratchy feeling in the eye D) A new floater in vision

D

A patient is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this patients care? A) Antioxidant supplements, vitamin C and E, beta-carotene, and selenium B) Eyeglasses or magnifying lenses C) Corticosteroid eye drops D) Surgical intervention

D

A patient is ready to be discharged home after a cataract extraction with intraocular lens implant and the nurse is reviewing signs and symptoms that need to be reported to the ophthalmologist immediately. Which of the patients statements best demonstrates an adequate understanding? A) I need to call the doctor if I get nauseated. B) I need to call the doctor if I have a light morning discharge. C) I need to call the doctor if I get a scratchy feeling. D) I need to call the doctor if I see flashing lights.

D

A patient with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education? A) Risk factors for postoperative cytomegalovirus (CMV) B) Compensating for vision loss for the next several weeks C) Non-pharmacologic pain management strategies D) Signs and symptoms of increased intraocular pressure

D

A patient with a sudden onset of hearing loss tells the nurse that he would like to begin using hearing aids. The nurse understands that the health professional dispensing hearing aids would have what responsibility? A) Test the patients hearing promptly. B) Perform an otoscopy. C) Measure the width of the patients ear canal. D) Refer the patient to his primary care physician.

D

A patient with chronic open-angle glaucoma is being taught to self-administer pilocarpine. after the patient administered the pilocarpine, the patient states that her vision is blurred. which nursing action is most appropriate? A) holding the next dose and notify the physician B) treating the patient for an allergic reaction C) suggesting that the patient put on her glasses D) explaining that this is an expected adverse effect

D

After mastoid surgery, an 81-year-old patient has been identified as needing assistance in her home. What would be a primary focus of this patients home care? A) Preparation of nutritious meals and avoidance of contraindicated foods B) Ensuring the patient receives adequate rest each day C) Helping the patient adapt to temporary hearing loss D) Assisting the patient with ambulation as needed to avoid falling

D

Following a motorcycle accident, a 17-year-old man is brought to the ED. What physical assessment findings related to the ear should be reported by the nurse immediately? A) The malleus can be visualized during otoscopic examination. B) The tympanic membrane is pearly gray. C) Tenderness is reported by the patient when the mastoid area is palpated. D) Clear, watery fluid is draining from the patients ear.

D

On otoscopy, a red blemish behind the tympanic membrane is suggestive of what diagnosis? A) Acoustic tumor B) Cholesteatoma C) Facial nerve neuroma D) Glomus tympanicum

D

Several residents of a long-term care facility have developed signs and symptoms of viral conjunctivitis. What is the most appropriate action of the nurse who oversees care in the facility? A) Arrange for the administration of prophylactic antibiotics to unaffected residents. B) Instill normal saline into the eyes of affected residents two to three times daily. C) Swab the conjunctiva of unaffected residents for culture and sensitivity testing. D) Isolate affected residents from residents who have not developed conjunctivitis.

D

The nurse is administering eye drops to a patient with glaucoma. After instilling the patients first medication, how long should the nurse wait before instilling the patients second medication into the same eye? A) 30 seconds B) 1 minute C) 3 minutes D) 5 minutes

D

The nurse is discharging a patient home after mastoid surgery. What should the nurse include in discharge teaching? A) Try to induce a sneeze every 4 hours to equalize pressure. B) Be sure to exercise to reduce fatigue. C) Avoid sleeping in a side-lying position. D) Dont blow your nose for 2 to 3 weeks.

D

The registered nurse taking shift report learns that an assigned patient is blind. How should the nurse best communicate with this patient? A) Provide instructions in simple, clear terms. B) Introduce herself in a firm, loud voice at the doorway of the room. C) Lightly touch the patients arm and then introduce herself. D) State her name and role immediately after entering the patients room.

D

Which of the following nurses actions carries the greatest potential to prevent hearing loss due to ototoxicity? A) Ensure that patients understand the differences between sensory hearing loss and conductive B) Educate patients about expected age-related changes in hearing perception. C) Educate patients about the risks associated with prolonged exposure to environmental noise. D) Be aware of patients medication regimens and collaborate with other professionals accordingly.

D

The nurse is reviewing the health history of a newly admitted patient and reads that the patient has been previously diagnosed with exostoses. How should the nurse accommodate this fact into the patients plan of care? A) The nurse should perform the Rinne and Weber tests. B) The nurse should arrange for audiometry testing as soon as possible. C) The nurse should collaborate with the pharmacist to assess for potential ototoxic medications. D) No specific assessments or interventions are necessary to addressing exostoses.

D (Exostoses are small, hard, bony protrusions found in the lower posterior bony portion of the ear canal; they usually occur bilaterally. They do not normally impact hearing and no treatments or nursing actions are usually necessary.)

The public health nurse is addressing eye health and vision protection during an educational event. What statement by a participant best demonstrates an understanding of threats to vision? A) Im planning to avoid exposure to direct sunlight on my next vacation. B) Ive never exercised regularly, but Im going to start working out at the gym daily. C) Im planning to talk with my pharmacist to review my current medications. D) Im certainly going to keep a close eye on my blood pressure from now on.

D (Hypertension is a major cause of vision loss, exceeding the significance of inactivity, sunlight, and adverse effects of medications.)

A patient presents to the ED complaining of a sudden onset of incapacitating vertigo, with nausea and vomiting and tinnitus. The patient mentions to the nurse that she suddenly cannot hear very well. What would the nurse suspect the patients diagnosis will be? A) Ossiculitis B) Mnires disease C) Ototoxicity D) Labyrinthitis

D (Labyrinthitis is characterized by a sudden onset of incapacitating vertigo, usually with nausea and vomiting, various degrees of hearing loss, and possibly tinnitus)

A nurse is working with a patient who has a diagnosis of Cushing syndrome. When completing a physical assessment, the nurse should specifically observe for what integumentary manifestation? A) Alopecia B)Yellowish skin tone C) Patchy, bronze pigmentation D)Hirsutism

D Cushing syndrome causes excessive hair growth, especially in women. Alopecia is hair loss from the scalp and other parts of the body. Jaundice causes a yellow discoloration in light-skinned patients, but this does not accompany Cushing syndrome. Patients that have Addison's disease exhibit a bronze discoloration to their skin due to increased melanin production.

Which of the following medication classification increases aqueous fluid outflow in the "PT" with glaucoma? A)Beta-blockers B)Alpha-adrenergic agonists C)Carbonic anhydrase inhibitors D)Cholinergics

D)Cholinergics Cholinergics increases aqueous fluid outflow by contracting the ciliary muscle, causing miosis, and opening the trabeculr mesh-work. *Beta-blockers decrease aqueous humor production *Alpha-adrenergic agonists decrease aqueous humor production *Carbonic anhydrase inhibitors decrese aqueous humor

Which of the following would not be included as a marker of medication effectiveness in glaucoma control? A)Lowering IOP to target pressure B)Appearance of optic nerve head C)Visual field D)Opacity of the lens

D)Opacity of the lens Relates to cataracts formation.The main markers of efficacy of the medication in glaucoma control are the lowering of the IOP tot he target pressure

Which of the following would be an inaccurate clinical manifestation of a retinal detachment? A)Sudden onset of a greater number of floater B)Cobwebs C)Bright flashing lights D)Pain

D)Pain "PT" do not complain of pain with retinal detachment

Which of the following is a accurate statement regarding refractive surgery? A)Refractive surgery will alter the normal aging of the eye B)Refractive surgery may be performed on all "PT", even if they have underlying health conditions C)Refractive surgery may be performed on "PT" with an abnormal corneal structure as long as they have a stable refractive error D)Refractive surgery is an elective cosmetic surgery performed to reshape the cornea

D)Refractive surgery is an elective cosmetic surgery performed to reshape the cornea It is performed to reshape the cornea for the purpose of correction of all refractive error.

When the "PT" tells the nurse that his vision is 20/200, ans asks what that means, the nurse informs the "PT" that a person with 20/200 vision A)Sees an object from 200 feet away that a person with normal vision sees from 20 feet away B)Sees an object from 20 feet away that a person with normal vision sees from 20 feet way C)Sees an object from 200 feet away that a person with normal vision sees from 200 feet away D)See's an objects from 20 feet away that a person with normal vision sees from 200 feet away

D)See's an objects from 20 feet away that a person with normal vision sees from 200 feet away The fraction 20/20 is considered the standard for normal vision. Most people. positioned 20 feet from the eye chart, can see the letters dignated as 20/20 from a distance of 20 feet

The nurse advises the "PT" undergoing photodynamic therapy (PDT) for macular degeneration to avoid exposure to direct sunlight or bright lights for A)The first 24 hours after the procedure B)2 weeks after the procedure C)The first month after the procedure D)The first 5 days after the procedure

D)The first 5 days after the procedure PDT includes the use of verteporfin, a light-activated dye. The dye within the blood vessels near the surface of the skin could become activated with exposure to strong light, such as sunlight or bright light. Inadvertent sunlight exposure can lead to serve blistering of the skin and sunburn

Transient/modifiable causes of incontinence

DIAPPERS d - delirium* i - infection* a - atrophic vaginitis p - pharmaceuticals p - psychological (depression) e - excessive urine output* r - reduced mobility* s - stool impaction* * may be med related

What is this condition? Gene ATP2A2 (AD) encoding a calcium pump that provides extracecullar calcium needed for normal epidermal differentiation. Calcium pump is affected, which if it doesn't work, the skin falls apart. Peak onset is during puberty. Besides skin findings, person may have schizophrenia and mental retardation.

Darier disease

Diagnoses for cataract:

Decisional Conflict: Cataract Removal and Readiness for Enhanced Self-Health Management

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which of the following?

Decreased fluid intake When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

Robert James is a 71-year-old man with erectile dysfunction. His healthcare provider prescribed a PDE5 inhibitor to treat his dysfunction. The nurse is meeting with Robert to review the newly prescribed medication. Which of the following would the nurse include in the client education?

Depending on the drug, most are taken "on demand" 15 minutes, 1/2 hour, to 1 hour before sexual activity.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? a) Submucosal layer of connective tissue b) Adventitia (connective tissue) c) Inner layer of epithelium d) Detrusor muscle

Detrusor muscle The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter.

A patient's health assessment has resulted in a diagnosis of alopecia areata. What nursing diagnosis should the nurse most likely associate with this health problem?A) Chronic Pain B) Impaired Skin Integrity C) Impaired Tissue Integrity D) Disturbed Body Image

Disturbed Body Image

A patient is planning to use a negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device? Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. Watch for the development of infection. Watch for erosion of the prosthesis through the skin. Do not use the device while taking nitrates

Do not leave the constricting band in place for longer than 1 hour to avoid penile injury.

The nurse is preparing a patient for a nuclear scan of the kidneys. Following the procedure, the nurse will instruct the patient to complete which of the following? a) Carefully handle urine as it is radioactive. b) Maintain bed rest for 2 hours. c) Drink liberal amounts of fluids. d) Notify the health care team if bloody urine is noted.

Drink liberal amounts of fluids. After the procedure is completed, the patient is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.

Terms relating to scale: Define Ichthyosis

Dry, scaling skin that may be thickened or very thin.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? a) Resonance b) Dullness c) Tympany d) Flatness

Dullness Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

What condition is this? Blister formation in EB dystrophic

Dystrophic EB

The term used to describe painful or difficult urination is which of the following? a) Oliguria b) Anuria c) Nocturia d) Dysuria

Dysuria Dysuria refers to painful or difficult urination. Oliguria is urine output less than 0.5 mL/kg/hr. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: a) Apply moist heat to the flank area. b) Encourage high fluid intake. c) Strain all urine for 48 hours. d) Monitor for hematuria.

Encourage high fluid intake. A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.

Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to: a) Encourage high fluid intake. b) Apply moist heat to the flank area. c) Monitor for hematuria. d) Strain all urine for 48 hours.

Encourage high fluid intake. A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.

Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? Urge the limited intake of foods and fluids containing caffeine. Ensure immunizations against infectious diseases such as mumps. Encourage the consumption of foods that are rich in fat and starch. Engage in activities and exercises that minimize heavy lifting.

Ensure immunizations against infectious diseases such as mumps Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.

Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests?

Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss

Skin is largest organ system of the body and has 3 layers called?

Epidermis: outermost layer of stratified epithelial cells, composed predominantly of keratinocytes. Thickest is on palms of hands and soles of feet. Dermis: largest portion of the skin; providing strength and structure. There are 2 layers. The papillary dermis is composed primarily of fibroblast cells capable of producing collagen, a connective tissue. The reticular dermis lies beneath the papillary dermis and produces collagen and elastic bundles. Dermis contains blood, lymph vessels, nerves, sweat and sebaceous glands, and hair roots. The "true skin". Subcutaneous Tissue (Hypodermis): inner layer of skin. Fat (adipose) tissue. Provides a cushion between skin layers, muscles, and bones. Promotes skin mobility, molds body contours, and insulates the body.

This condition is due to a mutation in keratin 5 and 14 and has different variants.

Epidermolysis bullosa simplex

After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true?

Erectile dysfunction may be due to testosterone insufficiency.

A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? Counter-balancing the I.V. pole Collecting a urine specimen before beginning irrigation Attaching the infusion set to an infusion pump Evaluating patency of the drainage lumen

Evaluating patency of the drainage lumen The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.

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.

Wet Macular Degeneration

FAST ONSET- irreversible -Neovascularization around macula >causes bleeding into retina >scarring & photoreceptor atrophy

The nurse is providing care to a client who has been admitted to the hospital for treatment of an infection. The client is visually impaired. Which of the following would be most appropriate for the nurse to do when interacting with the client?

Face the client when speaking directly to him.

A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH), reports taking Serenoa repens (saw palmetto berry). The nurse needs to intervene if the physician orders which of the following treatments?

Finasteride (Proscar)

Terms relating to textural changes of skin: Define Keratoderma

Focal or generalized thickening of the skin of the palms and/or soles.

What hormonal disturbances can delay puberty?

GH deficiency, hypothyroidism

A 42-year-old client is being seen by a urologist in the group where you practice nursing. She is experiencing some secretion abnormalities, for which diagnostics are being performed. Which of the following substances are typically reabsorbed and not secreted in urine? a) Potassium b) Glucose c) Creatinine d) Chloride

Glucose Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings? a) Glucose and protein b) Creatinine and chloride c) Potassium and sodium d) Bicarbonate and urea

Glucose and protein The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.

What is this condition? • Defect in genes encoding myosin Va, RAB27A, MLPH (AR) • Affected proteins involved in organelle trafficking and membrane transport • Pigmentary dilution of skin and silver-gray hair • Types: GS1: neurologic impairment (myosin Va) GS2: immune abnormalities (RAB27A) GS3: only cutaneous disease (melnophilin)

Griscelli syndrome

A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect?

Gynecomastia

Hair:

Hair is present everywhere except the palms and soles. Hair grows in a cavity called a hair follicle. Hair undergoes cycles of growth and rest. The growth phase (anagen) may last up to 6 years for scalp hair, resting phase (telogen) last 4 months. Hair sheds during telogen. Growth of hair on the face, chest and back, is controlled by the male hormones known as androgens. Women with higher levels of testosterone have hair in areas generally considered masculine. May indicate hormonal imbalance. Eyebrows and lashes filter out dust, bugs, and airborne debris. Loss of melanin in hair shaft results in gray or white hair. Hair quantity and distribution can be affected by endocrine conditions. Cushing syndrome causes hirsutism (excessive hair growth). Hypothyroidism causes changes in hair texture. Chemotherapy and radiation therapy cause hair thinning or weakening of the hair shaft. Several autoimmune disease (lupus and alopecia areata) cause hair loss in smaller defined areas. Folliculitis of the scalp will cause inflammation of the hair roots and scarring alopecia.

The nurse should monitor for which manifestation in a client who has undergone LASIK?

Halos and glare

What should a male client older than age 50 do to help ensure early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.

Assessment of the Skin

Health History: Ask about skin allergies, food allergies, medication allergies, eczema, chemical allergies, and skin cancer in family. Check signs, symptoms, location, and duration of pain, itching, rash. Ask about nonprescriptions and herbs being used. Physical Assessment: WEAR GLOVES. Check mucous membranes, scalp, hair, nails. Inspection and palpation used. Well lighted and warm room. Can use a penlight to highlight areas. Make sure patient disrobes and adequately draped. Check color, temperature, moisture or dryness, texture, lesions, vascularity, mobility, condition of hair and nails. Turgor, possible edema, and elasticity by palpation. Nails: Clubbing Scalp: Lesions, Inflammation, Itching, Infestation Hair: Texture, Color, Body hair, Amount Rash: Temperature of Rash, Palpate Lymph Nodes

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry red in color?

Hemangioma

Which of the following may result if prostate cancer invades the urethra or bladder? -Rectal discomfort -Hip pain -Backache -Hematuria

Hematuria Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.

A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?

Hemorrhage

What is this condition? • HPS1 (AR) most common for the ten subtypes • Eye similar to OCA • Bleeding diathesis • Pulmonary fibrosis and granulomatous colitis

Hermansky-Pudlak syndrome

What condition is this? • GJB6 (connexin 30) • Primarily affects the hair and nails, with normal teeth and sweating

Hidrotic Ectodermal Dysplasia aka Clouston Syndrome

The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?

High-fat diet

Which of the following should nurses teach all men, especially those who have had cryptorchidism? -Importance of regular monitoring of prostate-specific antigen (PSA) levels. -Need for blood tests to measure serum acid phosphatase levels. -Need to undergo a baseline and follow up lymph node biopsies. -How to perform a testicular self-examination.

How to perform a testicular self-examination.

What condition is this? • Defect in ectodysplasin A gene (X-linked recessive most common, also AD and AR) • Sparse absent and hypodontia, peg-shaped teeth • Hypo or Anhidrosis (can lead to overheating)

Hypohidrotic ED

The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition?

Ibuprofen

All prostatectomies include the risk of damage to the pudendal nerve. Therefore, postoperatively, the nurse assesses for:

Impotence.

A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure?

Improve outflow drainage

What is this condition? • X-linked dominant (NEMO) only in girls, thought to be prenatally lethal in boys • Causes defective NF-kB activation • Missing and conical teeth (40-50%) • Scarring alopecia: linear absence of hair (30-40%) • Eye problems • Microcephaly (30%), Seizures, DD/ID

Incontinentia pigmenti

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased potassium b) Increased serum albumin c) Decreased blood urea nitrogen (BUN) d) Increased serum creatinine

Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? a) Nephrotic syndrome b) Acute renal failure c) Infection d) Obstruction of the lower urinary tract

Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

What does PHACE stand for?

Inheritance: Sporadic • Posterior fossa brain malformations • Large facial Hemangioma • Arterial anomalies • Cardiac anomalies and coarctation of aorta • Eye abnormalities • Sternal clefting or supraumbilical raphe

A patient who complains of a dull, continuous pain in the suprapubic area that occurs with and at the end of voiding would most likely be diagnosed with which of the following? a) A kidney stone b) Interstitial cystitis c) Prostatic cancer d) Acute pyelonephritis

Interstitial cystitis Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.

A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention?

Irrigate both eyes.

A client comes to the eye clinic for a routine check-up. The client tells the nurse they think they are color blind. What screening test does the nurse know will be performed on this client to assess for color-blindness?

Ishihara

This condition leads to a blister formation in two major subtypes of junctional EB. Two subtypes are due to a defect in laminin 332 subunit.

Junctional epidermolysis bullosa

What condition is this? • Hoarse cry or cough indicative of laryngeal involvement • Infections, malnutrition and dehydration usually lead to early death by age 3-4

Junctional epidermolysis bullosa: generalized severe

What 2 things can cause hypogonadotrophic hypogonadism?

Kallman's syndrome, hypopituitarism

After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?

Kegel exercises

Within the urology group where you practice nursing, clients with urinary tract infections are frequently seen by physicians. In a diagnosis of an upper urinary tract infection, which structures could be affected? Choose all correct options.

Kidney Ureter The upper urinary tract is composed of the kidneys, renal pelves, and ureters.

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? a) Neurogenic bladder b) Kidney stones c) Fistula d) Chronic renal failure

Kidney stones A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.

What 5 things can cause hypergonadotrophic hypogonadism?

Klinefelter's, anorchia, orchitis, radiation/chemo, surgical or traumatic castration

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella?

Laser-assisted in situ keratomileusis (LASIK)

Amblyopia

Lazy Eye eye(s) cannot see clearly w/ normal lens/eye shape- not corrected w/ glasses alone -eye & brain not working together properly MCC: Strabismus- misaligned eyes Treatment: -occlusion therapy (eye patch) -corrective lenses -vivid vision (VR)

What is this condition? • PTPN11 (AD) • Lentigines begin at birth or within first months • Lentigines, Ekg conduction defects, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth, Deafness

Leopard syndrome

The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? Light yellow and clear Dark amber with copious mucous Reddish-pink with numerous clots Light pink with few red streaks

Light yellow and clear

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 nurse is reviewing gerontologic considerations relating to the care of patients with dermatologic problems. What vulnerability results from the age-related loss of subcutaneous tissue?A) Decreased resistance to ultraviolet radiation B)Increased vulnerability to infection C)Diminished protection of tissues and organs D) Increased risk of skin malignancies

Loss of the subcutaneous tissue substances of elastin, collagen, and fat diminishes the protection and cushioning of underlying tissues and organs, decreases muscle tone, and results in the loss of the insulating properties of fat. This age-related change does not correlate to an increased vulnerability to sun damage, infection, or cancer.

Assessment of a patient diagnosed with epididymitis reveals the findings listed. Place the findings in the order in which they most likely occurred. Testicular tendernesss to pressure Swelling of the scrotum Low-grade fever Severe pain in the lower abdomen

Low-grade fever Testicular tendernesss to pressure Swelling of the scrotum Severe pain in the lower abdomen Epididymitis develops slowly over 1 to 2 days, beginning with a low-grade fever, chills, and heaviness in the affected testicle. The testicle then becomes increasingly tender to pressure and traction. The patient may report unilateral pain, soreness in the inguinal canal along the course of the vas deferens, and pain and swelling in the scrotum and groin. The epididymis becomes increasingly swollen with extreme pain in the lower abdomen and pelvis.

Types of skin lesions

Macule, patch: flat, nonpalpable, skin color change (freckles, flat moles) Papule, plaque: elevated, palpable, solid mass with a circumscribed border (warts) Nodule, tumor: elevated, palpable, solid mass extending deeper into dermis (squamous cell carcinoma) Vesicle, bulla: circumscribed, elevated, palpable mass containing fluid (blister, herpes, poison ivy) Wheal: elevated mass with transient borders, irregular, size/color vary (insect bites) Pustule: pus-filled vesicle (acne, carbuncles, furuncles) Cyst: encapsulated fluid-filled mass in dermis (sebaceous cyst) Erosion: loss of superficial epidermis (scratch marks) Ulcer: skin loss extending pass epidermis, necrotic tissue loss (pressure ulcer) Fissure: linear crack in skin that may extend to dermis (chapped lips or hands, tinea pedis) Scales: flakes secondary to dead epithelium (dandruff, dry skin, psoriasis) Crust: dried residue of serum, blood, or pus on skin surface (eczema, herpes) Scar (cicatrix): mark left after healing wound or lesion (surgical incision or healed wound) Keloid: hypertrophied scar tissue secondary to excessive collagen formation (from ear piercing or surgery) Atrophy: thin, dry, transparent appearance of epidermis, loss of collagen (aged skin) LIchenification: thickening and roughening of skin secondary to repeated rubbing, irritation, and scratching (contact dermatitis)

Which of the following would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery?

Maintaining optimal bladder emptying

The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find?

Marked blurring of vision

Ocular Irrigants and Lubricants

May be used to irrigate the eye or for pts with dry eyes such as artificial tears

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?

Medication use

A nurse is providing an educational presentation addressing the topic of "Protecting Your Skin." When discussing the anatomy of the skin with this group, the nurse should know that what cells are responsible for producing the pigmentation of the skin?

Melanocytes are the special cells of the epidermis that are primarily responsible for producing the pigment melanin.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? a) Evaluate the client for periorbital edema. b) Monitor the client for signs of electrolyte and water imbalance. c) Monitor the client for an allergy to iodine contrast material. d) Assess the client's mental changes.

Monitor the client for an allergy to iodine contrast material. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.

The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening?

Monthly testicular self-examination (TSE)

Terms relating to malignant lesions: Define Malignant melanoma

More common, deadly skin cancer, neoplastic change of the melanocytes.

What condition is this? • MSH1, MSH2 (AD) • Adenocarcinoma of the colon w/ sebaceous neoplasm

Muir Torre syndrome

Stages of Glaucoma: Initiating event

Must be an initiating event that causes the increased IOP o Risk factors listed above, can also include illness, emotional stress, congenital abnormalities, long term use of corticosteroids, and use of mydriatics

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 in treating inflammatory conditions of the eyes?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

What is this condition? • Absent OCA1A or decreased function of OCA1B (both AR) • OCA1A: White hair, milky white skin. Age hair may yellow due to keratin denaturing. • OCA1B: White skin and hair darkens over time.

Oculocutaneous Albinism 1

What is this condition? • Normal # of melanocytes and tyrosinase, but defect in P gene (AR) • Hair is cream to yellow-brown. • Can be seen in patients with Prader-Willi and Angelman syndrome

Oculocutaneous albinism 2

Which term best describes a total urine output of less than 500 mL in 24 hours? a) Oliguria b) Dysuria c) Nocturia d) Polyuria

Oliguria Oliguria is a urine output of less than 400 mL in 24 hours. Polyuria is increased urine output. Nocturia is awakening at night to urinate. Dysuria is painful or difficult urination.

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification?

Ophthalmoscope

There are four major types of ophthalmitic procedures to complete a glaucoma examination. If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for:

Ophthalmoscopy.

Which of the following terms refers to the surgical removal of one of the testes?

Orchiectomy

Terms relating to malignant lesions: Define Basal cell carcinoma

Overgrowth of the basal layer of the skin (very bottom portion). The neoplastic change proliferates and leads to the basal cell carcinoma. They are considered nuances skin cancer, since they do not metastasis or cause a lot of disease, but you still want to treat it.

A patient with an indwelling catheter after a radical prostatectomy is having bladder spasms. What medication prescribed by the physician can the nurse administer to help alleviate the discomfort?

Oxybutynin (Ditropan)

Closed Angle Glaucoma

PAINFUL- complete blockage -sudden change in vision -halos around lights -red eye with fixated dilated pupil RF: medication side effects

The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique?

Palpate each testicle separately, following a warm shower.

A male patient undergoes a renal angiogram. The nurse prepares the patient for the test and provides postprocedure care to the patient. Which of the following postprocedure care interventions should the nurse provide to the patient who has already undergone a renal angiogram? a) Assess for signs of electrolyte and water imbalance b) Encourage the client to void c) Palpate the pulses in the legs and feet d) Monitor the client for signs and symptoms of pyelonephritis

Palpate the pulses in the legs and feet To observe for signs of arterial occlusion in a patient who has undergone renal angiogram, the nurse should palpate the pulses in the legs and feet. While preparing the patient for renal angiogram, the nurse asks the patient to void. It is during the physical examination of a patient that the nurse assesses for signs of electrolyte and water imbalance. The nurse should monitor for signs and symptoms of pyelonephritis in a patient who has undergone retrograde pyelogram.

A client is diagnosed with blepharitis. What symptoms should a nurse monitor in this client?

Patchy flakes clinging to the eyelashes

Terms relating to textural changes of skin: Define Cobblestoning

Pattern characterized by multiple, similarly-sized rounded densities that project from a linear surface. Pattern linked to cobbled stones paved stones. Marker for Cowden syndrome.

The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include? -Waiting to urinate for 5 to 10 minutes after feeling the initial urge -Using a bearing down motion to promote complete bladder emptying when voiding -Engaging in strenuous exercise to strengthen abdominal muscles -Performing perineal exercises frequently throughout the day

Performing perineal exercises frequently throughout the day

What condition is this? • STK11 • Lentigines favor perioral region, oral mucosa and hands • Hamartomatous GI polyps • Increased risk ovarian, breast, and pancreatic cancer Lentigines is a condition marked by small brown patches on the skin.

Peutz-Jeghers syndrome

Conjunctivitis

Pinkeye -inflammation of conjunctiva S/S: redness, swelling, excess tears, blurred vision -BACTERIAL: green/yellow discharge -VIRAL: watery discharge, itchy, bumps

Nursing students are reviewing information about the male reproductive system and normal age-related changes. They demonstrate understanding of the topic when they identify which of the following as occurring?

Plasma testosterone levels decrease.

Which of the following are age-related changes affecting the male reproductive system? -Increased prostate secretion -Testes become soft -Decreased plasma testosterone levels -Increased patency

Plasma testosterone levels decrease.

Retention of which electrolyte is the most life-threatening effect of renal failure? a) Sodium b) Potassium c) Phosphorous d) Calcium

Potassium Retention of potassium is the most life-threatening effect of renal failure.

Terms relating to malignant lesions: Define Actinic keratosis

Precursors for Squamous skin cancer.

An aging client is brought to the eye clinic by the son. The son states he has seen his parent holding reading materials at an increasing distance to focus properly. What age-related changes does this indicate?

Presbyopia

Visual loss

Progressive loss of vision is characterized by visual field defect - usually starts out with peripheral vision

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder?

Prolonged use of corticosteroids

Which of the following cancers rank second as the cause of death in American men?

Prostate

A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?

Prostate biopsy

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? a) Unusually smooth skin b) Pruritus c) Increased alertness d) Hypoventilation

Pruritus The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.

What condition is this? • ABCC6 (most common AR) • Yellow papules with lax soft skin folds • Common gastric artery hemorrhage • Increased risk 1st trimester miscarriage

Pseudoxanthoma elasticum

What is a disorder of connective tissue?

Pseudoxanthoma elasticum

The nurse is caring for a patient complaining of orange-colored urine. The nurse suspects which of the following as the cause of the urine discoloration? a) Pyridium (phenazopyridium hydrochloride) b) Phenytoin (Dilantin) c) Infection d) Metronidazole (Flagyl)

Pyridium (phenazopyridium hydrochloride) Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications Pyridium (phenazopyridium HCl) and nitrofurantoin (Furadantin). Infection would cause yellow to milky white urine. Phenytoin (Dilantin) would cause the urine to become pink to red in color. Metronidazole (Flagyl) would cause the urine to become brown to black in color.

The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. a) Renal papilla b) Renal medulla c) Renal pelvis d) Renal cortex

Renal cortex The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

Which of the following hormones is secreted by the juxtaglomerular apparatus? a) Aldosterone b) Calcitonin c) Renin d) Antidiuretic hormone (ADH)

Renin Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

The nurse is aware, when caring for patients with renal disease, that which of the following substances, made in the glomeruli, directly controls blood pressure? a) Renin b) Vasopressin c) Cortisol d) Albumin

Renin Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS).

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal?

Retinal Angiography

A client complains to the nurse about having difficulty seeing to read, but reports no difficulty with driving. What test would the nurse prepare for the physician to administer to this client?

Rosenbaum

tamsulosin dose for bph

SR or CR: 0.4-0.8mg/d

Terms relating to distribution: Define Seborrheic

Scaly greasy patches and red skin, mainly on the scalp

An African American is admitted to the medical unit with liver disease. To correctly assess this patient for jaundice, on what body area should the nurse look for yellow discoloration? A)Elbows B)Lips C)Nail beds D)Sclerae

Sclerae

Glands of Skin (2 types):

Sebaceous glands are associated with hair follicles. They secrete sebum onto the space between the hair follicles and the hair shaft, lubricating the hair and making skin soft and pliable. Sweat glands are all over the body but are most concentrated in the palms and soles. Only the glans penis, the margins of the lips, the external ear, and the nail bed are devoid of sweat glands. There are 2 types of sweat glands: eccrine and apocrine. Eccrine glands are found everywhere on skin. They secrete sweat, which is predominately composed of water. Sweat is released in response to elevated ambient temperature and body temperature. Rate of sweat is controlled by the sympathetic nervous system. Apocrine sweat glands are larger than eccrine glands. Located in axillae, anal region, scrotum, and labia majora. They become active at puberty. They produce a milky sweat that is sometimes broken down by bacteria causing body odor. Ceruminous glands, apocrine glands of the ear, produce cerumen (ear wax).

Medical management: intraocular foreign body

Should avoid an MRI because if it's metal it could further damage the patient

A nurse is explaining the importance of sunlight on the skin to a woman with decreased mobility who rarely leaves her house. The nurse would emphasize that ultraviolet light helps to synthesize what vitamin? D

Skin exposed to ultraviolet light can convert substances necessary for synthesizing vitamin D is essential for preventing rickets, a condition that causes bone deformities and results from a deficiency of vitamin D, calcium, and phosphorus.

Terms relating to scale: Define Collodion membrane

Skin that resembles a yellow, tight and shiny film or dried collodion (sausage skin).

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL

Specific gravity 1.035

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is:

Specific gravity 1.035 Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of mulitiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL

Specific gravity 1.035 Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of mulitiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

An older adult patient is diagnosed with a vitamin D deficiency. What would be an appropriate recommendation by the nurse?A) Spend time outdoors at least twice per week B)Increase intake of leafy green vegetables C)Start taking a multivitamin each morning D)Eat red meat at least once per week

Spend time outdoors at least twice per week

Hoedeolum

Sty -bacterial infection of meirbomian gland (what lubricates eye) S/S: painful, eyelid swollen, excess tearing Treatment: warm compress, antibiotics -goal get it to rupture on own

A wound care nurse is reviewing skin anatomy with a group of medical nurses. Which area of the skin would the nurse identify as providing a cushion between the skin layers, muscles, and bones?

Subcutaneous tissue

Gerontologic Considerations

Sun exposure, systemic diseases, and poor nutrition increases the range of skin conditions. Medications (antihistamines, antibiotics, and diuretic agents) increase photosensitivity. The major changes in the skin of older people include dryness, wrinkling, uneven pigmentation, and various proliferative lesions. There is thinning at the junction of the dermis and epidermis. The result of this thinning is fewer anchoring sites between the two skin layers, meaning minor injury can cause it to shear away from the dermis. The epidermis and dermis become thin and flat with age causing wrinkles, sags, and overlapping skin folds. Loss of subcutaneous tissue substances of elastin, collagen, and fat. This decreases muscle tone and the insulating properties of fat (warmth). Cellular replacement slows as a result of aging. The skin becomes fragile and transparent. Blood supply to the skin decreases with age and capillary loops decrease with number and age. This means increased wound healing time. Sweat and sebaceous glands decrease in number leading to dry skin. Hair growth diminishes over lower legs and feet, pubic areas, scalp, and axilla. Loss of sensory perception. Aging of skin from the sun causing lesions and wrinkling.

Which of the following should be included as part of the home care instructions for a patient with epididymitis and orchitis? -Resume sexual intercourse -Apply ice to the area after scrotal swelling subsides -Take prescribed antibiotics -Undertake lifting exercises

Take prescribed antibiotics

Which of the following should be included as part of the home care instructions for a patient with epididymitis and orchitis?

Take prescribed antibiotics.

A client with glaucoma has been given a prescription for a mydriatic drug. What is a priority action of the nurse?

Tell the physician.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make? Testicular cancer is more common in older men. Testicular cancer is the number one cause of cancer deaths in males. Testicular cancer is very difficult to diagnose. Testicular cancer is a highly curable type of cancer.

Testicular cancer is a highly curable type of cancer.

A patient presents at the dermatology clinic with suspected herpes simplex. The nurse knows to prepare what diagnostic test for this condition?A) Skin biopsy B)Patch test C) Tzanck smear D)Examination with a Wood's light

The Tzanck smear is a test used to examine cells from blistering skin conditions, such as herpes zoster, varicella, herpes simplex, and all forms of pemphigus.

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is:

The appearance of tiny, yellow spots in the field of vision.

Stages of glaucoma: Functional alterations

The built up pressure causes functional changes o Conditions such as increased intraocular pressure or impaired blood flow create functional changes that may lead to the fourth stage

Which nursing assessment finding indicates the client has not met expected outcomes? a) The client consumes 75% of lunch following an intravenous pyelogram. b) The client has blood-tinged urine following brush biopsy. c) The client reports a pain rating of 3 two hours post-kidney biopsy. d) The client voids 75 cc four hours post cystoscopy.

The client voids 75 cc four hours post cystoscopy. Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achieveable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram.

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?

The cost vertebral angle

Which of the following is not a definition of erectile dysfunction?

The inability to achieve an erection after sexual activity

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?

The left kidney usually is slightly higher than the right one. The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

A patient is undergoing treatment for prostate cancer. He has chemotherapy sessions regularly. However, of late he is showing symptoms of food allergy and loss of appetite. He has lost considerable weight due to this. Which of the following is an appropriate nursing task in this situation?

The nurse should ask the patient to keep a diet diary.

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.

A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign?

The presence of halos around lights

Functions of the Skin Protection, Sensation, Fluid Balance, Temperature Regulation, Vitamin Production, Immune Response Function

The skin is no more than 1 mm thick but protects us from bacteria, trauma, water loss, environmental factors (chemicals, microbes, insect bites). The receptor endings of nerves in the skin allow the body to constantly monitor the conditions of the immediate environment. The main functions are temperature, pain, light touch, and pressure (heavy touch). The stratum corneum, the outermost layer of the epidermis, has capacity to absorb water. This prevents loss of water and electrolytes. Insensible evaporation, amount of water continuously evaporating from skin, is about 600 mL daily. The body continuously produces heat as a result of metabolism of food, which produces energy. Heat loss is from 3 major physical processes: radiation, evaporation, conduction. Radiation is the transfer of heat to another object of lower temperature situated at a distance. Evaporation from the skin aids heat loss by conduction. Heat is conducted through the skin into water molecules onto water molecules on its surface, causing water to evaporate (perspiration). The rate of heat loss depends on the surface temperature of the skin. On cold days, the blood vessels constrict to reduce heat loss. And on hot days the body sweats in order to regulate heat loss. Vitamin D is essential for preventing osteoporosis and rickets. People need 5-30 minutes of sun exposure twice a week in order for this synthesis to occur. Langerhans cells facilitate the uptake of immunoglobulin E (IgE)-associated allergens. This action plays a pivotal role in the pathogenesis of atopic dermatitis and other allergic diseases such as asthma and allergic rhinitis.

The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? a) The specific gravity will be high. b) The specific gravity will be inversely proportional c) The specific gravity will be low d) The specific gravity will equal to one

The specific gravity will be high. The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.

The outer layer of the epidermis provides the most effective barrier to penetration of the skin by environmental factors. Which of the following is an example of penetration by an environmental factor? An insect bite

The stratum corneum, the outer layer of the epidermis, provides the most effective barrier to both epidermal water loss and penetration of environmental factors, such as chemicals, microbes, insect bites, and other trauma

Terms relating to scale: Define hyperkeratosis

Thickening of your skin's outer layer (this layer is made of a protein called keratin)

You are teaching a parent how to instill drops in their 12-year-old sons' eyes. Which action would you teach the parent is accomplished first?

Tilt the head slightly backward.

Which of the following is the only definitive way to diagnose testicular cancer?

Tissue biopsy

A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection?

To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first-aid treatment?

To prevent vision loss

Glaucoma treatment: surgery

Trabeculoplasty; trabeculectomy; gonioplasty; laser iridotomy; peripheral iridectomy o Will not test on specific surgeries - just know that these are for glaucoma & their purpose o Purpose - increase drainage of aqueous humor and decrease intraocular pressure

A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? -Transurethral resection of the prostate (TURP) -Suprapubic prostatectomy -Retropubic prostatectomy -Transurethral laser incision of the prostate

Transurethral resection of the prostate (TURP)

A dermatologist has asked the nurse to assist with examination of a patient's skin using a Wood's light. This test will allow the physician to assess for which of the following?A) The presence of minute regions of keloid scarring B)Unusual patterns of pigmentation on the patient's skin C)Vascular lesions that are not visible to the naked eye D)The presence of parasites on the epidermis

Unusual patterns of pigmentation on the patient's skin

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? a) Ureters b) Pelvic floor muscles c) Bladder d) Urethra

Ureters The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

The most frequent reason for admission to skilled care facilities includes which of the following? a) Stroke b) Urinary incontinence c) Congestive heart failure d) Myocardial infarction

Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply.

Urine: RBC 20 BUN 28 mg/dL Hematuria (> 3RBCs) and an elevated BUN are both suggestive of a problem within the genitourinary tract. A serum creatinine of 0.8 mg/dL and a urine specific gravity of 1.020 are within normal limits. A rare white blood cell is not clinically significant.

Which of the following instructions regarding future sexual activity should a nurse give a patient with a vasectomy?

Use a reliable method of contraception until the physician ensures that sperm are no longer present.

Which assessment finding would create the greatest risk to a client ordered a phosphodiesterase inhibitor such as sildenafil? Use of nitrates Type 2 diabetes History of hypertension Use of diuretics

Use of nitrates PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.

A client diagnosed with prostate cancer is to receive brachytherapy. Which of the following would the nurse include when discussing this therapy with the client? Need for daily treatments over a 7- to 8-week period Surgical castration to decrease the level of circulating testosterone Use of probes inserted using ultrasound to freeze the tissue Use of radioactive seeds implanted into the prostate

Use of radioactive seeds implanted into the prostate Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. External beam radiation therapy (teletherapy) involves the use of radiation treatments, usually 5 days/week over 7 to 8 weeks. Surgical castration is a type of androgen-deprivation therapy. Cryosurgery invovles the insertion of transperineal probes into the prostate to freeze the tissue directly.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

Use sterile technique when irrigating the catheter.

Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy?

Using a reliable method of contraception for several weeks.

Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy? Taking a prescribed opioid analgesic for pain relief. Resuming sexual activity in 24 to 48 hours. Applying warm compresses to the scrotum for the first 24 hours. Using a reliable method of contraception for several weeks.

Using a reliable method of contraception for several weeks. It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.

Treatment for Wet Type:

Usually targets the development and progression of angiogenesis to prevent leaking from vessels which causes damage o Can include laser surgery to destroy weak vessels to prevent bleeding o Photodynamic therapy meds injected that will adhere to new blood vessels and stop leaking

While assessing a dark-skinned patient at the clinic, the nurse notes the presence of patchy, milky white spots. The nurse knows that this finding is characteristic of what diagnosis?A) Cyanosis B) Addison's disease C) Polycythemia D) Vitiligo

Vitiligo is a condition characterized by destruction of the melanocytes in circumscribed areas of skin and appears in light or dark skin as patchy, milky white spots, often symmetric bilaterally.

What is this condition? • 4 types (PAX3), different transcription factors involved in neural crest differentiation • White forelock, synophrys unibrow • Dystopia canthorum • Congenital SNHL • Heterochromia

Waardenburg syndrome

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? a) When the urine output is about 100 mL/h b) When the urine output is less than 30 mL/h c) When the urine output is between 300 and 500 mL/h d) When the urine output is between 500 and 1,000 mL/h

When the urine output is less than 30 mL/h Oliguria is defined as urine output <0.5 mL/kg/h

Terms relating to distribution: Define Blaschkoid/following lines of Blaschko

Whirl/swirl appearance. If you hear a dermatologist say mosaic, they are generally referring of Blaschkoid lines. Not a dermatomes. That is a distinct area of your skin defined by its connection to one of 30 spinal nerves.

What condition is this? • Acute sun sensitivity (damaged by UV) • Basal cell cancer, squamous cell cancer, melanoma • Possible neurologic manifestations: HL, poor coordination, seizures, ID

Xeroderma pigmentosum (AR)

tinea

a common superficial fungal infection on the skin or scalp; also called ringworm

Vitiligo

a localized or widespread condition characterized by destruction of the melanocytes in circumscribed areas of the skin, resulting in white patches

vitiligo

a localized or widespread condition characterized by destruction of the melanocytes in circumscribed areas of the skin, resulting in white patches

hydrophilic

a material that absorbs moisture

hygroscopic

a material that absorbs moisture from the air

hydrophobic

a material that repels moisture

(diagnostic procedures) Tzanck smear

a smear test used to examine cells from blistering skin conditions such as, herpes zoster, varicella, herpes simplex

Otosclerosis

abnormal bone growth in middle ear -MCC: genetics (AD) -onset MC- caucasian, female, 20-30 years -Bilateral, slowly progressive hearing loss -Stapes has bony growth Treatment: surgery, hearing aids/implants

What is the aetiology of secondary gonadal failure?

abnormality in hypothalamus or pituitary, will have no/low FSH/LH

What is the aetiology of primary gonadal failure?

abnormality in testes, feedback can't sense testosterone, stimulates gonadotrophins

Glaucoma medications: Carbonic anhydrase inhibitors

acetazolamide, methazolamide, dorzolamide (-zolamide

A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained? pain during sexual intercourse premature ejaculation or other concerns of a sexual nature contraceptive practices age of first ejaculate

age of first ejaculate Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.

Presbycusis

age related hearing loss -bilateral sensorineural hearing loss -MC form S/S: -progressive decrease in hearing & understanding speech Treatment: hearing aids, cochlear implants

What is the testosterone level in hypogonadism

always low testosterone

describe pemphigus vulgaris

an autoimmune disorder - present first with oral lesions and then develop cutaneous lesions - in mouth, face, scalp, head, neck

what is thrush?

an infection of the mouth caused by candida fungus - yeast infection - can be from poor hygiene, use of inhalers, antibiotics

define keratin

an insoluble, fibrous protein that forms the epidermis layer - provides protection from bacteria, fungus, viruses - is responsible for the hardening of the skin - is stacked in layers (new cells pushing old/dead ones to the surface) - produced by keratinocytes

Keratin

an insoluble, fibrous protein that forms the outer layer of skin

keratin

an insoluble, fibrous protein that forms the outer skin layer

Pallor

anemia-decreased hematocrit Shock-decreased perfusion Skin is yellow brown. Ashen gray, dull Albinism Vitiligo

Angle closure (narrowed angle) glaucoma

angle closed and doesn't allow to drain at all o Obstruction in aqueous humor outflow due to the complete or partial closure of the angle o The obstruction results in an increased IOP, damages the retina neuron and optic nerve which leads to blindness o Can be an ocular emergency - should be treated immediately

Dermatosis

any abnormal skin condition

dermatosis

any abnormal skin lesion

dermatitis

any inflammation of the skin

(diagnostic procedures) patch testing

applying potential allergen to skin to detect allergies

antibiotics

are used to treat infections caused by bacteria, fungi, and viruses - can be given locally (topical) for superficial skin disorders - can be given systemically (oral/parenterally) for soft tissue infections like cellulitis and infected wounds

keratolytics

are used to treat keratin-containing skins conditions - hydroxy acids treat wrinkles and sun-damaged skin - salicylic acids treat warts, corns, and calluses

corticosteroids

are used to treat the inflammation present in dermatologic conditions - most often applied topically - choice of corticosteroid depends on severity, location, and extent of condition

retinoids

are vitamin A derivatives that are active in proliferation & differentiation of skin cells - are commonly used to treat acne, psoriasis, skin cancers, aging, wrinkles from sun exposure

keratinocytes

arising from the innermost layer of the epidermis, synthesize the insoluble protein, keratin

How can someone with Klinefelter's present?

backache, osteoperosis, gynaecomastia, little pubertal development, hypogonadism

striae

bandlike streaks on the skin, distinguished by color, texture, depression, or elevation from the tissue in which they are found; usually purplish or white

How do you treat Klinefelters?

bisphosphonates and calicum, remove breast tissue, testosterone replacement

(diagnostic procedures) wood's light examination

black light illuminates bacteria and fungus

(diagnostic procedures) skin scrapings

blade with oil to collect skin cells and examined under a microscope to detect fungi or scabies

Major disadvantage of ointments?

blurred vision - can last for a while after application which would be a safety issue

Can men with Kallmans have children?

cannot produce own endogenous FSH so not fertile however wilth pulsatile pump of GnRH can stimulate FSH release - enlarges testes and seminiferous tubules act for spermatogenesis so yes they can have kids

Merkel cells

cells of the epidermis that play a role in transmission of sensory messages

Melanocytes

cells of the skin that produce melanin

melanocytes

cells of the skin that produce melanin

what are some vascular skin lesions?

changes seen in the skin from a change in vasculature - petechiae / ecchymosis purpura (broken capillary vessels, red/purple dots (small / large), could happen from BP cuff) - venous star (dilated veins due to increased intravenous pressure - spider angioma (swollen blood vessel, red center) - cherry angioma (collection of small blood vessels into one resulting in small red bump)

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a) check the client's pedal pulses frequently. b) remove the dressing on the puncture site after vital signs stabilize. c) keep the client's knee on the affected side bent for 6 hours. d) apply pressure to the puncture site for 30 minutes.

check the client's pedal pulses frequently. After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

Cataracts

cloudy/opaque discolor of lens MCC: aging & UV light Pathophysiology: UV rays cause free radicals to damage lens overtime S/S: -cloudy/blurry vision -decrease color perfusion -decrease night vision Treatment: surgery

What 3 things can cause temporary delay of puberty?

constitutional delay, chronic illness, hormonal disturbances

what makes up the epidermis?

contains: - keratinocytes (produce keratin) - melanocytes (produce melanin) - Merkel cells (role as receptors that transmit stimuli) - langerhans cells (role in cutaneous immune reactions)

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution.

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:

cryptorchidism.

hypopigmentation

decrease in the melanin of the skin, resulting in a loss of pigmentation

Hypopigmentation

decrease in the melanin of the skin, resulting in loss of pigmentation

A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

demonstrate eyedrop instillation.

Langerhans cells

dendritic clear cells in the epidermis that carry surface receptors for immunoglobulin and complement and that are active participants in delayed hypersensitivity of the skin

cytotoxic

destructive of cells

epidermopoiesis

development of epidermal cells

Age- Related Macular Degeneration

distortion or loss of central vision -usually in older adults >55 years 2 Types: -Dry Macular Degeneration -Wet Macular Degeneration

Nails:

dorsal surface of fingers and toes. A hard, transparent plate of keratin. The nail grows from its root, which lies under a thin fold of skin called the cuticle. The nail protects the fingers and toes by preserving their highly developed sensory functions. Nail growth is continuous throughout life.

Open-angle glaucoma

draining clogged up o Increase fluid leads to increased IOP, neuronal ischemia and optic nerve degeneration and eventually loss of vision

Nursing management for glaucoma focuses on:

education, administer meds and monitoring for side effects

How often do you give IM testosterone injections

every 2-3 weeks

how often do you need to give subcutaneous testosterone pellets

every 4-6 months

Angle closure (narrowed angle) glaucoma signs and symptoms:

eye and face pain, malaise, N/V, colored halos around lights, decreased vision, red conjunctiva, corneal cloudiness

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

What is the primary abnormality of Klinefelters?

failure of development of seminiferous tubules - infertile

Sebum

fatty secretion of the sebaceous glands

sebum

fatty secretion of the sebaceous glands

Meniere's Disease

fluid accumulation in inner ear- affecting cochlea & vestibule -age onset: 40-60 years -Triad: tinnitus, vertigo (dizziness), hearing loss -sensorineural hearing loss >pressure in ear- often unilateral Treatment: avoid caffeine, alcohol, nicotine, salty foods

When the bladder contains 300 mL or more of urine, this is referred to as a) functional capacity b) anuria. c) specific gravity d) renal clearance

functional capacity A marked sense of fullness and discomfort with a strong desire to void usually occurs when the bladder contains 350 mL or more of urine, referred to as the "functional capacity." Anuria is a total urine output of less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.

Sebaceous Glands

glands that exist within the epidermis and secrete sebum to keep the skin soft and pliable

sebaceous glands

glands that exist within the epidermis and secrete sebum to keep the skin soft and pliable

What are some symptoms of craniopharyngioma

headache, visual disturbances, short stature, diabetes insipidus

what triggers onset of male puberty

higher centres - GnRH from hypothalamus

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

How does someone with the Kallman's syndrome present?

hypogonadism, small penis, scanty pubic hair, some degree of testosterone, low FSH/LH

what is the most common tca for urge ui?

imipramine (tofranil) - not really used anymore - avoid in older adults - may benefit mixed UI

Functional UI

impaired ability to reach the toilet - reduced mobility - inaccessible toilets or substitutes - dementia

NNT with antimuscarinics

in frail elderly: NNT=32 at 90d NNH (hip fracture)=36 at 90 days *do not use with cholinesterase inhibitors because you're exacerbating the detrusor muscle

Hyperpigmentation

increase in pigmentation.

hyperpigmentation

increase in the melanin of the skin, resulting in an increase in pigmentation

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).

Otitis Media

inflammation of middle ear -MC in children -Middle Ear Effusion- Bulging Tympanic Membrane -decreased hearing -fever Diagnosis: -Otoscope- erythema and bulging TM

cheilitis

inflammation of the lips (when dry, cracking, inflamed skin occurs at the corners of the mouth, it is called angular cheilitis; when caused by sun exposure, it is called solar cheilitis)

What do Sertoli cells make

inhibin

what is included in a skin assessment?

inspect (visually) - note skin color, tone, scares, lesions, wounds palpate (touch) - temp, edema, moisture, nodules Document - photographs must be taken of all pressure wounds

Funduscopy

inspection of optic fundus w/ ophthalmoscope

What is happening when skin is: Bluish (Cyanosis): Yellow-green: Red/flushed (Erythema): Carbon Monoxide Poisoning:

insufficient oxygenation (Greyish cast on dark people on lips) jaundice. Check sclera. inflammation or fever Cherry red lips, torso, mouth.

what is contained in the dermis layer?

is composed of 2 layers - papillary layer (upper) - reticular layer (lower) - overall the dermis contains blood & lymphatic vessels, nerves, sebaceous & sweat glands, hair follicles - the dermis is a network of elastic & collagen fibers (gives skin elasticity & toughness)

pruritus

itching

bullae

large, fluid-filled blisters

Goals of tx in UI

lessen frequency and urgency, minimize complications, and improve qol

suspensions

liquid preparations in which powder is suspended, requiring shaking before use

carbuncle

localized skin infection involving several hair follicles

furuncle

localized skin infection of a single hair follicle; also known as a boil

Alopecia

loss of hair from any cause

liniments

lotions with added oil for increased softening of the skin

what causes nail clubbing?

low level of oxygen in the blood

What chronic illness can delay puberty?

malabsorption, malnutrition, malignancy

enzymes

may be used to debride burn wounds and ulcers - they promote healing by removing necrotic tissue

Tonometry

measures intraocular pressure

Fundugonioscopy

measures the depth of the anterior chamber and determines open angle from closed angle glaucoma

How do you treat Kallmans?

monthly testosterone injections at full dose

Cyanosis

nail beds dusky. Central-chronic heart and lung diseases Peripheral-exposure to cold, anxiety

Mydriatic and Cycloplegic Agents contraindications:

narrow angles or shallow anterior chambers and in pts taking MAOI's or tricyclic antidepressants

What are the endocrine changes in puberty?

negative feedback of testosterone suppressing LH/FSH decreases in sensitivity meaning a rise in LH and FSH

What is anorchia?

no testes

Stages of Glaucoma: Structural alterations in the aqueous outflow system

not draining properly or no drainage causes pressure to build up o Tissue and cellular changes caused by factors that affect aqueous humor dynamics lead to structural alterations and may lead to the third stage

Medical management: Ocular Burns or Chemical Burns cont.

o A brief history and examination are performed • Critical information includes the name of the substance that went into the eye • Material safety data sheets (MSDS) should be accessed for reference as to how to treat that certain chemical o Prognosis depends on the type of injury and adequacy of the irrigation immediately after exposure

Nursing Management for retinal detachment: Education post surgery

o Activity restriction, no straining to reduce pressure o Wear an eye shield to protect the eye o Importance of seeking treatment for changes in vision or any complication such as drainage or pain/pressure that may occur

Pre-operative care for cataract surgery: Cont.

o Alpha-antagonist, particularly tamsulosin (Flomax), are known to cause a condition called intraoperative floppy iris syndrome • Can interfere w/ pupil dilation during surgery, resulting in miosis and iris prolapse and leading to complications • Can still occur even if the patient has stopped taking the medication • Nurse needs to ask pts about history of taking alpha-antagonists so surgical team can be alerted

3 lens replacement options for cataracts:

o Aphakic eyeglasses - lens in them to better vision o Contact lenses o Intraocular lens implants - most common •

Stages of glaucoma: Optical nerve damage

o Atrophy of the optic nerve is characterized by loss of nerve fibers and blood supply o This fourth stage inevitably progresses to the fifth stage

Glaucoma medications:

o Comfort, affordability, convenience, lifestyles, and personality are factors to consider in the patient's adherence to the medical regimen

Anti-allergy Medications

o Common for a pt with allergies o Not going to get into specific names or brands - just know there are allergy meds for the eye

Pre-operative care for cataract surgery: Cont.

o Common practice to withhold any anticoagulant therapy to reduce the risk of retrobulbar hemorrhage for 5 to 7 days before surgery • A recent study showed that the risk of adverse events for patients who continued anticoagulant therapy before cataract surgery was very low - up to the physician but MUST notify them about this • Researchers speculated that regular users of aspirin or warfarin are already at higher risk for transient ischemic attacks or angina and suggest that patients may not need to discontinue these medications prior to surgery

Pre-operative care for cataract surgery: Cont.

o Dilating drops are administered prior to surgery • Every 10 minutes for four doses at least 1 hour before surgery - Additional drops may be administered in the operating room o Nurses begin pt education about eye medications - Antibiotic, corticosteroid, and anti-inflammatory drops - that will need to be self-administered to prevent postop infection and inflammation

Nursing Management for Pts with Glaucoma: Glaucoma

o Disturbed Sensory Perception: Visual o Risk for Injury o Anxiety

Potential Early Postop Complication (not on chart) of cataract surgery: Cont.

o Effects - Corneal edema less than 24 hours postop o Symptoms - reduced visual acuity and pain o Management and Outcome - If there is no growth of microorganism, the treatment is topical steroids alone

Exudative/Wet/Neovascular macular degeneration (Abrupt onset)

o Formation of new, weak blood vessels between vessel layers and retina o New blood vessels are weak and prone to leaking, which interferes with vision o Repeated bleeding will cause scarring o Straight lines appear crooked and distorted or that letters in words appear broken o Blurred vision centrally - peripheral vision usually stays intact

Continuing Care for cataracts:

o If an eye patch is worn, it is removed after the first follow up appointment, usually within 48 hours after surgery o Educate patients on the importance of keeping their follow up appointments • Monitoring of visual status and prompt intervention of post op complications enhance good visual outcome

Ocular trauma: Chemical burns

o Immediately irrigate the eye with tap water or normal saline o pH of the eye should be assessed

Nursing Management for retinal detachment: complications

o Increase in IOP o Endophthalmitis o Other retinal detachments o Development of cataracts • Must be taught the signs and symptoms of complications, particularly of increasing IOP and postoperative infection • Given telephone numbers and instructed to call immediately if discomfort escalates • Diagnoses - Ineffective Tissue Perfusion: Retinal and Anxiety

Medical Management: Splash Injuries

o Irrigate with normal saline before further evaluation occurs o Further manipulation should be avoided until the patient is under general anesthesia o Parental broad spectrum antibiotics o Tetanus antitoxin is administered, if indicated, as well as analgesic agents o Any topical ophthalmic medication must be sterile

Medical management: Ocular Burns or Chemical Burns cont.

o Irrigate with normal saline or tap water if not at the hospital • Irrigation continues until the conjunctival pH normalizes • The pH of the corneal surface is checked by placing a pH paper strip in the fornix - normal pH is 7.3-7.6 • Antibiotic agents are instilled, and the eye usually is patched

Natural barriers of absorption that diminished the efficacy of ocular medications include:

o Limited size of the conjunctival sac o Corneal membrane barriers o Blood-ocular barriers o Tearing, blinking, and drainage • Increased tear production, excessive drainage, or excessive blinking may dilute or wash out an instilled eye drop

Non-exudative/Dry/Non-neovascular macular degeneration (usually occurs slowly)

o Most common type - between 85%-90% of people have dry type o Outer layer of the retina slowly break down - appearance of drusen occurs o Drusen outside of the macular area - no symptoms o Drusen within the macula - gradual blurring of vision that patients may notice when they try to read o Usually occurs slowly

Medical management: Penetrating Injuries and Contusions of the Eyeball

o Most penetrating injuries result in marked vision loss and usually have the following manifestations: • Edema of the conjunctiva (hemorrhagic chemosis) • Conjunctival laceration • Shallow anterior chamber with or without an eccentrically placed pupil

Glaucoma medications: Main treatment

o Must control increased IOP and prevent optic nerve damage o Cannot be cured or reversed o Relies on systemic and topical ocular medications that lower IOP o Takes into account the patients' health and stage of glaucoma

Medical management: Ocular Burns or Chemical Burns

o Must test the pH of the solution o Alkali burns (lye or ammonia) result in the most severe injury because they penetrate the ocular tissues rapidly and continue to cause long-term damage - can also cause increased IOP o Acids (bleach, car batteries, refrigerant) generally cause less damage because the precipitated necrotic tissue proteins form a barrier to further penetration and damage o In treating chemical burns - urgency is of importance

Ocular trauma: Foreign bodies

o No attempt should be made to remove it o The object should be protected from jarring or movement to prevent further ocular damage o Wouldn't want to put any type of pressure or patch on the affected eye

Nursing Management for retinal detachment: Postop for Pneumatic Retinopexy

o Positioning of the patient is critical because the injected bubble must float into a position overlying the area of detachment, providing consistent pressure to reattach the sensory retina o The patient must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break • Patients with respiratory problems, heart failure, obese pts, etc. will have more difficulty laying prone afterwards • Must be made aware of the special needs beforehand so that the patient can be made as comfortable as possible

Post-operative care for cataract surgery:

o Receives verbal and written instruction about how to protect the eye, administer medications, recognize signs of complications, and obtain emergency care o Should be minimal discomfort after surgery - instruct the pt to take a mild analgesic agent, such as acetaminophen as needed o Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively

Medical management: Foreign bodies and corneal abrasions

o Removed by the physician o Antibiotic ointments are applied and the eye may be patched if it's a corneal abrasion o Contact lens wear is a common cause of corneal abrasion o Topical anesthetic eye drops must not be given to the patient to take home for repeated use after corneal injury because their effects mask further damage, delay healing, and can lead to corneal scarring

Pre-operative care for cataract surgery:

o Routine pre-op labs if going for surgical procedure o The standard battery of preoperative test that were once required in all cases are prescribed only if they are indicated by the patient's medical history - complete blood count, electrocardiogram, urinalysis

Promoting home and community based care for cataract surgery:

o Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days o A clean, damp washcloth may be used to remove slight morning eye discharge o Because cataract surgery increases the risk of retinal detachment, the patient must know to notify the surgeon if new floaters (dots) in vision, flashing lights, decrease in vision, pain, or increase in redness occurs

nursing management stated in lecture:

o Slowly progress unless angle closure glaucoma o Primary progressive or open angle - treatment education o Contact physician for over the counter medications o Nursing interventions - focus on safety

Promoting home and community based care for cataract surgery:

o To prevent accidental rubbing or poking of the eye, the patient wears a protective eye patch for the first 24 hours after surgery, followed by eyeglasses worn during the day and an eye shield at night for 1 to 4 weeks o Educate the patient and family about applying and caring for the eye shield o Sunglasses should be worn while outdoors during the day because the eye is sensitive to light

Aqueous solutions are most commonly used for the eye:

o Topical routes (instilled eye drops and applied ointments) are the most commonly used for ocular disorders o Least expensive and interfere w/ vision the least o However, corneal contact time is brief o Ointments have extended retention time in the conjunctival sac and provide a higher concentrate than eye drops

Potential Early Postop Complication (not on chart) of cataract surgery:

o Toxic Anterior Segment Syndrome - Noninfectious inflammation that is a complication of anterior chamber surgery caused by a toxic agent such as agent used to sterilize surgical instruments

Treatments for Non-exudative/Dry Type - No known cure

o Use of antioxidants (vitamin C, vitamin E and beta carotene) and minerals (zinc oxide) in megadoses can slow the progression of AMD and vision loss for people at high risk for developing advanced AMD

Topical Anesthetic Agents:

o Used before diagnostic procedures or for pts having severe eye pain o Anesthesia occurs between 20 seconds - 1 minute and can last from 10 - 20 minutes o Nurses must educate pts to not rub eyes - this can cause corneal damage o Pts are not usually allowed to take meds home due to risk of overuse - can cause softening of the cornea o Prolonged use can result in delayed healing & can lead to permanent corneal opacification and scarring, resulting in visual loss

Corticosteroids and NSAIDS

o Used for inflame conditions of eye o When a suspension is prescribed, instruct pt to shake the bottle prior to use

Orbital Fractures

o Usually non emergent and require surgical repair o Detected by facial x-rays

Mydriatic and Cycloplegic Agents

o Usually used in combo for max. pupil dilation o Educate on the temporary effects: glare, inability to focus properly, difficulty reading o Effects can last from 3 hours to several days o Advise to wear sunglasses o Ability to drive depends on the individual's age, vision, and comfort level o These agents affect the CNS and are most prominent in younger and older adults - these pts must be assessed closely for symptoms

Continuing Care for cataracts: cont.

o Vision is stabilized when the eye is completely healed, usually within 6 to 12 weeks, when final corrective prescription is complete o Visual correctives may still be needed for any remaining refractive errors o Patients who choose multifocal IOLs should be aware that there may be increased night glare and contrast sensitivity

Treatment for Wet Type: cont.

o When administered, light activates the drug and destroys new blood vessels o After treatment - Avoid direct sunlight or bright indoor light for 5 days o Newer meds to be given once a month • ranibizumab (Lucentis) • aflibercept (Eylea)

Foreign bodies

o Would do an xray or CT to detect o Surgical intervention is directed at preventing further ocular injury and maintain the integrity of the affected areas o Cultures are usually obtained, and the pt is placed on prophylactic IV antibiotics that are later changed to ones in a n oral form

The term used to describe total urine output of less than 400 mL in 24 hours is a) oliguria. b) dysuria. c) anuria. d) nocturia.

oliguria. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

A client has developed diabetic retinopathy and is seeing the physician regularly to prevent further loss of sight. From where do the nerve cells of the retina extend?

optic nerve

xerosis

overly dry skin

non selective antimuscarinic

oxybutinin - targets m3, less selectivity for m1 (which is brain)

what are the types of pediculosis?

pediculosis capitis - head lice - not a sign of uncleanliness pediculosis corporis - body lice - a sign of uncleanliness pediculosis pubis - pubic lice (crabs) - spread by sexual contact

A client with multiple sclerosis is being seen by a neuroophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a ________.

perimetry test

petechiae

pinpoint red spots that appear on the skin as a result of blood leakage into the skin

Petechiae

pinpoint red spots that appear on the skin as a result of blood leakage into the skin. Round, red or purple macule.

what are the primary skin lesions?

primary lesions are the initial lesions and are characteristic of the disease itself - macule / patch (flat, circular) - papule / plaque (raised) - bulla / vesicle (raised, think burn blister) - wheal (irregular roundish shape, think allergic reaction) - nodule (like tumor, extends into dermis) - cyst (sac filled w/ fluid) - pustule (push filled, think pimple)

define melanin

produced by melanocytes and is responsible for coloration of the skin

What should you consider with men and UI?

prostate gland

A nurse notices that a client's left upper eyelid is drooping. The nurse has observed:

ptosis

Cataract surgery is contraindicated in:

pts with recurrent uveitis, proliferative diabetic retinopathy, neovascular glaucoma, or rubeosis iridis

pyodermas

pus-forming bacterial skin infections

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: a) chronic, excessive acetaminophen use. b) recent streptococcal infection. c) family history of pernicious anemia. d) childhood asthma.

recent streptococcal infection. A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

Telangiectasias

red marks on the skin caused by distention of the superficial blood vessels

Erythema

redness of the skin caused by congestion of the capillaries

erythema

redness of the skin caused by dilation of the capillaries due to injury, irritation, inflammation, or various skin conditions

what are the layers of the epidermis?

remember "come lets get sun burned" - stratum corneum - stratum lucidum - stratum granulosum - stratum spinosum - stratum basale

débridement

removal of necrotic or dead tissue by mechanical, surgical, chemical, or autolytic means

(diagnostic procedures) skin biopsy

removal of tissue core of nodules, plaques, blisters, or lesions to detect cancer

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: a) interstitial cystitis. b) an overdistended bladder. c) acute prostatitis. d) renal calculi.

renal calculi. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

Diabetic Retinopathy

retinal damage due to diabetes (MCC for blindness) -occurs in 80% of them 2 Types: -Non- Proliferative Diabetic Retinopathy (NPDR) -Proliferative Diabetic Retinopathy (PDR)

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

Ecchymosis

round or irregular macule, larger than petechia. Associated with trauma. Black, yellow, green hues.

what are the secondary skin lesions?

secondary lesions result from changes in primary lesions resulting from external causes (scratching, trauma, infection, wound healing) - erosion (loss of epidermis, after blister rupture) - scar - keloid (raised scar) - ulcer (loss of epidermis/dermis later) - fissure (linear crack) - scales - atrophy (thinning of skin, appears shiny) - crust (dried blood, scab) - lichenification (thickened/roughened skin)

acantholysis

separation of epidermal cells from each other due to damage or abnormality of the intracellular substance

How do you treat hypergonadotrophic delayed puberty?

sex steroid replacement

How do you treat hypogonadotrophic delayed puberty?

sex steroid replacement, pulsatile GnRH administration

What are symptoms of male repro pathology?

sexual dysfunction, fatigue, depressed mood, osteoperosis, decrease in muscle mass and strength, loss of facial and body hair

what infections can cause Bell's palsy?

shingles (herpes zoster) and herpes simplex

How do you treat constitutional delay of puberty?

short term, low dose, sex steroid replacement

Medical management and surgical management:

slows the progression but does not cure it.

Angiomas

spider-like, red.

What can be a test for Kallman's syndrome?

test smell function - these people can't really smell (anosmia)

Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include:

testicular self-examination

What do Leydig cells make

testosterone

How do you treat delayed puberty?

testosterone injections of 100mg monthly for 3 months - low dose so epiphysis don't fuse

Hirsutism

the condition of having excessive hair growth

hirsutism

the condition of having excessive hair growth

comedones

the primary lesions of acne, caused by sebum blockage in the hair follicle

Melanin

the substance responsible for coloration of the skin

melanin

the substance responsible for coloration of the skin

lichenification

thickening of the horny layer of the skin; also known as scaling

what is the subcutaneous layer?

this layer is composed of loose connective tissue & adipose tissue - insulates the body - provides cushion between the skin layers & muscle/bone - where energy is stored (adipose tissue) - bottom layer below the dermis

dermatologic drug therapy is applied

topically to skin, mucous membranes for local effect - comes in creams, lotions, powders, gels, paste - can be antimicrobials (antibiotics, antifungals) corticosteroids, retinoids, sunscreens use oral and intravenous for systemic effects

what is craniopharyngioma

tumour which presses on hypothalamus and compromises anterior pituitary hormones

Weber Test

tuning fork on center of head -Normal: equal -Abnormal: unequal- louder on one side >louder side- conductive loss >quieter side- sensorineural loss

Rhine Test

tuning fork to mastoid process and air -Normal: air louder -Abnormal: bone louder >conductive loss

Wood light

ultraviolet light used for diagnosing skin conditions

Wood's Light

ultraviolet light used for diagnosing skin conditions

Rete Ridges

undulations and furrows that appear at the dermis-epidermis junction and are responsible for cementing together the two layers

rete ridges

undulations and furrows that appear at the lower edge of the epidermis at the dermal junction where these two skin layers are cemented together

antiseptics

used to kill or inhibit the growth of bacteria, viruses, or fungi - primarily to prevent infection - examples: alcohol, hydrogen peroxide, chlorhexidine gluconate, Neosporin

antifungals

used to treat fungal infections of the skin, scalp, and nails - can be in creams, liquids, and sprays - medications end in zole

Open-angle glaucoma signs and symptoms:

usually painless, loss of peripheral vision, and increased IOP

telangiectasias

venous stars; red marks on the skin caused by distention of the superficial blood vessels

What are gonadotrophin levels like in Klinefelters?

very high as more and more FSH being produced to try to stimulate testes

What are skin findings you can see in Tuberous Sclerosis (TSC)?

• "Ashleaf tree" macules • Shagreen patch • Facial angiofibromas • Cafe au lait macules

Assessment and Diagnostic Findings for retinal detachment:

• After visual acuity is determine, the patient must have a dilated fundus examination using an indirect ophthalmoscope as well as slit lamp bio microscopy • Stereo fundus photography and fluorescein angiography are commonly used during the evaluation

What are dermatologic disorders of metabolism?

• Alkaptonuria • Fabry disease (X-linked)

Education for macular degeneration:

• Amslers grids - grid with straight line—as long as line are straight vision is fine o If they see wavy vision is becoming problem o Report to the physician o Given to patients to use in their homes to monitor for a sudden onset or distortion of vision o May provide the earliest signs that macular degeneration is getting worse o Encouraged to look at grid one eye at a time, several time each week with glasses on

Glaucoma medications: Alpha-adrenergic agonists - apraclonidine, brimonidine

• Assess for hypertension, dysrhythmias and heart disease - contraindicated in these pts • Be careful when taking it w/ OTC sinus and cold medications such as Sudafed or pseudoephedrine

Signs and symptoms of cataracts: cont.

• Astigmatism • Monocular diplopia - double vision • Color shift - the aging lens become progressively more absorbent at the blue end of the spectrum • Brunescens - color values shift to yellow brown

What are disorders of malignant potential?

• Basal cell nevus syndrome • Xeroderma pigmentosum

Antifungal Meds - Main one is amphotericin B

• Can have serious side effects Severe pain Conjunctival necrosis Inflammation or irritation of the iris (Iritis) Retinal toxicity

Causes and risk factors of macular degeneration:

• Cause unknown • Increase age • Females have higher risk • Patients who smoke • Genetics can play a role • Long term inflammation in eye

Macular degeneration continued:

• Central vision is generally the most affected, with most patients retaining peripheral vision • Have a wide range of visual loss, but most do not experience total blindness • Macula is the area of the retina that provides sharp vision, if this area becomes degenerative, then macular degeneration of vision loss occurs

CATARACTS

• Clouding of the lens of the eye that interferes with light transmission • Light scatters and does not have sharp vision • Can develop in one eye or both eyes • Half of all patients over the age of 80 have cataracts

What are some clinical features you can see in X-linked Ichthyosis

• Cryptorchidism w/ increased risk testicular cancer • For mom of affected child, failure of labor to progress. They always ask mom if labor was delayed, they usually say that labor took forever

Risk Factors of glaucoma:

• Family history • Thin cornea • African American race • Older age • Diabetes mellitus • Cardiovascular disease • Migraine syndromes • Nearsightedness (myopia) • Eye trauma • Prolonged use of topical or systemic corticosteroids

Nursing Management for retinal detachment:

• Focuses on educating the patient and providing supportive care

Most common ocular side effect of long term topical corticosteroid administration include:

• Glaucoma • Cataracts • Susceptibility to infection • Impaired wound healing • Mydriasis • Ptosis • Increase in IOP - reversible after steroid use is discontinued o To avoid the side effects of corticosteroids, NSAIDS are used as an alternative in controlling inflammation

What are terms that fall under scale?

• Hyperkeratosis • Icthyosis • Collodion membrane

Medical management: Penetrating Injuries and Contusions of the Eyeball cont.

• Hyphema (blood within the anterior chamber) - Can lead to increased IOP - must be monitored closely Preventing rebleeding and prolonged increased IOP are the goals of treatment for hyphema • Vitreous hemorrhage - if they have a hemorrhage, Aspirin would be contraindicated o Surgery may be indicated for some of these injuries

What are disorders of keratinizations?

• Ichthyosis vulgaris • X-linked ichthyosis (aka steroid sulfatase deficiency) • Lamellar icthyosis (LI) • Congenital ichthyosiform erythroderma (CIE) • Darier disease

Surgical Removal Is the Only Treatment for cataracts:

• If have in both eyes, will do one eye at a time - can be weeks to months between surgeries • Usually performed on an outpatient basis with local anesthesia - usually takes less than 1 hour and discharged in 30 minutes or less • Lens are broken apart and extracted and they will get some type of lens implant

Mydriatic and Cycloplegic Agents affect the CNS, symptoms include:

• Increased BP • Tachycardia • Dizziness • Ataxia • Confusion • Disorientation • Incoherent speech • Hallucinations

What are terms relating to textural changes of skin?

• Keratoderma • Cobblestoning

What are some clinical features you can see in Ichthyosis vulgaris?

• Keratosis pilaris chicken bumps • Hyperlinear palms lines on the palms

Education for macular degeneration: cont.

• Large print books may help them • Magnify glasses may be helpful

nursing management:

• Legal blindness - offered referrals to agencies that can assist them in obtaining federal assistance • A lifelong disease involving possible loss of sight has psychological, physical, social, and vocational ramifications • Because the disease has a familial tendency, family members should be encouraged to undergo examinations at least once every 2 years to detect glaucoma

Orbital trauma: cont.

• Management of soft tissue hemorrhage is usually conservative o Inspection, cleansing and repair of wounds o Cold compresses are used in the early phase, followed by warm compresses • Immediate vision loss after injury is usually permanent • Orbital trauma includes orbital fractures and foreign bodies

What are dermatologic disorders of the hair/nails?

• Menkes disease • Hypohidrotic ED • Hidrotic ectodermal dysplasia (Clouston syndrome)

MACULAR DEGENERATION

• Most common cause of vision loss in people over 60 • Pts develop drusen - tiny yellowish spots beneath the retina o Small cluster of debris or waste material that lie deep within the RPE o When located in macular area, they can affect vision

What conditions are genodermatoses associated with malignancies and facial papules?

• Muir Torre syndrome • Peutz Jeghers syndrome • Cowden syndrome (PTEN Hamartoma syndrome) • Birt-Hogg-Dube syndrome

Nursing Management for Pts Receiving Ocular Medications

• Need to ensure proper administration to maximize the therapeutic effects • To diminish systemic absorption and minimize side effects, it is important to: o Put gentle pressure on the inner canthus/puncta of the eye for 1 to 2 mins immediately after instilling eye drops o Wait at least 5 mins before instilling another eye drop, and 10 mins before instilling another ointment into the eye • Review medications and side effects and nursing implications for each

What are disorders associated with multiple cafe-au-lait macule?

• Neurofibromatosis Type 1 • Neurofibromatosis Type 2 • Leopard syndrome • Tuberous sclerosis

Ocular trauma:

• Occurs with occupations injuries, contact sports, weapons, assaults, motor vehicle accidents, and explosions • Two main types of ocular trauma include chemical burns and foreign objects in the eye • Other traumatic eye injuries should be protected using a patch, shield, or a stiff paper cup until can obtain medical treatment

What conditions fall under disorders of pigmentation?

• Oculocutaneous albinism 1 • Oculocutaneous albinism 2 • Hermansky-Pudlak syndrome • Chediak-Higashi syndrome • Griscelli syndrome • Waardenburg syndrome • Incontinentia pigmenti

Assessment and Diagnostic Findings for retinal detachment: cont.

• Optical coherence tomography and ultrasound are used for the complete retinal assessment, especially if the view is obscured by a dense cataract or virtual hemorrhage • All retinal breaks, all fibrous brands that may be causing traction on the retina, and all degenerative changes must be identified

Signs and symptoms of cataracts:

• Painless • Blurry vision - perceives that surroundings are dimmer, as if glasses need cleaning • Light scattering • Experiences reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity • Myopic shift - return of ability to do close work without eyeglasses

Nursing management:

• Patients need to be cautious in navigating their surrounding • Severe glaucoma and impaired function - referral to series that assist the patient in performing ADLs may be needed • Loss of peripheral vision impairs mobility the most - need to be referred for low vision and rehabilitation services

First sign of glaucoma:

• Peripheral vision loss

What does the skin do?

• Permeability barrier • Protection from infection • Thermoregulation • Sensation • UV protection • Wound repair • Physical appearance

Glaucoma medications: Cholinergics (miotics) - Prilocarpine, carbachol

• Prilocarpine can be stored at room temperature for up to 8 weeks and then should be discarded

Surgical Management:

• Reattach the retina surgically • Cryotherapy or laser photocoagulation - creates inflammation and adhesion to weld layers back together • Scleral buckling - causes the fold in sclera to bring the detachment back to contact - contact maintained with a buckle • Pneumatic retinopexy - air bubble is injected and pushes retina into contact with layer of the eye

Signs and symptoms of cataracts: cont.

• Reduced light transmission • Reduce visual acuity - can't see things as clear as before • Color visualization loss

What are the terms relating to distribution?

• Seborrheic • Blaschkoid/following lines of Blaschko

GLAUCOMA

• Second leading cause of blindness in adults in the US • A group of ocular conditions characterized by ocular nerve damage related to increased intraocular pressure from congestion of aqueous humor in the eye • Aqueous humor flows between the iris and the lens and nourishes cornea and lens, most of the fluid then flows out through the anterior chamber, drains through trabecular meshwork, when it's inhibited from flowing out - pressure builds up within the eye

RETINAL DETACHMENT

• Separation of the retina from the sensory layer of eye • Can occur spontaneously or from trauma to the eye • Retina allows perception of light - this path is disrupted if the retina is detached • Several different types - Do not need to know each type of detachment

Assessment and Diagnostic Findings of cataracts:

• Snellen visual acuity test is usually used • Visual inspection with an ophthalmoscope • Slit-lamp biomicroscopic exam used to establish the degree of cataract formation • Amount of cloudiness does not equal the amount vision loss

A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) NSAIDs b) Strenuous exercise c) Prolonged standing d) Diabetes mellitus e) Fever

• Strenuous exercise • Prolonged standing • Fever Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.

Retinal detachment clinical manifestations:

• Sudden onset of floaters or spots • Sensation of curtain coming across the vision of one eye - going black • Cobwebs • Bright flashing light • May have blurred vision • Painless

Glaucoma cont.

• Systemic conditions such as DM, inflammation of the eye and retinal detachment have been associated with increased intraocular pressure • Increase pressure - damages optic nerve which leads to blindness in pts w/ glaucoma • Increased IOP damages the optic nerve and nerve fiber, but the degree of harm is highly variable • No cure for glaucoma, but the disease can be controlled • Peripheral vision loss - first sign

nursing management:

• The nature of the disease and the importance of strict adherence to the medication regiment must be included in a teaching plan to help ensure compliance • The diuretic effect of acetazolamide(Diamox) has an additive effect on the diuretic effects of other antihypertensive medications and can result in hypokalemia

Glaucoma medications: Beta Blockers

• Topical - 1st line treatment • Can produce systemic effects including bronchospasms and heart failure • Assess for allergies • Vision may be blurred at first but should clear fairly quickly

Orbital trauma:

• Usually associated with a head injury, which MUST be assessed first! o Assess head injury first (priority), then the eye second • Soft tissue orbital injuries often result in damage to the optic nerve • s/s from blunt or penetrating trauma include tenderness, ecchymosis, lid swelling, proptosis or exophthalmos, and hemorrhage • Closed injuries lead to contusions w/ subconjunctival hemorrhage, commonly known as a black eye

Diagnostic tests for macular degeneration:

• Visual and retina exams • Fluorescein angiogram done to pass dye through vessels in eye to detect any leaks

RETINAL DETACHMENT cont.

• Vitreous humor can shrink with age and can pull retina from back of eye • Detached retina can increase in size and increase in vision loss • Must be restored back in contact w/ eye or ischemia can occur which will result in blindness • Medical emergency - must get it fixed immediately or will result in blindness