NUR 130 Exam 3

Your patient is ready to be discharged home after a cataract extraction with intraocular lens implant. You are teaching your patient about signs and symptoms that need to be reported to the ophthalmologist immediately. You know that the patient understands when he says what?

"I need to call the doctor if I see flashing lights."

You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing

Which type of glaucoma presents an ocular emergency?

Acute angle-closure glaucoma

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?

After cataract surgery, the client needs to avoid lifting, pulling, or pushing any object that weighs more than 15 pounds to prevent putting excessive pressure on the surgical site. Sunglasses should be worn when outdoors during the day because the eye is sensitive to light. Dots, flashing lights, a decrease in vision, pain, and increased redness need to be reported to the physician immediately. The eye patch is worn for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks.

Which of the following terms refers to the absence of the natural lens?

Aphakia

The nurse is performing patient teaching with a patient newly diagnosed with glaucoma. The nurse teaches the patient that this disease has a familial tendency. How often would the nurse tell the patient that family members should undergo examination for the detection of glaucoma?

At least once every 2 years

A nurse is caring for an older adult client who has DM. The client reports loss of peripheral vision. For which of the following is the client at risk? A.) Cataracts B.) Open angle glaucoma C.) Macular degeneration D.) Angle closure glaucoma

B

A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease (Select all that apply) ? A.) Gender B.) Genetic predisposition C.) Hypertension D.) Age E.) Diabetes mellitus

B,C,D,E

Which of the following is anticholinergic agent used to control tremor and rigidity in Parkinson's disease?

Benztropine Mesylate (Cogentin)

A client, diagnosed with a cataract, comes into the clinic. What assessments should the nurse observe in this client?

Blurred or cloudy visual image

A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following clinical manifestations should the nurse expect to find (Select all that apply) ? A.) Eye pain B.) Floating spots C.) Blurred vision D.) White pupils E.) Bilateral red reflexes

C,D

Which of the following medication classifications increases aqueous fluid outflow in the patient with glaucoma?

Cholinergics

A nurse is caring for a client following a trabeculectomy. Which of the following statements should the nurse include in the teaching? A.) You may resume playing golf B.) You need to tilt your head back when washing your hair C.) You may continue driving to and from work D.) You need to limit your housekeeping activities

D

Which of the following is an appropriate nursing intervention for a client who plans to use a hearing aid?

Describe the various types of hearing aids that are available to the client

The nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate and respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing and producing large amounts of thick white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, as she recognizes that this patient is likely demonstrating symptoms related to what?

Fat embolism syndrome

Open angle glaucoma indications

HA, mild eye pain, loss of peripheral vision, elevated IOP

The client is having a Weber test. During a Weber test, where should the tuning fork be placed?

In the midline of the client's skull or in the center of the forehead

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear?

Inner ear

A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear?

Instillation of mineral oil

Which of the following is the most common cause of visual loss in people older than 60 years of age?

Macular degeneration

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance?

Make sure the client is sitting with the head of bed elevated to 90 degrees

Which of the following would be an incorrect method for removing foreign bodies from the ear?

Manual pressure

Which group of medications causes pupillary constriction?

Miotics

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, or nearsightedness

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

Normally, intraocular pressure (IOP) ranges between 10 to 21 mm Hg. Any reading greater than 21 mm Hg indicates increased IOP

Which of the following is the term for swelling of the optic disc due to increased IOP?

Papilledema

You are teaching the daughter how to instill ear drops of her father to remove impacted cerumen. What is a priority action to teach this woman?

Place the container in warm water before instillation.

Nursing students are reviewing eye structures. The students demonstrate understanding of the material when they identify which of the following as the site of aqueous humor production?

Posterior chamber

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?

Risk factors associated with glaucoma include prolonged use of topical or systemic corticosteroids, older age, myopia, and a history of cardiovascular disease

Which of the following occurs when there is deviation from perfect ocular alignment?

Strabismus

A client is prescribed pilocarpine. When preparing the client's teaching plan about this drug, which of the following would the nurse integrate?

The client may experience difficulty seeing in the dark.

You are admitting a 30-year-old who has a hearing impairment. The client is accompanied by family members. What information would be important to ask the family members to help you care for your client?

The client's preferred method of communication

A client comes to the clinic for an ophthalmologic screening, which will include measurement of intraocular pressure (IOP) with a tonometer. Which statement about this procedure is true?

The tonometer will register the force required to indent or flatten the corneal apex

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.

Pilocarpine

a miotic, which constricts the pupil and allows for better circulation of the aqueous humor, can cause blurred vision

Risk factors for cataracts

age, diabetes, heredity, smoking, trauma, excessive sunlight, chronic corticosteroid use

Risk factors for glaucoma

age, infection, tumors, DM, genetics, hypertension

Cataract removal

avoid activities that increase IOP, limit activities, report pain with nausea/vomiting, best vision in 4-6 weeks, report any changes (pain, floating lights)

Timolol and Acetazolamide

beta-blockers (timolol) and carbonic anhydrase inhibitors (acetazolamide) decreases IOP by reducing aqueous humor production

Audiometry confirms a client's chronic progressive hearing loss. Further investigation reveals ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called:

conductive hearing loss

Subjective data for cataracts

decreased visual acuity, blurred vision, diplopia, light sensitivity/glare, halos

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

demonstrate eyedrop instillation.

Client education for macular degeneration

encourage to consume foods high in antioxidants, carotene, vitamin E and B 12, monthly eye exams, refer to community organizations that can assist patient

Risk factors for hearing loss

family history, congenital malformations, low birth weight, use of ototoxic medications, recurrent ear infections, bacterial meningitis, chronic exposure to loud noises, perforation of the tympanic membrane

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).

Subjective data of macular degeneration

lack of depth perception, objects appear distorted, blurred vision

Objective data of macular degeneration

loss of central vision, blindness

Cycloplegic mydriatic (Atropine 1% opthalmic solution)

prevents pupil constriction for prolonged periods of time and relaxes muscles in the eye. used to dilate the eye preop and for visualization of the eyes internal structure - long duration (7-14 days) -may cause photosensitivity

Prednisone acetate

ocular steroid used to decrease inflammation

A nurse is assessing a client following cataract surgery. The client reports nausea and severe eye pain. Which of the following actions should the nurse take? A.) Notify the provider B.) Administer an analgesic C.) Administer an antiemetic D.) Turn the client onto the operative side

A

Leslie Waterman, a 57-year-old corrections officer, is being seen at the ophthalmic group where you practice nursing. He's concerned about his vision changes where he sees distance much more clearly than nearby sights. What is the term used to describe his visual condition?

Hyperopia is farsightedness.

Which of the following would not be included as a marker of medication effectiveness in glaucoma control?

Opacity of the lens relates to cataract formation. The main markers of the efficacy of the medication in glaucoma control are lowering of the IOP to the target pressure, appearance of the optic nerve head, and the visual field

Nursing students are reviewing information about the causes associated with low vision and blindness. The students demonstrate a need for additional review when they identify which of the following as a common cause in older adults?

Presbyopia

Mannitol

used IV for the emergency treatment for angle closure glaucoma

Cataract prevention

wear sunglasses outside, wear protective eyewear when performing hazardous activities, annual eye exams

Cataracts

opacity of the lens of an eye that impairs vision

Angle closure glaucoma indications

rapid onset of elevated IOP, decreased or blurred vision, halos, nonreactive pupils, severe pain and nausea, photophobia

Risk factors for Dry macular degeneration

smokers, hyptertension, female, short body stature, family history, diet lacking carotene and vitamin A