Unit 06 Chapters 38

When assessing a client diagnosed with brain stem ischemia who is reporting vertigo, the nurse will likely observe which clinical manifestations? Select all that apply.

Inability to coordinate voluntary muscular movements Difficulty in articulating words Facial weakness

While performing a Romberg test on a client, the client asks, "What is the purpose of this test?" Which response by the nurse is most accurate?

It assesses for static vestibular function.

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they understand the education?

It can be caused by a bacterial infection.

The cornea functions as a protective membrane. What layers of tissues form the cornea? Select all that apply.

Outer epithelial layer Substantia propria or stroma Inner endothelial layer

What does the tinnitus that is caused by vascular disorders sound like?

Pulses

The nurse is performing a health history for a 72-year-old client. When reviewing the client's medications, the client states, "I take a baby aspirin every day, but I'm worried. I heard that aspirin can cause hearing problems!" What is an appropriate response by the nurse?

"A baby aspirin is a low dose that is considered to be safe."

Which of these clients' statements would be most suggestive of retinal detachment?

"I feel like there's a shadow that's blocking my vision."

The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states:

"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming."

A 69-year-old client comes to the clinic for a routine checkup. Upon examination, the nurse practitioner informs the client that she has cataracts. The client then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner?

"Surgery is the only effective treatment for cataracts."

A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."

Which individual is most likely to be diagnosed with a central vestibular disorder?

A woman who has ongoing difficulty balancing herself when walking

The nurse is caring for a pediatric client whose parent reports that the child has been pulling at her ears, has a fever, and has been crying more than usual. The nurse suspects the client may be experiencing which of the following?

Acute otitis media

The nurse is caring for a client who has been diagnosed with presbycusis. The nurse understands that with this disorder, the client experiences which of the following?

Difficulty hearing high-pitched frequencies

During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which condition?

Keratitis

The nurse who works at a clinic for pediatric clients observes that a frequent reason for client visits is acute otitis media (AOM). The nurse understands that which structural characteristic of the ear in infants and children increases the potential for AOM?

Less efficient tensor muscle to open the Eustachian tube

A client has been diagnosed with hemianopia. The client asks the nurse what this is describing concerning the eye?

Loss of half of the visual field in one eye

A college junior calls his mother, a nurse, reporting "not being able to see." When questioned further, he describes the following: "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which condition and have the teenager go to the emergency department immediately?

Retinal detachment

Which diagnostic test results indicate a client has a vestibular disturbance?

Romberg test response shows increased swaying with arm drift to one side.

A young child is flying on a plane for the first time. As the plane begins its decent for landing, his ears begin to hurt. The flight attendant sees that he is in pain and tells him to swallow until the pain goes away. Which structure is the child using to equalize the pressure and relieve the pain?

Swallowing pulls air through the eustachian tubes, allowing the air pressure to equalize in the inner ear.

A client has been diagnosed with sensorineural hearing loss. What should the care team assess to determine a plausible cause?

The client's recent medication use

The nurse is a conducting discharge teaching to a client prescribed an ototoxic medication. Which signs and/or symptoms will the nurse ask the client to report? Select all that apply.

Tinnitus Hearing loss Dizziness Light-headedness

The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be:

administration of topical beta-adrenergic antagonists to lower the pressure.

The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually:

asymptomatic and often self-limiting.

A young child has been diagnosed with amblyopia. The parents ask the nurse when treatment should be considered. At what age should treatment of children with the potential for development of amblyopia be instituted?

before 6 years

The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to:

conduction disorder

A client's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the client has:

cystlike mass in the middle ear.

During a physical exam, the nurse practitioner notes that the client's optic disk is very pale with a larger size/depth of the optic cup. At this point, the NP is thinking that the client may have:

glaucoma.

The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which measure will the nurse recommend during changes in air pressure?

swallowing

The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:

"Cut down on takeout meals because of high amounts of monosodium glutamate."

A client reports occasional ringing in the ears that worsens toward the end of the day. The most important question for the nurse to ask would be:

"What prescription medication and over-the-counter medication do you take?"

The nurse is caring for a client who reports, "My ears are constantly ringing!" The nurse will evaluate the client further for the use of which medication?

Acetylsalicylic acid (aspirin)

As part of the diagnostic workup for a client's longstanding vertigo, a clinician wants to gauge the eye movements that occur in the client. Which diagnostic test is the clinician most likely to utilize?

Electronystagmography (ENG)

Which nursing intervention is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo?

Fall precautions

The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which medication will be prescribed to manage the symptoms?

Promethazine

Otitis media (OM), which can occur is any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss?

Streptococcus pneumoniae

The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which symptom?

Vertigo

A student nurse has been assigned to a client in the ambulatory surgery center for a cataract. What is the most common type of cataract?

nucelar

The nurse takes a client's blood pressure in the primary care provider's office. The last three times the client has been in the office it has been high. What structure in the eye is this adverse effect of hypertension most likely to affect?

retina

The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located?

Anterior segment of the globe

An adult client has presented to the emergency department reporting symptoms of vertigo. Further assessment reveals that the client is ataxic and has facial weakness. The care team should consider which possible cause of this client's health problem?

Brain stem ischemia

A 64-year-old client comes to the clinic for a routine checkup and, while talking to the nurse, discusses some recent vision problems. Upon examination the nurse notices that the client's lenses are yellow. The client further states there have been problems with color discrimination as well as distance vision. What should the nurse suspect as the diagnosis for this client?

Cataracts

The nursing instructor is teaching a class on diabetes and discusses complications of the disease. The instructor further states that diabetic retinopathy is one of the leading causes of blindness. What does the instructor tell the students are major risk factors for developing diabetic retinopathy? Select all that apply.

Chronic hyperglycemia Hypertension Smoking

The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor that fills the anterior and posterior chambers of the eye. What is this disease called?

Glaucoma

The parents of a 1-month-old child are concerned, because the child does not always look toward them when they speak. What assessment does the nurse expect the provider to conduct?

Hearing screening

Following focal seizures that have damaged the dominant hemisphere of a client's auditory association cortex, the nurse may observe the client displaying:

Receptive aphasia

The nurse is treating a client with a history of chronic alcohol abuse. The client's spouse tells the nurse that the client has no difficulty speaking and responds when spoken to but is having difficulty understanding what is being said. The spouse asks if the nurse believes the client needs a hearing aid. The nurse explains to the spouse that the client probably does not require a hearing aid but may be suffering from:

Receptive aphasia

The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.

Sensorineural hearing loss of aging

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be:

Tympanostomy tube insertion

A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is:

Vestibular apparatus

The nurse understands that movement of otoliths may result in:

vertigo and nystagmus.

The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include:

Medial deviation

Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which teaching point by the care provider is most appropriate?

"There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."