Vision & Hearing problems

The nurse is performing an assessment on a client with a suspected diagnosis of cataract. What is the chief clinical manifestation that the nurse expects to note in the early stages of cataract formation? 1) Diplopia 2) Eye pain 3) Floating spots 4) Blurred vision

4

A client who is complaining of tinnitus is describing a symptom that is: 1) Objective 2) Subjective 3) Functional 4) Prodromal

A subjective symptom such as ringing in the ears can be felt only by the client.

The nurse is reviewing the physician's orders for a client with Meniere's disease. Which diet will most likely be prescribed? 1) Low-cholesterol diet 2) Low-sodium diet 3) Low-carbohydrate diet 4) Low-fat diet

Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are prescribed.

A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially? 1) Irrigation of the ear 2) Instillation of diluted alcohol 3) Instillation of antibiotic ear drops 4) Instillation of corticosteroids ear drops

Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is removed by using forceps. When the foreign object is vegetable matter, irrigation is not used because this material expands with hydration and the impaction becomes worse.

A nurse would question an order to irrigate the ear canal in which of the following circumstances? 1) Ear pain 2) Hearing loss 3) Otitis externa 4) Perforated tympanic membrane

Irrigation of the ear canal is contraindicated with perforation of the tympanic membrane because the solution entering the inner ear may cause dizziness, nausea, vomiting, and infection.

The nurse has notes that the physician has a diagnosis of presbycusis on the client's chart. The nurse plans care knowing the condition is: 1) A sensorineural hearing loss that occurs with aging 2) A conductive hearing loss that occurs with aging. 3) Tinnitus that occurs with aging 4) Nystagmus that occurs with aging

Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve.

The nurse is providing discharge instructions to the client being discharged after a fenestration procedure for the treatment of otosclerosis. Which statement, if made by the client, indicates a need for further instruction? 1) "I should use a straw to drink liquids for the next 2 to 3 weeks." 2) "I need to avoid washing my hair and showering for at least 1 week." 3) "I should avoid movements requiring bending over for at least 3 weeks." 4) "I should take stool softeners to avoid straining when having a bowel movement."

1

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implantation. Which home care measures should the nurse include in the plan?(Select all that apply) 1) Avoid activities that require bending over. 2) Contact the surgeon if eye scratchiness occurs. 3) Place an eye shield on the surgical eye at bedtime. 4) Episodes of sudden severe pain in the eye are expected. 5) Contact the surgeon if a decrease in visual acuity occurs. 6) Take acetaminophen (Tylenol) for minor eye discomfort.

1, 3, 5, 6

The part of the ear that contains the receptors for hearing is the: 1) Utricle 2) Cochlea 3) Middle ear 4) Tympanic cavity

The dendrites of the cochlear nerve terminate on the hair cells of the organ of Corti in the cochlea.

A client arrives at the ED with a foreign body in the left ear and tells the nurse that an insect flew into the ear. Which intervention should the nurse implement initially? 1) Irrigation of the ear 2) Instillation of mineral oil 3) Instillation of antibiotic eardrops 4) Instillation of corticosteroid ointment

2

The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test? 1) Stand 4 feet away from the client to ensure that the client can hear at this distance. 2) Whisper a statement and ask the client to repeat it. 3)Whisper a statement with the examiners back facing the client 4)Whisper a statement while the client blocks both ears.

The examiner stands 1-2 feet away from the client and asks the client to block one external ear canal. The nurse whispers a statement and asks the client to repeat it. Each ear is tested separately.

A labyrinthectomy can be preformed to treat Meniere's syndrome. This procedure results in: 1) Anosmia 2) Absence of pain 3) Reduction in cerumen 4) Permanent irreversible deafness

The labyrinth is the inner ear and consists of the vestibule, cochlea, semicircular canals, utricle, saccule, cochlear duct, and membraneous semicircular canals. A labrinthectomy is preformed to alleviate the symptoms of vertigo but results in deafness, because the organ of Corti and cochlear nerve are located in the inner ear.

Physiologically, the middle ear, containing the three ossicles, serves primarily to: 1) Maintain balance 2) Translate sound waves into nerve impulses 3) Amplify the energy of sound waves entering the ear 4) Communicate with the throat via the Eustachian tube.

The middle ear contains the three ossicles—malleus, incus, and stapes—which, along with the tympanic membrane and oval window, form an amplifying system.

The nurse is preparing to provide care for a client who will need an ear irrigation to remove impacted cerumen. Which interventions should the nurse take when performing the irrigation? Select all that apply. 1) Apply some force when instilling the irrigation solution. 2) Position the client with the affected side down after the irrigation. 3) Warm the irrigating solution to a temperature that is close to body temperature. 4) Position the client to turn the head so that the ear to be irrigated is facing upward. 5) Direct a slow, steady stream of irrigation solution toward the upper wall of the ear canal.

2, 3, 5

The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care? 1) Avoid overuse of the eyes. 2.)Decrease the amount of salt in the diet. 3) Eye medications will need to be administered for life. 4) Decrease fluid intake to control the intraocular pressure.

3

The nurse is educating a client on how to eliminate whistling from a hearing aid. The nurse recognizes that additional instruction is needed when the client makes which statement? 1) "I will cleanse my ear mold." 2) "I will try reinserting the hearing aid." 3) "I will raise the volume of my hearing aid." 4) "I will make sure that my hair is not caught between the ear mold and canal."

3

The nurse is planning a presentation on noise prevention and ear protection for a display booth at a local health fair. The nurse plans to incorporate which important concept regarding hearing loss in the presentation? 1) Sitting near loud music is not harmful. 2) Prolonged ringing in the ears after loud noises is normal. 3) Cup the hands over the ears if loud noise is expected suddenly. 4) Ear plugs or other protectors are necessary only with use of power tools.

3

A client with Meniere's disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo? 1) Increase fluid intake to 3000 ml a day 2) Avoid sudden head movements 3) Lie still and watch the television 4) Increase sodium in the diet

The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are prescribed. Lying still and watching television will not control vertigo.

The clinic nurse is performing an otoscopy examination on an adolescent who was hit in the ear with a basketball during a neighborhood game. A perforated eardrum is suspected. Which finding should the nurse expect to observe if the eardrum is perforated? 1) A red and bulging eardrum 2) Dense white patches on the eardrum 3) A colony of black dots on the eardrum 4) A round or oval darkened area on the eardrum

4

The nurse has conducted discharge teaching for a client who has undergone a fenestration procedure for the treatment of otosclerosis. Which statement, if made by the client, would indicate that teaching was effective? 1) "It is okay to take a shower and wash my hair." 2) "I can resume my tennis lessons starting next week." 3) "I should drink liquids through a straw for the next 2 to 3 weeks." 4) "I will take stool softeners as prescribed by my HCP."

4

The nurse is caring for a client in the postoperative period following enucleation. The nurse notes bloody staining on the surgical eye dressing. Which nursing action is most appropriate? 1) Document the finding. 2) Reinforce the dressing. 3) Mark the site and continue to monitor. 4) Contact the HCP.

4

The nurse is developing a plan of care for a client who is scheduled for cataract surgery. The nurse should identify which as the most appropriate problem in the client's plan of care? 1) Inability to bathe self 2) Lack of adequate nutrition 3) Nervousness about the surgery 4) Alteration in sensory perception

4

The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which sign/symptom is associated with this eye disorder? 1)Total loss of vision 2) Pain in the affected eye 3) A yellow discoloration of the sclera 4) A sense of a curtain falling across the field of vision

4

The nursing student is caring for a client with a diagnosis of presbycusis. The nursing instructor asks the student to describe the physiology associated with this diagnosis. The nursing instructor determines that the student understands this condition if the student indicates that which is a characteristic of presbycusis? 1) A loss of vision associated with aging 2) A loss of balance that occurs with aging 3) A conductive hearing loss that occurs with aging 4) A sensorineural hearing loss that occurs with aging

4

A nurse suspects the client may be experiencing dysfunction in the area of the semicircular canals of the ear if the client experiences which condition? 1) Tinnitus 2) Disturbance in balance 3) Conduction hearing loss 4) Sensorineural hearing loss

2

A 73-year-old client is being evaluated for a hearing impairment. Which question would be most appropriate to provide the most useful information? 1) "Are you having difficulty hearing high-frequency sounds?" 2) "Do you notice any drainage from your ears?" 3) "Are you experiencing any pain in your ears?" 4) "Have you felt any popping sensations?" 5) "Are you having difficulty hearing high-frequency sounds?"

1

A caloric test is prescribed for a client suspected of having disease of the labyrinth. The nurse should obtain which essential item in preparation for this test? 1) An otoscope 2) A tongue blade 3) An emesis basin 4) An ophthalmoscope

1

A client is diagnosed with glaucoma. Which nursing assessment data identifies a risk factor associated with this eye disorder? 1) Cardiovascular disease 2) Frequent urinary tract infections 3) A history of migraine headaches 4) Frequent upper respiratory infections

1

A client is experiencing blockage of the eustachian tubes. Which activity by the client may forcibly open the eustachian tube? 1) Performing the Valsalva maneuver 2) Tapping the side of the head lightly 3) Using cotton-tipped applicators in the ears 4) Chewing food using exaggerated mouth movements

1

A nurse is caring for a client diagnosed with Ménière's disease. The nurse plans care, understanding that this disorder is characterized by which manifestation? 1) Dizziness 2) Blurred vision 3) Hemianopsia 4) Photophobia

1

E.M. seems quite upset. She has many questions that indicate she has unwarranted concerns and worries about surgery. What should you say? 1. "E.M., would you like to talk to the doctor again before surgery?" 2. "E.M., can you tell me what your concerns are about the surgery?" 3. "E.M., you are going to be just fine, I promise to take good care of you." 4. "E.M., didn't you talk with your doctor a few minutes ago about the surgery?"

1

E.M.'s daughter tells you she lives an hour away and works full time.What nursing management is essential for her during the postoperative period? 1. "E.M. will likely need home health to assist with administration of medication, prevention of infection, and transportation to her follow-up appointments." 2. "E.M will need to be placed in a nursing home since she will not be able to take care of herself." 3. "E.M. will need written instructions so she can care for herself during recovery." 4. "E.M. will benefit from frozen meals and a cab voucher to get to her doctor's office for follow up."

1

The nurse in the health care clinic is providing instructions to a client regarding the use of a hearing aid. Which statement is most appropriate for the nurse to include? 1) "The hearing aid should not be worn if an ear infection is present." 2) "The ear mold for the hearing aid should be washed with mild soap and water once a month." 3) "The hearing aid should be removed from the ear at the end of the day and then turned off after removal." 4) "The hearing aid contains a lifelong battery, so you will not need to be concerned about changing batteries."

1

The nurse is developing a plan of care for a client with a diagnosis of Ménière's disease who is being admitted to the hospital. The priority nursing intervention in the plan of care should focus on which item? 1) Measures that will ensure safety 2) Determining any knowledge deficits 3) Knowledge about the treatment plan 4) Determining any psychosocial needs

1

The nurse is developing a plan of care for a client with a diagnosis of severe vertigo from Ménière's disease who is being admitted to the hospital. What is the priority nursing intervention in the plan of care? 1) Safety measures 2) Self-care measures 3) Food items to avoid 4) Knowledge about medication therapy

1

The nurse is providing discharge instructions to a client who had a fenestration procedure for the treatment of otosclerosis. The nurse should instruct the client to take which measure? 1) Avoid air travel. 2) Shower daily to prevent infection. 3) Resume all normal activities in 1 week. 4) Drink liquids through a straw for the next 2 to 3 weeks.

1

E.M.'s vision is equally impaired OU.She is scheduled in a few weeks for cataract removal in OS.What should you tell the patient and daughter to expect postoperatively? 1. "You can expect a great deal of pain after the surgery but your doctor will prescribe narcotic pain medication." 2. "You will likely go home with an eye patch over the affected eye which will put you at risk for falls." 3. "You should expect some bleeding and drainage from the eye for a few days after surgery." 4. "You will not have a good idea of how well the procedure went until about two weeks after surgery."

2

E.M., an 82-year-old female, is escorted by her daughter into preoperative area for removal of cataract OD. Her daughter asks you what can be done to prevent cataracts. What should you tell her? 1. "E.M should use good hygiene practices and remove eye make-up with baby shampoo to prevent cataracts." 2. "E.M. could wear sunglasses, should avoid extraneous or unnecessary radiation, and maintain appropriate intake of antioxidant vitamins." 3. "E.M. should receive ophthalmologic examinations every 1 to 2 years since she is over the age of 65." 4. "E.M. should take careful measure to keep her intraocular pressure low to prevent the development of cataracts."

2

The nurse has given a client who is at risk for motion sickness suggestions about medications that can prevent an occurrence. The nurse determines that the client has correctly learned the information if the client states that the medication is taken at what time before the triggering event? 1) At least 2 days before 2) At least 1 hour before 3) At least the day before 4) At least a half-day before

2

The nurse is caring for a client who was recently diagnosed with primary open-angle glaucoma (POAG). Which assessment finding is specific to this type of glaucoma? 1) Client report of blurred vision 2) Client report of "tunnel vision" 3) Client report of ocular erythema 4) Client report of halos around lights

2

The nurse is observing an unlicensed assistive personnel (UAP) communicating with a client who is deaf. The nurse should intervene if which behavior is observed? 1) The UAP is speaking directly to the client. 2) The UAP over-enunciates words when speaking. 3) The UAP faces the client when speaking to the client. 4) The UAP touches the client's arm to gain his or her attention.

2

The nurse is performing an assessment on a client with a diagnosis of Ménière's disease. The nurse anticipates that the client is most likely to report which symptom during an acute attack? 1) Fatigue 2) Tinnitus 3) Headache 4) Insomnia

2

The nurse is planning care for a client with acute otitis media. To reduce pressure and allow fluid to drain, the nurse anticipates that which measure would most likely be recommended to the client? 1) Strict bed rest 2) A myringotomy 3) A mastoidectomy 4) Diphenhydramine (Benadryl)

2

The nurse is reviewing the HCP's prescriptions for a client with Ménière's disease. Which diet would most likely be prescribed for the client? 1) Low-fat diet 2) Low-sodium diet 3) Low-cholesterol diet 4) Low-carbohydrate diet

2

Tonometry is performed on a client with a suspected diagnosis of glaucoma. The nurse looks at the test results documented in the client's chart, knowing that which is the range for normal intraocular pressure? 1) 2 to 7 mm Hg 2) 10 to 21 mm Hg 3) 22 to 30 mm Hg 4) 31 to 35 mm Hg

2

Which statement made by the client indicates the need for further teaching about hearing aids from the nurse? 1) "I should not purchase a hearing aid unless specifically prescribed by my otologist." 2) "I should check my hearing aid regularly to ensure it is not blocked with wax and that the battery is working." 3) "If I feel like I cannot hear well, I will just order a hearing aid from a mail-order catalog."

2

A client makes an appointment with an ear specialist because of the frequent recurrence of middle ear infections. In performing an intake assessment of the client, the nurse should ask about which risk factor related to infection of the ears? 1) Occupational noise 2) Exposure to loud noise 3) Congenital abnormalities 4) Use of drilling and other power tools

3

E.M. tells you she lives in an apartment and will return there post-op.If the patient is visited only once a day at her home, what may be of concern? 1. "E.M. should be completely independent 24 hours after the procedure." 2. "E.M. will not be able to manage the pain medication regime along." 3. "E.M. may not be able to perform self-care activities since her vision may be affected by the eye patch if her unoperated eye vision is poor." 4. "E.M. will not be able to see out of her peripheral vision."

3

The home care nurse is visiting a client who was recently diagnosed with a hearing impairment. The nurse should prepare to instruct the client's spouse in which measure that will facilitate communication? 1) Speak loudly to the client to facilitate hearing. 2) Speak directly into the impaired ear to facilitate hearing. 3) Speak in a normal tone and face the client when speaking. 4) Speak frequently to the client to provide sensory stimulation.

3

The nurse educator is conducting an in-service education session to the nurses employed in the eye and ear surgical unit of a large trauma center. In discussing the topic of cochlear implants, the educator notes that this surgical procedure is contraindicated in which client? 1) A client with bilateral profound hearing loss 2) A client who communicates primarily by speech 3) A client who became deaf before learning to speak 4) A client who received no benefit from conventional hearing aids

3

The nurse has admitted a client with a diagnosis of an acute attack of Ménière's disease to the hospital. The nurse reviews the health care provider's prescriptions for the client. Which prescription should the nurse question? 1) Diazepam (Valium) 2) Nicotinic acid (Niacin) 3) Ambulation four times daily 4) Diphenhydramine (Benadryl)

3

The nurse instructs a client in the use of a hearing aid. The nurse should include which instructions? 1) Hearing aids do not require any care. 2) Leave the hearing aid in place while showering. 3) Check the battery to ensure that it is working before use. 4) A water-soluble lubricant is used on the hearing aid before insertion.

3

The nurse is assigned to care for a client after a mastoidectomy. Which nursing intervention would be a priority in the care of this client? 1) Maintain a supine position. 2) Change the ear dressing daily. 3) Monitor for signs of facial nerve injury. 4) Position the client on the affected side to promote drainage.

3

A client's vision is tested with a Snellen chart. The results of the tests are documented as 20/60. How should the nurse interpret this finding? 1) The client is legally blind. 2) The client's vision is normal. 3) The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet. 4) The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet.

4

A client with retinal detachment is admitted to the nursing unit in preparation for a scleral buckling procedure. Which prescription should the nurse anticipate? 1) Allowing bathroom privileges only 2) Elevating the head of the bed to 45 degrees 3) Wearing dark glasses to read or watch television 4) Placing an eye patch over the client's affected eye

4

A nurse provides home care instructions to a client who has undergone cataract removal and placement of an intraocular implant in the right eye. Which statement by the client would indicate a need for further instruction? 1) "I need to avoid lying on my right side." 2) "I need to wear the metal eye shield at night when I sleep." 3) "I should take stool softeners to prevent becoming constipated." 4) "I need to remove the eye dressing as soon as I get home and place a warm pack on my eye."

4

Nerve deafness would most likely result from an injury or infection that damaged the: 1) Vagus nerve 2) Cochlear nerve 3) Vestibular nerve 4) Trigeminal nerve

Because the organ of hearing is the organ of Corti, located in the cochlea, nerve deafness would most likely accompany damage to the cochlear nerve.

The nurse has conducted discharge teaching for a client who had a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective? 1) "I should drink liquids through a straw for the next 2-3 weeks." 2) "It's ok to take a shower and wash my hair." 3) "I will take stool softeners as prescribed by my doctor." 4) "I can resume my penis lessons starting next week."

Following ear surgery, the client needs to avoid straining while having a bowel movement. The client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her hair wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.

During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as: 1) A normal finding 2) A conductive hearing loss in the right ear 3) A sensorineural or conductive loss 4)The presence of nystagmus

In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the client's head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard in equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.

The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate communication? 1) Speak frequently 2) Speak loudly 3) Speak directly into the impaired ear 4) Speak in a normal tone

Speaking in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear.

The ear bones that transmit vibrations to the oval window of the cochlea are found in the: 1) Inner ear 2) Outer ear 3) Middle ear 4) Eustachian tube

The bones in the middle ear transmit and amplify air pressure waves from the tympanic membrane to the oval window of the cochlea, which is the inner ear. The tympanic membrane separates the other from the middle ear.

A client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear? 1) Hearing loss 2) Pruritus 3) Tinnitus 4) Burning of the ear

Tinnitus is the most common complaint of clients with otological disorders, especially disorders involving the inner ear. Symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client's thinking process and attention span.

When teaching the client about Meniere's disease, which of the following instructions would a nurse give about vertigo? 1) Report dizziness at once 2) Drive in daylight hours only 3) Get up slowly, turning the entire body 4) Change your position using the logroll method

Turning the entire body, not the head, will prevent vertigo. Dizziness is expected but can be prevented. The client shouldn't drive as he may reflexively turn the wheel to correct vertigo. Turning the client in bed slowly and smoothly will be helpful; logrolling isn't needed.

Which of the following interventions is essential when instilling Cortisporin suspension, 2 gtt right ear? 1) Verifying the proper client and route 2) Warming the solution to prevent dizziness 3) Holding an emesis basin under the client's ear 4) Positioning the client in the semi-fowlers position

When giving medications, a nurse follows the five R's of medication administration. The drops may be warmed to prevent pain or dizziness, but this action is not essential. An emesis basin would be used for irrigation of the ear. Put the client in the lateral position to prevent the drops from draining out for 5 minutes, not semi-fowlers position.

Otosclerosis is a common cause of conductive hearing loss. Which such a partial hearing loss: 1) Stapedectomy is the procedure of choice 2) Hearing aids usually restore some hearing 3) The client is usually unable to hear bass tones 4) Air conduction is more effective than bone conduction

With a partial hearing loss that auditory ossicles have not yet become fixed; as long as vibrations occur, a hearing aid may be beneficial.