ch 20 & 21 Visual & Auditory

The nurse is preparing to administer timolol eye drops for treatment of glaucoma. What statement made by the patient would cause the nurse to hold the medication and report to the health care provider? a. "I have sinusitis." b. "I have migraine headaches a lot." c. "I have chronic obstructive pulmonary disease." d. "I have a history of chronic urinary tract infections."

c. "I have chronic obstructive pulmonary disease." MS

When examining the patient's ear with an otoscope, the nurse observes discharge in the canal and the patient reports pain with the examination. What should the nurse next assess the patient for? a. Sebaceous cyst b. Swimmer's ear c. Metabolic disorder d. Serous otitis media

b. Swimmer's ear MS

An appropriate nursing intervention for the pt during an acute attack of Meniere's disease includes providing: a. frequent repositioning b. a quiet, darkened room c. a television for diversion d. padded side rails on bed

b. a quiet, darkened room (minimizes vertigo) workbook

The nurse is teaching a patient about timolol eye drops for the treatment of glaucoma. What statement made by the patient demonstrates that teaching was effective? a. "I may feel some palpitations after instilling these eye drops." b. "I should withhold this medication if my blood pressure becomes elevated." c. "I should keep my eyes closed for 15 minutes after instilling these eye drops." d. "I may have some temporary blurring of vision after instilling these eye drops."

d. "I may have some temporary blurring of vision after instilling these eye drops." MS

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? a. Absence of pain or pressure b. Blurred vision in the morning c. Seeing colored halos around lights d. Eye pain accompanied with nausea and vomiting

a. Absence of pain or pressure MS

The patient reports a loss of central vision. What test should the nurse teach the patient about to identify changes in macular function? a. Amsler grid test b. B-scan ultrasonography c. Fluorescein angiography d. Intraocular pressure testing with Tono-Pen

a. Amsler grid test MS

medications for open-angle glaucoma (4)

-beta blockers -alpha agonists -cholinergics -carbonic anhydrase inhibitors

presbycusis

hearing loss associated with aging, related to degenerative changes in the inner ear

presbyopia

inability to focus on near objects, appears around age 40

glaucoma

increased intraocular pressure that causes optic nerve atrophy and peripheral visual field loss

astigmatism

irregular corneal curvature that results in visual distortion

risk factors for glaucoma (5)

-age -ethnicity (African Americans at higher risk) -hypertension -diabetes mellitus -genetics

risk factors for retinal detachment (5)

-age -severe myopia (nearsightedness) -eye trauma -cataract surgery -family or personal hx of retinal detachment

risk factors for cataracts (6)

-age -trauma -UV light exposure -long-term corticosteroid use -diabetes -genetics

risk factors for macular degeneration (6)

-age (> 60 yrs) -ethnicity (caucasians at higher risk) -smoking -hypertension -diet lacking carotene and vitamin E -genetics, family hx

symptoms of macular degeneration (4)

-blurred and darkened vision -vision distortion -loss of central vision, blind spots in visual field -drusen: yellow extracellular deposits in retina (dry AMD)

symptoms of retinal detachment (5)

-light flashes (photopsia) -floaters -"cobweb" in field of vision -loss of peripheral or central vision -no pain

2 types of glaucoma

-primary open-angle glaucoma (POAG) -primary angle-closure glaucoma (PACG)

nursing interventions: Meniere's disease (5)

-safety from falls (side rails up x 3) -quiet, darkened room -no TV or florescent lights (flickering lights) -no sudden head movements -IV meds and fluids

medications for angle-closure glaucoma (2)

-topical cholinergic -hyperosmotic agent

The nurse is providing instructions to a client and the family regarding home care after right eye cataract removal. Which statement made by the client would indicate an understanding of the instructions? 1. "I should sleep on my left side." 2. "I should sleep on my right side." 3. "I should sleep with my head flat." 4. "I should not wear my glasses at any time."

1. "I should sleep on my left side." (after cataract surgery, the pt should not sleep on the side of the body that was operate on to prevent edema formation and intraocular pressure) NCLEX

The nurse is preparing a teaching plan for a client who had a 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. take acetaminophen for minor eye discomfort 4. expect episodes of sudden severe pain in the eye 5. place an eye shield on the surgical eye at bedtime 6. contact the surgeon if a decrease in visual acuity occurs

1. avoid activities that require bending over 3. take acetaminophen for minor eye discomfort 5. place an eye shield on the surgical eye at bedtime 6. contact the surgeon if a decrease in visual acuity occurs (scratchiness and mild eye discomfort is normal and is usually relieved by mild analgesics, severe pain is a sign of hemorrhage, infection, or increased IOP) NCLEX

The nurse is caring for a hearing-impaired client. Which approach will facilitate communication? 1. speak loudly 2. speak frequently 3. speak at a normal volume 4. speak directly into the impaired ear

3. speak at a normal volume NCLEX

The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which sign or 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. a sense of a curtain falling across the field of vision NCLEX

The nurse is performing an assessment on a client with a suspected diagnosis of cataract. Which clinical manifestation should the nurse expect to note in the early stages of cataract formation? 1. diplopia 2. eye pain 3. floating spots 4. blurred vision

4. blurred vision (a gradual, painless blurring of central vision is the chief clinical manifestation of a cataract) NCLEX

A college student reports eye pain after studying for finals. What assessment should the nurse make first in determining the possible etiology of this eye pain? a. Do you wear contacts? b. Do you have any allergies? c. Do you have double vision? d. Describe the change in your vision.

a. Do you wear contacts? (corneal abrasion) MS

Which characteristics of glaucoma are related to only primary open-angle glaucoma (POAG)? (Select all that apply) a. gradual loss of peripheral vision b. treated with iridotomy or iridectomy c. causes loss of central vision with corneal edema d. may be caused by increased production of aqueous humor e. treated with cholinergic agents such as pilocarpine f. resistance to aqueous outflow through trabecular meshwork

a. gradual loss of peripheral vision d. may be caused by increased production of aqueous humor f. resistance to aqueous outflow through trabecular meshwork workbook

The pt who has conductive hearing loss a. hears better in a noisy environment b. hears sound but does not understand speech c. often speaks loudly because his own voice seems low d. experiences clearer sound with a hearing aid if the loss is less than 30 dB

a. hears better in a noisy environment MS

A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? a. increase intake of deep yellow and orange vegetables b. administer eye drops twice daily c. avoid bending at the waist d. wear an eye patch at night

a. increase intake of deep yellow and orange vegetables (vitamins, carotene) ATI

The nurse is providing care for a patient with loss of hearing acuity over the past several years. Which statement by the nurse is most accurate? a. "This is often due to an infection that will resolve on its own." b. "Many people experience an age-related decline in their hearing." c. "This is likely an effect of your medications. Try stopping them for a few days." d. "You can likely accommodate for your hearing loss with a few small changes in your routine."

b. "Many people experience an age-related decline in their hearing." MS

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? a. "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." b. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." c. "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." d. "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening.

b. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." MS

A patient with Ménière's disease had decompression of the endolymphatic sac to reduce the frequent and incapacitating attacks being experienced. What should the nurse include in the discharge teaching for this patient? a. Airplane travel will be more comfortable now. b. Avoid sudden head movements or position changes. c. Cough or blow the nose to keep the Eustachian tubes clear. d. Take antihistamines, antiemetics, and sedatives for recovery.

b. Avoid sudden head movements or position changes. MS

The nurse is assessing a patient's medical history. What aspects of the patient's medical history are most likely to have potential consequences for the patient's visual system? a. Hypothyroidism and polycythemia b. Hypertension and diabetes mellitus c. Atrial fibrillation and atherosclerosis d. Vascular dementia and chronic fatigue

b. Hypertension and diabetes mellitus MS

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? a. Apply pressure to each eyeball for a few seconds after administration. b. Have the patient close the eyes and move them back and forth several times. c. Have the patient put pressure on the inner canthus of the eye after administration. d. Have the patient try to blink out excess medication immediately after administration.

c. Have the patient put pressure on the inner canthus of the eye after administration. MS

A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? a. "You can resume playing golf in 2 days" b. "You need to tilt your head back when washing your hair" c. "You can get water in your eyes in 1 day" d. "You need to limit your housekeeping activities"

d. "You need to limit your housekeeping activities" ATI

hyperopia

farsightedness (see distant objects clearly but close objects are blurred)

myopia

nearsightedness (see near objects clearly but objects in distance are blurred)

pt teaching post-cataract surgery (5)

-avoid activities that increase IOP (bending over, sneezing, coughing) -limit activities (tilting back head to wash hair, cooking and housekeeping, driving) -report pain with nausea/vomiting (indications of increased IOP or hemorrhage) -wear sunglasses -report signs of infection (yellow or green drainage)

symptoms of angle-closure glaucoma (4)

-colored halos around lights -blurred vision -ocular redness -pain in or around the eye

symptoms of cataracts (4)

-decreased visual acuity -abnormal color perception -glare -white pupil

symptoms of open-angle glaucoma (2)

-gradual peripheral vision loss/tunnel vision -no symptoms of pain or pressure

A client is diagnosed with a disorder involving the inner ear. Which is the most common client complaint associated with a disorder involving this part of the ear? 1. pruritus 2. tinnitus 3. hearing loss 4. burning in the ear

2. tinnitus NCLEX

A client diagnosed with conductive hearing loss asks the nurse to explain the cause of the hearing problem. The nurse plans to explain to the client that this condition is caused by which problem? 1. a defect in the cochlea 2. a defect in cranial nerve VIII 3. a physical obstruction to the transmission of sound waves 4. a defect in the sensory fibers that lead to the cerebral cortex

3. a physical obstruction to the transmission of sound waves (other options apply to sensorineural hearing loss) NCLEX

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. eye medications will need to be administered for life NCLEX

A client with retinal detachment is admitted to the nursing unit in preparation for a repair 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. placing an eye patch over the client's affected eye -eye patch reduces eye movement -usually the prescription is to lie flat -reading and TV aren't allowed NCLEX

An older adult patient states they don't seem to hear well and have to ask people to repeat themselves. What should the nurse do first to determine the cause of the hearing loss? a. Look for cerumen in the ear. b. Assess for increased hair growth in the ear. c. Tell the patient it is probably related to aging. d. Ask the patient if he has fallen because of dizziness.

a. Look for cerumen in the ear. MS

Which changes of aging can impair hearing in the older adult? (Select all that apply) a. atrophy of eardrum (middle ear) b. increased hair growth (external ear) c. increased production and dryness of cerumen (external ear) d. increased vestibular apparatus in semicircular canals (inner ear) e. decreased cochlear efficiency from increased blood supply (inner ear) f. neuron degeneration in auditory nerve and central pathways (inner ear)

a. atrophy of eardrum (middle ear) c. increased production and dryness of cerumen (external ear) f. neuron degeneration in auditory nerve and central pathways (inner ear) workbook

What makes up the triad of symptoms that occur with inner ear problems? (Select all that apply) a. vertigo b. nausea c. tinnitus d. sensorineural hearing loss e. inflammation of the ear

a. vertigo c. tinnitus d. sensorineural hearing loss workbook

Always assess the pt with an ophthalmic problem for a. visual acuity b. pupillary reactions c. intraocular pressure d. confrontation visual fields

a. visual acuity MS

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 the disease? Select all that apply: a. gender b. genetic predisposition c. hypertension d. age e. diabetes mellitus

b. genetic predisposition c. hypertension d. age e. diabetes mellitus ATI

A nurse is caring for an older adult client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following disease? a. cataracts b. open-angle glaucoma c. macular degeneration d. angle-closure glaucoma

b. open-angle glaucoma ATI

Which strategies would best assist the nurse in communicating with a pt who has hearing loss? Select all that apply: a. overenunciate speech b. speak normally and slowly c. exaggerate facial expressions d. raise the voice to a higher pitch e. write out names or difficult words

b. speak normally and slowly e. write out names or difficult words MS

Question pts using eyedrops to treat their glaucoma about a. use of corrective lenses b. their usual sleep pattern c. a history of heart or lung disease d. sensitivity to opioids or depressants

c. a history of heart or lung disease MS

What should be included in the nursing plan for a patient who needs to administer antibiotic eardrops? a. cool the drops so they decrease swelling in the canal b. avoid placing a cotton wick to assist in administering the drops c. be careful to avoid touching the tip of the dropper bottle to the ear. d. keep the head tilted 5-7 minutes after administration of the drops.

c. be careful to avoid touching the tip of the dropper bottle to the ear. MS

A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (Select all that apply) a. eye pain b. floating spots c. blurred vision d. white pupils e. bilateral red reflexes

c. blurred vision d. white pupils ATI

During an assessment of hearing, the nurse would expect that a normal findings would be a. absent cone of light b. bluish purple tympanic membrane c. midline tone heard equally in both ears d. fluid level at hairline in the tympanum

c. midline tone heard equally in both ears MS

sensorineural hearing loss

caused by an impairment of function of the inner ear or cranial nerve #8 (auditory nerve)

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing action should be the nurse's priority? a. Teach about visual enhancement techniques. b. Teach nutritional strategies to improve vision. c. Assess coping strategies and support systems. d. Assess impact of vision on normal functioning.

d. Assess impact of vision on normal functioning. MS

During the course of an interview to assess vision, a patient complains of dry eyes. What should the nurse implement next? a. Assess for contact lenses. b. Suggest saline eye drops. c. Ask about eyeglass usage. d. Check the medication list.

d. Check the medication list. MS

When administering a scheduled dose of pilocarpine, in which area should the nurse place the drops? a. Inner canthus b. Outer canthus c. Center of the eyeball d. Lower conjunctival sac

d. Lower conjunctival sac MS

A patient with septic shock is receiving multiple medications. Which intravenous (IV) medication is most likely to cause a hearing loss? a. Dopamine b. Ampicillin c. Aspirin d. Vancomycin

d. Vancomycin MS

The nurse suspects a pt has presbycusis when she says she has a. ringing in the ears b. a sensation of fullness in the ears c. difficulty understanding the meaning of words d. a decrease in the ability to hear high-pitched sounds

d. a decrease in the ability to hear high-pitched sounds workbook

Increased intraocular pressure may occur as a result of a. edema of the corneal stoma b. dilation of the retinal arterioles c. blockage of the lacrimal canals and ducts d. increased production of aqueous humor by the ciliary process

d. increased production of aqueous humor by the ciliary process MS

A nurse is caring for a client with Meniere's disease. Which of the following is an expected finding? a. presence of a purulent lesion in the external ear canal b. feeling of pressure in the ear c. bulging, red bilateral tympanic membrane d. unilateral hearing loss

d. unilateral hearing loss ATI

conductive hearing loss

occurs when conditions in the outer or middle ear impair the transmission of sound through the air to the inner ear

macular degeneration

often called age-related macular degeneration, central loss of vision that affects the macula of the eye

what is usually the 1st symptom of hearing loss?

tinnitus (ringing in the ears)

POAG vs PACG

-POAG: reduction in outflow of aqueous humor due to blockages in the eye's drainage system (more common) -PACG: reduction in outflow of aqueous humor due to closure of angle between the iris and sclera

symptoms of acute angle-closure glaucoma (5)

-severe pain in or around the eye -nausea, vomiting (related to pain) -colored halos around lights -blurred vision -ocular redness

A client is diagnosed with glaucoma. Which piece of 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. cardiovascular disease NCLEX

3 manifestations that indicate disease of the inner ear (triad of symptoms)

1. vertigo 2. sensorineural hearing loss 3. tinnitus (MS p. 386)

A client with Meniere's disease is experiencing severe vertigo. Which instruction should the nurse give to the client to assist in controlling the vertigo? 1. increase sodium in the diet 2. avoid sudden head movements 3. lie still and watch the television 4. increase fluid intake to 3000 mL a day

2. avoid sudden head movements NCLEX

Which characteristics of glaucoma are associated with only acute primary angle-closure glaucoma (PACG)? (Select all that apply) a. caused by lens blocking papillary opening b. treated with trabeculoplasty or trabeculectomy c. causes loss of central vision with corneal edema d. treated with beta blockers such as betaxolol e. causes sudden, severe eye pain associated with nausea and vomiting f. treated with hyperosmotic IV fluids to lower intraocular pressure

a. caused by lens blocking papillary opening c. causes loss of central vision with corneal edema e. causes sudden, severe eye pain associated with nausea and vomiting f. treated with hyperosmotic IV fluids to lower intraocular pressure workbook

When obtaining a health history from a pt with cataracts, it is most important for the nurse to ask about the pt's use of which drug? a. corticosteroids b. oral hypoglycemic agents c. beta blocking agents d. antihistamines and decongestants

a. corticosteroids workbook

Age-related changes in the auditory system commonly include (select all that apply): a. drier cerumen b. tinnitus in both ears c. auditory nerve degeneration d. atrophy of tympanic membrane e. grater ability to hear high-pitched sounds

a. drier cerumen c. auditory nerve degeneration d. atrophy of tympanic membrane MS

What should be included in the postop teaching of the patient who has undergone cataract surgery (select all that apply) a. eye discomfort is often relieved with mild analgesics b. a decline in visual acuity is common for the first week c. stay on bed rest and limit activity for the first few days d. notify surgeon if an increase in redness or drainage occurs e. nighttime eye shielding and activity restrictions are essential to prevent eyestrain.

a. eye discomfort is often relieved with mild analgesics d. notify surgeon if an increase in redness or drainage occurs MS

Presbyopia occurs in older individuals because a. the eyeball elongates b. the lens becomes inflexible c. the corneal curvature becomes irregular d. light rays are focusing in front of the retina

b. the lens becomes inflexible MS

The nurse sees a 76-year-old woman in the outpatient clinic. She states that she recently started noticing a glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. The nurse suspects that the woman may have: a. Presbyopia. b. Presbycusis c. Cataract(s). d. Depression.

c. Cataract(s). Fundamentals ch 14

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, what nursing action would be a priority? a. Recognizing that eye damage caused by glaucoma can be reversed in the early stages b. Giving anticipatory guidance about the eventual loss of central vision that will occur c. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision d. Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

c. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision MS

When assessing an adult patient's external ear canal and tympanum, what assessment techniques should the nurse use? a. Ask the patient to tip his or her head toward the nurse. b. Identify a pearl gray tympanic membrane as a sign of infection. c. Gently pull the auricle up and backward to straighten the canal. d. Identify a normal light reflex by the appearance of irregular edges.

c. Gently pull the auricle up and backward to straighten the canal. MS

During a health history, a 43-yr-old teacher complains of increasing difficulty reading printed materials for the past year. What change related to aging does the nurse suspect? a. Myopia b. Hyperopia c. Presbyopia d. Astigmatism

c. Presbyopia MS

Meniere's disease symptoms (4)

characterized by: -vertigo -tinnitus -fluctuating/unilateral sensorineural hearing loss -aural fullness

The nurse is teaching a patient with glaucoma about administration of pilocarpine. What statement is important for the nurse to include during the instructions? a. "Prolonged eye irritation is an expected adverse effect of this medication." b. "This medication will help to raise intraocular pressure to a near normal level." c. "This medication needs to be continued for at least 5 years after your initial diagnosis." d. "It is important not to do activities requiring visual acuity immediately after administration."

d. "It is important not to do activities requiring visual acuity immediately after administration." MS