Chapter 19: Diseases Affecting Vision and Hearing

Persons with normal age-related sensory changes are likely to have the most difficulty distinguishing which of the following? a. Spoken pairs of phrases such as "she's praised" and "fees raised" b. Orange towel hanging on a beige wall c. "Go" and "to" in lowercase letters in fine print d. Spoken word pairs like "cupful" and "capful"

ANS: A A person with presbycusis has trouble hearing the higher frequencies, where most of the differences between consonant sounds occur. The contrast between a vivid color such as orange and a pale color such as beige can help an older person distinguish objects. The details of the letters may be poorly focused, but their overall shape, relative to the line around them, helps distinguish them. Age-related hearing impairments affect the hearing of consonants more than vowels. A person would have more trouble distinguishing "cupful" and "couple."

A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse bases the response on the knowledge that the increase in intraocular pressure is a result of a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower eyelid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

When preparing a patient teaching session on diabetic retinopathy, the nurse should include which interventions when discussing treatments for slowing the progression of the disease? (Select all that apply.) a. Glucose control b. Blood pressure control c. Laser therapy d. Cornea transplant

ANS: A, B, C Better control of glucose, blood pressure, and cholesterol can assist in halting the progression of diabetic retinopathy. Laser therapy is also a treatment. A cornea transplant is not an option.

Which of the following interventions should the nurse use when communicating with a hearing impaired older patient? a. Stand beside the patient's chair when speaking. b. Always clearly identify yourself and others with you. c. Exaggerate your voice, depending on the cause of the hearing loss. d. Select colors for paint, furniture, and pictures with rich intensity.

ANS: B Always speak promptly, and clearly identify yourself and others who are with you. State when you are leaving to ensure that the person is aware of your departure. Get down to the person's level and face him or her when speaking. Speak normally but not from a distance; do not raise or lower your voice and continue to use gestures if doing so is natural to your communication. Selecting colors for paint, furniture, and pictures with rich intensity is for the visually impaired, not those with a hearing impairment.

An older man who has tinnitus complains to the nurse that it is very annoying. Which should the nurse implement to alleviate the stress he is experiencing from tinnitus? a. Irrigate the bilateral eustachian tubes. b. Assess for modifiable risk factors. c. Propose a hearing aid and a masker. d. Use white noise to override the tinnitus.

ANS: B The nurse assesses the patient for risk factors potentially contributing to tinnitus that can be altered such as smoking cigarettes, consuming caffeine, drinking alcohol, experiencing fatigue, and taking medications that carry a high risk of causing tinnitus. Removing these potential offenders can help give the patient a sense of control, as well as provide potential relief from tinnitus. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus. Although a hearing aid and a masker have the potential to alleviate tinnitus, introducing them can also serve as a potential source of additional stress, depending on the financial and functional status of the individual. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress.

Which population groups are most at risk for developing macular degeneration? (Select all that apply.) a. African American b. Asian American c. Caucasian d. Hispanic

ANS: B, C Individuals who are white or Asian American are most at risk for developing macular degeneration than are African Americans or Hispanics.

Which of the following is used to treat the most common cause of impairment to an older person's hearing? a. Hearing aids b. Cochlear implants c. Ear canal irrigation d. Sign language

ANS: C Irrigation is used to dissolve and remove impacted cerumen, the most common cause of impaired hearing in older adults. Hearing aids are useful for sensorineural hearing loss, but the most common cause impairing the hearing of older persons is cerumen impaction. Cochlear implants are useful for profound sensorineural deafness, but the most common cause impairing the hearing of older persons is cerumen impaction. Sign language has been used primarily by those who become deaf in childhood or at birth, but it is not considered a treatment.

The nurse plans the care of an older female resident of a nursing home who has experienced a sudden deterioration in visual acuity. Which intervention should the nurse complete first? a. Prevent behavioral and social decline. b. Tell her to hold onto the rails during ambulation. c. Examine her mood and functional status. d. Use problem solving involving the resident.

ANS: C The most important intervention for the nurse to complete first is to assess the impact of the visual impairment on the resident's quality of life, mood, and functional ability. The resulting assessment data will provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Preventing decline can be a goal in the overall plan of care for this resident, but that cannot be determined until the assessment is complete. Telling her to hold onto rails during ambulation is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed, based on the assessment. Problem solving takes place after a complete assessment.

An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid. b. Raise her voice in when speaking to the resident. c. Examine the resident's ears for cerumen impaction. d. Teach the resident to read lips.

ANS: C When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing loss. Raising one's voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

The nurse recognized which of the following as symptoms of wet age-related macular degeneration (AMD)? (Select all that apply.) a. Rarely causes severe visual impairment b. Yellow deposits under the retina c. Decrease in central vision d. Visual distortion

ANS: C, D Patients with wet AMD experience a decrease in central vision and visual distortion. Wet AMD leads to blindness. With distortion, edges or lines become wavy. Dry AMD rarely causes severe visual impairment, and yellow deposits under the retina are a classic sign.

Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina? a. Glaucoma b. Presbyopia c. Cataract d. Macular degeneration

ANS: D Macular degeneration is a disease characterized by damage to the central part of the retina that leaves the outer edges of the visual field intact. Presbyopia, a gradual decline in the flexibility of the lens, makes close-up focusing more difficult and is a common age-related change but not a disease. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness in those 65 years of age and older. A cataract is a disease marked by clouding and blurring of the lens.

An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the patient's complaint? a. Vitamin B deficiency b. Use of a humidifier at home c. History of diabetes mellitus d. Prescription antihistamine use

ANS: D Medications can cause dry eye, especially antihistamines, diuretic agents, beta blockers, and some sleeping pills. Vitamin A deficiency is a risk factor, not vitamin B deficiency. The use of a humidifier should help with dry eyes, not cause it. Diabetes mellitus is an endocrine disorder, and dry eyes are an exocrine disorder.

A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following? a. Sensorineural hearing loss b. Presbycusis c. Tinnitus d. Unilateral conductive hearing loss

ANS: D Weber's test, in which a vibrating tuning fork is placed on the center of the forehead, detects the differences in hearing between one ear and the other caused by poor sound conduction. During testing, the patient is asked to describe the sensation felt when the tuning fork is activated and then placed on the forehead. If the patient's hearing by conduction is intact, then he or she will feel vibrations conducted through the bones of the skull from the tuning fork. Weber's test with the tuning fork is used to detect conductive hearing loss. Presbycusis affects both ears and has a sensorineural origin. The tuning fork test is used to detect conductive hearing loss in one ear. Tinnitus is a hearing sensation not caused by an actual sound. The tuning fork test is used to detect hearing loss caused by poor sound conduction.

An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include (Select all that apply.) a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

ANS: D, E Age-related hearing impairment (presbycusis) is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss. The other options are associated with conductive hearing loss.