Chapter 21

Which nonverbal aids can the nurse adopt to effectively communicate with a patient with hearing loss?

Refraining from covering the mouth or face with hands

The nurse has completed patient teaching for a patient who had cataract surgery on the left eye. Which statement by the patient indicates a need for further teaching?

"I should notice an improvement in my vision in a few days."

The nurse is discussing glaucoma prevention with a 52-year-old African American patient. Which statement by the patient reflects a correct understanding of glaucoma prevention?

"I will visit my eye doctor every one to two years."

The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching?

"I'll check the labels on my nonprescription drugs."

When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement?

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

Which statement of the student nurse indicates the need for further learning about age-related macular degeneration (AMD)?

"People with dark-colored eyes are more at the risk for AMD."

A patient has lost an eye after an industrial accident. Which action by the nurse is most appropriate during this time?

Assist the patient with the same grieving process that is associated with other losses

A patient has a prescription to receive timolol two drops to both eyes every 12 hours. The nurse would withhold the dose and question the prescription if the patient had which condition?

Asthma

The nurse is reviewing refractive errors of the eye. Which statement does the nurse identify as being true?

Astigmatism is caused by an irregular corneal curvature

The patient is given an oral dose of glycerol followed by serial audiograms over three hours. Which symptom did the nurse assess in the patient?

Aural fullness and fluctuating sensorineural hearing loss

A patient is being provided with discharge instructions after undergoing cataract extraction and intraocular lens implantation. What should the nurse include in the teaching?

Avoid straining during bowel movements

A patient is diagnosed with otitis media with effusion. The nurse expects that the patient will most likely exhibit what symptoms?

Feeling of fullness of the ear, a plugged feeling or popping, and decreased hearing

A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient?

Glaucoma results in increased intraocular pressure

The nurse provides education to a patient with Ménière's disease. What long-term effect of the disease should the nurse include in the teaching?

Hearing loss

The nurse is reviewing the types of hearing loss. The patient who has a sensorineural hearing loss should display which of these problems?

Hears sound but does not understand speech

A patient has undergone kidney transplantation surgery and takes immunosuppressant drugs. The patient comes in contact with a person who has chickenpox. The nurse recognizes that the patient is susceptible to which viral ophthalmic infection?

Herpes zoster ophthalmicus

The nurse would refrain from administering a prescribed dose of pilocarpine two drops to both eyes if it was documented that the patient has which comorbidity?

Secondary glaucoma

Which symptom occurs initially with retinal detachment?

Seeing flashes of light and floaters

A patient reports an inability to understand speech in spite of being able to hear sounds properly. The patient has a history of Paget's disease of the bone and is being treated with antibiotics. The nurse recognizes that the patient is most likely experiencing which type of hearing loss?

Sensorineural hearing loss

While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team?

Stabilize the foreign object within the injury site.

Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention?

Strict adherence to prescribed eye drop medication schedule

A patient is prescribed bimatoprost. What nursing intervention would ensure safe administration of the drug?

Suggest the patient remove contact lenses 15 minutes before instilling the drops.

A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct?

"Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema."

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate?

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

Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma?

"You may have a temporary headache after instilling these drops."

Which instruction should the nurse give the patient who is prescribed verteporfin for age-related macular degeneration?

"You should avoid direct exposure to sunlight while on treatment."

The nurse, who is reinforcing medication teaching before administering the scheduled dose of pilocarpine, would include which statement?

"You will need someone to drive you home."

A nurse provides education to a group of people about eye health care. Which statements by group indicate that the teaching has been understood? Select all that apply.

-"Wash hands regularly to prevent the spread of diseases." -"Wear sunglasses and ensure proper nutrition to prevent cataract development." -"Wear eye protection during hazardous work activities to reduce the risk of eye injuries." -"Regular eye checkups help in early detection of disease and prevent further loss of vision."

What instructions would the nurse teach a patient and caregiver regarding the prevention of external otitis? Select all that apply.

-Do not dry the ears with a cotton-tipped applicator. -Use earplugs if the patient is prone to swimmer's ear -Do not put anything in the ear canal unless instructed by the healthcare provider

A patient admitted to the hospital has been taking pilocarpine eye drops at home. What is the desired effect of this medication? Select all that apply.

-Facilitates aqueous humor outflow -Lessens the amount of pupillary dilation

A patient, discharged after eye surgery, is told to avoid activities that will increase intraocular pressure. Which activities should the patient avoid? Select all that apply.

-Lifting -Coughing -Bending over

What instruction should the nurse include when teaching a caregiver ways to communicate better with a patient who has hearing loss? Select all that apply.

-Maintain eye contact -Speak normally and slowly -Move closer to the better ear -Write out names or difficult words.

A nurse is explaining measures to prevent external otitis to a group of patients. Which interventions should the nurse include in the teaching? Select all that apply.

-Report any itching in the ear -Use earplugs when swimming -Keep the ears as dry as possible -Avoid putting anything in the ear canal

A patient has undergone cataract surgery. What nursing interventions help to prevent postoperative complications? Select all that apply.

-Teach the patient to instill medicine following aseptic techniques -Teach the patient about proper hygiene and eye care techniques -Advise the patient to avoid actions that can cause increased intraocular pressure

A patient presents with a sty in the left eye. Which nursing actions are appropriate to manage the patient's condition? Select all that apply.

-Teach the patient to perform lid scrubs daily -Administer appropriate antibiotic ointments or drops, as prescribed -Instruct the patient to apply warm, moist compresses at least four times a day.

What instructions should the nurse include when teaching a patient how to administer ear drops? Select all that apply.

-The tip of the dropper should not touch the ear. -The ear should be positioned so that the drops can run into the canal. -The position of the ear should be maintained for two minutes to let the drops spread

The nurse is interviewing an elderly patient who has hearing loss. Which strategies would best assist the nurse in communicating with this patient? Select all that apply.

-Use simple sentences -Speak normally and slowly -Avoid distracting environments

The patient has been diagnosed with benign paroxysmal positional vertigo. The nurse knows that which anatomic area of the ear contributes to this disturbance?

1

Which nursing intervention is the highest priority for a patient who has undergone retinal surgery?

Positioning and activity as preferred by surgeon

A patient has received a prescription for ketoconazole eyedrops. The nurse recognizes that the probable reason for the medication is that the patient is experiencing what?

Acanthamoeba keratitis

The nurse is admitting a patient with glaucoma who states that he or she is allergic to all sulfa drugs. Which medication order should the nurse question and immediately report to the primary care provider?

Acetazolamide

When using the otoscope, the nurse is unable to see the landmarks or light reflex of the tympanic membrane. The tympanic membrane is bulging and red. What does the nurse think is most likely occurring in the patient's ear?

Acute otitis media

Which treatment is administered to fight infection in a patient with external otitis?

Antibiotics

The nurse assesses a patient with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin. What action does the nurse anticipate providing to assist with the relief of discomfort due to this condition?

Application of a warm, moist compress four times a day

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing intervention should be the nurse's priority?

Assess impact of vision on normal functioning

The nurse cares for a patient with a detached retina. The patient says, "Before my eye was patched, I saw a lot of spots." The nurse explains that the symptoms are caused by what?

Blood cells released into the eye by the detached retina

While examining the eye of a patient, the nurse finds a cone-shaped anterior cornea. Which other finding is associated with this condition?

Blurred vision

In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder?

Pressure damage to the optic nerve may occur because of clogged drainage channels.

The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom?

Carbachol

Before administrating timolol eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine?

Chronic obstructive pulmonary disease (COPD)

Which part of the eye is inflamed in keratitis?

Cornea

The nurse is preparing a patient for penetrating keratoplasty. What disorder does the nurse determine the patient is being treated for?

Corneal scars

A patient is having a surgical procedure that involves using extreme cold to create an inflammatory response to produce a sealing scar. What procedure will the nurse educate the patient regarding?

Cryopexy

Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos?

Exposure keratitis

The nurse is assessing a patient for esotropia. What sign observed by the nurse is clinically significant related to this disorder?

Eye deviating in

A nurse should instruct a patient who had cataract surgery to contact the surgeon if which condition develops?

Eye pain

A patient experiences an attack of Ménière's disease. Which intervention is most important for the nurse to include in the patient's plan of care?

Decreased environmental stimuli

While evaluating a patient the nurse suspects primary open-angle glaucoma if which classic symptom is present?

Decreased peripheral vision

A patient admitted for a total knee replacement has a history of primary open-angle glaucoma. The nurse expects to see which finding recorded in the history and physical examination report?

Denial of pain or pressure

Which instruction is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis?

Discard all opened or used lens care products

A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms?

Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching?

Do not bend, stoop, cough, or lift.

A patient sustained an eye injury, and the nurse assesses blood in the anterior chamber as well as redness of the sclera. What is a priority nursing action for this patient?

Elevating the head of bed to 45 degrees

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, on what should the nurse focus?

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

A 68-year-old patient has undergone a total hip replacement and has glaucoma. The nurse forms a nursing diagnosis of disturbed sensory perception related to increased intraocular pressure. The plan of care should focus on which main element?

Encouraging medication compliance to reduce the risk of vision loss

A patient reports ocular pain, photophobia, decreased visual acuity, headaches, corneal edema, and conjunctiva that is reddened and swollen. The nurse recognizes that the patient is most likely experiencing which type of inflammation?

Endophthalmitis

Which condition involves inflammation of the vitreous cavity?

Endophthalmitis

A patient is diagnosed with strabismus. The nurse expects the patient to exhibit which symptoms?

Inability to focus two eyes simultaneously on the same object

A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient?

Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

What behavior does the nurse assessing a patient with hearing loss expect to encounter?

Irritability with others not speaking up

A patient informs the nurse that allergy symptoms are occurring in the eyes. What symptoms should the nurse ask the patient about when assessing for allergic conjunctivitis?

Itching

An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect?

Keratoconjunctivitis sicca

While assessing a patient with systemic lupus erythematosus (SLE), the nurse observes the patient rubbing the eyes frequently and decreased tear production. What condition should the nurse educate the patient regarding?

Keratoconjunctivitis sicca

A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. On which treatment option does the nurse educate the patient?

Laser photocoagulation

When performing an assessment for a patient with glaucoma, the nurse observes brown iris pigmentation. Which antiglaucoma drug does the nurse determine the patient is taking?

Latanoprost

A patient reports, "While I was walking, I got something in my eye." What nursing intervention is most appropriate for a patient with a suspected foreign object in the eye?

Loosely covering the eye with a sterile patch and referring the patient to emergency care

In presbyopia the lens of the eye loses flexibility and is unable to accommodate close vision. The nurse recognizes that this condition generally occurs in which group?

Men and women older than 40

Which condition is caused by a refractive error in the eye?

Myopia

On a home visit to a patient who underwent cataract surgery, the nurse finds that the patient has intense pain in the operated eye. What should be the immediate nursing action?

Notify the surgeon

Which disorder can malignant external otitis cause in an older patient with diabetes mellitus?

Osteomyelitis

A nurse is comparing otosclerosis and otitis media with effusion. Which statement is correct regarding these two diseases?

Otosclerosis is treated by oral administration of sodium fluoride, with vitamin D and calcium carbonate, whereas otitis media with effusion does not require antibiotic therapy.

The nurse is assessing four patients with visual problems. Which patient does the nurse determine is exhibiting signs of retinal detachment?

Patient A

The nurse is assessing four patients with different refractive errors. Which patient will the nurse suspect to have hyperopia?

Patient B

A patient has severe myopia. Which type of correction is the patient planning to have if the patient tells the nurse, "I can't wait to be able to see after they implant a contact lens over my lens"?

Phakic intraocular lenses (phakic IOLs)

Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells?

Photodynamic therapy

A patient informs the nurse that he or she is using a homemade saline solution to store contact lenses but is now having irritation and soreness. The nurse assesses inflammation of the cornea. On what medication does the nurse anticipate educating the patient?

Polyhexamethylene biguanide

A nurse reviews the medical record for a patient with acute glaucoma for which acetazolamide has been prescribed. The patient has a history of high-dose aspirin therapy. Considering the concomitant use of the medications, the nurse expects what change in medication prescriptions?

The patient cannot take both medications due to gastric disturbances.

A patient with glaucoma is taking timolol drops. What should the nurse include while reinforcing principles of medication administration with the patient?

The patient may experience blurred vision after administration of the drops lasting several minutes.

The patient needs, but does not want, a corneal transplant because of difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this?

There are newer procedures in which only the damaged cornea's epithelial layer is replaced, and these procedures have a faster recovery.

Which statement is true regarding a patient with conductive hearing loss?

This patient hears better in a noisy environment

While preparing a patient with a visual problem for surgical therapy, the primary health care provider orders the nurse to administer cycloplegics to the patient. What rationale does the nurse identify for this action?

To block the effect of acetylcholine on ciliary body muscles

A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse?

To minimize photophobia

A patient has sustained an injury to the cornea. The nurse assists the primary health care provider in rinsing the eye with saline solution and then instilling a dye into the conjunctiva of the injured eye. What is the purpose of the dye?

To stain the injured tissue so it can more easily be identified

The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering?

Topical corticosteroids

A patient with septic shock is receiving multiple medications. Which intravenous (IV) medication is most likely to cause a hearing loss?

Vancomycin

A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient?

Verbalize feelings related to visual impairment

What is a possible effect of cold otic drops administered in the ear canal?

Vertigo

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. Which surgical procedure will be used to relieve traction on the retina and will the nurse educate the patient?

Vitrectomy

A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention?

Walking behind the patient holding the patient's back