Course Point 12 pathophysiology
A client has been diagnosed with conductive hearing loss. Which issue can cause this type of hearing loss?
Excess middle ear wax
A 60-year-old client's long history of poorly controlled hypertension has culminated in a diagnosis of retinal detachment. What type of retinal detachment is this client most likely to have experienced?
Exudative retinal detachment
A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be:
"Pain threshold is the point at which a stimulus is perceived as painful."
When conditions occur that impair retinal blood flow, such as hyperviscosity of the blood or a sickle cell crisis, what can occur in the eye?
Neovascularization
For which type of hearing loss should the nurse assess in a child who has had recurrent otitis media since birth?
Conductive loss
The nurse is teaching a client about various methods of pain control. Which information will the nurse include when teaching the client about applying heat for pain control?
"Heat promotes more blood flow to the area to improve oxygen supply."
A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate?
"Let's keep a close eye on his condition for a couple of days before starting antibiotics."
The nurse is caring for an adolescent client diagnosed with otitis externa. Which statement will the nurse include when teaching the client?
"Make sure and dry the outside of your ear after swimming."
The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?
"Many people find that maintaining regular eating and sleeping habits is beneficial."
The nurse is teaching a client who has tinnitus about suggested dietary modifications. What information is most important for the nurse to include?
"Try cutting down on foods high in monosodium glutamate."
The nurse is caring for a client diagnosed with migraines and prescribed an oral triptan medication. Which information will the nurse include when teaching about this treatment? Select all that apply.
"You should take the medication early as soon as you feel a migraine coming on." "Triptans increase the response of serotonin receptors interrupting pain signals."
Which client may be experiencing the effects of neuropathic pain?
A man with pain secondary to his poorly controlled diabetes
When pupillary dilation partially compensates for the reduced size of the retinal image by increasing the light entering the pupil, this is a component of which eye adjustment?
Accommodation
A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing:
Acute angle-closure glaucoma
For which older adult client would pain assessment likely be most challenging for the nurse?
An 87-year-old client with vascular dementia and numerous other health problems, such as heart failure
A diabetic client has developed diabetic neuropathy and is prescribed pharmacologic intervention. The medication most likely to be prescribed would be an:
Antiseizure
The nurse is caring for an 18-year-old client with otosclerosis. Which findings does the nurse expect upon assessment? (Select all that apply.)
Conductive hearing loss Family history of the disease
A client who has cut a finger drops the knife in pain. Which component of this pain signal was transmitted by third-order neurons?
Between the thalamus and the cerebral cortex
The nurse is caring for a client with cataracts. Which assessment findings does the nurse anticipate? (Select all that apply.)
Clouding of the lens Decreased visual acuity
The client asks the health care provider, "What is the purpose of applying cold to a sprained ankle?" Which response by the health care provider is best?
Cold provides pain relief and suppresses the release of products from tissue damage.
A client presents to the clinic complaining, "I have something in my eye." When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed:
Conjunctivitis
Which intervention would be considered a nonpharmacologic method of pain control? Select all that apply.
Distraction by knitting Guided imagery Biofeedback
Which principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer?
Dosing and timing should aim for a steady serum level of the prescribed drug.
Which characteristic differentiates open-angle glaucoma from angle-closure glaucoma?
Dysfunction of the aqueous humor drainage system
A parent of a child with otitis media with effusion (OME) asks, "How is this different from typical acute otitis media (AOM)?" Which response by the nurse correctly identifies the main difference?
Excess middle ear fluid
A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?
Limiting the infant's exposure to large group settings
Which statement is true of migraine headaches?
Migraines may have a hormonal etiology in some clients.
Nociceptors are sensory receptors that are activated by which type of stimuli?
Noxious stimuli
To maintain fixation on stable objects during head rotation, the eyes slowly drift in the opposite direction and then jump rapidly back toward the direction of rotation. This process is known by what term?
Nystagmus
The nurse is assessing a client who presents with conjunctivitis. The nurse advocates testing for a viral cause of conjunctivitis based on which assessment findings? Select all that apply.
Only one of the client's eyes is affected. The client reports excessive tearing. Symptoms have persisted despite topical antibiotics.
A 38-year-old client who has begun to develop hearing loss is being evaluated by the nurse practitioner. The client tells the nurse that hearing improves when she is on the telephone and that chewing sounds very loud. What does the nurse practitioner suspect?
Otosclerosis
Which visual deficit is a clinician justified in attributing to the normal aging process?
Presbyopia
With aging, progressive inelasticity and thickening of the lens causes which accommodation disorder?
Presbyopia
The nurse is assessing a client's hearing and wants to determine if the client has hearing loss of certain frequencies. Which audiometry test will the nurse perform?
Pure-tone audiometry
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:
Referred
A client expresses concern about feeling fullness in the ear. Which additional manifestation leads the health care provider to suspect Menière disease?
Rotary vertigo and tinnitus
A client with rheumatoid arthritis has taken high doses of aspirin for several years. Which type of hearing loss is this client at high-risk of developing due to ototoxicity?
Sensorineural hearing loss
Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain?
Somatosensory cortex
A nurse working in an outpatient pediatric clinic notes a large number of ear infections among children. What is the nurse's understanding of this increased rate?
The eustachian tube is narrower in children.
The nurse is caring for several clients experiencing acute pain. The nurse notes that each client has a different perception of the pain that they are experiencing. What is the nurse's understanding of why this is true? (Select all that apply.)
The intensity of the pain required to achieve a response varies among individuals. Pain that exists in other areas of the body changes the perception among individuals. The degree to which the pain is endured over time varies among individuals.
The nurse is caring for an older adult client who reports a recent decline in hearing acuity and suspects "wax buildup." Which action will the nurse take first?
The nurse is caring for an older adult client who reports a recent decline in hearing acuity and suspects "wax buildup." Which action will the nurse take first?
A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?
The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron
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
While playing outside in the snow a young child did not keep gloves on. In the emergency department, the child reported painful fingertips. The nurse knows this painful sensation is a result of which transmission of proprioceptive somatosensory information?
Type C dorsal root ganglion neurons
A client with trigeminal neuralgia usually complains of excruciating pain. Which activities may trigger an acute pain attack? Select all that may apply.
Working in the office that has an air duct located directly overhead Spouse other lightly stroking his or her face Walking outside on a windy day
A new mother brings her infant to the clinic reporting that the child is not sleeping or eating much. Upon assessment, the health care provider notes that the infant's ear canal is reddened with a bulging tympanic membrane. Which other data collected would lead to the diagnosis of acute otitis media (AOM)? Select all that apply.
Yes, he has been pulling at his ear." "He's been very irritable and fussy the past couple of days."
The nurse is caring for a client who reports having a mildly painful, itchy ear canal with no other associated symptoms. For which condition will the nurse assess the client based on the presenting symptoms?
external otitis (acute otitis externa or swimmer's ear)
Which stimulus would be used to elicit the withdrawal reflex when testing response to nociceptive stimuli?
pressure from a sharp object
A client seeks medical care when he wrecks his car because of poor eyesight. At the time of admission, his blood glucose level was 390 mg/dL. The client is diagnosed with diabetes (type 2). The ophthalmologist must perform an urgent intravitreal injection. The nurse explains this to the client by stating the doctor will:
put a needle with syringe into your eyeball and inject some medication to decrease active bleeding.
When lecturing about heart attacks (myocardial infarctions), the instructor will emphasize the client may present with: Select all that apply.
substernal chest pain. neck pain. pain that radiates to left arm
The nurse offers a client recovering from knee surgery a prescribed opioid analgesic. The client states, "I don't find the pain that severe. I think acetaminophen will be fine." How should the nurse respond?
"This is fine as long as your pain tolerance allows you to participate in the prescribed postoperative exercises."
A middle-aged client whose father experienced progressive vision loss from macular degeneration (MD) asks the nurse if there is anything that can reduce the risk of developing MD. How should the nurse respond?
"You can reduce your risk by preventing high blood pressure and maintaining a healthy weight."
The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include:
Medial deviation
Select the tactile receptors that are sensitive to the movement of very light objects over the surface of the skin.
Meissner corpuscles
The nurse is caring for a client with visual impairment who states recent difficulty seeing clearly at night. Which condition does the nurse suspect the client may suffer from?
Vitamin A deficiency
The nurse is teaching a client about the treatment of open-angle glaucoma. The mostappropriate information for the nurse to give the client would be:
administration of topical beta-adrenergic antagonists to lower the pressure.
A client tells the health care provider he has noticed a recent change in his vision: he can bring distant images into focus, but near images become blurred. The client has most likely developed:
hyperopia.
The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as:
involuntary eye movements that preserve eye fixation on stable objects in the visual field.
An older adult client is scheduled for outpatient cataract surgery. While taking a presurgery history, which statement by the client correlates to the manifestations of cataracts, thereby verifying the client has received information about the condition?
"I have blurred vision in both my eyes and my vision is distorted."
An older adult client has been diagnosed with macular degeneration. Which statement by the client best demonstrates an accurate understanding of the new diagnosis?
"I suppose that this may be one of the things that happens when you get older."
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?"
A client tells the health care provider that he developed an acute onset (hours) of vertigo, nausea, and vomiting lasting several days, but he has not had auditory or other neurologic manifestations. Which possible diagnosis is responsible for this client's manifestations?
Acute vestibular neuronitis
Causes of eyelid weakness include neurologic causes. There can be damage to the cranial nerves (CN) that innervate the eyelids, or there can be damage to the central nuclei of the cranial nerves. Where are the central nuclei of cranial nerve III (oculomotor nerve) and CN VII (facial nerve)?
Midbrain and caudal pons
The somatosensory system consists of three types of sensory neurons. The special somatic type of afferent sensory neurons has receptors that sense:
Muscle position
The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.
Sensorineural hearing loss caused by natural aging
Although both vertigo and dizziness can result from peripheral or central vestibular disorders, vertigo is distinctly different because it causes:
an illusion of motion.
The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely the result of:
imbalance between aqueous production and outflow.
The nurse is making a plan of care for a client in the initial stage of otosclerosis. Which assessment finding correlates to the early development of this diagnosis?
inability to hear whispering
The nurse is developing a plan of care for a client diagnosed with fibromyalgia. Which interventions will the nurse include? Select all that apply.
application of heat and cold for pain control referral to a qualified physiotherapist active range of motion exercises twice daily referral to a licensed psychologist
A client has been diagnosed with open-angle glaucoma during a routine eye exam. The client has been prescribed a topical β-adrenergic antagonist. Client teaching about how this drug works should include which of the following statements? β-adrenergic antagonists:
lower intraocular pressure by decreasing aqueous humor production.
The nurse is caring for a client experiencing phantom limb pain after amputation. The nurse applies which theory of pain to best help explain the client's pain?
neuromatrix
The nurse is explaining the role of aqueous humor in the development of glaucoma to a client who has just been diagnosed with the condition. How should the nurse describe the role of aqueous humor in the pathogenesis of glaucoma?
Aqueous humor is continually produced and drained to maintain the appropriate pressure. In glaucoma, the normal drainage is impeded and the increased pressure can damage the optic nerve.
Which characteristic differentiates a migraine with aura from a migraine without aura?
Visual symptoms such as flickering lights precede the headache
An adult client presents with new onset of involuntary oscillations of both eyes. For which possible causes of this finding will the nurse assess the client? Select all that apply.
recent alcohol use evidence of head injury evidence of acute stroke diagnosis of multiple sclerosis
A client suffering from chronic sinusitis arrives at the urgent care center complaining of a sudden onset of dizziness and difficulty walking straight. What diagnosis does the admitting nurse suspects this client has?
Labyrinthitis
