Eyes & Ears Practice Questions

When performing a neurologic check on a client with a head injury, the nurse identifies a diminished corneal reflex in the left eye. What does appropriate nursing care for a client with an absent corneal reflex include? A. Irrigating the eye routinely B. Instilling artificial tears frequently C. Checking the corneal reflex every hour D. Taping the eyelids open during the day

B Rationale Instilling artificial tears frequently lubricates the eye and prevents drying of the cornea. Irrigating the eye is inappropriate; eye irrigations are used to flush foreign matter from the eye. Checking the corneal reflex every hour can lead to corneal abrasion. Taping the eyelid open can cause corneal ulceration or injury.

Which ophthalmic conditions can cause a client to have photophobia? Select all that apply. A. Nystagmus B. Chalazion C. Trachoma D. Hordeolum E. Keratoconjunctivitis sicca

B, C, E Rationale A chalazion is an inflammation of a sebaceous gland in the eyelid. The client may experience fatigue, light sensitivity, and excessive tears. Trachoma is chronic conjunctivitis caused by Chlamydia trachomatis. It scars the conjunctiva and is a common cause of preventable blindness. It is manifested with tears, photophobia, and eyelid edema. Keratoconjunctivitis sicca, or dry eye syndrome, results from changes in tear production, tear composition, or tear distribution. The client has a foreign body sensation in the eye, burning and itching eyes, and photophobia. Nystagmus is an involuntary and rapid twitching of the eyeball. It may also be caused by abnormal nerve function or problems with the inner ear but will not cause photophobia. A hordeolum, or stye, is an infection of the eyelid sweat glands or the eyelid sebaceous glands. A red, swollen, painful area occurs on the skin surface side of the eyelid.

A client with a detached retina is scheduled for surgery to reattach the retina. What should the nurse address in the preoperative teaching plan about the procedure used with this surgery? A. Radiation B. Burr holes C. Dermabrasion D. Laser technique

D Rationale A laser beam causes a thermal inflammatory response, which results in a chorioretinal scar that holds the retina in place. Radiation is not used, because it destroys retinal tissue. Burr holes are used in brain, not retinal, surgery. Dermabrasion is used for acne vulgaris and other disfiguring skin conditions, not retinal surgery.

A nurse performs a Rinne test during physical assessment of a client. The client indicates that the sound is louder when the vibrating tuning fork is placed against the mastoid bone than when held closely to the ear. What conclusion should the nurse make about these results? A. This represents an expected finding. B. The client may have a sensorineural deficit. C. This is evidence of a conductive hearing loss. D. The client has an inflammation of the mastoid.

C Rationale Conductive hearing loss[1][2] involves impaired transmission of sound waves to the inner ear so that sound transmitted directly through bone is perceived louder and longer than through air conduction. Clients with normal hearing or sensorineural deficit perceive air conduction of sound waves louder and longer than bone conduction. The Rinne test is not related to inflammation of the mastoid.

Which hearing disorder is most common in women? A. Tinnitus B. Hyperacusis C. Otosclerosis D. Meniere's disease

C Rationale Gender of the client may also influence the conditions associated with hearing loss. Women are at a higher risk of otosclerosis compared to men. Both men and women are equally at risk of some hearing loss due to conditions such as tinnitus and hyperacusis. Meniere's disease is common in men compared to women

Which refractive error condition is due to a decrease in elasticity of the client's lens? A. Myopia B. Hyperopia C. Presbyopia D. Astigmatism

C Rationale Presbyopia is an age-related problem in which the lens loses its elasticity and is less able to change its shape to focus the eye for close work. As a result, images fall behind the retina. Myopia, or nearsightedness, is a condition in which the eye over-refracts the light and the bent images fall in front of, not on, the retina. Hyperopia, also called hypermetropia, or farsightedness, is a condition in which refraction is too weak, causing images to be focused behind the retina. Astigmatism occurs when the curve of the cornea is uneven. Because light rays are not refracted equally in all directions, the image does not focus on the retina.

A client with glaucoma asks a nurse about future treatment and precautions. Which information should the nurse's explanation include? A. Avoidance of cholinergics B. Surgical replacement of lens C. Continuation of therapy for life D. Prevention of high blood pressure

C Rationale Therapy must be continued for life to prevent damage to the optic nerve from increased intraocular pressure. Cholinergics are used in the treatment of glaucoma; anticholinergics are contraindicated. The surgical replacement of lens is the treatment for cataracts. There is an increase in intraocular pressure with glaucoma; the blood pressure may be unaffected.

A nurse is assessing a client with a diagnosis of primary open-angle glaucoma. Which ocular symptom should the nurse expect the client to report? A. Attacks of acute pain B. Constant blurred vision C. Decreased peripheral vision D. Complete loss of central vision

C Rationale With glaucoma[1][2], loss of peripheral vision occurs long before central vision is affected. The client also may complain of seeing halos around lights. Primary closed-angle glaucoma causes pain. Blurred vision may be because of a refractive error. Complete loss of central vision occurs with damage to the central retina.

A client's relative asks the nurse what a cataract is. Which explanation should the nurse provide? A. An opacity of the lens B. A thin film over the cornea C. A crystallization of the pupil E. An increase in the density of the conjunctiva

A Rationale A cataract[1][2] is a clouding (opacity) of the crystalline lens or its capsule. A thin film over the cornea, a crystallization of the pupil, and an increase in the density of the conjunctiva are not the pathophysiology related to cataracts.

After a left cataract extraction, a client reports severe discomfort in the operated eye. The nurse concludes that this problem may be caused by which condition? A. Hemorrhage into the eye B. Expected postoperative discomfort C. Isolation related to sensory deprivation D. Pressure on the eye from the protective shield

A Rationale Acute postoperative pain is a sign of increased intraocular pressure and is caused by hemorrhaging; this is a medical emergency. Postoperative discomfort usually is minimal. Isolation and sensory deprivation will not occur because only one eye is patched. The shield may be slightly uncomfortable but will not cause severe discomfort.

A client asks for information about glaucoma. How should the nurse explain glaucoma to the client? A. An increase in the pressure within the eyeball B. An opacity of the crystalline lens or its capsule C. A curvature of the cornea that becomes unequal D. A separation of the neural retina from the pigmented retina

A Rationale An increase in intraocular pressure (IOP) results from a resistance of aqueous humor outflow. Open-angle glaucoma, the most common type of glaucoma, results from increased resistance to aqueous humor outflow. An opacity of the crystalline lens or its capsule is the description of a cataract. A curvature of the cornea that becomes unequal is the description of astigmatism. A separation of the neural retina from the pigmented retina is the description of a detached retina.

The nurse is providing preoperative teaching for a client who is to have cataract surgery. Which is appropriate for the nurse to include concerning what the client should do after surgery? Select all that apply . A. Do not blow your nose. B. Remain flat for three hours. C. Eat a soft diet for two days. D. Breathe and cough deeply. E. Avoid bending from the waist.

A, E Rationale The client needs to avoid activities that cause a sudden rise in intraocular pressure, such as bending from the waist, blowing the nose, sneezing, and coughing. It is not necessary to remain flat in bed for three hours after surgery, and the diet is not restricted.

A client has sensorineural hearing loss. Which finding in the client's history will alert the nurse to the most likely cause of the sensorineural hearing loss? A. Prolonged exposure to noise B. Buildup of cerumen in the ear C. Blockage of the ear from a foreign body D. Perforation of the tympanic membrane

A Rationale Sensorineural hearing loss occurs due to damage to the auditory nerve in the inner ear. Prolonged exposure to noise can cause damage to the cochlea. Cerumen in the ear can cause obstruction in the ear and lead to a conductive hearing loss. Foreign bodies can cause infection and inflammation in the ear, thereby leading to a conductive hearing loss. Perforation of the tympanic membrane leads to an increased risk of ear infections, which can cause conductive hearing loss.

A nurse is assessing a client with a diagnosis of dry age-related macular degeneration. Which ocular symptom should the nurse expect the client to report? A. Loss of central vision B. Attacks of acute pain C. Constant blurred vision D. Decreased peripheral vision

A Rationale The main characteristic of dry age-related macular degeneration is loss of central vision, which is gradual. Primary closed-angle glaucoma causes pain. Blurred vision may be caused by a refractive error. Loss of peripheral vision does not occur with macular degeneration; peripheral vision loss can occur with glaucoma.

The nurse is assessing an older adult client with suspected hearing loss. Which observations made by the nurse in the client indicates a decrease in hearing acuity? Select all that apply. A. Frequent usage of words such as "what" B. Postural changes while listening to the speaker C. Bending towards the other person while talking D. Mismatch in the questions asked and the responses given E. Startled expression when there is any unexpected sound in the environment

A, B, C, D Rationale Hearing assessment begins while observing the client listening to and answering the questions asked by the nurse. Indicators of hearing difficulty in the client frequently include asking the speaker to repeat statements or frequently saying "What?" or "Huh?" Changes in the client's posture, such as leaning forward when listening to the speaker or tilting the head to one side, can provide information about hearing acuity. The nurse should also assess whether the client's responses match the questions asked; mismatch in the client's responses may indicate a decrease in hearing acuity. Startling to an unexpected sound in the environment determines no loss in hearing acuity.

While assessing a client for hearing acuity, which questions asked by the nurse helps in assessing the personal history of the client? Select all that apply. A. "Are you diabetic?" B. "Do you work in a noisy environment?" C. "Do you have a history of ear infections?" D. "Do you have a history of diseases due to vitamin C deficiency?" E. "Do you have a habit of listening to loud music?"

A, B, C, E Rationale Personal history includes past or current manifestations of changes in hearing acuity. A history of health problems, such as heart disease, hypertension, or diabetes, may decrease the blood supply to the ears and thereby decrease hearing acuity. Exposure to loud noise causes hearing loss. Past ear infections may lead to a decrease in hearing acuity. Exposure to loud music often may cause loss of hearing acuity. Deficiency of vitamin B 12 and folic acid may cause hearing loss, but vitamin C deficiency will not.

What clinical indicators should the nurse expect when interviewing and assessing a client with Meniere disease? Select all that apply. A. Nausea B. Dizziness C. Decreased pulse rate D. Increased temperature E. Jerky lateral eye movements

A, B, E Rationale Nausea is related to vertigo, which is associated with this disorder. The sensation of spinning (vertigo) occurs with inflammation of the inner ear. Jerky lateral eye movement (nystagmus), particularly toward the involved ear, occurs with Meniere disease. The heart rate does not decrease with this disorder. Body temperature is not influenced by this disorder.

The nurse is teaching a client about caring for a hearing aid. Which statements made by the client indicates the need for further learning? Select all that apply. A. "I should always keep my hearing aid on." B. "I can adjust the volume of my hearing aid." C. "I should check and replace the battery frequently." D. "I can use hair sprays and hair oil while wearing a hearing aid." E. "I can clean the ear mold with a soap and water with limited wetting."

A, D Rationale A hearing aid is a small electronic amplifier which assists clients with conductive hearing loss. The hearing aid should be turned off when not in use. Hair sprays and hair oils can cause damage when they come in contact with the hearing aid. The volume of the hearing aid can be adjusted to prevent feedback squeaking. Batteries should be checked and replaced frequently. The ear mold of the hearing aid can be cleaned with soap and water; excessive wetting should be avoided.

The nurse frequently provides care for clients with hearing aids. Which condition does the nurse recall responds best to hearing aids? A. Destruction of the auditory nerve B. Diminished sensitivity of the cochlea C. Perforation of the tympanic membrane D. Immobilization of the auditory ossicles

B Rationale Because hearing aids use the person's own middle ear, they increase hearing acuity in cases of diminished sensitivity of the cochlea; the amplified signal from the hearing aid gives the cochlea greater stimulation and promotes hearing. Destruction of the auditory nerve results in deafness because impulses cannot be transmitted to the brain's auditory center. Perforation of the tympanic membrane prevents ossicular conduction, which involves transmission of resonant vibrations from the tympanic membrane to the ossicles to the cochlea. Hearing aids will not correct this type of hearing loss; surgery is preferred. Immobilization of the ossicles prevents conduction of resonant vibrations from the tympanic membrane to the cochlea. Hearing aids may help but will not correct this problem; surgery is preferred.

The nurse is assessing the clinical data of four clients. Which client is characterized with mixed conductive-sensorineural type of hearing loss? A. Inflammation in the tympanic membrane B. Retraction in the tympanic membrane and damaged cochlear hair C. Damage to the vestibulocochlear nerve D. Fused bony ossicles

B Rationale Client B is diagnosed with a retraction in the tympanic membrane, causing obstruction to sound wave transmission. Damaged cochlear hair results in decreased sensory perception. Therefore, this client is characterized by a mixed conductive-sensorineural type of hearing loss. Client A is diagnosed with inflammation in the tympanic membrane resulting in retraction or bulging of the tympanic membrane, leading to obstruction of sound wave transmission thereby causing conductive hearing loss. The type of hearing loss diagnosed in client C is characterized as sensorineural hearing loss, as there is damage to the vestibulocochlear cranial nerve. Client D is diagnosed with fused bony ossicles, which obstructs sound wave transmission thereby causing conductive hearing loss.

A client with Meniere disease is advised to eat a sodium-restricted diet to reduce endolymphatic fluid. Which food selection provides evidence that the nurse's teaching was effective? A. Cake B. Macaroni C. Baked clams D. Grilled cheese

B Rationale Macaroni, boiled in unsalted water, has the least sodium of the food choices offered. Cake has a high sodium content, which promotes fluid retention and increases endolymphatic fluid in the cochlea of a client with Meniere disease. Baked clams have a high sodium content, which promotes fluid retention and increases endolymphatic fluid in the cochlea of a client with Meniere disease. Grilled cheese has a high sodium content, which promotes fluid retention and increases endolymphatic fluid in the cochlea of a client with Meniere disease.

After performing an otoscopic examination on a client who reports a decrease in hearing acuity, the primary healthcare provider diagnoses the condition as otitis media. Which assessment finding supports the diagnosis? A. Nodules on the pinna B. Redness of the eardrum C. Lesions in the external canal D. Excessive soft cerumen in the external canal

B Rationale Many conditions are associated with a decrease in hearing acuity. One such condition is otitis media. This condition is diagnosed by redness of the eardrum observed during the otoscopic examination. Nodules on the pinna may be an indication of rheumatoid arthritis, chronic gout, or basal or squamous cell carcinoma. Lesions in the external canal may cause a decrease in hearing acuity but not the manifestation of otitis media. Excessive soft cerumen in the external canal impacts the hearing acuity but not the manifestation of otitis media.

A client who just has been diagnosed with primary open-angle glaucoma (POAG) refuses therapy. The nurse reinforces that it is important for the client to seek treatment. Which goal is the nurse trying to achieve? A. Prevent cataracts B. Prevent blindness C. Prevent retinal detachment D. Prevent blurred distance vision

B Rationale POAG progresses gradually without symptoms; if untreated, blindness occurs. Peripheral vision slowly disappears until tunnel vision occurs in which there is only a small center field. Without treatment, eventually all vision is lost. POAG is not related to the development of cataracts, retinal detachment, or blurred distance vision.

A nurse is caring for a client with glaucoma. Which rationale associated with the need for treatment of this condition should the nurse include in a teaching program? A. Total blindness is inevitable. B. Lost vision cannot be restored. C. Use of both eyes usually is restricted. D. Surgery will help the problem only temporarily.

B Rationale Retinal damage caused by the increased intraocular pressure of glaucoma is progressive and permanent if the disease is not controlled; lost vision cannot be restored. Early treatment may prevent blindness. One eye may be affected, and there is no restriction on the use of either eye. Surgery can open up drainage and permanently reduce pressure.

A man walks into the emergency room (ER) with sunglasses on and tells the nurse that he fell off a ladder and hit his head and was unconscious for a few minutes. What is the most appropriate next question the nurse should ask the client? A. "Did you pass out?" B. "Can you take off your sunglasses?" C. "Are you injured anywhere else?" D. "How many feet (meters) did you fall?"

B Rationale The nurse cannot quickly assess the client for raccoon eyes[1][2] unless the sunglasses are removed. Raccoon eyes is periorbital ecchymosis around the eyes. If bilateral, it is highly suggestive of basilar skull fracture. It is caused by rupture of the meninges causing the venous sinuses to bleed into the arachnoid villi and cranial sinuses, resulting in pooling of blood around the eyes. It most often is associated with fractures of the anterior cranial fossa and requires immediate attention. It is also important to assess for any loss of consciousness, other injuries, and the height of the fall. However, visually assessing the client comes first.

Which condition is associated with unevenly curved surfaces of the client's cornea? A. Myopia B. Hyperopia C. Emmetropia D. Astigmatism

D Rationale Astigmatism is a refractive error caused by unevenly curved surfaces on or in the eye, especially of the cornea. These uneven surfaces distort vision. Myopia (nearsightedness) occurs when the eye overbends the light and images converge in front of the retina. Hyperopia (farsightedness) occurs when the eye does not refract light enough. As a result, images actually converge behind the retina. Emmetropia is the perfect refraction of the eye, in which light rays from a distant source are focused into a sharp image on the retina.

A nurse is teaching a client with a diagnosis of open-angle glaucoma. The nurse explains that the chief aim of treatment is to meet which goal? A. Rest the eye. B. Dilate the pupil. C. Prevent secondary infections. D. Control the intraocular pressure.

D Rationale Individuals with glaucoma have increased intraocular pressure that must be returned to the expected range, or blindness will result. Resting has no effect on this condition because it will not decrease the pressure. Dilation of the pupils may increase the pressure further by obstructing flow; increased pressure reduces the visual field and leads to blindness. Glaucoma does not lead to secondary infections.

Which clinical indicator is the nurse most likely to identify when exploring the history of a client with open-angle glaucoma? A. Constant blurring B. Abrupt attacks of acute pain C. Sudden, complete loss of vision D. Impairment of peripheral vision

D Rationale Open-angle glaucoma[1][2] has an insidious onset, with increased intraocular pressure on the retina and blood vessels in the eye. Peripheral vision is decreased as the visual field progressively diminishes. Constant blurring may occur with untreated acute angle-closure glaucoma. Pain occurs in acute angle-closure, not open-angle, glaucoma. Occlusions of the central retinal artery or retinal detachment will cause a sudden loss of vision.

After surgery to repair a retinal detachment, an older adult client is transferred to the postanesthesia care unit with the affected eye patched. During the first four hours after surgery, the nurse should plan to notify the primary healthcare provider if the client reports which information? A. Has not voided B. Cannot open the eye C. Cannot remember the date D. Has sharp pain in the affected eye

D Rationale Reports of sharp pain in the eye indicate that hemorrhage may be occurring in the eye. Four hours is too soon to be concerned that the client has not voided. The eye is patched; in addition, there is edema of the lid, which can interfere with opening the eye. Becoming disoriented and not remembering the date may occur in an unfamiliar environment with the eye patched, especially in older adults.

A client is scheduled for a labyrinthectomy to treat Meniere syndrome. Which expected outcome of the procedure should be included in preoperative teaching? A. Absence of pain B. Decreased cerumen C. Loss of sense of smell D. Permanent irreversible deafness

D Rationale The labyrinth is the inner ear and consists of the vestibule, cochlea, semicircular canals, and other structures. A labyrinthectomy is performed to alleviate the symptom of vertigo but results in deafness on the affected side because the organ of Corti and cochlear nerve are located in the inner ear. There is no pain associated with Meniere syndrome. Meniere syndrome is not related to cerumen production. The loss of sense of smell (anosmia) is not affected by surgery to the ear.

An older client with macular degeneration comes to the eye clinic. Which response reported by the client does the nurse identify as consistent with the diagnosis? A. Sees best in dim light B. Sees halos around lights C. Cannot see objects in the periphery D. Cannot see objects in the center of the visual field

D Rationale The macula is the central vision area of the retina; therefore macular degeneration affects central vision and makes it difficult to see objects within direct, central vision. Dim light will make vision more difficult for this client. Seeing halos around lights is related to glaucoma rather than to macular degeneration. An inability to see objects in the periphery is related to glaucoma rather than to macular degeneration.