Integumentary

The nurse is reviewing the health record of a client diagnosed with a cataract. Which are signs and symptoms of cataract formation? Select all that apply.

Floaters in visual field 3.Difficulty in night vision Decreased color perception

The nurse is reviewing the record of a client with mastoiditis. The nurse should expect to note which signs and symptoms? Select all that apply.

Headache 2.Swelling directly behind the ear Red and immobile tympanic membrane

The nurse is reviewing the health care record of a client suspected of having mastoiditis. Which documented findings should the nurse expect to note if this disorder is present? Select all that apply.

Headache Elevated white blood cell count Swelling behind the ear on affected ear

A client diagnosed with primary open-angle glaucoma has been prescribed pilocarpine ophthalmic drops. The nurse has given the client instructions on how to administer the eye drops. Which client statement indicates a need for further teaching?

I will drop the eye drop in the middle of my eye."

Which medications cause ototoxicity? Select all that apply.

Ibuprofen Furosemide 4.Vancomycin

The nurse is explaining how sound is conducted from the middle ear to the inner ear in teaching a client who is experiencing hearing loss. What is the order of structures conducting sound waves from the middle ear to the inner ear? Arrange the structures in the order that they should occur. All options must be used.

Cochlea oval window organ of corti tympanic membrane malleus

The nurse caring for a client in the postoperative period following an enucleation notes bloody staining on the surgical eye dressing. Which is the appropriate nursing action?

Contact the registered nurse.

A client arrives at the emergency department for treatment of an injury to the eye after being hit by a baseball bat. On data collection, the nurse notes that the eye is bleeding. Which nursing action is appropriate?

Cover the eye with cold, sterile saline gauze.

The nurse reinforces home care instructions to a client after cataract removal and placement of an intraocular implant in the right eye. Which statement by the client indicates a need for further teaching?

"I need to remove the eye dressing as soon as I get home and place a warm pack on my eye."

A client was just admitted to the hospital to rule out a gastrointestinal bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication should the nurse determine to be the cause of the client's complaint?

Acetylsalicylic acid

The nurse is reviewing the preoperative prescriptions of a client scheduled for a keratoplasty. Which prescriptions noted in the client's chart should the nurse question?

Administer medication to dilate the affected pupil.

The client is receiving an eye drop and an eye ointment to the right eye. Which action should the nurse take?

Administer the eye drop first, followed by the eye ointment.

A client has been admitted to the telemetry unit with a diagnosis of bradycardia. The nurse is reviewing the client's prescriptions with the registered nurse. The client has a history of open-angle glaucoma. Which prescription should the nurse suggest should be questioned?

Atropine intravenously

Pilocarpine hydrochloride is prescribed for the client with glaucoma. Which medication should the nurse plan to have available in the event of systemic toxicity?

Atropine sulfate

The nurse should check for vision loss in a client with which condition?

Diabetes mellitus

The nurse is collecting data from a client who has a history of untreated cataracts. The nurse checks the client for which associated manifestation?

Difficulty with driving a car at night

The nurse is gathering data from a client with a history of untreated cataracts. The nurse asks the client about the presence of which sign of a cataract?

Difficulty with driving at night and blurred vision

After an eye examination, a client has been diagnosed with acute angle-closure glaucoma. The nurse collecting data from the client asks the client about an accompanying history of which sign/symptom?

Eye pain

Betaxolol hydrochloride eye drops have been prescribed for the client with glaucoma. Which nursing action is most appropriate related to monitoring for the side/adverse effects of this medication?

Monitoring blood pressure

The nurse is caring for a client with acute otitis media. The nurse plans care knowing which treatment for this problem is likely to be included?

Myringotomy

An adult client has increased fluid in the middle ear that is causing vertigo. The nurse checks this client for which associated signs and symptoms of this condition?

Nausea and vomiting

A client has been newly diagnosed with glaucoma. As part of the discharge instructions, the nurse should plan to reinforce which information?

The need for lifelong medication therapy

The nurse assigned to care for a hearing-impaired client should use which approach to communication in order to enhance communication and preserve the client's self-esteem? Select all that apply.

Speaking slowly and clearly 3.Standing directly in front of the client while speaking Turning down the volume on the radio or TV when talking

The nurse interprets that a client diagnosed with glaucoma needs additional information about the expected effects of this condition when the client makes which statement?

"Taking my daily walk right around dusk each evening has proven to be so enjoyable."

The nurse is assisting the primary health care provider in performing a caloric test on a client. Following instillation of cool water into the ear, the nurse observes the presence of nystagmus. The nurse should document the findings of this test as indicative of which result?

Normal

The nurse is assisting the primary health care provider in performing a caloric test on a client. Following instillation of warm water into the ear, the client complains of vertigo. The nurse documents the findings of this test as indicative of which result?

Normal

The nurse in the ambulatory care unit is caring for a client following cataract extraction. The client suddenly complains of nausea and severe eye pain in the surgical eye. The nurse should take which action?

Notify the registered nurse.

The nurse is caring for a client following enucleation. On data collection, the nurse notes staining and bleeding on the dressing. The nurse should take which action?

Notify the registered nurse.

The nurse is preparing a plan of care for a client being admitted to the hospital with a diagnosis of retinal detachment. Which measure should the nurse include in the plan of care?

Place an eye patch over the affected eye.

The nurse is assisting a primary health care provider in performing a caloric test on a client. Following instillation of warm water into the ear, the nurse notes that nystagmus does not occur. The nurse should document the findings of this test as indicative of which result?

Positive

Which are age-related changes to the eyes? Select all that apply.

Presbyopia 2.Arcus senilis 3.Yellow-tinged sclera Decreased ability to see in dim light

After a routine eye examination, a client has been told there are refractive errors in both eyes. The nurse explains to the client that this problem is primarily treated with which intervention?

Prescription of corrective lenses

The nurse is preparing to instill an otic solution into the adult client's right ear. The nurse should include which action while performing this procedure? Select all that apply.

Pulling the auricle of the right ear upward 2.Pulling the auricle of the right ear backward 3.Warming the solution to room temperature 4.Placing the client in a left side-lying position

The nurse is preparing to administer eardrops to an adult client. The nurse administers the eardrops by which technique?

Pulling the pinna up and back

During the early postoperative stage, the client who had a cataract extraction complains of nausea and severe eye pain over the operative site. Which action should the nurse implement?

Report the client's complaints.

The nurse is caring for a client after enucleation and notes the presence of bright red drainage on the dressing. The nurse should take which appropriate action?

Report the finding to the registered nurse (RN).

The nurse is attempting to inspect the lacrimal apparatus of a client's eye. Because of its anatomical location, the nurse should do which action?

Retract the upper eyelid and ask the client to look down.

The nurse is assisting in preparing a teaching plan for a client with Ménière's disease. The nurse places highest priority on teaching the client information related to which information?

Safety

The nurse is inserting soft contact lenses into the eyes of a client. Which direction does the nurse tell the client to look?

Straight ahead

The nurse provides dietary instructions to a client with Ménière's disease. The nurse tells the client that which food or fluid item is acceptable to consume?

Sugar-free Jell-O

A client is being discharged from the ambulatory care unit following cataract removal. Which instruction from the discharge teaching plan should the nurse reinforce?

Take acetaminophen if any discomfort occurs.

A client susceptible to motion sickness asks the nurse about the use of medication to prevent an occurrence. The nurse plans to incorporate into the discussion that the medication works effectively if which guideline is followed?

Taking the medication 1 hour before a triggering event

The nursing student is developing information for use in a clinical conference about hearing disorders. In the presentation, the student plans to include the statement that the ear is housed in which bones of the skull?

Temporal

A client arrives in the emergency department following an eye injury from a chemical solution. Which is the initial nursing action?

Test the eye pH with litmus paper.

The nurse is reinforcing discharge instructions to a client going home after same-day eye surgery. During the postoperative period, the nurse stresses that the client may safely perform which activity?

Watch television.

The nurse is reinforcing discharge instructions to a client who just underwent a myringotomy with placement of a polyethylene tube in the left ear. Which statement by the client indicates a need for further teaching? Select all that apply.

"I may wash my hair tomorrow." "I will irrigate the ear with gentle pressure." 5."I can expect to feel pressure inside the ear."

The nurse is reinforcing discharge instructions to a client following right eye corneal transplantation surgery. The nurse determines that the client understands the instructions if the client makes which statement?

"I will lie on my back or left side."

The nurse is giving the client discharge instructions concerning glaucoma. Which client statement indicates a need for further teaching?

"I will only take the eye drops until my vision improves."

The nurse is giving home care instructions to a client with conjunctivitis. Which client statement indicates a need for further teaching?

"I will use a sterile gauze to rub any matter from my eyes."

A nursing instructor asks a student about cochlear implants. The student understands that which clients are candidates for such a procedure? Select all that apply.

A client who has a profound hearing loss in both ear A client who has received no benefit from conventional hearing aids

The nurse is reviewing the medication list for an assigned client. Which medication is the only one on the client's prescription sheet that does not have an ototoxic effect?

Acetaminophen

A nursing student is caring for a client in the health care clinic who has been diagnosed with glaucoma. The client has a history of heart disease. The nursing instructor asks the student about group of medications used to treat glaucoma that would be contraindicated?

Alpha2-adrenergic agonist

Which diagnostic test would verify the diagnosis of macular degeneration?

Amsler grid test

A caloric test is prescribed for a client suspected of having a disease of the labyrinth. The nurse obtains which essential item in preparation for this test?

An otoscope

A client sustains a contusion of the eyeball after a traumatic injury with a blunt object. The nurse should take which immediate action?

Apply ice to the affected eye.

A client has been diagnosed with open-angle glaucoma. Which signs and symptoms are found in open-angle glaucoma? Select all that apply.

Blurred or hazy vision 2.Colored rings around lights 3.Tonometry reading 30 mm Hg

A client with a history of ear problems telephones the ambulatory care nurse to cancel an appointment because he will be away on business. The client mentions that he will be flying during this trip. The nurse advises the client to engage in which activities to prevent barotrauma during takeoff and landing? Select all that apply.

Chewing gum 2.Yawning occasionally 3.Swallowing a few times Sucking on a piece of hard candy

The nurse administers meclizine hydrochloride to a client diagnosed with an attack of Ménière's disease. Which observations demonstrate to the nurse that the medication is effective? Select all that apply.

Decrease in nausea 3.Decrease in vertigo

The nurse has reinforced instructions to a client following a right keratoplasty. Which statement by the client indicates a need for further teaching?

In 1 week, I'll return to have the sutures removed."

The nurse has been assigned to a client with a hearing impairment. To enhance nurse-client communication, the nurse should plan to communicate with the client by speaking in which manner?

In a normal tone while facing the client

A client arrives at the emergency department after experiencing a traumatic blow to the eye and a hyphema is diagnosed. In which position should the nurse place the client?

In semi-Fowler's position

A clinic nurse is reviewing the record of a client recently diagnosed with a cataract. Which clinical manifestations associated with this disorder should the nurse expect to be documented in the client's record? Select all that apply.

Increasing nearsightedness 4.Need for more light when reading 5.Painless progressive loss of vision

A client who frequently experiences hearing loss due to built-up cerumen in the ears asks the nurse about ways to deal with the problem including irrigating the ears. Which information is correct for the nurse to include in the teaching plan? Select all that apply.

Irrigate the ear canal with lukewarm tap water around 98° F. The ear irrigation should be stopped if the client becomes dizzy or nauseous. Instill drops of mineral oil and hydrogen peroxide for several days to soften dried cerumen before irrigation.

The nurse is preparing to reinforce a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures should the nurse include in the plan? Select all that apply.

To avoid activities that require bending over To take acetaminophen for minor eye discomfort To place an eye shield on the surgical eye at bedtime To contact the surgeon if a decrease in visual acuity occurs

When reinforcing information to a client regarding how to appropriately care for a new hearing aid, the nurse should provide the client with which instruction?

To check the battery regularly to ensure that it is working before use

In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops. The nurse administers the eye drops knowing that which is the purpose of this medication?

To dilate the pupil of the operative eye

The nurse is reviewing the results of an eye examination on a client. Which tests can detect glaucoma? Select all that apply.

Tonometry Visual field check

A client sustains a chemical eye injury from a splash of battery acid. The nurse should prepare the client for which immediate measure?

Irrigating the eye with sterile normal saline

The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply.

Wash hands. 2.Put on gloves. 3.Place the drop in the conjunctival sac. 4.Pull the lower lid down against the cheekbone.

The nurse is caring for a client hospitalized with an acute attack from Ménière's disease. The client verbalizes concern because the client has experienced a hearing loss as a result of the attack. Which response should the nurse make to the client regarding the hearing loss?

"The attack leaves a hearing loss in the involved ear."

A client arrives at the emergency department following an eye injury in which an acid used to clean the brick on the fireplace splashed into the eye. Which question should the nurse ask initially?

"Did you flush the eye following the injury?"

A client reports to the health care clinic for an eye examination, and a diagnosis of primary open-angle glaucoma is suspected. Which question will elicit information regarding the signs/symptoms associated with this disorder?

"Have you had difficulty with peripheral vision?"

The nurse is reinforcing preoperative instructions to a client scheduled for cataract surgery and prepares a written list of instructions for the client. Which statement by the client indicates a need for further teaching?

"I can drink any liquids that I want to on the morning of the surgery."

The nurse reinforces instructions to a client with glaucoma regarding measures that will prevent an increase in intraocular pressure in the eyes. Which statement by the client indicates a need for further teaching?

"I can tie my shoelaces by bending over slowly."

A client with a diagnosis of otosclerosis is admitted to the ambulatory care unit for stapedectomy, and the nurse reinforces instructions to the client regarding home care following the procedure. Which statement by the client indicates a need for further teaching?

"I need to avoid air travel for at least 6 months."

The nurse is reinforcing instructions to a client regarding the use of a hearing aid. Which statement by the client indicates a need for further teaching?

"I should turn the hearing aid off after removing it from my ear."

The nurse is assigned to care for a client with a diagnosis of Ménière's disease. After reinforcing discharge instructions, which client statement indicates a need for further teaching?

"I will become totally deaf if I don't follow instructions."

The nurse is providing discharge instructions for a client who has had a fenestration procedure for the treatment of otosclerosis. Which statement by the client indicates an understanding of the instructions?

"I will take stool softeners as prescribed by my doctor."

The instructor is quizzing the student nurse concerning care of a visually impaired client. Which statement indicates a need for further teaching?

"I will take the client's arm to lead while we are walking."

A client is being discharged from the ambulatory care unit following cataract removal, and the nurse provides instructions regarding home care. Which statement by the client indicates an understanding of the instructions?

"I will wear my eye shield at night and my glasses during the day."

A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about the purpose of the medication. The nurse should tell the client which purpose?

"The medication causes the pupil to constrict and will lower the pressure in the eye."

Prescriptive glasses are prescribed for a client with bilateral aphakia, and the nurse reinforces instructions to the client regarding the use of the glasses. Which statement by the client indicates the need for further teaching?

"The prescriptive glasses will correct my visual field of sight."

The primary health care provider will perform a caloric test. Which is the priority order of the actions to perform this test? Arrange the actions in the order that they should be performed. All options must be used.

1 Examine and clean the ear canal. Irrigate until the client complains of nausea and dizziness or nystagmus is observed 3 Expl4 Note if the client has had central nervous system depressants, alcohol, or barbituratesain the purpose and procedure to the client 5 Check for the presence of nystagmus, postural deviation (Romberg sign), and past-pointing 6 Place emesis basin under ear to be tested then irrigate the suspected ear with hot or cold water

Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse reviews the test and determines that the intraocular pressure is normal if which result is noted?

15 mm Hg

The nurse is reviewing the plan of care developed by a nursing student for a client scheduled for keratoplasty. The nurse discusses the plan with the student if which incorrect intervention is listed in the plan?

Administering medications that will dilate the pupil

A client who was hit in the eye with a baseball bat sustains a contusion of the eyeball. The emergency department nurse implements which immediate action?

Applies ice to the affected eye

The nurse is caring for a client with glaucoma. Which medication prescribed for the client should the nurse question?

Atropine sulfate

A client with Ménière's disease is experiencing severe vertigo. The nurse reinforces instructions to the client to do which to assist with controlling the vertigo?

Avoid sudden head movements.

The nurse collects data from a client with a diagnosis of macular degeneration of the eye. The nurse should expect the client to report which symptoms? Select all that apply.

Blurred central vision 2.Bending of straight lines Inability to see color vividness

The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. The nurse understands that assessment of which cranial nerve should identify a complication specifically associated with this surgery?

Cranial nerve VII, facial nerve

The nurse is reviewing the health care record of a client with a diagnosis of otosclerosis. Which signs and symptoms should the nurse note? Select all that apply.

Difficulty hearing voices of others 5.Bone conduction better than air conduction Tinnitus

The nurse is providing client teaching regarding glaucoma. Which instructions are important to include in the teaching plan? Select all that apply.

Follow a low-sodium, minimal-caffeine diet with plenty of fiber. Be sure to report halos of light or increased eye pain to your primary health care provider.

The nurse determines that the client diagnosed with Ménière's disease understands the reinforced dietary instructions when the client states that which food will be avoided in the diet?

Hot dogs

The nurse is assigned to care for a client hospitalized with Ménière's disease. The nurse expects that which would most likely be prescribed for the client?

Low-sodium diet

The nurse is communicating with a client who is hard of hearing in both ears. To facilitate communication with this client, the nurse should perform which?

Lower the voice pitch and face the client when speaking.

A client arrives in the emergency department after an automobile crash. The client's forehead hit the steering wheel and a hyphema has been diagnosed. Which position should the nurse prepare to position the client?

On bed rest in a semi-Fowler's position

A client has been diagnosed with cataracts. Which signs and symptoms should the nurse expect to note? Select all that apply.

Photophobia 3.Blurred vision 4.Decreased color perception

A client with retinal detachment is admitted to the outpatient nursing unit in preparation for a scleral buckling procedure. Which prescription should the nurse anticipate?

Placing an eye patch over the client's affected eye

While at home, the nurse receives a telephone call from a neighbor who reports that while accidentally breaking a mirror, a piece of glass flew into her eye. Which is the appropriate initial nursing action after observing that the large glass shard is protruding from the neighbor's eye?

Secure a paper cup over the affected eye.

A client is diagnosed with labyrinthitis. Which are signs and symptoms of labyrinthitis? Select all that apply.

Severe dizziness Nausea and vomiting 5.Abnormal jerking movement of eyes

Which actions should be performed when communicating with a client with presbycusis? Select all that apply.

Speak slowly and distinctly. 3.Face client when speaking. Use short sentences and phrases.

The nurse is preparing to communicate with an older client who is hearing impaired. Which intervention should be implemented initially?

Stand in front of the client.

The nurse is caring for a client who will be undergoing surgical treatment for Ménière's disease. The nurse plans care based on which expected outcome?

The surgery relieves pressure from accumulation of inner ear fluid in the endolymphatic sac.

The nurse is assigned to care for a client with a detached retina. Which finding should the nurse expect to be documented in the client's record?

A sense of a curtain falling across the field of vision

A client is brought to the ambulatory care department by the spouse 1 day following a cataract extraction procedure. A diagnosis of hyphema is made, which occurred as a result of the surgical procedure. The nurse reinforces instructions to the client and spouse regarding the treatment for the complication and makes which statement?

"Maintain bed rest and patching of both eyes."

A client has bilateral aphakia. When reinforcing teaching instructions regarding the prescribed eyeglasses, the nurse determines the need for further teaching when the client makes which statement?

"My peripheral vision will not be distorted."

The nurse has reinforced instructions to a client who is scheduled for a cataract extraction. Which statement by the client indicates a need for further teaching?

"No eating or drinking for at least 18 hours before the surgery."

The nurse is providing discharge instructions to a client following a keratoplasty. Which statement by the client indicates the need for further teaching?

"Sutures are removed in 2 weeks."

A client with glaucoma has suffered significant eye damage before diagnosis and now has impaired vision. The nurse determines that the client needs further assistance in adapting to this situation if the client makes which statement?

"There is no difficulty driving at dusk."

The nurse in the outpatient unit is preparing a client who is scheduled for a laser trabeculoplasty for the treatment of primary open-angle glaucoma. Which instructions should the nurse reinforce to the client?

"You may return to work 1 or 2 days following the procedure."

The nurse is reinforcing discharge instructions with a client who is being discharged following a fenestration procedure for the treatment of otosclerosis. Which should be included on the list of instructions prepared for the client?

"You need to avoid air travel."

The nurse is assisting the primary health care provider with performing a Rinne tuning fork test on a client. The nurse expects that the steps of the testing will be performed in which priority order? Arrange the actions in the order that they would be performed. All options must be used.

1 Tap tuning fork to activate. 2 Move the tuning fork close to the ear canal. 3 Have client indicate when the sound disappears 4 Place base of tuning fork on the mastoid bone. 5 Document whether bone or air conduction is better. 6 Ask the client if he or she hears the sound and to indicate when the sound disappears.

The nurse is assigned to care for a client with a diagnosis of detached retina. Which findings would indicate that bleeding has occurred as a result of retinal detachment? Select all that apply.

Vision may be cloudy Complaints of a burst of black spots or floaters

The nurse assists with preparing the client for ear irrigation as prescribed by the primary health care provider (PHCP). Which action should the nurse plan to take?

Warm the irrigating solution to 98° F (36.6° C).

The nurse is providing client and family instructions for a client who has been recently diagnosed with glaucoma. Which statement indicates that the client's family member needs further teaching regarding the eye drop application of pilocarpine hydrochloride? Select all that apply.

"I should apply the eye drops directly over my family member's pupil." "I have to contact the prescriber if my family member develops a small pupil." "I need to wipe off the tip of the eye drop bottle with a tissue between administrations."

The nurse notes that the primary health care provider (PHCP) has documented a diagnosis of presbycusis on the client's chart. Which explanation should the nurse give to the client to explain this condition?

A sensorineural hearing loss that occurs with aging

These are signs and symptoms of glaucoma. Which sign or symptom is found only in narrow-angle glaucoma?

Severe pain in and around eye

The nurse is attempting to communicate with a hearing-impaired client. Which strategy by the nurse would be least helpful when talking to this client?

Smiling continuously during conversation

The nurse is caring for a client who is hearing-impaired and should take which approach to facilitate communication?

Speak in a normal tone.

The nurse provides discharge instructions to the client who was hospitalized for an acute attack of Ménière's disease. Which statement made by the client indicates a need for further teaching?

"It is not necessary to restrict salt in my diet."

A client has been diagnosed with a hearing loss caused by age-related changes in the ear. The nurse reinforces information about obtaining and learning to use a hearing aid. Which statement by the client indicates understating of the information?

"I should obtain a hearing aid as soon as possible."

A client has a diagnosis of presbycusis. The nurse interprets that which behavior indicates that the client has successfully adapted to this disorder?

Agrees to use a prescribed hearing aid especially when home alone

A client is diagnosed with hyphema after experiencing a traumatic blow to the eye. The nurse explains to the client that which activity limitation needs to be implemented following this type of injury?

Bed rest with the head in semi-Fowler's position

A client has been diagnosed with glaucoma. The nurse who is teaching the client principles of self-care should encourage the client to limit or refrain from which usual activity on a repeated basis?

Picking objects up off the floor

A client who has undergone cataract removal without an intraocular lens implant is visibly upset because his vision is still blurry. Which action should the nurse perform to provide realistic reassurance to this client?

Explain that vision will improve with adjustment to aphakic lenses.

The nurse is reinforcing discharge teaching to a client following right eye cataract surgery. The nurse determines that the client needs further teaching about ways to avoid strain on the operative eye when the client makes which statements? Select all that apply.

I can lie on my right side." "I will wear my eye shield only during the daytime.

A client arrives in the emergency department with an eye injury resulting from metal fragments that hit the eye while the client was drilling into metal. The nurse checks the eye and notes small pieces of metal floating on the eyeball. Which action should the nurse take first?

Irrigate the eye with sterile saline.

The nurse is reinforcing education to a client who has just obtained a hearing aid about its use and maintenance. The nurse tells the client that it is helpful to follow which practice?

Keep an extra battery readily available.

A client has sought treatment in the ambulatory care clinic after an insect has become trapped in the external ear canal. The nurse prepares to assist the primary health care provider to instill which acceptable solutions into the ear to remove the insect? Select all that apply.

Lidocaine 2.Mineral oil 3.Ether solution

Which nursing interventions are appropriate for a client recovering from surgery for retinal detachment? Select all that apply.

Monitor for hemorrhage. 2.Administer eye medications. 3.Maintain the eye patch or shield. 4.Assist with activities of daily living. Educate regarding symptoms of retinal detachment.

The nurse in the recovery room area is preparing to care for a client following cataract extraction of the right eye. Which position does the nurse prepare to place the client?

On the left side with the head of the bed elevated

The nurse is assigned to care for a client following a cataract extraction. The nurse plans to place the client in which position?

On the nonoperative side

A client is experiencing blockage of the eustachian tubes. The nurse teaches the client that which activities by the client may forcibly open the eustachian tube?

Performing the Valsalva maneuver

The nurse is observing an unlicensed assistive personnel (UAP) talk to a client who is hearing impaired. The nurse should intervene if which actions are performed by the UAP during communication with the client? Select all that apply.

The UAP speaks in a very loud voice. The UAP speaks while cleaning the room. 4.The UAP speaks directly into the impaired ear.

A client has had same-day surgery to insert a ventilating tube in the tympanic membrane. The nurse reinforces to the client to be sure to perform which action until the postoperative assessment by the primary health care provider?

Use a shower cap to protect the ears if taking a shower.

The nurse is speaking with a client with a hearing impairment. The nurse refrains from doing which least likely helpful action when communicating with this client?

Using many exaggerated hand gestures while talking

An adult client with a history of ear infections reports a right earache accompanied by a sensation of fullness. The client also reports nausea and has a temperature of 100.6° F. The nurse questions the client about which aspect of the client's history?

Whether the client has had a recent upper respiratory infection (URI)

A client with glaucoma and an acute exacerbation of chronic obstructive pulmonary disease (COPD) has a new prescription to receive carteolol HCl eye drops. Which action by the nurse is most appropriate?

Withhold the dose and notify the registered nurse.

The nurse is reinforcing instructions to a client regarding the use of ice packs to treat an eye injury. The nurse instructs the client to do which action?

Wrap a plastic bag filled with ice with a pillowcase and place it on the eye.

The nurse in a health care clinic is assisting in testing the client for accommodation. Arrange the actions and observations in the order that they should occur. All options must be used.

dilate constrict findings close object distant object

The nurse is assisting a client who has just been given a hearing aid to wear for the first time. When reinforcing client teaching, the nurse should include which instruction?

"The hearing aid should not be worn if an ear infection is present."

A client who had previously undergone cataract surgery tells the nurse that she has begun seeing flashing lights and floaters in the eye. Based on the client's history, the nurse interprets that the client is at risk for which?

Detached retina

The nurse is reviewing the medical record of a client diagnosed with conjunctivitis. Which signs and symptoms should the nurse expect to be noted? Select all that apply.

itching redness sensation

A nursing student is preparing to assist with an ear irrigation on an assigned client who has a buildup of cerumen in the left ear. The nursing instructor asks the student about the procedure for the irrigation. The student nurse should perform the procedure in which correct order? Arrange the actions in the order that they should be used. All options must be used.

temp 95 to 105 straighten the external canal select irrigating syringe bulb direct solution toward the top have the client sit up

A client arrives at the emergency department with a foreign body in the left ear that has been determined to be an insect. Which initial intervention should the nurse anticipate to be prescribed?

Instillation of mineral oil or diluted alcohol

A myringotomy is performed on a client in the ambulatory care center. The ambulatory care nurse calls the client 24 hours after the procedure to evaluate the status of the client. The client reports to the nurse that a small amount of brownish drainage has been coming from the ear. Which instruction should the nurse provide to the client?

"Continue to monitor the drainage because this is normal and may occur for 24 to 48 hours following the surgery."

The nurse is assisting with developing a teaching plan for the client with glaucoma. Which instruction should the nurse suggest to include in the plan of care?

Eye medications may need to be administered for the rest of your life.

Which instruction is appropriate for the nurse to provide to a client who reports via telephone that he is certain an insect has flown into his ear because he can hear it "buzzing"?

Use a flashlight to coax the insect out of the ear.

Which intervention should be implemented for the older client with presbycusis who has a hearing loss?

Use low-pitched tones.

A client arrives in the emergency department with a foreign body in the eye. Which action should the nurse plan to perform first?

Apply an eye patch to both eyes.

The nurse is providing discharge instructions to a client who is postoperative cataract surgery on the left eye. Which statement indicates a need for further teaching?

"If I have severe eye pain, I will take the narcotic pain pill that my doctor will prescribe for me."

The nurse is assigned to administer the prescribed eye drops for a client preparing for cataract surgery. Which type of eye drops should the nurse expect to be prescribed?

A mydriatic medication

Surgery has been recommended for the client with otosclerosis. The client tells the nurse that she would prefer not to have surgery and asks the nurse about alternative methods to improve hearing. The nurse should make which appropriate response to the client?

"A hearing aid may improve your hearing."

A client with glaucoma asks the nurse if complete vision will return. The nurse should make which response to the client?

"Although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan."

The nurse is reinforcing instructions to a client with a diagnosis of hordeolum regarding the treatment plan. Which instruction should the nurse include in the teaching plan for the client?

Apply a warm compress for 15 minutes 4 times daily.

A client arrives at the emergency department following a blow to the eye from a softball. Which intervention should be implemented by the nurse initially?

Apply ice to the affected eye

The nurse is assisting in developing a plan of care for a client following the surgical removal of an acoustic neuroma. Which assessment will be included in the plan of care for this specific intervention?

Assessment of cranial nerve VII (facial)

A client has been diagnosed with macular degeneration. The nurse should expect to expect which signs and symptoms noted with macular degeneration? Select all that apply.

Blurred vision Inability to see the vividness of colors 5.Objects that appear to be the wrong size

A client is diagnosed with glaucoma. Which data gathered by the nurse indicate a risk factor associated with glaucoma?

Cardiovascular disease

A client is brought to the emergency department by the ambulance team after collapse at home. Cardiopulmonary resuscitation is attempted but is unsuccessful. The wife of the client tells the nurse that the client is an organ donor and that their eyes are to be donated. Which action should the nurse take next?

Close the eyes, elevate the head of the bed, and place a small ice pack on the eyes.

A client arrives in the emergency department with a chemical eye injury. The nurse immediately performs which action?

Irrigates the eye with copious amounts of sterile normal saline

The nurse is providing instructions to a client who will be self-administering eye drops. To minimize the systemic effects that eye drops can produce, the client is instructed to perform which action?

Occlude the nasolacrimal duct with a finger over the inner canthus for 30 to 60 seconds after instilling the drops.

A perforated eardrum is suspected in a client who was hit in the ear with a basketball. A tympanoplasty was performed. The nurse is giving the client discharge instructions. Which client statement indicates a need for further teaching?

"I will drink from the plastic bottle mouth since I can't use drinking straws."

The nurse is reinforcing home-care instructions to a client and family regarding care after left cataract surgery with lens implant. Which statements made by the client indicate an understanding of the instructions? Select all that apply.

"I will not sleep lying on my left side." 3."I will sit at the table to eat breakfast." 4."I will sit in my recliner with my feet elevated." 5."I will not lift anything heavier than 10 pounds."

A client who sustained an eye injury arrives at the emergency department. Which is the initial nursing action?

Obtain a history regarding the cause of the injury.

The nurse notes that the client's physical examination record states the client's eyes moved normally through the six cardinal fields of gaze. The nurse makes which interpretation?

The client has normal ocular movements.

The nurse is reinforcing discharge instructions to a client who has had ocular surgery of the left eye. Which statement by the client indicates a need for further teaching?

"I need to call the doctor if I develop any fever."

A clinic nurse is reinforcing home care instructions to a client with a diagnosis of glaucoma. Which statement by the client indicates an understanding of the treatment plan for glaucoma?

"I need to take my eye drops for the rest of my life."

The nurse is reinforcing home care instructions to a client who has a hordeolum (sty) of the right eye. Which statement by the client indicates an understanding of the instructions?

"I should apply antibiotic ointment as prescribed."

A client reporting recent right eye discomfort is diagnosed with chalazion of the right eye. The nurse reinforces instructions to the client regarding care to the eye. Which statement by the client indicates an understanding of the measures?

"I should apply warm packs to my eye."

Immediately following cataract repair, the client's affected conjunctiva and eyelids are edematous. Which statement by the nurse accurately characterizes these findings for the client?

"The edema is normal and should subside within 3 days."

The nurse is assisting in performing a confrontation test on a client seen in the clinic. The nurse understands that this test is performed to determine what?

The ability to demonstrate effective peripheral vision

The nurse is reviewing the primary health care provider's prescriptions for a client admitted to the hospital with a diagnosis of an acute attack of Ménière's disease. Which prescription noted on the client's chart should the nurse question?

The administration of a vasoconstrictor

The nurse is reinforcing home care instructions to a client following a fenestration procedure for the treatment of otosclerosis. Which instruction should the nurse give the client?

Increase fluids and take a stool softener daily.

The nurse is caring for a client following enucleation. Which postsurgical observation requires immediate attention by the nurse?

Bright red drainage on the dressing