N102 Visual and Hearing Problems EAQ

Which drug worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? 1. Buspirone 2. Duloxetine 3. Chlorpromazine 4. Lithium carbonate

2. Duloxetine Duloxetine is an antidepressant drug used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant drug contraindicated in clients with known allergic reactions to this drug. Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias.

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? 1 Total blindness is inevitable. 2 Lost vision cannot be restored. 3 Use of both eyes usually is restricted. 4 Surgery will help the problem only temporarily

2. Lost vision cannot be restored. 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.

Which visual system assessment technique provides a magnified view of the retina and optic nerve head? 1. Keratometry 2. Ophthalmoscopy 3. Visual acuity testing 4. Confrontation visual filed test

2. Ophthalmoscopy Ophthalmoscopy provides a magnified view of the retina and optic nerve head. Keratometry measures corneal curvature. Visual acuity testing determines distance and near vision acuity. The confrontation visual field test determines if a client has a full field of vision without obvious scotomas.

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? 1 Prevent cataracts 2 Prevent blindness 3 Prevent retinal detachment 4 Prevent blurred distance vision

2. Prevent blindness 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.

What could be the reason for cataracts in a 36-year-old client? Select all that apply. 1 Prolonged exposure to heat 2 Prolonged exposure to pesticides 3 Prolonged exposure to cement dust 4 Prolonged exposure to metal powders 5 Prolonged exposure to anesthetic gases

1,4 Glass workers are exposed to heat and metal powders for prolonged periods, which may increase their risk of developing cataracts. A prolonged exposure to pesticides may cause pesticide poisoning. Prolonged exposure to cement dust may cause bronchitis. Prolonged exposure to anesthetic gases may have reproductive effects.

A client with glaucoma is receiving a carbonic anhydrase inhibitor. Which statement made by the client will require the nurse to notify the primary healthcare provider? 1. "I have asthma." 2. "I use contact lenses." 3. "I am allergic to sulfonamides." 4. "I have been taking phenelzine medication for three months."

3. "I am allergic to sulfonamides." Carbonic anhydrase inhibitors are used for the treatment of glaucoma. These drugs are similar to sulfonamides, and if a client is allergic to the sulfonamides, they may have a chance of developing an allergy. Beta-adrenergic blockers such as betaxolol hydrochloride and carteolol are used for treating glaucoma. These drugs, when absorbed systemically, may lead to constriction of the pulmonary smooth muscles and narrow airway. Clients who wear contact lenses is not an issue with carbonic anhydrase inhibitors; however, if using adrenergic agonists clients should not use the eyedrops with the contact lenses in place and should wait 15 minutes after using the drug to put in the lenses. Clients taking antidepressants such as phenelzine should not be prescribed adrenergic agonists because it may lead to a hypertension crisis when taken together.

Which clinical indicator is the nurse most likely to identify when exploring the history of a client with open-angle glaucoma? 1 Constant blurring 2 Abrupt attacks of acute pain 3 Sudden, complete loss of vision 4 Impairment of peripheral vision

4. Impairment of peripheral vision 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.

Which structure is a component of the auditory ossicles? 1. Malleus 2. Vestibule 3. Tympanic membrane 4. External acoustic meatus

1. Malleus The malleus along with the incus and stapes constitutes the auditory ossicles. The vestibule is present in the inner ear and is an organ of balance. The tympanic membrane (eardrum) is a part of the middle ear. The external acoustic meatus is a component of the external ear.

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? 1 Prolonged exposure to noise 2 Buildup of cerumen in the ear 3 Blockage of the ear from a foreign body 4 Perforation of the tympanic membrane

1. Prolonged exposure to noise 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.

Which beta-adrenergic blocker is prescribed to clients with glaucoma? 1 Betaxolol 2 Carbachol 3 Brimonidine 4 Methazolamide

1 Betaxolol Betaxolol is a beta-adrenergic blocker that is prescribed for glaucoma. Carbachol is a cholinergic agent that is used to treat glaucoma. Brimonidine is an alpha-adrenergic agonist that is prescribed in glaucoma. Methazolamide is a carbonic anhydrase inhibitor that is used to treat glaucoma.

. Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? 1. Trazodone 2. Bupropion 3. Duloxetine 4. Mirtazapine

3. Duloxetine Duloxetine can worsen uncontrolled angle-closure glaucoma. Trazodone is contraindicated in clients with a known drug allergy. Bupropion is contraindicated for clients with seizures. Mirtazapine is contraindicated in cases of known drug allergy and concurrent use of monoamine oxidase inhibitors.

Which antiinfective agent may lead to blindness if not used correctly by the client in prescribed amounts? 1 Bromfenac 2 Natamycin 3 Trifluridine 4 Gentamicin

4. Gentamicin Gentamicin is an antiinfective agent that can lead to blindness if not used in prescribed amounts. The nurse should instruct clients to take this only as prescribed, because bacterial and fungal eye infections may worsen rapidly and can lead to blindness if not treated adequately. Bromfenac is a nonsteroidal antiinflammatory (NSAID) agent and does not lead to blindness. Natamycin is an antifungal agent and trifluridine is a topical antiviral agent; both do not cause blindness.

A client with the diagnosis of multiple sclerosis experiences a sudden loss of vision and asks the nurse what caused it to happen. The nurse considers the common clinical findings associated with multiple sclerosis before responding. Which is the most probable cause of the client's sudden loss of vision? 1 Virus-induced iritis 2 Intracranial pressure 3 Closed-angle glaucoma 4 Optic nerve inflammation

4. Optic nerve inflammation Optic nerve inflammation is a common early effect of multiple sclerosis caused by lesions in the optic nerves or their connections (demyelization). This effect may resolve during periods of remission. At present there is no evidence of viral infection of the eyes in multiple sclerosis. Tumors of the brain and cerebral edema, not multiple sclerosis, cause increased intracranial pressure because the skull cannot expand. Closed-angle glaucoma causes blindness as a result of increased intraocular pressure, not inflammation of the optic nerve, which is commonly associated with multiple sclerosis. Closed-angle glaucoma is unrelated to multiple sclerosis.

The nursing is caring for four different clients with eye disorders. Which client should be assessed for asthma before prescribing beta-adrenergic blockers? Client A: 1. Increased lens density 2. Reduced visual sensory perception Client B: 1. Increased tear secretion 2. Blood shot eye appearance Client C: 1. Degeneration of corneal tissue 2. Severe visual impairment Client D: 1. Reduced outflow of aqueous humor 2. Increased intraocular pressure

Client D Reduced outflow of acqueous humor and increased intraocular pressure causes glaucoma, which can be treated with different types of drugs. Before prescribing beta-adrenergic blockers, the client should be assessed for moderate to severe asthma because if these drugs are absorbed systematically, they constrict pulmonary smooth muscle and narrow airways. Increased lens density and reduced visual sensory perception indicates cataracts that can be treated only with cataract surgery. Increased tear secretion and blood shot eye appearance is observed in a client with conjuctivitis; this can be treated with ophthalmic antibiotics. Degeneration of corneal tissue indicates keratoconus, which can be cured by performing a surgery called keratoplasty (corneal transplant).

Which beta-adrenergic blocker is used to reduce a client's intraocular pressure? 1 Timolol 2 Travopost 3 Carbachol 4 Apraclonidine

1 Timolol Glaucoma is manifested by increased intraocular pressure. Timolol is a beta-adrenergic blocker used in the treatment of glaucoma. Carbachol is a cholinergic agonist used to treat glaucoma. Travopost is a prostaglandin agonist, and apraclonidine is an adrenergic agonist used in the treatment of glaucoma.

Which gerontologic assessment findings of the auditory system are related to the inner ear? Select all that apply. 1. Hair cell degeneration 2. Reduced blood supply to the cochlea 3. Atrophic changes of the tympanic membrane 4. Decline in the ability to filter out unwanted sounds 5. Less effective vestibular apparatus in the semicircular canals

1,2, 5 Hair cell degeneration, reduced blood supply to the cochlea, and less effective vestibular apparatus in the semicircular canals are assessment findings related to the inner ear. Atrophic changes of the tympanic membrane is an assessment finding associated with the middle ear. A decline in an ability to filter out unwanted sounds is an assessment finding related to the brain.

What clinical indicators should the nurse expect when interviewing and assessing a client with Meniere disease? Select all that apply. 1 Nausea 2 Dizziness 3 Decreased pulse rate 4 Increased temperature 5 Jerky lateral eye movements

1,2,5 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 communicating with an older adult who has a hearing disability. Which intervention by the nurse is beneficial to promote communication? Select all that apply. 1 Giving the client a chance to speak 2 Assuming the client is being uncooperative 3 Chewing gum while talking to the client 4 Making sure that the client knows you are speaking 5 Keeping the communication concise

1,4,5 When communicating with an older adult who has hearing disability, the nurse should give the client a chance to speak, make sure that the client knows the nurse is talking, and keep the communication concise. The nurse should not assume that the client is uncooperative if he or she does not reply or gives a delayed response. The nurse should also not chew gum while talking because this action may garble the nurse's language.

The primary healthcare provider prescribes an adrenergic agonist to a client with increased intraocular pressure. Which question is priority that the nurse should ask the client? 1. "Do you take antidepressants?" 2. "Do you have any respiratory disorders?" 3. "Do you wear contact lens?" 4. "Do you have allergies to sulfonamides?"

1. "Do you take antidepressants?" Clients prescribed adrenergic agonists should be asked whether they are taking any antidepressants, such as phenezeline, because these medications increase blood pressure as do the adrenergic agonists; hence, this may lead to a hypertensive crisis. Clients prescribed beta-adrenergic blockers should be asked about any respiratory disorders, such as asthma, because the drug causes constriction of pulmonary smooth muscle which may lead to narrowing of the airway. Carbonic anhydrase inhibitors are similar to sulfonamides. Therefore, they should not be prescribed to clients who are allergic to sulfonamides. While asking about contact lensesis appropriate, this is not the priority for adrenergic agonist; discoloration of lens is not a critical as hypertensive crisis.

A client is being prepared for discharge from an ambulatory surgical clinic after a cataract extraction and an intraocular lens implant. Which statement indicates to the nurse that the discharge teaching is effective? 1 "I should call the clinic if my eye begins to hurt." 2 "I am so glad that I can take a shower tomorrow." 3 "There will be bright flashes of light for a few days." 4 "My vision should show some improvement by tomorrow."

1. "I should call the clinic if my eye begins to hurt." Pain after a cataract extraction and intraocular lens implant may indicate infection, increased intraocular pressure, or hemorrhage and should be reported immediately. Soap may irritate the eye, and showers or shampooing of the hair should be avoided as instructed. Seeing bright flashes of light is a symptom of retinal detachment and is not expected. Although rapid vision improvement may occur in some people, others may require several weeks to achieve improved visual acuity.

A client asks for information about glaucoma. How should the nurse explain glaucoma to the client? 1 An increase in the pressure within the eyeball 2 An opacity of the crystalline lens or its capsule 3 A curvature of the cornea that becomes unequal 4 A separation of the neural retina from the pigmented retina

1. An increase in the pressure within the eyeball 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.

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? 1 Hemorrhage into the eye 2 Expected postoperative discomfort 3 Isolation related to sensory deprivation 4 Pressure on the eye from the protective shield

1. Hemorrhage into the eye 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's relative asks the nurse what a cataract is. Which explanation should the nurse provide? 1 An opacity of the lens 2 A thin film over the cornea 3 A crystallization of the pupil 4 An increase in the density of the conjunctiva

1. Opacity of the lens A cataract 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.

A client is being evaluated based on client reports of an impairment of a portion of the peripheral vision. After testing is completed, a diagnosis of retinal detachment is made, and a cryosurgical procedure is scheduled. As part of the preoperative teaching, the nurse provides information about what the client can expect and includes which information? 1 An explanation that the surgery will be brief 2 A description of the surgical suite environment 3 The procedure and risks of the repair of the retina 4 The importance of postoperative coughing and deep-breathing exercises

2. A description of the surgical suite environment Because vision will be limited somewhat after surgery, it is important to familiarize the client with vital aspects of the environment, which provides for physical and emotional safety. Surgery usually takes approximately two hours, followed by a stay in the postanesthesia care unit. The healthcare provider should discuss the procedure and risks; informed consent is the primary healthcare provider's responsibility not the nurse's. Coughing or other activity that increases intraocular pressure should be avoided.

7. Immediately after cataract surgery a client reports feeling nauseated. What should the nurse do? 1 Provide some dry crackers to eat 2 Administer the prescribed antiemetic 3 Explain that this is expected after surgery 4 Encourage deep breathing until the nausea subsides

2. Administer the prescribed antiemetic An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Aggressive intervention is required rather than dry crackers. Explaining that this is expected after surgery is incorrect. Deep breathing will not minimize nausea; aggressive intervention is required to prevent vomiting.

Which prostaglandin agonist is used in the treatment of clients with glaucoma? 1. Carteolol 2. Bimatoprost 3. Brinzolamide 4. Apraclonidine

2. Bimatoprost Bimatoprost is the prostaglandin agonist used in the treatment of glaucoma. Carteolol is the beta-adrenergic blocker used for treatment of glaucoma. Brinzolamide is the carbonic anhydrate inhibitor used for the treatment of glaucoma. Apraclonidine is the adrenergic agonist used in the treatment of glaucoma

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? 1 Attacks of acute pain 2 Constant blurred vision 3 Decreased peripheral vision 4 Complete loss of central vision

3 Decreased peripheral vision With glaucoma, 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.

After an assessment, the nurse finds that the client has a partial loss of peripheral vision. The client's eye examination report shows an intraocular pressure of 24 mmHg. What does the nurse suspect is causing this condition? 1 Reduced elasticity of the lens 2 Unevenness in the cornea 3 Excess production of aqueous humor 4 Presence of nontransparent substance in the vitreous humor

3 Excess production of aqueous humor Partial loss of peripheral vision and a high intraocular pressure of 24 mmHg (normal is 10 to 21 mmHg) are indicative of glaucoma. Glaucoma is typically caused by an excess production of aqueous humor. Reduced elasticity of the lens due to aging may result in loss of accommodation and presbyopia. Unevenness in the cornea may cause astigmatism. The presence of nontransparent substances in the vitreous humor may block light passing through the vitreous membrane and affect vision.

After cataract surgery the nurse teaches a client how to self-administer eye drops. The nurse reinforces the use of what technique? 1 Placing the drops on the cornea of the eye 2 Raising the upper eyelid with gentle traction 3 Holding the dropper tip above the conjunctival sac 4 Squeezing the eye shut after instilling the medication

3 Holding the dropper tip above the conjunctival sac Drops are placed within the lower lid (conjunctival sac). To protect against physical injury and infection, the dropper tip should not touch the eye. The lower lid is retracted for placement of eyedrops. Squeezing the eyes shut after administration of the medication should be avoided; this will squeeze medication out of the eye.

A client with glaucoma asks a nurse about future treatment and precautions. Which information should the nurse's explanation include? 1 Avoidance of cholinergics 2 Surgical replacement of lens 3 Continuation of therapy for life 4 Prevention of high blood pressure

3. Continuation of therapy for life 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.

Following a motor vehicle accident a client reports seeing frequent flashes of light. Which condition should the nurse be prepared to address? 1 Glaucoma 2 Scleroderma 3 Detached retina 4 Cerebral concussion

3. Detached retina The detached retina is caused by vitreous traction on the retina. Glaucoma causes the individual to see halos around lights. Scleroderma is a disease of the connective tissue, not the eye. Cerebral concussions do not result in this ocular symptom.

The nurse is assessing a client with impaired hearing. Which action of the nurse is most important for establishing a good communication with the client? 1 Speaking at a normal volume 2 Reducing environmental noise 3 Getting the client's attention before speaking 4 Rephrasing rather than repeating if misunderstood

3. Getting the client's attention before speaking The first step that the nurse should take for starting a communication with a client with impaired hearing is getting client's attention before speaking. The nurse should never shout and should always speak in a normal volume. The nurse should reduce the environmental noise before starting a conversation to avoid disturbances. The nurse should always rephrase the sentences rather than repeating if misunderstood because it can cause confusion.

Which action of the nurse would be most important to convey interest in starting a conversation with a client who has hearing loss? 1 Smiling while seeing the client 2 Nodding head in front of the client 3 Making eye contact with the client 4 Leaning forward towards the client

3. Making eye contact with the client The nurse should make eye contact with the client to show interest in starting a conversation with a client with hearing loss. Smiling while seeing the client would help to build a positive relationship. Nodding in front of the client helps to regulate the conversation. Leaning forward towards the client shows attention and awareness.

Which condition is characterized with an involuntary and rapid twitching of the client's eyeball? 1 Ptosis 2 Anisocoria 3 Nystagmus 4 Enophthalmos

3. Nystagmus Nystagmus is characterized by an involuntary and rapid twitching of the eyeball. Ptosis is characterized by drooping of eyelids. Anisocoria is characterized by a normally noticeable difference in the size of the pupils and is a normal finding in 5% of the population. Enophthalmos is characterized by the sunken appearance of the eye.

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? 1 This represents an expected finding. 2 The client may have a sensorineural deficit. 3 This is evidence of a conductive hearing loss. 4 The client has an inflammation of the mastoid.

3. This is evidence of a conductive hearing loss. Conductive hearing loss 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.

A client has primary open-angle glaucoma. The nurse expects that the client will receive a prescription for which eye drops? 1 Tetracaine 2 Cyclopentolate 3 Timolol maleate 4 Atropine sulfate

3. Timolol maleate Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical anesthetic; it will not reduce the increased intraocular pressure associated with glaucoma. Cyclopentolate is contraindicated because it dilates the pupil and paralyzes ciliary muscles. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage, which increases intraocular pressure.

A nurse is providing instructions to a client with glaucoma. Which statements made by the client indicate the nurse needs to intervene? Select all that apply. 1 "I should take stool softeners." 2 "I can wear loose collar shirts." 3 "I should refrain from sneezing and coughing." 4 "I can lift objects that weigh more than 10 lbs (4.5 kg)." 5 "I should keep my head in a dependent position."

4,5 Glaucoma is a group of eye disorders that result in increased intraocular pressure. Therefore the nurse should intervene to correct the misconceptions of keeping the head in a dependent position and lifting objects that weigh more than 10 lbs (4.5 kg). All the rest are correct statements and need no follow up. Straining to have a bowel movement leads to increased intraocular pressure. Therefore the client should be instructed to use stool softeners. Wearing tight shirt collars is to be avoided; loose collar shirts are appropriate to wear. Sneezing and coughing also lead to increased intraocular pressure and should be avoided.

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? 1 Rest the eye. 2 Dilate the pupil. 3 Prevent secondary infections. 4 Control the intraocular pressure.

4. Control the intraocular pressure. 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.

A nurse is caring for a client who is scheduled for surgery for a detached retina. Which goal of surgery identified by the client indicates that the preoperative teaching is effective? 1 Promote growth of new retinal cells. 2 Adhere the sclera to the choroid layer. 3 Graft a healthy piece of retina in place. 4 Create a scar that aids in healing retinal holes.

4. Create a scar that aids in healing retinal holes. Scar formation seals the hole and promotes attachment of the two retinal surfaces. The retina is part of the nervous system; it does not regenerate or grow new cells. The sclera is not involved; the retina adjoins and is nourished by the choroid. Grafting a healthy piece of retina in place is not the treatment used; treatment includes the formation of a scar by the use of lasers or surgical "buckling."

After sustaining a head trauma, a client reports hearing ringing noises. Which area should the nurse assess further? 1 Frontal lobe 2 Occipital lobe 3 Sixth cranial nerve (abducens) 4 Eighth cranial nerve (vestibulocochlear)

4. Eighth cranial nerve (vestibulocochlear) The eighth cranial nerve has two parts: the vestibular nerve and the cochlear nerve [1] [2] [3]. Sensations of hearing are conducted by the cochlear nerve. The frontal lobe is concerned with thinking and emotions. The occipital lobe is concerned with sight, particularly shape and color. Cranial nerve VI (abducens) is concerned with abduction of the eye.

While assessing an older adult, the nurse observes visual impairment in the client. Which technique should the nurse use to communicate? 1 Face the caregiver while speaking 2 Provide bright, diffuse, glare lighting 3 Stand or sit far away from the client while remaining in the client's full view 4 Encourage the older adult to use assistive devices such as glasses

4. Encourage the older adult to use assistive devices such as glasses If an older adult has visual impairment, the nurse should encourage the older adult to use assistive devices such as glasses. The nurse should face the older adult while speaking and should not cover his or her mouth. The light should be bright and non-glaring so that the older adult can see properly. The nurse should stand or sit closely in front of the client in full view so that the client is able to identify.

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? 1 Has not voided 2 Cannot open the eye 3 Cannot remember the date 4 Has sharp pain in the affected eye

4. Has sharp pain in the affected eye 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 nurse obtains the nursing history from a client who has open-angle (chronic) glaucoma. The nurse anticipates that the client will report which finding during the history? 1 Flashes of light 2 Sensitivity to light 3 Seeing floating specks 4 Loss of peripheral vision

4. Loss of peripheral vision Increased intraocular pressure damages the optic nerve, interfering with peripheral vision. Flashes of light may be associated with a detached retina. There is difficulty in adjusting to darkness, not an intolerance to light. Seeing floating specks is not specific to glaucoma.

A client is scheduled for a labyrinthectomy to treat Meniere syndrome. Which expected outcome of the procedure should be included in preoperative teaching? 1 Absence of pain 2 Decreased cerumen 3 Loss of sense of smell 4 Permanent irreversible deafness

4. Permanent irreversible deafness 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.