Patho 8 Eye, Ear, Nose, and Throat Health Problems

A client reports sudden onset of continuous eye pain and impaired vision. Pupil dilation is noted. The nurse concludes that this assessment data is consistent with which disorder? 1. Closed-angle (narrow-angle) glaucoma 2. Open-angle glaucoma 3. Cataracts 4. Retinal detachment

1. Closed-angle (narrow-angle) glaucoma Closed- or narrow-angle glaucoma has an abrupt onset and is characterized by severe pain of sudden onset that usually lasts longer than 20 minutes. Open-angle glaucoma occurs gradually with no initial manifestations but subsequent loss of peripheral visual fields. Pain is not associated with cataracts or retinal detachment. Eliminate the diseases that do not cause pain.

Which of the following is a priority nursing diagnosis that the nurse should address for a client with epistaxis? 1. Risk for Aspiration 2. Risk for Infection 3. Acute Pain 4. Impaired Verbal Communication

1. Risk for Aspiration Blood draining into the nasopharynx poses a Risk for Aspiration. Risk for Infection and Acute Pain are appropriate nursing diagnoses related to nasal packing but are not the priorities because they do not address airway and breathing, impaired Verbal Communication is unlikely in the client with epistaxis. Consider which diagnosis poses the most immediate threat.

The nurse developing a teaching plan for a client with atrophic macular degeneration should include information about which of the following? 1. Surgical treatment options 2. Availability of aids to enhance vision and promote safety 3. Risks associated with the loss of peripheral vision 4. Antibiotic therapy

2. Availability of aids to enhance vision and promote safety Atrophic macular degeneration causes loss of central vision. Magnification devices and enhanced lighting help to promote safety. Peripheral vision remains intact. Although laser photocoagulation is effective for exudative macular degeneration, there is no treatment for the atrophic form. Since macular degeneration is not an infectious process, antibiotic therapy is not indicated. Apply knowledge of anatomy and physiology and determine what the macula does. Choose the option that can assist with the lost function.

The nurse would include which interventions in the plan of care for a client with sensorineural hearing loss? 1. Provide information about availability of hearing aids to amplify sound. 2. Educate family members about social isolation and depression. 3. Administer antibiotics as prescribed. 4. Prepare client for tympanoplasty.

2. Educate family members about social isolation and depression. The client with sensorineural hearing loss experiences social isolation and depression and may appear withdrawn. Amplification devices such as hearing aids are helpful for clients with conductive hearing loss but only amplify noxious sounds for the client with sensorineural hearing loss. Antibiotics would not be helpful for sensorineural hearing loss, and tympanoplasty is used to correct damage to structures in the middle ear. The critical word sensorineural in the stem of the question tells what type of hearing loss is being tested. Consider the psychological as well as physical problems and then determine the nursing actions needed.

An adult client presents to the emergency department a few hours after a sizeable rock hit his eye while weeding along a ditch near a busy highway. The nurse assesses the eye and finds redness and weeping, but the client denies any pain. Which early symptoms would help confirm retinal detachment? Select all that apply. 1. Pain 2. Floaters 3. Subconjunctival hemorrhage 4. Sensation of curtain drawn across the vision 5. Dark lines or spots in the field of vision

2. Floaters 4. Sensation of curtain drawn across the vision 5. Dark lines or spots in the field of vision Retinal detachment is painless, but eventually floaters, lines or spots, and visual loss will be manifested, especially if hemorrhage has occurred. Dark lines, spots, or sensation of a curtain drawn across the field of vision is a common manifestation. Subconjunctival hemorrhage is a manifestation of blunt trauma to the eye and not of retinal detachment. Consider the consequences of damage to the retina, which receives visual stimuli.

The nurse would take which priority action for the client with a penetrating eye injury from a visible foreign body? 1. Patch both eyes. 2. Immobilize the foreign body and cover the eye. 3. Irrigate the eye with copious amounts of water. 4. Administer carbonic anhydrase inhibitors as prescribed.

2. Immobilize the foreign body and cover the eye. The foreign body should not be removed or manipulated. It should be immobilized if possible and the eye covered to protect from further injury. A paper cup can be used in place of an eye patch. Patching both eyes is an appropriate intervention to prevent ocular movement but follows immobilization of the foreign body. Irrigation with water is an intervention, for chemical burns to the eyes. Carbonic anhydrase inhibitors are used to decrease intraocular pressure following blunt trauma. For emergency actions, choose the option that stabilizes the client and prevents further injury.

A client presents to the clinic with reports of pain in the cheekbones that is worse when bending forward. What other symptoms should the nurse expect if the diagnosis is acute sinusitis? Select all that apply. 1. Nausea and food intolerances 2. Nasal congestion and purulent discharge 3. Bad breath 4. Nuchal rigidity 5. Pain in the upper teeth

2. Nasal congestion and purulent discharge 3. Bad breath 5. Pain in the upper teeth Manifestations of acute sinusitis include nasal congestion with postnasal drip and purulent discharge. Bad breath is a frequent finding. With involvement of the maxillary sinuses, pain and pressure may be felt in the upper teeth. Food intolerances are not related. Nuchal rigidity would indicate a more serious problem, such as meningitis. Consider upper respiratory symptoms of infection.

The community health nurse interprets that which client is at highest risk for macular degeneration? 1. Biochemist exposed to various toxins 2. Older adult client 3. Youth hit in the eye with a baseball 4. Young adult with multiple allergies

2. Older adult client Age-related macular degeneration is the leading cause of loss of vision in clients over 50 years of age. Blunt trauma, exposure to toxins, and allergies are not known causes of macular degeneration. Consider the factors associated with macular degeneration. Note that 3 of the options include the age of the client.

The nurse notes uvular deviation when examining the oropharynx of a client reporting dysphasia and throat pain. The nurse concludes that this is consistent with which health problem? 1. Pharyngitis 2. Peritonsillar abscess 3. Esophagitis 4. Epiglottis

2. Peritonsillar abscess Peritonsillar abscess is a complication of tonsillitis and can cause unilateral swelling, which can in turn cause uvular deviation away from the affected side. Pharyngitis, epiglottitis, and esophagitis can all cause swelling and throat pain, but it is bilateral. Additionally, the nurse would not attempt to visualize the oropharynx of a client with suspected epiglottitis. The question asks for a particular presentation. Unilateral swelling, causing uvular deviation, is found only in peritonsillar abscess. Epiglottitis and pharyngitis both cause throat pain, and all 4 conditions could cause-dysphagia.

The nurse is assessing a client with Meniere's disease. What subjective assessment data does the nurse expect to obtain? 1. Bilateral hearing impairment 2. Vertigo and nausea 3. Pain when the tragus is touched 4. Tenderness over the mastoid area

2. Vertigo and nausea Ménière's disease is associated with vertigo that may last for hours, as well as fluctuating hearing loss, nausea, and vomiting. The disorder is unilateral, but because hearing is bilateral, the client often does not realize the extent of the hearing loss. Pain when the tragus is touched is indicative of otitis externa or swimmer's ear, and tenderness over the mastoid area is indicative of acute otitis media. Note that the incorrect options are found with other ear disorders.

The nurse should include which items of information in a teaching plan for the parents of an infant with acute otitis media? Select all that apply. 1. Antibiotics can be discontinued when infant is afebrile. 2. When bottle-feeding, infant should be maintained in an upright position. 3. Orange juice and other fruit juices should be eliminated 4. Cigarette smoke in the home is a significant risk factor in acute otitis media. 5. Infants should be fed in a horizontal position, not upright.

2. When bottle-feeding, infant should be maintained in an upright position. 4. Cigarette smoke in the home is a significant risk factor in acute otitis media. A higher incidence of acute otitis media is noted in infants who are bottle-fed in a horizontal position and who live in homes with smokers. The full 10- to 12-day course of antibiotic therapy must be administered. There is no relationship between the ingestion of fruit juices and acute otitis media. The wording of the question indicates the correct options contain true information. Use nursing knowledge and the process of elimination to make selections.

The community health nurse interprets that which client is at highest risk for laryngeal cancer? 1. A client who has an injury to the larynx. 2. An older adult who is 85 years old. 3. A man who has chewed tobacco and smoked for 20 years. 4. A woman who has chronic sinusitis and seasonal allergies.

3. A man who has chewed tobacco and smoked for 20 years. The 2 major risk factors for laryngeal cancer are prolonged smoking along with concomitant use of alcohol. Although the majority of cases occur in men ages 50 to 75, advancing age does not significantly increase risk. Injury to the larynx, seasonal allergies, and chronic sinusitis are not risk factors. Consider unhealthy lifestyle as etiology for many disorders.

A 60-year-old man presents to the clinic reporting having a cough and hoarseness for at least 2 months. His spouse states his voice has changed in the last few months. The nurse interprets that the client's symptoms are consistent with which health problem? 1. Gastroesophageal reflux disease (GERO) 2. Coronary heart disease (CAD) 3. Laryngeal cancer 4. Chronic sinusitis

3. Laryngeal cancer These symptoms, along with dysphagia, foul-smelling breath, and pain when drinking hot or acidic fluids, are common signs of laryngeal cancer. Chronic sinusitis can produce foul breath and pain or burning in the throat. Gastroesophageal reflux disease and coronary heart disease may produce epigastric and/ or chest pain, but hoarseness and change of voice do not occur. Recall that these are classic warning signs of cancer.

The nurse notes a cloudy appearance to the lens of an 80-year-old client's eye. Which additional assessment finding would help confirm the diagnosis of cataracts? 1. Sense of a curtain falling over the visual field 2. Persistent, dull eye pain 3. Loss of red reflex 4. Double vision

3. Loss of red reflex A cloudy-appearing lens is symptomatic of cataract development. As the cataract matures, the red reflex is lost. A sense of a curtain falling over the visual field is associated with detached retina. Eye pain and double vision are not associated with cataracts. Recall normal assessment findings related to the eye. Consider what other assessment changes would occur if the lens is clouding.

The nurse is caring for a client immediately after surgery. The client has nasal packing. What is the most important action that the nurse should take to provide safe care to this client? 1. Provide frequent oral care. 2. Ensure adequate intake of oral fluids. 3. Monitor respiratory function and oxygen saturation. 4. Administer analgesics as prescribed.

3. Monitor respiratory function and oxygen saturation. All of the nursing actions listed are appropriate for the client following nasal packing for epistaxis or surgery; however, the risk of respiratory and cardiovascular complications is high, and monitoring respiratory function is essential, and therefore of highest priority. Notice the question asks for the priority intervention. Use the process of elimination and physiological priorities in making a selection.

A client has just been diagnosed with angle closure (narrow-angle or closed-angle) glaucoma. The nurse assesses the client for which common presenting symptoms of this disorder? Select all that apply. 1. Halo vision 2. Dull eye pain 3. Severe eye and face pain 4. Impaired night vision 5. Sudden loss of vision

3. Severe eye and face pain 5. Sudden loss of vision Angle closure or narrow-angle glaucoma develops abruptly and manifests with sudden loss of vision and acute face and eye pain. It is a medical emergency. Halo vision, dull eye pain, and impaired night vision are symptoms commonly associated with open-angle glaucoma. Use nursing knowledge to answer the question. If none of the options are recognizable, keep in mind that when options are opposite, one of them is more likely to be correct.

A young child has had a recent upper respiratory infection. The child now reports severe pain in the right ear and says, "I can't hear." The nurse concludes that the pathology that led to this problem is most likely which of the following? 1. Tympanic membrane has ruptured causing hearing loss 2. Child has been exposed to secondhand smoke, which caused an acute allergic response 3. Narrowed auditory tube impaired equalization of pressure in the middle ear, stopping air from entering 4. Edema of the auditory tube followed the respiratory infection, impairing drainage of the middle ear

4. Edema of the auditory tube followed the respiratory infection, impairing drainage of the middle ear In acute otitis media, the auditory tube provides entry of pathogens. This infection typically follows an upper respiratory infection. Edema of the tube causes mucus and fluid to accumulate and the pathogens to grow. There is no evidence in the question to indicate rupture of the tympanic membrane or exposure to secondhand smoke. Impaired pressure equalization is not suggested by these symptoms. Consider the history of upper respiratory infection (URI) and apply knowledge of complications. Also remember that the client is a child.

A male client has just had a cataract operation with a lens implant. In discharge teaching, the nurse will instruct the client's wife to do which of the following? 1. Prepare only soft foods for several days to prevent facial movement. 2. Encourage sleeping on the affected side for greater comfort. 3. Have her husband resume all normal activities starting the next day. 4. Instill eye drops correctly.

4. Instill eye drops correctly. Postoperative information includes limitations on reading, lifting, strenuous activity, and sleeping on the affected side. A family member needs to be taught to instill eye drops. There are no dietary restrictions. Consider which activities are necessary and which restrictions are needed for safety and home care after eye surgery.

A client is diagnosed with conductive hearing loss and asks how this occurred. The nurse's response should include which statement about conductive hearing loss? 1. Has an unknown etiology 2. Occurs as a result of damage to the hair cells of the inner ear 3. Usually results from chronic exposure to loud noise 4. Occurs as a result of damage to the middle ear structures

4. Occurs as a result of damage to the middle ear structures Conductive hearing loss results from changes that occur in the external or middle ear. Hearing aids, assistive listening devices (i.e., "pocket talkers"), and reconstructive surgeries can improve or correct hearing loss. Exposure to high levels of noise on an intermittent or constant basis damages the hair cells of the organ of Corti, resulting in sensorineural hearing loss. Note the clarifying word conductive in the stem of the question that identifies the type of hearing loss. Read the question carefully and choose the option that is consistent with this form of hearing loss.

The nurse should anticipate that a client with suspected sensorineural bearing loss will be evaluated using which of the following methods? Select all that apply. 1. Tympanocentesis 2. Transillumination of the sinuses 3. Electronystagmography 4. Weber and Rinne tests 5. Audiometry

4. Weber and Rinne tests 5. Audiometry Weber and Rinne tests are used to differentiate conductive hearing loss from sensorineural. Audiometry is used to evaluate and diagnose sensorineural and conductive hearing loss. Tympanocentesis is the aspiration of fluid or pus from the middle ear to identify the causative organism of acute otitis media. Transillumination of the sinuses is a diagnostic tool used to assess for sinusitis. The diagnosis of Ménière's disease is confirmed by electronystagmography, a series of tests to evaluate vestibular-ocular reflexes. Decode unfamiliar terms by finding the root word and prefixes or suffixes. Note the wording of the question indicates that more than one option is correct.