Patho Final Review Chap:
A client reports occasional ringing in the ears that worsens toward the end of the day. The most important question for the nurse to ask would be: "How often do you clean your ears?" "What prescription medication and over-the-counter medication do you take?" "Have you had any recent respiratory infections?" "Do you use Q-tips in your ears?'
"What prescription medication and over-the-counter medication do you take?" Medications and stimulants, such as aspirin, caffeine, and nicotine, can cause tinnitus. The client should be questioned to determine if this is a potential cause. Impacted cerumen is a benign cause of tinnitus, which resolves after the earwax is removed. Respiratory infections may cause fluid in the ears and decreased hearing.
What is the best menu selection for a client prescribed a low-sodium diet for Ménière disease? Salami sandwich on rye bread with pickle Baked chicken with steamed broccoli Canned spaghetti with garlic bread Seafood stir-fry with fried rice
Baked chicken with steamed broccoli A low-sodium diet helps to minimize fluid retention and has been recommended for treatment of Ménière disease. Foods high in sodium include many processed foods such as TV dinners, salty snacks, cheeses, cured meats, seafood, broths, gravy, salad dressings, pickles, and soy sauce.
A young child has been diagnosed with amblyopia. The parents ask the nurse when treatment should be considered. At what age should treatment of children with the potential for development of amblyopia be instituted? Between 10 and 18 years After 18 years Between 6 and 10 years Before 6 years
Before 6 years The treatment of children with the potential for development of amblyopia must be instituted well before the age of 6 years to avoid the suppression phenomenon.
An adult client has presented to the emergency department reporting symptoms of vertigo. Further assessment reveals that the client is ataxic and has facial weakness. The care team should consider which possible cause of this client's health problem? Cerumen impaction Auditory tumor Brain stem ischemia Acute otitis media
Brain stem ischemia Central causes of vertigo include brain stem ischemia. When brain stem ischemia is the cause of vertigo, it usually is associated with other brain stem signs such as diplopia, ataxia, dysarthria, or facial weakness. Cerumen impaction and auditory tumors can affect hearing, but not balance. Otitis media does not cause ataxia or facial weakness.
The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to: Mixed sensorineural and conduction disorder Sensorineural disorder Conduction disorder Infection
Conduction disorder Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.
Which cranial nerve is designated as the vestibulocochlear nerve? Cranial nerve III Cranial nerve IV Cranial nerve VI Cranial nerve VIII
Cranial nerve VIII The vestibulocochlear nerve is cranial nerve VIII.
The nurse is educating a client diagnosed with Meniere disease on lifestyle modifications to reduce the frequency and/or intensity of exacerbations. Which should the nurse include? Decrease dietary intake of sodium Avoid acetaminophen Avoid crowds to reduce infection Decrease dietary intake of fats
Decrease dietary intake of sodium A lifestyle change that would be recommended for a client with Meniere disease is to consume a low sodium diet, related to the medication treatment (diuretics). The other modifications are not relevant to Meniere disease.
Adult strabismus is almost always of the paralytic variety. What is a cause of adult strabismus? Huntington disease Graves disease Addison disease Parkinson disease
Graves disease Paralytic strabismus is uncommon in children, but accounts for nearly all cases of adult strabismus. It can be caused by infiltrative processes, including Graves disease, myasthenia gravis, stroke, and direct optical trauma. The other diseases have nothing to do with adult strabismus.
Why is it important for a client with a diagnosis of papilledema to follow up with a health care provider? It is usually caused by retinal detachment. It is associated with visual loss. It must not be mistaken for glaucoma. It indicates a tumor is pressing on the optic nerve.
It is associated with visual loss. Papilledema is important because it indicates a need for diagnosis of the cause. It can be associated with visual loss if unresolved and causes destruction of the optic nerve axons. It is not mistaken for glaucoma and it is not caused by retinal detachment.
During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which condition? Uveitis Arcus senilis Conjunctivitis Keratitis
Keratitis Keratitis, or inflammation of the cornea, can be caused by infections, hypersensitivity reactions, ischemia, trauma, defects in tearing, or trauma.
The cornea functions as a protective membrane. What layers of tissues form the cornea? Select all that apply. Outer epithelial layer Inner endothelial layer Substantia propria or stroma Bowman and Descement membranes
Outer epithelial layer Substantia propria or stroma Inner endothelial layer Three layers of tissue form the cornea: an extremely thin outer epithelial layer, which is continuous with the bulbar conjunctiva; a middle layer called the substantia propria or stroma; and an inner endothelial layer, which lies next to the aqueous humor of the anterior chamber. The three layers of the cornea are separated by two important basement membranes: Bowman and Descemet membranes.
A client suffers from seasonal allergic rhinoconjunctivitis. What is the best treatment for prolonged allergic conjunctivitis? Topical nonsteroidal anti-inflammatory drugs Topical mast stablizers Systemic antihistamines Histamine type 1 receptor antagonists
Systemic antihistamines The treatment of seasonal allergic rhinoconjunctivitis includes allergen avoidance and the use of cold compresses and eye washes with tear substitute. Allergic conjunctivitis also has been successfully treated with topical mast cell stabilizers, histamine type 1 (H1) receptor antagonists, and topical nonsteroidal anti-inflammatory drugs. Systemic antihistamines may be useful in prolonged allergic conjunctivitis. In severe cases, a short course of topical corticosteroids may be required to afford symptomatic relief.
A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be: Re-treating with a stronger antibiotic The child will need a hearing aid. Tympanostomy tube insertion Monitoring for complications of OM
Tympanostomy tube insertion Tympanostomy tubes should be the next course of action with the child having hearing loss and OM persisting for 4 months or longer. The parents should be taught to continue to monitor for signs of OM.
During a physical exam, the nurse practitioner notes that the client's optic disk is very pale with a larger size/depth of the optic cup. At this point, the NP is thinking that the client may have: diabetes retinopathy. glaucoma. retinal tear. macular degeneration.
glaucoma. The normal optic disk has a central depression called the optic cup. With progressive atrophy of axons caused by increased intraocular pressure, pallor of the optic disk develops, and the size and depth of the optic cup increases. Diabetes retinopathy, macular degeneration, and retinal tear do not have these clinical manifestations.
The nurse is performing a health history for a 72-year-old client. When reviewing the client's medications, the client states, "I take a baby aspirin every day, but I'm worried. I heard that aspirin can cause hearing problems!" What is an appropriate response by the nurse? "The benefits of baby aspirin outweigh the risk." "Perhaps a better alternative would be Plavix [clopidogrel]." "If your doctor ordered you to take it, I'm sure he has considered that." "A baby aspirin is a low dose that is considered to be safe."
"A baby aspirin is a low dose that is considered to be safe." A frequently overlooked ototoxic agent is aspirin. Little is known about what level of dosage causes ototoxicity, but it is generally believed that 81 mg of aspirin on a daily basis is safe.
The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be: "Increase intake of red wine to two glasses per day twice a week." "There are no dietary restrictions that you have to follow." "Cut down on takeout meals because of high amounts of monosodium glutamate." "You can drink one serving of caffeine a day and one cola."
"Cut down on takeout meals because of high amounts of monosodium glutamate." Tinnitus can be caused by some cheeses, red wine, monosodium glutamate, and caffeine. These items should be reduced in the diet to help control the symptom.
The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states: "I'll wear ear plugs each time I swim." "I will take my allergy medication as it has been prescribed." "I will use the eardrops as prescribed for me." "I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming."
"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." Otitis externa treatment usually includes the use of eardrops containing an appropriate antimicrobial or antifungal agent. Use of ear plugs is recommended to prevent moisture. Cotton-tipped applicators and other devices should be avoided.
A 31-year-old female has been recently diagnosed with type 2 diabetes mellitus, and is attending a diabetes education class. Which statement by the woman demonstrates an accurate understanding of her health problem? "It's surprising that sugar in my blood can accumulate on the lens of my eye and cause a loss of sight." "I'll have to control my blood sugars, my blood pressure, and my cholesterol in order to make sure I don't develop sight problems." "I'm grieving the fact that I won't be able to get pregnant without causing permanent damage to my vision." "I want to avoid going through the treatments for sight restoration that I would need if my diabetes causes damage to my vision."
"I'll have to control my blood sugars, my blood pressure, and my cholesterol in order to make sure I don't develop sight problems." The threat to vision that is posed by poorly controlled blood sugars is compounded by high blood pressure and/or cholesterol levels. Pregnant women with diabetes need additional care to monitor their sight, but they are not necessarily guaranteed to lose their sight. The damage caused by diabetes does not occur on the lens and restoration of lost visual acuity is not normally possible.
A 69-year-old client comes to the clinic for a routine checkup. Upon examination, the nurse practitioner informs the client that she has cataracts. The client then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner? "You are wrong and should not listen to your doctor." "The doctor was correct and you are doing everything you can to help with this condition." "Surgery is the only effective treatment for cataracts." "Strong bifocal lenses can often cure cataracts."
"Surgery is the only effective treatment for cataracts." There is no effective medical treatment for cataract. Strong bifocal lenses, magnification, appropriate lighting, and visual aids may be used as the cataract progresses, but surgery is the only treatment for correcting cataract-related vision loss. Telling the client that bifocals will cure cataracts is false as well as telling her that her doctor was correct. The other option is not a therapeutic response by the nurse.
A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo." "We usually don't actively treat BPPV unless it starts to affect your hearing." "Unfortunately there aren't any proven treatments for your condition."
"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option and even in the absence of hearing loss, treatment is warranted.
Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which teaching point by the care provider is most appropriate? "There are many drugs such as blood pressure pills, relaxants, heart medications and antihistamines that can cause tinnitus." "There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success." "This is most often the result of a psychological disturbance and therapy is often useful in relieving tinnitus." "A specialist can listen with a sensitive microphone to determine whether you are actually hearing these sounds."
"There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success." Current treatment modalities for tinnitus address the symptoms of the problem rather than curing the underlying etiology. While therapy can be of some use, it is inaccurate to characterize tinnitus as a psychological disturbance. Medications, including antihistamines, anticonvulsant drugs, calcium channel blockers, benzodiazepines, and antidepressants, have been used for tinnitus alleviation; they are not implicated as a cause. While listening to differentiate between objective and subjective tinnitus is possible, the absence of objective sounds does not mean that tinnitus does not exist, rather that it is subjective. The use of tinnitus retraining therapy, which includes directive counseling and extended use of low-noise generators to facilitate auditory adaptation to the tinnitus, has met with considerable success.
Following a serious bout of bacterial meningitis, the parents of a 14-month old have noted the child is not responding to verbal commands. The nurse will explain the pathophysiologic principle behind this by making which statement? "The ear and the lining of the brain that was infected are all connected together." "It is common for meningitis to use up all the natural killer cells and therefore increase the risk of having brain tumors develop." "This could be caused by the same organism that caused the meningitis infecting the child's tympanic membrane." "This may be due to a loss of hair cells and damage to the auditory nerve."
"This may be due to a loss of hair cells and damage to the auditory nerve." Deafness or some degree of hearing impairment is the most common serious complication of bacterial meningitis in infants and children. The mechanism causing hearing impairment seems to be suppurative labyrinthitis or neuritis resulting in the loss of hair cells and damage to the auditory nerve. There is no direct connection between the meninges of the brain and the tympanic membrane. Bacterial meningitis is not associated with an increased risk of developing a brain tumor.
The health care provider is reviewing the results of a client's caloric test. The results were as follows: the client's eyes exhibited a jerk nystagmus lasting 2 to 3 minutes, with the slow component toward the irrigated ear followed by rapid movement away from the ear. This would be interpreted as: A brainstem that has been altered by medication A nonfunctioning brain stem that requires immediate surgical intervention A nonfunctioning brain stem A functioning brain stem
A functioning brain stem Results of a caloric test in an unconscious person with a functional brain stem and intact vestibuloocular reflexes will show that the eyes exhibit a jerk nystagmus lasting 2 to 3 minutes, with the slow component toward the irrigated ear followed by rapid movement away from the ear. With impairment of brain stem function, the response becomes perverted and eventually disappears.
Which individual is most likely to be diagnosed with a central vestibular disorder? A man who states that he feels carsick whenever he rides in the back seat of a vehicle A man who got up quickly from his bed and sustained an injury after he "blacked out". A woman who has ongoing difficulty balancing herself when walking A woman who suffered a loss of consciousness after being struck on the head during a soccer game
A woman who has ongoing difficulty balancing herself when walking Central vestibular disorders are marked by a sensation of motion that interferes with balance, but that is mild and constant and chronic in duration. It should be differentiated from postural hypotension, loss of balance from a head injury, or motion sickness.
The nurse is caring for a client who reports, "My ears are constantly ringing!" The nurse will evaluate the client further for the use of which medication? Acetylsalicylic acid (aspirin) Acetaminophen Potassium chloride Vitamin C
Acetylsalicylic acid (aspirin) Tinnitus ("ringing in the ears") may be caused by aspirin.
The nurse is caring for a pediatric client whose parent reports that the child has been pulling at her ears, has a fever, and has been crying more than usual. The nurse suspects the client may be experiencing which of the following? Acute otitis media Impacted cerumen Acute vestibular neuronitis Otitis externa
Acute otitis media Acute otitis media is characterized by the following key criteria: acute onset of otalgia (or pulling of the ears in an infant), fever, hearing loss, evidence of middle ear inflammation, and middle ear effusion.
The nurse understands that an antimicrobial drug is most likely to be prescribed for which condition? Acute otitis media Otosclerosis Barotrauma Otitis media with effusion
Acute otitis media Otitis media with effusion does not usually require treatment with antimicrobial agents; however, acute otitis media is treated with antimicrobials. Barotrauma and otosclerosis are not treated with antimicrobials.
What is ocular muscle imbalance resulting in "lazy eye" called? Presbyopia Myopia Hyperopia Amblyopia
Amblyopia Ocular muscle imbalance resulting in "lazy eye" is known as amblyopia. Myopia is the error in refraction resulting from altered focus on an image in front of the retina due to lens thickness. If the anterior-posterior dimension of the eyeball is too short, the image is theoretically focused posterior to (behind) the retina. This is called hyperopia or farsightedness. The term presbyopia refers to a decrease in accommodation that occurs because of aging.
A 42-year-old client reports increasing difficulty reading the labels on packages. He states that he has to continually hold it further and further away from his face in order to see the type clearly. Which eye disorder is this client most likely experiencing? The normal decline in retinal function that occurs in adulthood. An age-related change in accommodation. Undiagnosed diabetic retinopathy. The accumulated effects of ultraviolet light exposure.
An age-related change in accommodation. The term presbyopia refers to a decrease in accommodation that occurs because of aging. This is unrelated to UV light exposure and diabetes does not normally cause a specific decline in accommodation. Presbyopia is not the result of changes in retinal function.
The nurse is working at a first aid station in an amusement park. A 45-year-old client arrives reporting severe dizziness after a ride on the roller coaster. The nurse understands that a common cause of this sensation is: Benign paroxysmal positional vertigo Acute otitis media Otosclerosis Barotrauma
Benign paroxysmal positional vertigo Benign paroxysmal positional vertigo is the most common cause of pathologic vertigo and usually develops after the fourth decade of life. It commonly occurs when the person is getting in and out of bed, bending over and straightening up, or extending the head to look up. It also can be triggered by amusement rides that feature turns and twists. The other conditions are not manifested by severe sudden vertigo.
The nursing instructor is teaching a class on diabetes and discusses complications of the disease. The instructor further states that diabetic retinopathy is one of the leading causes of blindness. What does the instructor tell the students are major risk factors for developing diabetic retinopathy? Select all that apply. Hypertension Smoking Chronic hyperglycemia Chronic hypoglycemia Hypotension
Chronic hyperglycemia Hypertension Smoking Diabetic retinopathy is one of the leading causes of blindness. Chronic hyperglycemia, hypertension, hypercholesterolemia, and smoking are risk factors for the development and progression of the disorder.
The nurse is assessing a client's risk for sensorineural hearing loss. Which condition or situation places the client at greatest risk? Otitis media Impacted earwax Chronic noise exposure Nystagmus
Chronic noise exposure Chronic exposure to noise is a risk factor for sensorineural hearing losss. Impacted earwax and otitis media are risk factors for conductive hearing loss.
As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response? Cranial nerve III Cranial nerve IV Cranial nerve VI Cranial nerve I
Cranial nerve III The CN III (oculomotor) nucleus, which extends through a considerable part of the midbrain, contains clusters of lower motor neurons for each of the five eye muscles it innervates. Because of its plane of attachment, the inferior oblique rotates the eye in the frontal plane, pulling the top of the eye laterally. In other words, as the eyes rotate upward, the upper eyelid is reflexively retracted and in the downward gaze it is lowered, restricting exposure of the conjunctiva to air and reducing the effects of drying. CN I (olfactory) innervates the nasal cavity and provides the ability of the nose to smell. CN VI (abducens) innervates the lateral rectus muscle, which abducts the eye. CN IV (trochlear) innervates the superior oblique muscle, which depresses, rotates laterally, and intorts the eyeball.
Which nursing intervention is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo? Fall precautions Skin assessment Weber test Administer ordered antibiotic
Fall precautions The client with benign paroxysmal positional vertigo (BPPV) experiences brief periods of vertigo when getting in and out of bed, bending over and straightening up, and extending head to look up. This places the client at increased risk for falls and necessitates implementation of fall precautions. The Weber test and administration of an antibiotic are not indicated when caring for a client with BPPV. Skin assessment, while always a part of the nursing assessment, has a lower priority than implementation of safety measures for this client.
The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they understand the education? It can be caused by a bacterial infection. It is another name for swimmer's ear. The tympanic membrane appears cloudy. Breast-fed babies have a higher incidence of this condition.
It can be caused by a bacterial infection. The nurse determines that the participants understand the information when they state that acute otitis media can be caused by a bacterial infection. Breast-fed babies have a lower incidence of acute otitis media. The tympanic membrane appears cloudy in otitis media with effusions. Acute otitis media is not another name for swimmer's ear.
A client has been diagnosed with hemianopia. The client asks the nurse what this is describing concerning the eye? Loss of a quarter of the visual field in one eye Loss of half of the visual field in one eye Blindness in one eye Loss of the temporal or peripheral visual fields on both sides
Loss of half of the visual field in one eye Blindness in one eye is called anopia. If half of the visual field for one eye is lost, the defect is called hemianopia; if a quarter of the field is lost, it is called quadrantanopia. Loss of the temporal or peripheral visual fields on both sides results in a narrow binocular field, commonly called tunnel vision.
Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on which factor? The child has to have bilateral congenital cataracts. The child has to be older than 5 years. The child has to be able to wear contact lenses. Maturity of the visual system at time of onset.
Maturity of the visual system at time of onset. The reversibility of amblyopia depends on the maturity of the visual system at the time of onset and the duration of the abnormal experience.
The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include: Lateral deviation Medial deviation Downward deviation Upward deviation
Medial deviation Disorders of eye movement are described according to the direction of movement. Esotropia refers to medial deviation, exotropia to lateral deviation, hypertropia to upward deviation, hypotropia to downward deviation, and cyclotropia to torsional deviation.
A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis? Her temporal bone is experiencing unusually rapid resorption. New spongy bone has been formed around her stapes and oval window. Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis. Her incus, malleus, and stapes have become disconnected from her normal neural pathways.
New spongy bone has been formed around her stapes and oval window. Otosclerosis begins with resorption of bone in one or more foci. During active bone resorption, the bone structure appears spongy and softer than normal (i.e., otospongiosis). The resorbed bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis.
Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss? Huntington disease Parkinson disease Alzheimer disease Paget disease
Paget disease More permanent causes of hearing loss are thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear due to otosclerosis or Paget disease. Huntington, Alzheimer, and Parkinson diseases are not associated with conductive hearing loss.
What is the nursing focus when the nurse performs a hearing test on a newborn infant? Increasing emotional health Improving sensory perception Preventing developmental delays Promoting communication skills
Preventing developmental delays. Early detection of hearing loss can prevent developmental delay by allowing early intervention. The hearing test on a newborn evaluates the physical ability to respond, not the ability to perform language or communication skills. The test records the infant's ability to perceive sound but does not improve it. Older adults, not infants, are at risk for depression as a result of hearing loss.
The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which medication will be prescribed to manage the symptoms? Chlorpropamide Clopidogrel Promethazine Pantoprazole
Promethazine Pharmacologic management includes suppressant drugs such as promethazine. The other medications are not used to treat Meniere disease.
The nurse is treating a client with a history of chronic alcohol abuse. The client's spouse tells the nurse that the client has no difficulty speaking and responds when spoken to but is having difficulty understanding what is being said. The spouse asks if the nurse believes the client needs a hearing aid. The nurse explains to the spouse that the client probably does not require a hearing aid but may be suffering from: Moderate hearing loss Global aphasia Expressive aphasia Receptive aphasia
Receptive aphasia Chronic alcohol abuse causes damage to the Wernicke's area in the brain, which controls a person's ability to understand spoken language, and which is termed receptive aphasia. Clients who have receptive aphasia can speak without difficulty and hear words spoken, but cannot understand what is being said.
A college junior calls his mother, a nurse, reporting "not being able to see." When questioned further, he describes the following: "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which condition and have the teenager go to the emergency department immediately? Retinal detachment Strabismus Glaucoma Macular degeneration
Retinal detachment The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur as the vitreous pulls away from the posterior pole of the eye. As detachment progresses, the person perceives a shadow or dark curtain progressing across the visual field.
An older adult client comes to the clinic complaining of seeing flashing lights and small spots. The client tells the nurse that this has been going on for over 24 hours but now it is as if there is a dark curtain whenever the client opens the eyes. The client asks the nurse if this means that blindness is imminent. What diagnosis should the nurse suspect? Glaucoma Conjunctivitis Cataracts Retinal detachment
Retinal detachment The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur. As the detachment progresses the person perceives a shadow or dark curtain across the visual field.
Which diagnostic test results indicate a client has a vestibular disturbance? Electronystagmography shows no nystagmus with focused gaze. Caloric stimulation test shows slow nystagmus toward the irrigated side for 2 to 3 minutes. Romberg test response shows increased swaying with arm drift to one side. Dix-Hallpike maneuver did not elicit vertigo or nystagmus.
Romberg test response shows increased swaying with arm drift to one side. During a Romberg test the client closes the eyes while standing with feet together and arms extended. A vestibular disorder will produce increased swaying, and arm drift toward the affected side. A caloric stimulation test instills ice water into the ear to trigger the vestibular system. The eyes should have a slow nystagmus toward the irrigated side for 2 to 3 minutes followed by rapid movement away from the irrigated side. A client should not have nystagmus when focusing on a steady object. The Dix-Hallpike maneuver is commonly used to stimulate benign positional vertigo. The test is considered normal if the client does not experience nystagmus or vertigo.
Otitis media (OM), which can occur is any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss? Haemophilus influenzae Streptococcus pneumoniae Parainfluenza Acoustic neuromas
Streptococcus pneumoniae S. pneumoniae is the most common cause of bacterial meningitis that results in sensorineural hearing loss after the neonatal period. Acoustic neuromas is a cancer that causes impaired hearing. Parainfluenza and influenza viruses are common viral pathogens in OM.
The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which measure will the nurse recommend during changes in air pressure? Mouth breathing Cupping the ears with one's hands Swallowing Forcefully coughing
Swallowing Swallowing, yawning, and chewing gum are measures that open the Eustachian tube, which equalizes air pressure in the middle ear.
The nurse observes nystagmus in a client sitting quietly without head movement. The nurse interprets this finding in which way? This is a common finding in older adult clients. This is a pathological finding. This is a normal variation in all people. This is an emergency finding that requires immediate intervention.
This is a pathological finding. Spontaneous nystagmus that occurs without head movement or visual stimuli is always pathologic and requires investigation, but is not an emergency situation.
It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss? Audioscope Audiometer Tuning fork Tone analysis
Tuning fork Tuning forks are used to differentiate conductive and sensorineural hearing loss. Audioscope, audiometer, and tone analysis do not differentiate between conductive and sensorineural hearing loss.
Which condition or situation is a risk factor for the development of acute otitis media in a child? Inappropriate ear hygiene techniques Upper respiratory infection Repeated exposure to loud noises Foreign object in the ear
Upper respiratory infection Acute OM, which refers to an acute middle ear infection, usually follows an upper respiratory tract infection. The other options may be considered risk factors for certain types of hearing loss.
The nurse is assisting a client who is undergoing the Romberg test. The nurse understands that the client will be asked to: stand with feet broadly apart. keep the arms at the sides of the body. close the eyes. touch the nose with one finger.
close the eyes. The Romberg test is used to demonstrate disorders of static vestibular function. The person being tested is requested to stand with feet together and arms extended forward so that the degree of sway and arm stability can be observed. The person then is asked to close his eyes. When visual clues are removed, postural stability is based on proprioceptive sensation from the joints, muscles, and tendons and from static vestibular reception. Deficiency in vestibular static input is indicated by greatly increased sway and a tendency for the arms to drift toward the side of deficiency.
The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of: the development of degenerative cataracts. amage to the retina leading to vision changes. imbalance between aqueous production and outflow. a breakdown of cells in the macula lutea.
imbalance between aqueous production and outflow. Increases in intraocular pressure occur when there is an imbalance between aqueous production and outflow. A cell breakdown in the macula lutea results in macular degeneration. Cataracts may cause blurring of vision but do not alter pressure.
The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as: involuntary eye movements that preserve eye fixation on stable objects in the visual field. voluntary eye movements that preserve eye fixation on stable objects in the visual field. unilateral eye movements that preserve eye fixation on unstable objects in the visual field. fixed eye movements that preserve eye fixation on unstable objects in the visual field.
involuntary eye movements that preserve eye fixation on stable objects in the visual field. Nystagmus refers to the involuntary eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. As the body rotates, the vestibuloocular reflexes cause a slow compensatory drifting of eye movement in the opposite direction, thus stabilizing the binocular fixation point.
If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This client would be diagnosed as having: cycloplegia. hyperopia. myopia. presbyopia.
myopia. If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This condition is called myopia or nearsightedness. People with myopia can see close objects without problems. Hyperopia is farsightedness. Cycloplegia is paralysis of the ciliary muscle, with loss of accommodation. Presbyopia refers to a decrease in accommodation that occurs because of aging.