prep u 4
The nurse assesses gross hearing and performs the Weber and Rinne tests. It also is important to determine the extent and effect of the client's disability.
The nurse caring for a client with Ménière's disease makes which primary assessments?
Determine whether the client can count fingers.
The nurse is assessing a client's visual acuity using a Snellen chart. The client states he cannot read the letter at the top of the chart. What action should the nurse do next?
The infection usually lasts less than 6 weeks conductive hearing loss may occur purulent exudate usually present in middle ear
Which statements are consistent with acute otitis media?
dizziness
Which term refers to an altered sensation of orientation in space?
nuclear
Which type of cataract is caused by central opacity of the lens?
optic nerve 4
The accompanying illustration depicts the neural pathway for vision. Which of the numbered areas is responsible for receiving the stimulus from the retina?
The radiation dosage
is dependent on the sensitivity of the target tissues to radiation and on the tumor size. The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue.
lung sounds
A client has received several treatments of bleomycin. It is now important for the nurse to assess
Myringotomy
A patient has serous otitis media with significant hearing loss in the right ear. The patient states, "I have not been able to hear for 2 months." What procedure does the nurse anticipate preparing the patient for?
Provide time for the patient to discuss her concerns.
A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?
Wash and rinse hair before test but do not apply any other hair products.
A patient is scheduled to have an auditory brain stem response in 2 days. What does the nurse instruct the patient to do in preparation for the test?
Beta-blockers
decrease aqueous humor production.
Dizziness may be associated
with inner ear disturbances. Vertigo is the illusion of movement wherein an individual senses that they or their surroundings are moving. Tinnitus refers to a subjective perception of sound with internal origin. Nystagmus refers to involuntary rhythmic eye movement.
Alterations in carbohydrate, fat, and protein metabolism Endocrine dysfunction Anemia
A patient near the end of life is experiencing anorexia-cachexia syndrome. What characteristics of the syndrome does the nurse recognize?
An antifibrinolytic agent
, aminocaproic acid (Amicar), stabilizes clot formation at the site of hemorrhage. Corticosteroids, antiplatelets, and diuretics do not have this action. Aspirin is contraindicated.
During an ophthalmic assessment
, the nurse should examine the appearance of the external eye and the pupil responses in the client. A qualified examiner determines internal eye function, visual acuity, and intraocular pressure.
During the Weber test
, which tests bone conduction, a client with a conductive hearing loss hears sound on the affected side by bone conduction. Hearing sound on the unaffected side by bone conduction occurs in sensorineural hearing loss. Also, during the Rinne test, the client with sensorineural hearing loss hears sound longer through air conduction than through bone conduction.
"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."
A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?
various diagnostic studies
A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor.
Test the client's visual acuity.
A client comes to the clinic for a routine examination. After obtaining the ocular history, which of the following would the nurse do next?
Durable power of attorney for health care
A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?
closely monitor for at least 3 months
A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation?
presbyopia
A client has noticed needing to hold printed material at arms length to make the print readable. What is the term used to describe this visual condition?
Macular degeneration
A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause?
It inhibits deoxyribonucleic acid (DNA) synthesis.
A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects?
It interferes with DNA replication and RNA transcription.
A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?
show movement of the GI tract.
A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will:
Asks the client to open his or her mouth to facilitate inspection of the oral mucosa Instructs the client to brush the teeth with a soft toothbrush Consults with the healthcare provider about use of nystatin
A client with cancer is receiving chemotherapy and reports to the nurse that his or her mouth is painful and has difficulty ingesting food. What actions should the nurse take?
over the course of several visists
A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?
inhalation of aerosols.
A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through:
increase intake of calcium rich foods
A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:
Profound protein loss
A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following?
The health care provider provides the means for the clients to take their life.
A nurse is caring for a terminally ill client inquiring about physician-assisted suicide. Which statement if made by the nurse would correctly inform the client of this practice?
Ask the client to rate the dyspnea on a scale of 0 to 10.
A nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client's complaint?
A proxy directive
A patient authorizes a son to make medical decisions and brings the completed forms for the nurse to place on the chart. What form does the nurse understand this is?
closed awareness
A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is?
Aspergillus
A patient has been diagnosed with a fungal infection causing external otitis. What is the most common fungal infection in the ear?
in the canal
A patient's range of hearing loss is diagnosed as "mild-moderately severe." The nurse knows that the audiologist would recommend which of the following hearing aid sites?
20
According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level?
client diagnosed with Ménière disease.
Alcohol, high salt, monosodium glutamate, and caffeine can worsen symptoms of Ménière disease by affecting fluid levels in the inner ear. There are no restrictions on spicy food for clients displaying symptoms of Ménière disease. Milk and whole grains are encouraged in a
"An implanted lens has replaced the need for corrective glasses."
An elderly client is scheduled for cataract surgery and asks the nurse, "Will I need to wear pop-bottle lenses after surgery?" Which is the most appropriate response from the nurse?
conduction problems
An initial, convenient assessment of an older adult client's complaint of hearing loss would be inspection, using an otoscope, for the presence of impacted cerumen. Which of the following is a primary cause of an external ear disorder in the elderly?
Otalgia is ear pain or an earache. Otalgia has several causes, one of which is accumulated earwax.
An older adult client reports pain in the ears and an unusual sense of fullness. The client also indicates not hearing as well as in the past. On inspection, the nurse notes that there is an accumulation of earwax in the client's ears. The client is suffering from:
middle ear
Approximately 3 in 4 children experience an ear infection by the time they are 3 years of age. The infection usually lasts less than 6 weeks. Conductive hearing loss may occur. A purulent exudate is usually present in the
lung and colon
Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women?
Flushing the lids, conjunctiva, and cornea with tap water or normal saline.
Chemical burns of the eye are immediately treated by:
health care power of attorney medical power of attorney proxy directive
Durable power of attorney for health care
Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening?
Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.
bed rest
Nursing management of the client with acute symptoms of benign paroxysmal positional vertigo includes
apical pulse reaches 100 beats per minute
How does a nurse who has been providing home care to a terminally ill client know that the client's condition is beginning to deteriorate?
The client states he cannot read the letter at the top of the chart. What action should the nurse do next? (Snellen chart)
If the client cannot read the top letter of the Snellen chart, then the nurse needs to determine whether the client can count fingers. If the client can count fingers, then the nurse will hold up a random number of fingers, starting 5 feet away, moving forward until the client can clearly count the fingers. A complete visual acuity assessment should be completed before the findings are documented. The tumbling "E" chart is administered in the same fashion as the Snellen chart and is used for people who are illiterate or cannot read the English alphabet. The nurse should not complete an internal eye examination as the next action.
Alcohol High-salt foods Monosodium glutamate Caffeine
It is important for the nurse to educate clients newly diagnosed with Ménière disease to avoid which foods in their diet?
Whistling Noise
Loose ear mold Improperly made Improperly worn Worn out
older than 60 years of age.
Macular degeneration is the most common cause of visual loss in people
aging visual changes relate to which of the following?
The changes that occur in vision during aging, which include difficulty reading and the need for reading glasses, include changes in accommodation. Accommodation occurs when the ciliary muscles contract or relax to focus an image on the retina.
an 8 lb weight loss
The client is 45 years old and has a family history of breast cancer. The client was diagnosed with breast cancer 2 months ago. During a routine visit, the physician prescribes dexamethasone to be taken over a 3-week period. Which symptom would prompt the physician to add dexamethasone to the client's treatment plan?
Preparing cool or cold foods that may be better tolerated
The family of a dying client being cared for at home is requesting information on how best to prepare food. Which suggestion by the nurse may stimulate appetite?
to dilute the effectiveness of the agent that is causing the burn.
The immediate response is to always flush the affected eyelid and eye with normal saline or tap water
95%
The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue?
Aspergillus .
The most common bacterial pathogens associated with external otitis are Staphylococcus aureus and Pseudomonas species. The most common fungus isolated in both normal and infected ears is
slow rate of growth
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic?
brachytherapy
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as
Clearly articulate Speak in a lower tone Face the client when speaking Speak in a clear voice
The nurse is obtaining subjective data from a client with difficulty hearing. In order to assist the client in hearing the nurse's voice, which adjustments are made?
"To detect corneal abrasions, a slit lamp is used."
The nurse is precepting a nursing student when a new client comes to the eye clinic. The client explains that she thinks she may have a corneal abrasion. The nurse should explain what to the student nurse?
cohesion and boundaries
The nurse is providing care to a family who is facing a life-threatening illness. The nurse is assessing how family members bond and how the family works as a team. The nurse is assessing which of the following?
The way a person dies is of great individual importance. Pain is viewed as a mechanism for cleansing. Death occurs through God's permission
The nurse is providing care to a terminally ill client and his family who practice the Islamic faith. Which of the following concepts would the nurse need to integrate into this client's plan of care?
vision pathway
The stimulus from the retina is sent to the optic nerve (option D) and then through the optic chiasm (option C), to the optic tract (option B), eventually reaching the visual cortex in the occipital lobe of the brain.
dietary substances
What are considered carcinogens?
Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles
Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening?
Appearance of the external eye
Which feature should a nurse observe during an ophthalmic assessment?
palliative
Which type of surgery is used in an attempt to relieve complications of cancer?
living will
a type of advance directive I in which the individual documents treatments preferences, instruction for care, accompanied with durable POA for health. also known as medical directive or treatment directive
Cholinergics increase
aqueous fluid outflow by contracting the ciliary muscle, causing miosis, and opening the trabecular meshwork. Beta-blockers decrease aqueous humor production. Alpha-adrenergic agonists decrease aqueous humor production. Carbonic anhydrase inhibitors decrease aqueous humor production.
People who have myopia
are said to be nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. Myopic people experience blurred distance vision.
Presbyopia is
associated with aging and results in difficulty with near vision. People with presbyopia hold reading material or handwork at a distance to see it more clearly.
hyphemia
blood in the anterior chamber of the eye in front of the iris
Aerosol inhalation or absorption through the skin
can cause accidental chemotherapy exposure. A nurse must wear a disposable gown and gloves when preparing and administering chemotherapy. She won't absorb chemicals through an intact gown, protective gloves, or goggles.
Mydriatics
cause pupillary dilation. .
Bed rest is recommended
for clients with acute symptoms. Canalith repositioning procedures may be used to resolve attacks of vertigo, and clients with acute vertigo may be medicated with meclizine for 1 to 2 weeks. The Epley procedure is not recommended for clients with acute vertigo. The Dix-Hallpike test is an assessment test used to evaluate for benign paroxysmal positional vertigo.
Exudative retinal detachment results
from the production of a serous fluid under the retina from the choroid from such conditions as uveitis and macular degeneration. Trauma and diabetes (specifically, retinopathy associated with diabetic neovascularization) are associated with rhegmatogenous retinal detachment. Hypertension is associated with retinal vascular occlusion.
Bleomycin
has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.
An "in the canal"
hearing aid is used for mild to moderately severe hearing loss. It is cosmetically pleasing but requires good manual dexterity. Refer to Table 50-1 in the text.
Dexamethasone initially
increases appetite and may provide short-term weight gain in some clients
miotics cause
pupillary constriction.
Opacity of the lenses
relates to cataract formation. The main markers of the efficacy of the medication in glaucoma control are lowering of the IOP to the target pressure, appearance of the optic nerve head, and the visual field.
The nurse should advise patients recovering from cataract surgery to eat
soft, easily chewed foods until healing is complete to avoid tearing from excessive facial movements. Eating spinach or collard greens two to four times per week reduces the risk of macular degeneration and increasing the intake of vitamins A and C is essential for preventing cataracts; however, these have no implications on recovery from cataract surgery.
Conductive hearing loss
usually results from an external ear disorder, such as impacted cerumen, or a middle ear disorder, such as otitis media or otosclerosis. In such instances, the efficient transmission of sound by air to the inner ear is interrupted.
Opacity of the lens
Which of the following would not be included as a marker of medication effectiveness in glaucoma control?
Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.
Which statement is accurate regarding refractive surgery?
Miotics
Which group of medications causes pupillary constriction?
Avoiding criticizing or giving advice
Which intervention should a nurse perform during the grieving period when caring for a dying client?
macular degeneration
Which is the most common cause of visual loss in people older than 60 years of age?
Cholinergics
Which medication classification increases aqueous fluid outflow in the client with glaucoma?
ask family about spiritual care
Which of the following interventions should the nurse perform while providing spiritual care for a dying client?
focus on client's basic needs
Which of the following is an appropriate method of assessing the dying client?
Eat soft, easily chewed foods.
Which of the following is the correct advice regarding food for a patient who underwent a cataract surgery?
Maintaining client comfort Supporting family members Providing personal care
Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family?
Prevent optic nerve damage
Which of the following is the overall aim of glaucoma treatment?
beta blockers
Which of the following medications decreases the production of aqueous humor?
clinicians attitude toward terminally ill
Which of the following remains the greatest barrier to improving end-of-life care?
A nuclear cataract is caused
by central opacity in the lens and has a substantial genetic component. Cortical cataracts involve the anterior, posterior, or equatorial cortex of the lens. Vision is worse in very bright light. Posterior subcapsular cataracts occur in front of the posterior capsule. Near vision is diminished, and the eye is increasingly sensitive to glare from bright light. A subluxated cataract requires the entire lens to be removed, as with a partially or completely dislocated lens.
Snellen chart
chart containing symbols that is used in the testing of visual acuity, sharpness of vision
After obtaining the client's ocular history,
the nurse would test the client's visual acuity. Then the nurse would examine the client's external eye. Direct ophthalmoscopy would follow, and then other examinations, such as a slit-lamp examination, would be done.
Beta blockers decrease
the production of aqueous humor, with a resultant decrease in IOP. Miotics and sympathomimetics decrease the size of the pupil, facilitating the outflow of the aqueous humor, which decreases IOP. Mydriatics dilate the pupil.
Changes in accommodation
The nurse is caring for geriatric clients who state that they are prescribed reading glasses. Some individuals state needing assistance with seeing writing far away, and others need assistance with closer vision. The nurse is correct to understand that the aging visual changes relate to which of the following?
inability to differentiate colors
The nurse is correct to anticipate the client being able to identify numbers and shapes dictated by different color codes. The other options do not test for color vision or indicate an .
The nurse would anticipate the client identifying numbers and shapes.
The nurse is evaluating the client while taking the color vision test. Which response would the nurse anticipate when caring for a client with normal color vision?
Antifibrinolytics
A patient has been diagnosed with hyphema. Which of the following medication classifications stabilizes clot formation at the site of hemorrhage?
maintaining balances diet
Which of the following would not be consistent with promoting nutrition in terminally ill patients?
A slit lamp is
a binocular microscope that magnifies the surface of the eye. A beam of light, narrowed to a slit, is directed at the cornea, facilitating an examination of structures and fluid in the anterior segment of the eye. This examination is used to identify disorders such as corneal abrasions, iritis, conjunctivitis, and cataracts. Options A, B, and D are not used to detect corneal abrasions.
on the affected side by bone conduction.
a client is diagnosed with a conductive hearing loss. When performing a Weber test, the nurse expects that this client will hear sound:
According to federal guidelines
hospices may provide no more than 20% of the aggregate annual patient-days at the inpatient level.
Refractive surgery
is an elective procedure and is considered a cosmetic procedure (to achieve clear vision without the aid of prosthetic devices). It is performed to reshape the cornea for the purpose of correcting all refractive errors. Refractive surgery will not alter the normal aging process of the eye. Clients with conditions that are likely to adversely affect corneal wound healing (corticosteroid use, immunosuppression, elevated intraocular pressure) are not good candidates for the procedure. The corneal structure must be normal and refractive error stable.
A myringotomy (i.e., tympanotomy)
is an incision in the tympanic membrane. Under microscopic guidance, an incision is made through the tympanic membrane to relieve pressure and to drain serous or purulent fluid from the middle ear.
anorexia- cachexia syndrome
is characterized by disturbances in carbohydrate, protein, and fat metabolism; endocrine dysfunction; and anemia. The syndrome results in severe asthenia (loss of energy).
The aim of all glaucoma treatment
is prevention of optic nerve damage. Although treatment cannot reverse optic nerve damage, further damage can be controlled. Reattachment of the retina is not part of glaucoma treatment.
vision pathway to the brain
optic nerve
visual acuity
the ability to see fine detail. sharpness of vision
ear mold loosens or wears out.
A patient visited a health clinic with a complaint that her hearing aid was making a whistling noise. The nurse is aware that this hearing aid problem occurs frequently when the:
Blurred distance vision.
An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by:
How does a nurse who has been providing home care to a terminally ill client know that the client's condition is beginning to deteriorate?
Failing cardiac function is one of the first signs that a client's condition is worsening. At first, heart rate increases in a futile attempt to deliver oxygen to cells. The apical pulse rate may reach 100 or more beats/minute. In clients who are dying, the skin becomes pale or mottled, nail beds and lips may appear blue, and the client may feel cold. In clients who are dying, urine volume decreases, and the jaw and facial muscles relax.
types of awareness
In closed awareness, the patient is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the patient suspects what others know and attempts to find out details about his or her condition. In mutual pretense awareness, the patient, the family, and the health care professionals are aware that the patient is dying, but all pretend otherwise. In open awareness, the patient, the family, and the health care professionals are aware that the patient is dying and openly acknowledge that reality.
Vision is usually restored after
cataract surgery with an intraocular lens implant. Contact lenses can be used but can be burdensome for the elderly. Corrective glass lenses can cause a distortion of peripheral vision and only required one lens (over operative eye). To restore vision after cataract surgery, a lens is required.
Adrenergic agonists
increase aqueous outflow but primarily decrease aqueous production with an action similar to that of beta-blockers and carbonic anhydrase inhibitors
The auditory brain stem response
is a detectable electrical potential from cranial nerve VIII and the ascending auditory pathways of the brain stem in response to sound stimulation. Electrodes are placed on the patient's scalp and on each earlobe. Patients are instructed to wash and rinse their hair prior to this study but to avoid applying any other hair product.
