chapter 22

While assessing a patient with systemic lupus erythematosus (SLE), the nurse observes the patient rubbing the eyes frequently and decreased tear production. What condition should the nurse educate the patient regarding? 1 Cataract 2 Strabismus 3 Keratoconus 4 Keratoconjunctivitis sicca

4

A patient is diagnosed with strabismus. The nurse expects the patient to exhibit which symptoms? 1 Inability to focus two eyes simultaneously on the same object 2 Inability to accommodate for near objects 3 Discomfort, pruritus, and redness in the eye 4 Red, swollen, and acutely tender area in the lid margin

4

A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention? 1 Walking behind the patient holding the patient's back 2 Describing the environment to the patient while walking 3 Helping the patient to sit by placing the patient's hand on the seat of the chair 4 Standing slightly in front and to one side of the patient and providing elbow for support

1

The nurse is assessing a patient for esotropia. What sign observed by the nurse is clinically significant related to this disorder? 1 Eye deviating in 2 Eye deviating up 3 Eye deviating out 4 Eye deviating down

1

The nurse is preparing a patient for ultrasonography of the eye. Of what should the nurse inform the patient while explaining the test procedure? 1 "You will not experience pain during the test." 2 "You may have difficulty focusing on near objects for three to four hours after the test." 3 "You may have nausea and yellow-orange urine after the test." 4 "You should fixate on the center dot and record abnormalities of the grid lines during the test."

1

The patient has described a loss of central vision. What test should the nurse teach the patient about to identify changes in macular function? 1 Amsler grid test 2 B-scan ultrasonography 3 Fluorescein angiography 4 Intraocular pressure testing with Tono-pen

1

Which condition is caused by a refractive error in the eye? 1 Myopia 2 Cataract 3 Glaucoma 4 Conjunctivitis

1

Which instruction is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? 1 Discard all opened or used lens care products. 2 Disinfect contact lenses by soaking in a cleaning solution for 48 hours. 3 Put all used cosmetics in a plastic bag for one week to kill any bacteria before reusing. 4 Disinfect all lens care products with the prescribed antibiotic drops for one week after infection.

1

Identify risk factors associated with development of cataracts. Select all that apply. 1 Advanced age. 2 History of diabetes mellitus. 3 Exposure to ultraviolet light. 4 Eating a diet high in lutein. 5 History of eye chronic open angle glaucoma. 6 History of prolonged therapy with systemic corticosteroid

1 2 3 6

The adult child of a patient with macular degeneration asks the nurse how to avoid developing the condition. Which intervention should the nurse include in teaching? Select all that apply. 1 Stop smoking or do not start. 2 Avoid exposure to ultraviolet light. 3 Wash hands before touching face or eyes. 4 Wear eye protection while doing yard work. 5 Eat green leafy vegetables such as spinach or kale daily

1 2 5

A nurse provides education to a group of people about eye health care. Which statements by group indicate that the teaching has been understood? Select all that apply. 1 "Wash hands regularly to prevent the spread of diseases." 2 "Avoid removing contact lenses if there is redness and pain in the eye." 3 "Wear sunglasses and ensure proper nutrition to prevent cataract development." 4 "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." 5 "Regular eye checkups help in early detection of disease and prevent further loss of vision.

1 3 4 5

Which nursing intervention is the highest priority for a patient who has undergone retinal surgery? 1 Positioning and activity as preferred by surgeon 2 Monitoring the blood pressure 3 Preventing fluid volume excess Maintaining a darkened environment

1 Postoperatively, the patient may be on bed rest and may require special positioning to maintain proper positioning to maintain proper position of an intravitreal bubble. The level of activity restriction after retinal surgery varies greatly, depending on the patient and surgeon. Monitoring blood pressure and preventing fluid volume excess are not necessarily related to post-retinal surgery care. Maintaining a darkened environment is not necessary and may present a risk for falling. Text Reference - p. 397

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. About which surgical procedure that will be used to relieve traction on the retina will the nurse educate the patient ? 1 Vitrectomy 2 Cryotherapy 3 Photodynamic therapy 4 Ocular coherence tomography

1 Vitrectomy is the surgical removal of the vitreous and is used to relieve traction on the retina caused especially by proliferative diabetic retinopathy. Cryotherapy is a procedure used to seal retinal breaks. Photodynamic therapy is a procedure used to treat age-related macular degeneration. Ocular coherence tomography is used to identify fluid in the central retina; it determines the need for continued intravitreal injections. Text Reference - p. 397

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? 1 "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." 2 "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." 3 "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." 4 "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

2

Which part of the eye is inflamed in keratitis? 1 Sclera 2 Cornea 3 Conjunctiva 4 Eyelid margins

2

A nurse administered tropicamide in both eyes of a patient in the preoperative room before cataract surgery. What is the most important nursing intervention for this patient? 1 Brighten the room with extra lights. 2 Instruct the patient to wear dark glasses. 3 Monitor for pulmonary effects of the drug. 4 Reassure the patient that the surgery will be uneventful.

2

A patient has received a prescription for natamycin eyedrops. The nurse recognizes that the probable reason for the medication is that the patient is experiencing what? 1 Myopia 2 Astigmatism 3 Acanthamoeba keratitis 4 Generalized poor hygiene of the eye

3

A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. About what treatment option does the nurse educate the patient? 1 Filtration surgery 2 Photodynamic therapy 3 Laser photocoagulation 4 Argon laser trabeculoplasty

3

A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? 1 Use suitable coping strategies to reduce stress 2 Identify patient's strengths and support system 3 Verbalize feelings related to visual impairment 4 Transition successfully to the sudden vision loss

3

The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering? 1 Oral acyclovir 2 Trifluridine drops 3 Topical corticosteroids 4 Topical vidarabine ointmen

3

The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom? 1 Carteolol 2 Dipivefrin 3 Carbachol 4 Latanoprost

3

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? 1 Apply pressure to each eyeball for a few seconds after administration. 2 Have the patient close the eyes and move them back and forth several times. 3 Have the patient put pressure on the inner canthus of the eye after administration. 4 Have the patient try to blink out excess medication immediately after administration

3

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, on what should the nurse focus? 1 Recognizing that eye damage caused by glaucoma can be reversed in the early stages. 2 Giving anticipatory guidance about the eventual loss of central vision that will occur. 3 Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision. 4 Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies.

3

Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos? 1 Strabismus 2 Keratoconus 3 Exposure keratitis 4 Keratoconjunctivitis sicca

3

While evaluating a patient the nurse suspects primary open-angle glaucoma if which classic symptom is present? 1 Vacillating pupil 2 Constant tearing 3 Decreased peripheral vision 4 Colored halos around lights

3

An otoscopic examination of a patient reveals a positive Schwartz's sign. A tuning fork test and an audiogram demonstrate air-bone gaps. Which statement describes the disorder these tests are used to diagnose? 1 Free-floating debris in the semicircular canal causes vertigo with specific head movements. 2 A unilateral benign tumor grows where the vestibulocochlear nerve enters the internal auditory canal. 3 The spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window. 4 The patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.

3 The patient has otosclerosis, which can be diagnosed with otoscopic examination revealing a positive Schwartz's sign along with tuning fork tests and an audiogram identifying air-bone gaps. In otosclerosis, spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window, thereby reducing the transmission of vibrations to the inner ear fluids. This results in conductive hearing loss. In benign paroxysmal positional vertigo (BPPV), free-floating debris in the semicircular canal causes vertigo with specific head movements, such as getting out of bed, rolling over in bed, and sitting up from lying down. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve enters the internal auditory canal. The tumor can compress the trigeminal and facial nerves and arteries within the internal auditory canal. In Ménière's disease, the patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor. Text Reference - p. 405

A 68-year-old patient has undergone a total hip replacement and has glaucoma. The nurse forms a nursing diagnosis of disturbed sensory perception related to increased intraocular pressure. The plan of care should focus on which main element? 1 Use of occupational and physical therapy for visual deficits 2 Managing the pain using oral antiinflammatories and opioids as needed 3 Restriction of driving privileges immediately 4 Encouraging medication compliance to reduce the risk of vision loss

4

A nurse is comparing otosclerosis and otitis media with effusion. Which statement is correct regarding these two diseases? 1 Otosclerosis can be caused by changes in air pressure, whereas otitis media with effusion follows chronic sinus infections. 2 Otosclerosis is an inflammation of the middle ear, whereas otitis media with effusion is a hereditary recessive disease. 3 Otosclerosis may be accompanied by a reddish blush of the tympanum, whereas otitis media with effusion is accompanied by purulent discharge from the ear. 4 Otosclerosis is treated by oral administration of sodium fluoride, with vitamin D and calcium carbonate, whereas otitis media with effusion does not require antibiotic therapy.

4

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing intervention should be the nurse's priority? 1 Teach about visual enhancement techniques. 2 Teach nutritional strategies to improve vision. 3 Assess coping strategies and support systems. 4 Assess impact of vision on normal functioning

4

Prevention of vision loss resulting from chronic open angle glaucoma is accomplished best by which intervention? 1 Tobacco smoking cessation 2 Yearly ophthalmic examination 3 Eating a diet high in green leafy vegetables and lysine 4 Strict adherence to prescribed eye drop medication schedule

4

The nurse is caring for a patient suspected of having age-related macular degeneration. What symptoms should the nurse document and report regarding this disorder? 1 Decreased vision, abnormal color perception 2 Sudden, excruciating pain in the eye 3 Itching, burning, and redness 4 Blurred, darkened vision

4

The patient needs, but does not want, a corneal transplant because of difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this? 1 If the transplant is done soon after the donor dies, there will not be as much trouble recovering vision. 2 The astigmatism the patient is experiencing may be corrected with glasses or rigid contact lenses. 3 Increasing the amount of light and using a magnifier to read will be helpful if a transplant is not wanted. 4 There are newer procedures in which only the damaged cornea's epithelial layer is replaced, and these procedures have a faster recovery.

4

What should the nurse include in the teaching plan for a patient who has just had cataract surgery with intraocular lens implantation? 1 Use saline eye drops as needed. 2 Wear the eye patch and shield at all times. 3 Cough and deep-breathe at least every 2 hours 4 Don't drive for 10 days or until you are seen by the surgeon.

4

When administering a scheduled dose of pilocarpine, in which area should the nurse place the drops? 1 Inner canthus 2 Outer canthus 3 Center of the eyeball 4 Lower conjunctival sac

4

Which condition involves inflammation of the vitreous cavity? 1 Uveitis 2 Blepharitis 3 Otitis media 4 Endophthalmitis

4

The nurse is preparing to perform irrigation of the ear canal for a patient with impacted cerumen. What is the correct order of steps for this process? Correct 1. Place the patient in a sitting position. Correct 2. Put the emesis basin under the ear. Correct 3. Pull the auricle up and back. Correct 4. Direct the flow of solution above or below the impaction.

Management of cerumen impaction involves irrigation of the ear canal with body temperature solutions to soften the cerumen using special syringes. First, the patient should be placed in a sitting position, and an emesis basin is put under the ear. The nurse should then pull the auricle up and back. Finally, the solution is to be flowed directly above or below the impaction. Text Reference - p. 403

The nurse recalls that presbycusis is hearing loss primarily caused by: 1 Traumatic injury 2 Congenital defect 3 Conductive defect 4 Sensorineural loss

4

The nurse is preparing a patient for penetrating keratoplasty. What disorder does the nurse determine the patient is being treated for? 1 Retinopathy 2 Corneal scars 3 Chronic open-angle glaucoma 4 Age-related macular degeneration

2

A nurse is obtaining a health history from a patient with decreased visual acuity. Which question related to sexuality is relevant for this patient? 1 "Do you use birth control pills?" 2 "How many children do you have?" 3 "Do you have regular periods?" 4 "Do you and your partner use condoms during intercourse?"

1

A patient has a prescription to receive timolol two drops to both eyes every 12 hours. The nurse would withhold the dose and question the prescription if the patient had which condition? 1 Asthma 2 Urinary retention 3 Cluster headaches 4 Chronic constipation

1

A patient informs the nurse that he or she is using a homemade saline solution to store contact lenses but is now having irritation and soreness. The nurse assesses inflammation of the cornea. About what medication does the nurse anticipate educating the patient? 1 Natamycin 2 Tropicamide 3 Besifloxacin 4 Acetazolamide

1

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. About which surgical procedure that will be used to relieve traction on the retina will the nurse educate the patient ? 1 Vitrectomy 2 Cryotherapy 3 Photodynamic therapy 4 Ocular coherence tomography

1

A patient is having a surgical procedure that involves using extreme cold to create an inflammatory response to produce a sealing scar. What procedure will the nurse educate the patient regarding? 1 Cryopexy 2 Scleral buckling 3 Pneumatic retinopexy 4 Laser photocoagulation

1

The nurse provides education to a patient with Ménière's disease. What long-term effect of the disease should the nurse include in the teaching? 1 Hearing loss 2 Double vision 3 Chronic vertigo 4 Chronic headaches

1

The nurse, using a tuning fork to assess the patient for differences in air and bone conduction, recalls that this is known as the: 1 Rinne test 2 Weber test 3 Schilling test 4 Standard hearing tes

1

Which auditory disorders are related to the inner ear? 1 Presbycusis 2 Cholesteatoma 3 Serous otitis 4 Acoustic neuroma

1

Which treatment is administered to fight infection in a patient with external otitis? 1 Antibiotics 2 Corticosteroids 3 Mild analgesics 4 Irrigation of the cana

1

A nurse is explaining measures to prevent external otitis to a group of patients. Which interventions should the nurse include in the teaching? Select all that apply. 1 Keep the ears as dry as possible. 2 Avoid using hairdryers to dry the external ear. 3 Report any itching in the ear. 4 Avoid putting anything in the ear canal. 5 Use earplugs when swimming.

1 3 4 5 External otitis is associated with the inflammation or infection of the epithelium of the auricle and ear canal. External otitis can be prevented by keeping the ears as dry as possible because moisture promotes bacterial growth. However, if itching becomes a problem, it should be immediately reported. The patient should be advised to avoid inserting anything into the ear, because this may cause infection. Water in the swimming pool may be contaminated or contain chemicals that alter the flora of the external canal. Therefore earplugs should be used at the time of swimming. A hair dryer set to low and held at least six inches from the ear can speed water evaporation. Text Reference - p. 403

A patient presenting with an itching, burning sensation and redness in the eye is diagnosed with allergic conjunctivitis. What interventions are most important to ease the symptoms? Select all that apply. 1 Instruct the patient to avoid the allergen if it is known. 2 Instruct the patient to wash hands regularly. 3 Administer artificial tears, as prescribed. 4 Administer topical antihistamines and corticosteroids. 5 Instruct the patient to use individual or disposable towels.

1 3 4 Allergic conjunctivitis is caused by exposure to any allergen. If the allergen is known, the patient should be instructed to avoid the allergen as much as possible. Artificial tears can be used to dilute the allergen and wash it from the eye. Topical antihistamines and corticosteroids can be used to further decrease the symptoms. Hand washing and using individual or disposable towels are general measures to prevent the spread of infection, but they are not specific to allergic conjunctivitis. Text Reference - p. 391

The nurse reviews a patient's health assessment and notes the abbreviation: PERRLA under vision. Which assessment finding is included in this abbreviation? Select all that apply. 1 Pupils are round 2 Retina responds to light 3 Lacrimal apparatus is functioning 4 Intraocular pressure is even and within normal 5 Pupils constrict when the patient focuses on a nearer object

1 5

Which surgical procedure involves an incision in the tympanum to release the increased pressure and exudate from the middle ear? 1 Myringotomy 2 Stapedotomy 3 Tympanoplasty 4 Mastoidectomy

1 A myringotomy is a surgical procedure being performed on a patient with acute otitis media. It involves an incision in the tympanum to release the increased pressure and exudate from the middle ear. A stapedotomy is a microdrill or laser surgical treatment that involves opening the footplate as a part of collaborative care of otosclerosis. A tympanoplasty, also called a myringoplasty, involves reconstruction of the tympanic membrane and/or the ossicles of a patient with otitis media. A mastoidectomy is a surgery performed along with a tympanoplasty to remove the infected portions of the mastoid bone in a patient with chronic otitis media. Text Reference - p. 404

Which statement is true regarding a patient with conductive hearing loss? 1 This patient hears better in a noisy environment. 2 This patient can hear sound, but not understand speech. 3 This patient speaks very loudly because of an inability to hear his or her own voice. 4 This patient does not benefit from using a hearing aid, because it makes speech clearer, not louder

1 A patient with a conductive hearing loss hears better in a noisy environment. A patient with sensorineural hearing loss hears sound but does not understand speech. A patient with conductive hearing loss often speaks softly because his or her own voice seems loud. If correcting the cause of conductive hearing loss is not possible, a hearing aid may help if the loss is greater than 40 to 50 dB. For a patient with sensorineural hearing loss, the hearing aid may not always help because it only makes sounds and speech louder, not clearer. Text Reference - p. 407

A nurse reviews the medical record for a patient with acute glaucoma for which acetazolamid has been prescribed. The patient has a history of high-dose aspirin therapy. Considering the concomitant use of the medications, the nurse expects what change in medication prescriptions? 1 The patient cannot take both medications due to gastric disturbances. 2 The dose of acetazolamide will be decreased. 3 There will be no change in prescriptions of either medication. 4 The patient will be advised to take acetazolamide at a different time than aspirin.

1 Acetazolamide is used in the treatment of glaucoma. The patient is on high-dose aspirin therapy; therefore acetazolamide is avoided because it increases the risk of gastric disturbances. Decreasing the dose of acetazolamide may not decrease the risk of developing complications. A combination of acetazolamide and aspirin is not recommended because it can cause GI upset. Taking acetazolamide at a different time than aspirin does not prevent drug interactions and should be avoided. Text Reference - p. 400

What is a possible effect of cold otic drops administered in the ear canal? 1 Vertigo 2 Tympanum burn 3 Barotrauma 4 Infection

1 Administration of cold ear drops can cause vertigo due to the stimulation of the semicircular canals of the ear. Hot drops, not cold drops, can burn the tympanic membrane of the ear. For this reason, ear drops are instilled at room temperature. Barotrauma of the ear is ear discomfort caused by pressure changes. Increased air or water pressure can cause this. Microorganisms such as bacteria or fungi cause infection to the ear. Eardrops are not responsible for this. Text Reference - p. 403

Which instruction should the nurse give the patient who is prescribed verteporfin for age-related macular degeneration? 1 "You should avoid direct exposure to sunlight while on treatment." 2 "You can wear clothes with short sleeves after receiving treatment." 3 "You should avoid lutein-containing green leafy vegetables while on treatment." 4 "You should consume vitamin E-containing foods but avoid vitamin C-containing foods after receiving treatment."

1 Age-related macular degeneration is an eye condition that leads to the deterioration of the macula, leading to loss of central vision. Verteporfin is a photosensitizing drug that becomes active when exposed to a low-level laser light wave or sunlight and may cause thermal burns. Therefore, the nurse instructs the patient to avoid direct exposure to sunlight. The patient should cover the body completely, rather than wear short sleeves, because any exposure of the skin to sunlight could activate the medication in that area, resulting in a thermal burn. Lutein-containing green leafy vegetables do not react with verteporfin. Therefore, there is no need of avoiding lutein-containing green leafy vegetables. Vitamins C and E are helpful in reducing the risk of age-related macular degeneration. Text Reference - p. 398

The nursing student prepares a chart on the diagnostic tests and treatments associated with different auditory problems. Which disease has the nursing student correctly associated with its diagnostic test and treatment?, 1 External otitis 2 Chronic otitis media 3 Endolymphatic hydrops 4 Otitis media with effusion

1 External otitis involves inflammation or infection of the epithelium of the auricle and ear canal. Pseudomonas aeruginosa is the most common bacterial cause of this disease. Culture and sensitivity studies of the drainage can be used to diagnose external otitis. Topical treatments may include antibiotic drops for infection and corticosteroids for inflammation. Chronic otitis media can involve the mastoid bone, so mastoid x-ray is one of the diagnostic tests for this disease. However, a labyrinthectomy is not used for treating chronic otitis media; instead, it can be used as surgical therapy for Ménière's disease. In otosclerosis, tuning fork tests and an audiogram demonstrate a difference of at least 20 to 25 dB between air and bone conduction levels of hearing. Otosclerosis can be treated surgically by replacing the stapes with a metal or Teflon prosthesis. Endolymphatic hydrops, or Ménière's disease, is not diagnosed by the air-bone gap, nor treated with a prosthetic stapes. For the diagnosis of Ménière's disease, tests are done to rule out CNS disease; it is treated with antihistamines and benzodiazepines during an acute attack. This is not how otitis media with effusion is diagnosed or treated. Text Reference - p. 404

A patient reports sudden, severe pain in the eye accompanied by nausea and vomiting. The assessment findings of the patient indicated optic nerve atrophy and peripheral visual field loss. Which drug will the nurse expect to be prescribed by the primary healthcare provider? 1 Betaxolol 2 Besifloxacin 3 Tropicamide 4 Ranibizumab

1 Glaucoma is a group of disorders characterized by increased intraocular pressure and optic nerve atrophy and peripheral visual field loss. The symptoms of glaucoma are pain in or around the eye, nausea, and vomiting. Betaxolol is an antiglaucoma drug that decreases intraocular pressure. Besifloxacin is an antibiotic that is used to treat acute bacterial conjunctivitis. Tropicamide is a cycloplegic that is used to produce pupillary dilation. Ranibizumab is a selective inhibitor of endothelial growth factor that is used to slow vision loss in age-related macular degeneration. . Text Reference - p. 400

A patient is having retinal hemorrhages, anoxic cotton-wool spots, and macular swelling in the eye. What should the nurse closely monitor that is a contributing factor to this disorder? 1 Blood pressure 2 Glucose level 3 Thyroid hormone levels 4 Intraocular pressure

1 Hypertensive retinopathy is caused by high blood pressure that creates blockages in retinal blood vessels. The eye examination of a patient with hypertensive retinopathy reveals retinal hemorrhages, anoxic cotton-wool spots, and macular swelling. If the eye examination shows capillary microaneurysms, retinal swelling, and hard exudates, then the nurse will suspect nonproliferative retinopathy and high blood glucose level. Exposure keratitis is seen in patients who cannot close their eyes adequately because of protruding eyeballs, which is caused by increased thyroid hormone. Angle-closure glaucoma occurs because of pupil dilation. When the pupil remains partially dilated long enough, it may result in increased intraocular pressure. Text Reference - p. 395

An asthmatic patient is diagnosed with chronic glaucoma. The patient is prescribed carteolol. In regard to patient safety, what action should the nurse take? 1 Do not administer carteolol and notify the health care provider. 2 Ask the health care provider to decrease the dose of carteolol. 3 Suggest the patient only use carteolol for a short period of time. 4 Explain to patient that carteolol may cause vomiting

1 In an asthmatic patient, administration of carteolol should be avoided because it causes bronchospasm. Decreasing the dose and suggesting that the patient only use the medicine for a short period of time do not reduce the risk of bronchospasm. Vomiting is not a side effect of carteolol. Text Reference - p. 400

The nurse is discussing glaucoma prevention with a 52-year-old African American patient. Which statement by the patient reflects a correct understanding of glaucoma prevention? 1 "I will visit my eye doctor every one to two years." 2 "I will wear protective sunglasses while outside." 3 "I will take lutein and vitamin E supplements for eye health." 4 "There is nothing that can be done to prevent vision loss from glaucoma."

1 Loss of vision as a result of glaucoma is a preventable problem. Teach the patient and the caregiver about the risk of glaucoma and that it increases with age. Stress the importance of early detection and treatment in preventing visual impairment. A comprehensive ophthalmic examination is important in identifying persons with glaucoma or those at risk of developing glaucoma. The current recommendation is for an ophthalmologic examination every two to four years for persons between ages 40 and 64 years, and every one to two years for persons age 65 years or older. African Americans in every age category should have examinations more often because of the increased incidence and more aggressive course of glaucoma in these individuals. Wearing protective sunglasses while outside may help to reduce the development of cataracts, not glaucoma. Lutein and vitamin supplements may be helpful for preventing macular degeneration, not glaucoma. Text Reference - p. 401

The nurse, who is reinforcing medication teaching before administering the scheduled dose of pilocarpine, would include which statement? 1 "You will need someone to drive you home." 2 "This medication should be used as needed to reduce eye pain." 3 "Eye irritation is to be expected during the first two weeks of use." 4 "This medication will help to raise intraocular pressure to a near normal level."

1 Pilocarpine causes blurred vision and difficulty focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Pilocarpine will not reduce eye pain, will not cause eye irritation, and will decrease, not increase, intraocular pressure. Text Reference - p. 400

The patient experiences loss of high-pitched sounds but understands speech with good response to sound amplification. Which statement accurately describes the patient's condition? 1 There is loss of sensory hair cells. 2 There is stiffening of the basilar membrane. 3 There are degenerative changes in the cochlea. 4 There is atrophy of the blood vessels in the wall of the cochlea

1 Presbycusis is hearing loss associated with aging. Loss of sensory hair cells occurs in the case of neural presbycusis; as a result the patient experiences loss of high-pitched sounds. The patient, however, correctly understands speech and responds well to sound amplification. Stiffening of the basilar membrane occurs with cochlear presbycusis, and this condition interferes with sound transmission in the cochlea. With this disorder, speech discrimination is affected with higher-frequency losses. Degenerative changes in the cochlea, termed as neural presbycusis, results in loss of speech discrimination. In the case of metabolic presbycusis, there is atrophy of the blood vessels in wall of the cochlea. Such patients experience uniform loss for all frequencies accompanied by recruitment. Text Reference - p. 411

Otoscopic examination of the ear reveals the presence of a living insect in the ear canal. What is the nurse's first action in this case? 1 Apply a drop of lidocaine. 2 Apply a drop of antibiotics. 3 Apply a drop of mild lubricant. 4 Apply a drop of corticosteroids

1 The nurse should use lidocaine drops to kill any insect that may have entered the ear canal of the patient. The removal of the insect should be done after this with microscope guidance. Antibiotics are used to control infection in the ear. A mild lubricant in the ear is used to soften the earwax. Corticosteroids control inflammation in the ear. Text Reference - p. 403

The nurse assesses a patient with an inner ear problem. What is the most significant symptom for which the nurse should be alert in this patient? 1 Vertigo 2 Tinnitus 3 Headaches 4 Hearing loss

1 The patient with an inner ear problem will most often complain of vertigo, because the inner ear is directly related to maintenance of equilibrium and balance. The patient should be assessed by the nurse because of the safety implications. A patient with an inner ear issue may manifest tinnitus (ringing or buzzing in the ear), headaches, or hearing loss. Vertigo presents the greatest safety risk. Text Reference - p. 405

The nurse is reviewing refractive errors of the eye. Which statement does the nurse identify as being true? 1 Presbyopia occurs when the eyeball elongates. 2 Astigmatism is caused by an irregular corneal curvature. 3 Myopia is an inability to accommodate for near objects. 4 Hyperopia is an inability to accommodate for objects at a distance

2

The patient calls the clinic about a stye that the patient has had for some time on the upper eyelid. The patient says warm moist compresses have been used, but it is no better. What should the nurse tell the patient to do? 1 "Go to the pharmacy to get some eye drops." 2 "Come in so the ophthalmologist can remove the lesion for you." 3 "The health care provider will need to inject it with an antibiotic." 4 "Wash the lid margins with baby shampoo to remove the crusting.

2

What behavior does the nurse assessing a patient with hearing loss expect to encounter? 1 Answering questions appropriately 2 Irritability with others not speaking up 3 Aggressiveness 4 Constant repetition

2

Which decibel loss indicates moderately severe hearing impairment? 1 52 dB 2 60 dB 3 85 dB 4 110 db

2

While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team? 1 Place the patient in a flat supine position. 2 Stabilize the foreign object within the injury site. 3 Instruct the patient to bend over and take deep breaths. 4 Continuously irrigate the eye with sterile saline solution

2

While examining the eye of a patient, the nurse finds a cone-shaped anterior cornea. Which other finding is associated with this condition? 1 Pain 2 Blurred vision 3 Corneal inflammation 4 Abnormal color perception

2

The patient is given an oral dose of glycerol followed by serial audiograms over three hours. Which symptom did the nurse assess in the patient? 1 Presence of positive Schwartz's sign 2 Aural fullness and fluctuating sensorineural hearing loss 3 Reduction in touch sensation in the posterior ear canal 4 A painless condition with hearing loss, nausea, and episodes of dizziness

2 A glycerol test is a diagnostic test aimed to confirm Ménière's disease. The symptoms of this disorder include aural fullness and fluctuating sensorineural hearing loss. A series of audiograms over three hours is done after the patient is given an oral dose of glycerol. Improvement in hearing or speech discrimination occurs due to the osmotic effect of glycerol that pulls fluid from the inner ear. An otoscopic examination, the Rinne test, the Weber test, audiometry, and tympanometry are the diagnostic tests used to confirm otosclerosis. Such patients show positive Schwartz's sign. Patients with acoustic neuroma have reduced touch sensation in the posterior ear canal. Diagnostic tests to confirm acoustic neuroma include neurologic, audiometric, and vestibular tests; CT scans; and MRI. A mastoid x-ray is one of the tests used to diagnose chronic otitis media. This is a painless auditory disorder with hearing loss, nausea, and episodes of dizziness. Text Reference - p. 405

A patient is using dipivefrin for the treatment of glaucoma. For what side effects should the nurse educate the patient to monitor? Select all that apply. 1 Depression 2 Tachycardia 3 Hypertension 4 Bronchospasm 5 Taste alteration

2 3

A patient, discharged after eye surgery, is told to avoid activities that will increase intraocular pressure. Which activities should the patient avoid? Select all that apply. 1 Eating 2 Lifting 3 Coughing 4 Bending over 5 Breathing deeply

2 3 4

What instructions should the nurse include when teaching a patient how to administer ear drops? Select all that apply. 1 Administer cold, not warm, drops. 2 The ear should be positioned so that the drops can run into the canal. 3 The position of the ear should be maintained for two minutes to let the drops spread. 4 The tip of the dropper should not touch the ear. 5 The drops should not be put in using a cotton wick placed in the ear canal.

2 3 4 When administering ear drops, the patient should position the ear so that the drops run into the canal, and this position should be maintained for two minutes to let the drops spread. The dropper should not touch the ear; avoiding contact reduces the spread of infection. The ear drops should be at room temperature when administered. Cold drops can cause vertigo; very warm drops can burn the tympanic membrane. Text Reference - p. 404

A patient, discharged after eye surgery, is told to avoid activities that will increase intraocular pressure. Which activities should the patient avoid? Select all that apply. 1 Eating 2 Lifting 3 Coughing 4 Bending over 5 Breathing deeply

2 3 4 Activities such as coughing, bending over, and lifting, increase the pressure within the eye. Eating and breathing deeply do not involve straining or lowering the head, so the pressure within the eye is not increased. Text Reference - p. 394

The nurse is interviewing an elderly patient who has a hearing loss. Which strategies would best assist the nurse in communicating with this patient? Select all that apply. 1 Overenunciate speech. 2 Use simple sentences. 3 Speak normally and slowly. 4 Exaggerate facial expressions. 5 Avoid distracting environments. 6 Raise the voice to a higher pitch.

2 3 5

A patient admitted to the hospital has been taking pilocarpine eye drops at home. What is the desired effect of this medication? Select all that apply. 1 Reverses damage to the optic nerve. 2 Facilitates aqueous humor outflow. 3 Improves the patient's vision in dim light. 4 Lessens the amount of pupillary dilation. 5 Decreases the amount of fluid within the eye.

2 4

The patient with Ménière's disease had decompression of the endolymphatic sac to reduce the frequent and incapacitating attacks the patient was experiencing. What should the nurse include in the discharge teaching for this patient? 1 Airplane travel will be more comfortable now 2 Avoid sudden head movements or position changes 3 Cough or blow the nose to keep the eustachian tube clear 4 Take antihistamines, antiemetics, and sedatives for recovery

2 After ear surgery the patient should avoid sudden head movements or position changes. Airplane travel should be avoided at first, because increased pressure and ear popping normally are experienced, which will disrupt healing. The patient should not cough or blow the nose, because this increases pressure in the eustachian tube and middle ear cavity and may disrupt healing. Antihistamines, antiemetics, and sedatives are used to decrease the symptoms of acute attacks of Ménière's disease. Text Reference - p. 406

Which visual problem will the nurse suspect in the patient who has symptoms of itching, irritation, intolerance towards light, with crusts on the lid margins and lashes? 1 Cataract 2 Blepharitis 3 Retinal detachment 4 Allergic conjunctivitis

2 Blepharitis is a common chronic bilateral inflammation of the lid margins associated with crusts on the lid margins. Blepharitis is also associated with itching, irritation, and photophobia. Cataract is a clouding of the lens in the eye, which affects vision by abnormal color perception and glaring. Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium. The symptoms of retinal detachment are photopsia and seeing a ring or cobwebs in the field of vision. Allergic conjunctivitis is caused by exposure to an allergen and is associated with itching and swelling. Text Reference - p. 389

Which type of hearing loss involves an inability to interpret sound, including speech, because of a problem in the central nervous system (CNS)? 1 Mixed hearing loss 2 Central hearing loss 3 Conductive hearing loss 4 Sensorineural hearing loss

2 Central hearing loss involves an inability to interpret sound, including speech, because of a problem in the CNS. Mixed hearing loss occurs due to a combination of conductive and sensorineural causes. In conductive hearing loss, the patient often speaks softly because hearing his or her own voice seems loud. Sensorineural hearing involves a diminished ability to hear high-pitched sounds, including consonants, because of the impairment of function of the inner ear or the vestibulocochlear nerve (CN VIII). Text Reference - p. 407

A patient receiving injectable gentamicin for acute diarrhea complains of tinnitus, diminished hearing, and dizziness. What is the most appropriate nursing action? 1 Decrease the drug dosage. 2 Stop the drug immediately. 3 Plug the ear canals with cotton. 4 Reassure the patient that the effects are temporary

2 Gentamicin is an ototoxic drug, and the nurse should monitor the patient for ototoxic effects, such as tinnitus, diminished hearing, and changes in equilibrium. If the patient experiences these symptoms, the drug should be immediately stopped. The symptoms may reverse after discontinuing the drug. Decreasing the dosage may still be ototoxic. Reassuring the patient that symptoms may be temporary and plugging the ears may not contribute to management of symptoms. Text Reference - p. 409

hich part of the eye is inflamed in keratitis? 1 Sclera 2 Cornea 3 Conjunctiva 4 Eyelid margins

2 Keratitis is an infection or inflammation of the cornea. Scleritis involves inflammation of the sclera. Inflammation of the conjunctiva is a clinical manifestation of conjunctivitis. Blepharitis is associated with inflammation of the margins of both eyelids. Text Reference - p. 391

A nursing student is preparing a chart on the various problems associated with different parts of the ear. Which chart entry indicates that the nursing student has correctly mapped the disease with the part of the ear involved, and the cause of the disease? 1 BPPV 2 Otosclerosis 3 Ménière's disease 4 Chronic otitis media

2 Otosclerosis affects the internal ear. It is a hereditary autosomal dominant disease and therefore caused by genetic factors. BPPV is an infection of the inner ear, not the middle ear. Head trauma, infection, or degeneration from the aging process injures the utricle, which leads to the formation of debris known as "ear rocks." This debris leads to BPPV by causing vertigo with specific head movements. Ménière's disease does affect the inner ear. However, its cause is unknown; excessive accumulation of endolymph in the membranous labyrinth is an effect of this disease, not its cause. Chronic otitis media affects the middle ear, not the inner ear. Also, it is caused by repeated attacks of otitis media, especially in adults who have a history of recurrent otitis in childhood. Text Reference - p. 404

Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells? 1 Filtration surgery 2 Photodynamic therapy 3 Laser photocoagulation 4 Argon laser trabeculoplasty

2 Photodynamic therapy treats AMD by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells. Filtration surgery is the treatment for chronic open-angle glaucoma but not for AMD. Laser photocoagulation is used for treatment of proliferative retinopathy. Argon laser trabeculoplasty is a noninvasive procedure to lower the intraocular pressure in glaucoma. Text Reference - p. 398

In presbyopia the lens of the eye loses flexibility and is unable to accommodate close vision. The nurse recognizes that this condition generally occurs in: 1 Adolescents and young adults 2 Men and women older than 40 3 Men between the ages of 30 and 50 4 Women between the ages of 20 and 40

2 Presbyopia is an age-related change in vision that generally occurs in men and women older than 40 years. Adolescents and young adults are not subject to the condition, and it does not affect one gender exclusively. Text Reference - p. 387

Which type of presbycusis is associated with the loss of sensory hair cells? 1 Neural 2 Sensory 3 Cochlear 4 Metabolic

2 Sensory presbycusis is associated with atrophy of the auditory nerve and loss of sensory hair cells. Neural presbycusis is associated with degenerative changes in the cochlea and spinal ganglion. Cochlear presbycusis is associated with stiffening of basilar membrane. Metabolic presbycusis is associated with atrophy of the blood vessels in the wall of cochlea. Text Reference - p. 411

A patient experiences an attack of Ménière's disease. Which intervention is most important for the nurse to include in the patient's plan of care? 1 Increased fluid intake 2 Decreased environmental stimuli 3 Provision of the patient's regular diet 4 Assessment for orthostatic hypotension

2 The etiology of Ménière's disease is not well understood, but stress and excessive sensory stimulation are possible causes. Decreasing environmental stimuli is one approach to treatment and controlling the severity of the symptoms. Fluid intake should be decreased; this may ease the symptoms, because in Ménière's disease there is an increase in the endolymphatic fluid of the inner ear. It is believed this causes disease symptoms. If there is no nausea and vomiting the patient may eat a regular diet as tolerated, but this is not as high a priority as decreasing environmental stimuli is. Patients may experience tinnitus and vertigo, but the blood pressure is not affected, so orthostatic hypotension does not occur. Text Reference - p. 401

When using the otoscope, the nurse is unable to see the landmarks or light reflex of the tympanic membrane. The tympanic membrane is bulging and red. What does the nurse think is most likely occurring in the patient's ear? 1 Swimmer's ear 2 Acute otitis media 3 Impacted cerumen 4 Chronic otitis media

2 The manifestations of the inability to see the landmarks or light reflex of the tympanic membrane and the bulging and redness of the tympanic membrane are those of acute otitis media. With swThe manifestations of the inability to see the landmarks or light reflex of the tympanic membrane and the bulging and redness of the tympanic membrane are those of acute otitis media. With swimmer's ear and chronic otitis media, there is frequently drainage in the external auditory canal. Impacted cerumen would block the visualization of the tympanic membrane. Text Reference - p. 404

A patient reports an inability to see near objects. The nurse recalls that which physiologic condition is responsible for this disorder? 1 Cornea having irregular curvature 2 Light rays focusing behind the retina 3 Incoming light rays bending unequally 4 Light rays focusing in front of the retina

2 The patient with an inability to see near objects suffers from hyperopia or farsightedness. In this case, the light rays focus behind the retina. Normally the light rays should focus on the retina for near objects. This type of refractive error occurs when the cornea or lens does not have adequate focusing power or when the eyeball is too short. Irregular corneal curvature and incoming light rays bending unequally are associated with astigmatism. Focusing light rays in front of the retina is the sign of myopia. Text Reference - p. 387

A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? 1 "Papilledema is caused by irritants and microorganisms." 2 "Papilledema is fluid accumulation between two layers within the retina." 3 "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." 4 "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

3

A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching? 1 Restrict activity at home. 2 Wear a nighttime eye shield. 3 Do not bend, stoop, cough, or lift. 4 Wash hands before touching the eye.

3

Which nursing intervention is most appropriate for facilitating communication with a patient who has a hearing impairment? 1 Speaking loudly and shouting if necessary 2 Asking the patient questions that can be answered with a yes or no response 3 Standing close to the patient and speaking slowly and clearly in a normal tone 4 Standing to one side of the patient when speaking and directing the voice directly into the patient's ear

3

Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? 1 "You may feel some palpitations after instilling these eye drops." 2 "You should withhold this medication if your blood pressure becomes elevated." 3 "You may have some temporary blurring of vision after instilling these eye drops." 4 "You should keep your eyes closed for 15 minutes after instilling these eye drops.

3

Which statement of the student nurse indicates the need for further learning about age-related macular degeneration (AMD)? 1 "AMD is related to retinal aging." 2 "Family history is a major risk factor for AMD." 3 "People with dark-colored eyes are more at the risk for AMD." 4 "Long-term exposure to ultraviolet light is a risk factor for AMD

3

patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? 1 "Papilledema is caused by irritants and microorganisms." 2 "Papilledema is fluid accumulation between two layers within the retina." 3 "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." 4 "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

3

A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient? 1 Glaucoma leads to detachment of the retina. 2 Glaucoma results from chronic eye inflammation. 3 Glaucoma results in increased intraocular pressure. 4 Glaucoma is caused by decreased blood flow to the retina

3 In chronic open-angle glaucoma the outflow of aqueous humor is obstructed, leading to increased intraocular pressure. The increased intraocular pressure eventually causes destruction of the nerve fibers of the retina and painless vision loss, beginning in the periphery. Glaucoma does not cause detachment of the retina, result from chronic inflammation, or result from decreased retinal blood flow. Text Reference - p. 398

A patient is diagnosed with otitis media with effusion. The nurse expects that the patient will most likely exhibit what symptoms? 1 Pain, fever, malaise, and reduced hearing 2 Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness 3 Feeling of fullness of the ear, a plugged feeling or popping, and decreased hearing 4 Limited movement of the footplate of the stapes in the oval window.

3 Otitis media with effusion is an inflammation of the middle ear with an accumulation of fluid in the middle ear space. The patient may complain of a feeling of fullness of the ear, a plugged feeling or popping, and decreased hearing. The fluid may be thin, mucoid, or purulent. Pain, fever, malaise, and reduced hearing are symptoms of acute otitis media. Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness are signs of Ménière's disease. Spongy bone developments from the bony labyrinth, preventing movement of the footplate of the stapes in the oval window, are signs of otosclerosis. Text Reference - p. 404

A patient has just been fitted with a new hearing aid. Which statement by the patient reflects a correct understanding of care and use of hearing aids? Select all that apply. 1 "I will replace the batteries monthly." 2 "I need to clean the ear molds daily." 3 "I will disconnect or remove the batteries when not in use." 4 "I will always keep them in their storage box when I am not wearing them." 5 "I will wear this at home at first to get used to how it works while it is quiet."

3 4 5

Which is the most powerful hearing aid available for use by patients with hearing loss? 1 In the ear 2 In the canal 3 Behind the ear 4 Completely in the cana

3 A behind-the-ear hearing aid is the most powerful hearing aid and is used for all types of hearing loss. An in-the-ear hearing aid is used for mild to severe hearing loss, which provides powerful amplification. An in-the-canal hearing aid is also used for mild to severe hearing loss. A hearing aid set completely in the canal is used for mild to moderate hearing loss. Text Reference - p. 409

Which symptom occurs initially with retinal detachment? 1 Redness of the conjunctiva. 2 Increased glare with artificial light. 3 Seeing flashes of light and floaters. 4 Severe pain when moving the eyes

3 A detached retina involves the separation of the sensory retina from the underlying pigment epithelium. Fluid accumulates in the space and blocks essential nourishment and circulation to retinal cells. Initially symptoms include seeing flashes of light, an increased amount of floaters, or lines in the vision field. If the detachment advances, there is a loss of vision peripherally or centrally, depending where the detachment has occurred. Eye irritation or infection causes redness of the conjunctiva. Increased glare that interferes with visual acuity is noted by patients with cataracts. Inflammation or infection within the eye causes pain with eye movement. Text Reference - p. 396

During assessment, the nurse finds rough sandpaper-like changes to the upper border of the auricle of the patient. What does this observation indicate? 1 Otosclerosis 2 Cholesteatoma 3 Actinic keratoses 4 Chronic otitis media

3 Actinic keratoses are premalignant lesions associated with chronic sun exposure. The upper border of the auricle with premalignant lesions looks like rough sandpaper. Otosclerosis is a hereditary autosomal dominant disease that results in hearing loss and mostly affects young adults. Cholesteatoma is the mass of epithelial cells and cholesterol that develops in the middle ear, which may enlarge and destroy the adjacent bones. Chronic otitis media is a painless condition of the ear characterized by a purulent exudate and inflammation that can involve the ossicles, the auditory tube, and the mastoid bone. Text Reference - p. 403

The nurse assesses a patient with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin. What action does the nurse anticipate providing to assist with the relief of discomfort due to this condition? 1 Administration of artificial tears 2 Insertion of intacs on the cornea 3 Application of a warm, moist compress four times a day 4 Administration of nonsteroidal antiinflammatory eye drops

3 Hordeolum is an infection of the sebaceous glands in the lid margin. The symptoms of hordeolum are a red, swollen, circumscribed, and acutely tender area near the eye. The only treatment that may be necessary for this patient is to apply warm, moist compresses four times a day, which will decrease the swelling and redness of the eye. Administering artificial tears is the treatment for allergic conjunctivitis to dilute the allergen and wash it away. Insertion of intacs on the cornea is the treatment for keratoconus. Administration of nonsteroidal antiinflammatory eye drops is the treatment given if the patient has inflammation. Text Reference - p. 389

A patient is admitted to the recovery area after cataract removal with an intraocular lens implant on his right eye. In what position should the nurse place the patient? 1 Supine, flat 2 High Fowler's 3 On the left side 4 On the right side

3 Lying on the side opposite the surgery helps prevents pressure on the affected eye. In this patient the left side is best, and the head of the bed should be elevated 30 to 45 degrees. Supine and flat and high Fowler's are not desirable positions during the recovery period. In this patient the right side should be avoided because it is the side on which surgery was performed. Text Reference - p. 394

Which disorder can malignant external otitis cause in an older patient with diabetes mellitus? 1 Otalgia 2 Otosclerosis 3 Osteomyelitis 4 Acoustic neuroma

3 Malignant external otitis, a serious infection caused by the bacteria Pseudomonas aeruginosa, occurs mainly in older patients with diabetes mellitus. This infection can spread from the external ear to the parotid gland and temporal bone, causing osteomyelitis. Otalgia, or ear pain, is one of the first signs of external otitis. Otosclerosis is a hereditary autosomal dominant disease in which a spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window. An acoustic neuroma is the result of a unilateral benign tumor at the spot where the eighth cranial nerve enters the internal auditory canal. Text Reference - p. 403

What substance is most appropriate for the nurse to use to remove an insect from a patient's ear? 1 Water 2 Alcohol 3 Mineral oil 4 Hydrogen peroxide

3 Mineral oil causes the least amount of trauma and irritation to the ear canal. Water and hydrogen peroxide should not be used because the insect could swell, which would make it more difficult to remove. Alcohol may cause both irritation of the ear canal and swelling of the insect. Text Reference - p. 403

Which auditory disorder is caused by an excessive accumulation of endolymph in the membranous labyrinth? 1 Otitis Media 2 Otosclerosis 3 Ménière's disease 4 Acoustic neuroma

3 Ménière's disease, also called endolymphatic hydrops, results in an excessive accumulation of endolymph in the membranous labyrinth. The volume of endolymph increases until the membranous labyrinth ruptures. Otitis media is caused by an infection of the tympanum, ossicles, and space of the middle ear. Otosclerosis is a hereditary autosomal dominant disease caused by the vascular and bony changes in the middle ear. Otoscopic examination may reveal Schwartz's sign. Acoustic neuroma is a disorder of cranial nerve VIII on which a unilateral benign tumor grows. Text Reference - p. 405

A nurse should instruct a patient who had cataract surgery to contact the surgeon if which condition develops? 1 Glare 2 Itching 3 Eye pain 4 Blurred vision

3 Pain should not be present after cataract surgery, although there may be slight discomfort that is easily relieved with acetaminophen. The patient should be told that the other symptoms, including glare, itching, and blurred vision, may be present and are expected until healing takes place. Text Reference - p. 395

A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse? 1 To decrease pain 2 To prevent anxiety 3 To minimize photophobia 4 To minimize intraocular pressure

3 Pupil dilation medications enlarge the pupil during eye examinations. After administering pupil dilation medications, patients generally have photophobia. Analgesics are administered to decrease pain. Anxiolytics are given to patients to prevent anxiety. Miotics and oral or intravenous hyperosmotic agents such as glycerin liquid, isosorbide solution, and mannitol solution are useful in lowering the intraocular pressure. Text Reference - p. 395

Which instruction given by the nursing student during ear care training needs correction by the registered nurse? 1 "Do not put anything in your ear canal." 2 "Report itching if it becomes a problem." 3 "Dry the ear with cotton-tipped applicators." 4 "Report chronic excessive cerumen if it impairs your hearing."

3 The ears should be kept as dry as possible. However, cotton-tipped applicators should not be used for drying the ears. Rather, a hair dryer set to low and held at least 6 inches from the ear can be used to evaporate the water from the ear. Unless requested by the health care provider, nothing should be put in the ear canal. The health care provider should be consulted if consistent itching occurs or if excessive cerumen impairs hearing. Text Reference - p. 403

A patient has sustained an injury to the cornea. The nurse assists the primary health care provider in rinsing the eye with saline solution and then instilling a dye into the conjunctiva of the injured eye. What is the purpose of the dye? 1 To disinfect the injured tissue 2 To help seal and heal the injured tissue 3 To stain the injured tissue so it can more easily be identified 4 To bind with foreign particles, allowing them to be rinsed away from injured tissue

3 The injured tissue is susceptible to the dye and will remain stained even after the eye is rinsed with saline. Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects and locate foreign objects in the eye. The dye is not used to disinfect the tissue, seal and heal it, or bind with foreign particles. Text Reference - p. 398

A patient reports an inability to understand speech in spite of being able to hear sounds properly. The patient has a history of Paget's disease of the bone and is being treated with antibiotics. The nurse recognizes that the patient is most likely experiencing which type of hearing loss? 1 Mixed hearing loss 2 Conductive hearing loss 3 Sensorineural hearing loss 4 Central and functional hearing loss

3 The patient is able to hear sound but is unable to understand speech. The patient also has a history of Paget's disease of the bone and is receiving antibiotic therapy. These factors lead to sensorineural hearing loss. Sensorineural hearing loss is caused by impairment of function of the inner ear or the vestibulocochlear nerve. Mixed hearing loss occurs due to a combination of conductive and sensorineural causes. In conductive hearing loss, the patient often speaks softly because he can hear his own voice quite loud. The patient hears better in a noisy environment. In central and functional hearing loss, the patient is unable to interpret sound, including speech. This is caused mainly due to a problem in the brain area controlling speech. Text Reference - p. 407

The registered nurse is preparing to teach a group of nursing students about the use of verbal aids when communicating with hearing-impaired patients. Which information does the nurse include in the teaching plan? 1 Refrain from having light behind the patient. 2 Speak in a clear voice and shout at the patient. 3 Use simple sentences and rephrase sentences if required. 4 Maintain eye contact and draw the attention of the patient with hand movements.

3 The use of simple sentences is an example of a verbal aid that the nurse can use while communicating with a hearing-impaired patient. If required, the nurse should rephrase the sentence, and use different words to help the patient understand. As a nonverbal aid, the nurse should avoid light behind the speaker, not the patient. As a verbal aid, the nurse should speak in a normal voice directly into the better ear. The nurse should not shout to make the patient understand. As a nonverbal aid, the nurse should maintain eye contact and draw attention of the patient with hand movements. Text Reference - p. 410

A patient complains of a red, swollen, circumscribed, and acutely tender area in the lid margin. After the medical checkup, it is diagnosed as a hordeolum. The nurse should provide what instructions to help the patient care for the affected eye? 1 Advise the patient to not perform lid scrubs for 10 days. 2 Suggest wearing glasses to reduce development of the infection. 3 Advise to avoid any treatment because the condition is a normal body protective mechanism. 4 Suggest applying warm, moist compresses at least four times a day until the condition improves

4

A patient has undergone kidney transplantation surgery and takes immunosuppressant drugs. The patient comes in contact with a person who has chickenpox. The nurse recognizes that the patient is susceptible to which viral ophthalmic infection? 1 Blepharitis 2 Hordeolum 3 Astigmatism 4 Herpes zoster ophthalmicus

4

A patient with glaucoma is taking timolol drops. The nurse, who is reinforcing principles of medication administration with the patient, should include that the patient: 1 Should use these on an as needed basis for eye irritation 2 Will notice an improvement in vision within one month 3 Should maintain a supine position for 30 minutes after the drops are instilled 4 May experience blurred vision after administration of the drops lasting several minutes

4

Which instruction should the nurse provide while teaching the patient and caregiver how to reduce the risk of external otitis? 1 "Report if you notice earwax in the ear canal." 2 "Dry your ears with cotton-tipped applicators." 3 "Never use a hair dryer to speed up water evaporation from the ear." 4 "Turn your head to each side for 30 seconds to drain water from the ear."

4

Identify a causative factor associated with a sensorineural hearing loss. 1 Otosclerosis 2 Impacted cerumen 3 Perforation of the tympanic membrane 4 Ototoxicity from chemotherapeutic medications

4 A sensorineural hearing loss involves damage to the neural component of hearing. Within the inner ear there are sensory hair cells in the cochlea that pick up impulses and initiate nerve impulse to the brain via the acoustic branch of the eighth cranial nerve. Medications, including some chemotherapy, can damage this nerve pathway of hearing. Otosclerosis is a hereditary condition causing a conductive hearing loss because of bony growth that limits the stapes from vibrating in response to sound. Impacted cerumen (earwax) causes a conductive hearing loss because the sound vibrations are blocked by excessive earwax in the ear canal. A perforated tympanic membrane (ruptured eardrum) causes a conductive hearing loss because the tympanic membrane is no longer intact to adequately conduct sound vibrations. Text Reference - p. 407

The nurse is admitting a patient with glaucoma who states that he or she is allergic to all sulfa drugs. Which medication order should the nurse question and immediately report to the primary care provider? 1 Carteolol 2 Dipivefrin 3 Carbachol 4 Acetazolamide

4 Acetazolamide is an antiglaucoma drug and a carbonic anhydrase inhibitor that may cause immunologically mediated reactions and result in sulfa-type allergic reactions in patients allergic to sulfa. Carteolol is a β-adrenergic blocker and may cause blurred vision, photophobia, and bradycardia. Dipivefrin is an α-adrenergic agonist and may cause side effects such as ocular discomfort and redness. Carbachol is an antiglaucoma drug and a cholinergic agent that may cause transient ocular discomfort, headache, and blurred vision. Text Reference - p. 400

A patient has lost an eye after an industrial accident. Which action by the nurse is most appropriate during this time? 1 Speak louder when talking to the patient. 2 Avoid making eye contact during a conversation. 3 Introduce the patient to other visually impaired persons. 4 Assist the patient with the same grieving process that is associated with other losses.

4 Assist the patient with the same grieving process that is associated with other losses.

A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms? 1 Itching, burning, irritation, and photophobia 2 Tearing, redness, photophobia, and foreign body sensation 3 Red, swollen, circumscribed, and acutely tender area in the lid margin 4 Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

4 Bacterial conjunctivitis manifests as discomfort, pruritus, redness, and a mucopurulent drainage in the eye. It occurs due to unhygienic conditions. The infection is caused by Staphylococcus. aureus. It can be treated with antibiotic drops. Itching, burning, irritation, and photophobia are signs of blepharitis. Tearing, redness, photophobia, and foreign body sensation are symptoms of epidemic keratoconjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum. Text Reference - p. 390

A patient with scleroderma reports eye irritation and a feeling of sand grains in the eye. The nurse recognizes that the patient is experiencing what condition? 1 Myopia 2 Strabismus 3 Acanthamoeba keratitis 4 Keratoconjunctivitis sicca

4 Irritation or a feeling of sand particles in the eyes is a symptom of keratoconjunctivitis sicca. Patients with scleroderma and systemic lupus erythematosus are more susceptible to this disorder. It is also known as dry eye disorder. In myopia, the patient is unable to accommodate for near objects. In strabismus, the patient cannot consistently focus both eyes simultaneously on the same object. Acanthamoeba keratitis is an infection caused by a parasite associated with wearing contact lenses that are contaminated by lens care solutions or cases. Text Reference - p. 392

An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect? 1 Cataract 2 Strabismus 3 Keratoconus 4 Keratoconjunctivitis sicca

4 Keratoconjunctivitis sicca is a dry eye disorder commonly seen in older adults. The patient with keratoconjunctivitis sicca reports irritation and presence of sand in the eye. Cataract is a condition in which there is opacity within the lens and the patient reports decreased vision, abnormal color perception, and glare. Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object and the patient will complain of double vision. Keratoconus is a noninflammatory disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape and the patient complains of blurred vision. Text Reference - p. 392

When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement? 1 "Prolonged eye irritation is an expected adverse effect of this medication." 2 "This medication will help to raise intraocular pressure to a near normal level." 3 "This medication needs to be continued for at least five years after the initial diagnosis." 4 "It is important not to do activities requiring visual acuity immediately after administration.

4 Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Prolonged eye irritation is not an expected adverse effect of pilocarpine. Pilocarpine will stimulate iris sphincter contraction. At least five years is not an appropriate amount of time to estimate to the patient. Text Reference - p. 400

A patient with septic shock is receiving multiple medications. Which intravenous (IV) medication is most likely to cause a hearing loss? 1 Dopamine 2 Ampicillin 3 Aspirin 4 Vancomycin

4 The IV medication in use that is most likely to cause a hearing loss is vancomycin, because it is an ototoxic medication. For that reason, serum drug levels are monitored to maintain therapeutic levels and reduce the risk of ototoxicity. Neither dopamine nor ampicillin is likely to cause hearing loss. Aspirin also can cause hearing loss, but it is not administered IV. Text Reference - p. 407

Before administrating timolol eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine? 1 Sinusitis 2 Migraine headaches 3 Chronic urinary tract infection 4 Chronic obstructive pulmonary disease (COPD)

4 Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches, and does not affect sinusitis or chronic urinary tract infections. Text Reference - p. 400

In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder? 1 The lens enlarges with normal aging, pushing the iris forward, blocking the outflow of aqueous humor 2 The pupillary opening is blocked secondary to decreased aqueous humor in the anterior chamber 3 The retinal nerve is damaged by an abnormal increase in the production of aqueous humor 4 Pressure damage to the optic nerve may occur because of clogged drainage channels

4 With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain properly from the eye. This leads to damage to the optic nerve over time. The iris is not affected, the retinal nerve is not damaged, and the aqueous humor builds up because of blockage. Text Reference - p. 398

A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient? 1 Instruct the patient to quit smoking. 2 Suggest that the patient consider using supplements of vitamins and minerals. 3 Advise the patient to eat lots of dark green, leafy vegetables containing lutein. 4 Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

4Verteporfin, used for phototherapy, is a photosensitizing drug. It becomes active in the presence of low-level laser light waves. It can be activated by exposure to sunlight or high-intensity light until it is fully excreted. If activated, it can cause thermal burns in the area. The patient should be instructed to avoid direct sunlight and other intense forms of light for five days after treatment. Taking vitamin and mineral supplements, eating green leafy vegetables high in lutein, and cessation of smoking are measures to decrease the risk of AMD. Text Reference - p. 397

A patient with high amounts of myopia is scheduled for laser-assisted in situ keratomileusis (Lasik). In which order should the primary health care provider perform the procedure? 1. The flap is repositioned carefully. 2. A flap is created in the cornea using a laser or surgical blade. 3. The flap adheres on its own without sutures in a few minutes. 4. The flap is folded back on the middle section, or stroma, of the cornea. 5. Pulses from a computer-controlled laser vaporize a part of the stroma.

Correct 1. A flap is created in the cornea using a laser or surgical blade. Correct 2. The flap is folded back on the middle section, or stroma, of the cornea. Correct 3. Pulses from a computer-controlled laser vaporize a part of the stroma. Correct 4. The flap is repositioned carefully. Correct 5. The flap adheres on its own without sutures in a few minutes. Laser-assisted in situ keratomileusis is a surgical procedure considered for patients with low to moderately high amounts of myopia or hyperopia, with or without astigmatism. The procedure first involves using a laser or surgical blade to create a flap in the cornea. Then the flap is folded back on the middle section, or stroma, of the cornea. Next, pulses from a computer-controlled laser vaporize a part of the stroma and then the flap is repositioned. Finally, ensure that the flap adheres on its own without sutures in a few minutes. Text Reference - p. 387