Medsurg 2 Exam 4 119

After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the clients understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy?

I will take this medicine immediately before I eat -Type 2 diabetic med

Sensorineural Hearing Loss

(inner ear) o Alteration in the inner ear, auditory nerve, or hearing center of the brain o Caused by: damage to CN VIII Exposure to loud noise, ototoxic meds, older age (presbycusis - decreased ability to hear high-pitched sounds) Ototoxic Meds: Antibiotics: gentamicin, metronidazole Diuretics: furosemide NSAIDSs: ibuprofen Aspirin Chemotherapeutic agents: cisplatin

Conductive Hearing Loss

(middle ear) Sounds waves are blocked before they reach the cochlea of the inner ear Caused by otitis media, foreign body (cerumen), otosclerosis

In reviewing a patients medical record , the nurse notes that the last eye examination revealed an intraocular pressure 28 mm Hg. The nurse will plan to assess?

Peripheral vision *Glaucoma reduces peripheral vision

The patient is a chronic diabetic with 233 blood glucose, per sliding scale. How many mL are you given? Units to mL round to the nearest 100th. 0.02 2 units =

0.02 mL

Which assessment finding alerts the nurse to provide patient teaching about cataract development? a. History of hyperthyroidism b. Unequal pupil size and shape c. Blurred vision and light sensitivity d. Loss of peripheral vision in both eyes

ANS: C Classic signs of cataracts include blurred vision and light sensitivity. Thyroid problems are a major cause of exophthalmos. Unequal pupil is indicative of anisocoria, not cataracts. Loss of peripheral vision is a sign of glaucoma.

A patient who has undergone a left tympanoplasty should be instructed to a. remain on bed rest. b. keep the head elevated. c. avoid blowing the nose. d. irrigate the left ear canal.

ANS: C Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.

In reviewing a 55-year-old patients medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a. visual acuity. b. pupil reaction. c. color perception. d. peripheral vision.

ANS: D The patients increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma.

Cataracts:

1st leading cause of blindness

The nurse is caring for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 7:00am. At which time would the nurse assess the client for potential hypoglycemia related to the NPH insulin?

4:00 p.m. (1600)

With which specific interprofessional team member, would the nurse collaborate to man-age a client's dry, age-related macular degeneration for which there is no cure? A. Registered dietitian nutritionist B. Eye health care provider C. Mental health professional D. Speech-language pathologist.

A Dry AMD has no cure. Management in the community setting is focused on slowing the progression of the vision loss and helping the client maximize remaining vision and quality of life. The risk for dry AMD can be reduced by increasing long-term dietary intake of vita-mins C and E, zinc oxide, copper, and the ca-rotenoids lutein and zeaxanthin. The registered dietitian nutritionist is best equipped to collaborate with the nurse to increase dietary in-take of the crucial elements.

Which interprofessional collaboration will the nurse seek to assist a client diagnosed with glaucoma to cope who expresses anxiety over the possibility of sight loss? A. Mental health professional B. Eye health care provider C. Home health nurse D. Occupational therapist

A The possibility or reality of the loss of vision can be distressing for clients. For clients who experience anxiety or depression related to changes in their sight, the nurse collaborates with a mental health professional. The nurse supports the client at regular visits, and the mental health professional can provide ongoing counseling and support to the client during this time of transition.

Which precaution is a priority for the nurse to teach a client prescribed dulaglutide to prevent harm? A. Only take this drug once weekly. B. Do not drink alcohol when taking this drug. C. Take this drug right before or with the first bite of a meal. D. Report any genital itching to your diabetes health care provider immediately.

A This drug is an incretin mimetic (GLP1-agonist) that works with insulin to prevent hy-perglycemia. It is taken as an injection only once per week. If taken more frequently, the client is at risk for an overdose. This drug is not associated with fasciitis of the perineum and does not require total abstinence from alcohol.

How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 91 mg/dL (5.1 mmol/L) and an A1C of 8.2%? A. The client's glucose control for the past 24 hours has been good, but the overall control is poor. B. The client's glucose control for the past 24 hours has been poor, but the overall control is good. C. The values indicate that the client has poorly managed his or her disease. D. The values indicate that the client has managed his or her disease well.

A Fasting blood glucose levels provide an indication of the client's adherence to drug and nutrition therapy for DM for the previous 24 hours. This client's FBG is well within the normal range. A1C provides an indication of general blood glucose control for the past several months be-cause when glucose attaches to hemoglobin, the attachment is permanent for as long as those hemoglobin molecules are present within red blood cells. Normal red blood cell life span is about 120 days. This client's A1C level is out-side the desirable range, indicating chronic hyperglycemia and poor long-term glucose control despite good short-term control.

Which assessment finding will the nurse expect in a client with diabetes who has peripheral neuropathy of the motor neurons? A. Muscle weakness B. Orthostatic hypotension C. Absence of feeling in the feet D. Increased risk for myocardial infarction

A Neuropathy of motor neurons leads to muscle weakness and increased risk for falls. Neuropathy of sensory neurons leads to loss of sensation in the feet and hands and can cause the client not to feel symptoms when MI occurs but does not increase the risk for having an MI. Cardiac autonomic neuropathy, not motor neuropathy, causes orthostatic hypotension.

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?

A 58 year old American Indian or Hispanic

Thyroid storm (thyroid crisis)

A life-threatening event that occurs in patients with uncontrolled hyperthyroidism, most often with Graves' disease

Myxedema coma (hypothyroid crisis)

A serious complication of untreated or poorly treated hypothyroidism with dangerously reduced cardiopulmonary and neurologic functioning, although few affected adults become comatose.

Which health problems that are complications of chronic hyperglycemia will the nurse rein-force to the client with diabetes could be delayed or prevented with long-term good glucose control? Select all that apply. A. Amputations B. Blindness C. Chronic kidney disease D. Heart attack E. Erectile dysfunction F. Stroke

A, B, C, D, E, F All of these health problems are common complications of diabetes that develop as a result of chronic hyperglycemia. The hyperglycemia causes microvascular and macrovascular changes that reduce perfusion and gas exchange in these tissues resulting in hypoxia, anoxia, ischemia, and buildup of toxic waste products that injure organs and lead to dysfunction. Long-term blood glucose delays or may even prevent these serious complications.

Which priority topics would the nurse teach the client and family for postoperative care after cataract surgery? Select all that apply. A. Proper instillation of antibiotic and steroid ointments B. Remind the client that mild eye itching and "bloodshot appearance" is normal C. Apply cool compresses for mild eyelid swelling D. Use acetaminophen or aspirin for mild discomfort E. Report yellow or green drainage to the eye health care provider immediately F. Final best vision will not occur until 4 to 6 weeks after surgery

A, B, C, E, F All of these teaching points are taught by the nurse to the client and family except option D. Aspirin is avoided because it affects bleeding. If the client's pain is more severe, then acetaminophen with oxycodone may be prescribed.

Which assessment findings in a 33-year-old female client indicate to the nurse that she has an increased risk for type 2 diabetes? Select all that apply. A. A1C is 5.8% B. Weight is 25 lb (11.3 kg) above ideal C. Had a 10 lb (4.5 kg) baby 2 years ago D. Has irritable bowel syndrome with constipation E. Fasting blood glucose (FBG) level is 119 mg/dL (6.5 mmol/L) F. Mother, sister, and maternal grandmother all have type 2 diabetes

A, B, C, E, F Risk factors for type 2 diabetes include obesity, indications of gestational diabetes (first baby larger than 9 lb [4.1 kg]), and a family history of a parent or other first-degree relative with type 2 diabetes. In addition, although this client's A1C and FBG levels are not high enough for a diabetes diagnosis, they are consistent with prediabetes, a strong risk factor for development of type 2 diabetes. Irritable bowel syn-drome is not a diabetes risk factor.

With which signs and symptoms will the nurse teach a client to take action to prevent harm as indicators of mild hypoglycemia? Select all that apply. A. Headache B. Weakness C. Cold, clammy skin D. Irritability E. Pallor F. Tachycardia

A, B, D The earliest signs and symptoms of mild hypo-glycemia are associated with changes in neuro-logic functioning including headache, sensation of hunger, irritability, and weakness. The other symptoms listed are present when hypo-glycemia becomes more severe.

Which predisposing factors will the nurse ask about when taking a history of a client at risk for cataracts? Select all that apply. A. Recent or past trauma to the eyes B. Presence of diabetes or hypertension C. History of excessive alcohol intake D. Family history of cataracts E. Prolonged use of corticosteroids or beta blockers F. Recent or past history of cancer

A, B, D, E While age is important because cataracts are most prevalent in the older adult, the nurse asks about other predisposing factors including: recent or past trauma to the eye; exposure to radioactive materials, x-rays, or UV light; prolonged use of corticosteroids, chlorpromazine, or beta blockers; presence of intraocular disease (e.g., recurrent uveitis); presence of systemic disease (e.g., diabetes mellitus, hypo-parathyroidism, hypertension); previous cataract, or family history of cataracts; and history of smoking.

Which statements about drugs administered by the nurse for treatment of increased intraocular pressure (IOP) in a client with glaucoma are accurate? Select all that apply. A. The prostaglandin agonist drugs reduce IOP by dilating blood vessels in the trabecular mesh, which then collects and drains aqueous humor at a faster rate. C. Cholinergic agonists reduce IOP by limiting the production of aqueous humor and making more room between the iris and the lens, which improves fluid outflow. D. Carbonic anhydrase inhibitors directly and strongly inhibit production of aqueous humor. E. Teach clients prescribed adrenergic agonists to wear dark glasses outdoors and also indoors when lighting is bright. F. Teach clients prescribed beta blockers to check their pulse at least twice per day and to notify the eye health care provider if the pulse is consistently below 60 beats/ min.

A, C, D, E, F All statements about drugs used to treat IOP in glaucoma are correct except option B. Prostaglandin agonists are the only drugs for glaucoma that cause eye color to darken and eyelashes to elongate over time in the eye or eyes receiving the drug.

What will the nurse teach the client to prevent harm postoperatively after keratoplasty (corneal transplant)? Select all that apply. A. Do not use an ice pack on the eye. B. Wear an eye shield at night for the first week after surgery. C. Avoid jogging and any other activity that promotes rapid or jerky head motions for several weeks after surgery. D. Lie on the operative side to reduce intraocular pressure (IOP). E. Report the presence of purulent discharge immediately to the surgeon. F. Examine the eye daily for the presence of infection or graft rejection.

A, C, E, F All options are correct except B and D. The client is taught to wear a protective shield over the eye at night for a month (not a week) after surgery. The nurse teaches the client to lie on the nonoperative side to decrease IOP.

Which physiologic actions result from normal insulin secretion? Select all that apply. A. Increased liver storage of glucose as glycogen B. Increased gluconeogenesis C. Increased cellular uptake of blood glucose D. Increased breakdown of lipids (fats) for fuel E. Increased production and release of epinephrine F. Decreased storage of free fatty acids in fat cells G. Decreased blood glucose levels H. Decreased blood cholesterol levels

A, C, G, H The main metabolic effects of insulin are to stimulate glucose uptake in skeletal muscle and heart muscle and to suppress liver production of glucose and very-low-density lipoprotein (VLDL). In the liver, insulin promotes the pro-duction and storage of glycogen (glycogenesis) at the same time that it inhibits glycogen break-down into glucose (glycogenolysis). It increases protein and lipid (fat) synthesis and inhibits ketogenesis (conversion of fats to acids) and gluconeogenesis (conversion of proteins to glucose). In muscle, insulin promotes protein and glycogen synthesis. In fat cells, it promotes tri-glyceride storage. Overall, insulin keeps blood glucose levels from becoming too high and helps keep blood lipid levels in the normal range.

Which issues regarding diabetes management will the nurse consider delaying to teach about to a client with newly diagnosed type 1 diabetes until after the initial phase? Select all that apply. A. Discussing exactly what causes type 1 diabetes B. Preparing and administering insulin C. Implementing sick-day management rules D. Recognizing indications of hypoglycemia and hyperglycemia E. Explaining the risk for passing on type 1 diabetes to one's children F. Monitoring urine ketone levels

A, E, F Responses B, C, and D are "survival skills" and critically important for the client and family to know for safe management of this serious dis-order. The other issues are less important for the client to know to prevent immediate harm.

The nurse should report which assessment finding Immediately to the health care provider? a. The tympanum is blue-tinged. b. There is a cone of light visible. c. Cerumen is present in the auditory canal. d. The skin in the ear canal is dry and scaly.

ANS: A A bluish-tinged tympanum can occur with acute otitis media, which requires immediate care to prevent perforation of the tympanum. Cerumen in the ear canal may need to be removed before proceeding with the examination but is not unusual or pathologic. The presence of a cone of light on the eardrum is normal. Dry and scaly skin in the ear canal may need further assessment but does not require urgent care.

A 42-year-old woman with Meniere's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan? a. Dim the lights in the patients room. b. Encourage increased oral fluid intake. c. Change the patients position every 2 hours. d. Keep the head of the bed elevated 30 degrees.

ANS: A A darkened, quiet room will decrease the symptoms of the acute attack of Menieres disease. Because the patient will be nauseated during an acute attack, fluids are administered IV. Position changes will cause vertigo and nausea. The head of the bed can be positioned for patient comfort.

The priority nursing diagnosis for a patient experiencing an acute attack with Meniere;s disease is a. risk for falls related to dizziness. b. impaired verbal communication related to tinnitus. c. self-care deficit (bathing and dressing) related to vertigo. d. imbalanced nutrition: less than body requirements related to nausea.

ANS: A All the nursing diagnoses are appropriate, but because sudden attacks of vertigo can lead to drop attacks, the major focus of nursing care is to prevent injuries associated with dizziness.

During the preoperative assessment of the patient scheduled for a right cataract extraction and intraocular lens implantation, it is Most important for the nurse to assess a. the visual acuity of the patients left eye. b. how long the patient has had the cataract. c. for a white pupil in the patients right eye. d. for a history of reactions to general anesthetics.

ANS: A Because it can take several weeks before the maximum improvement in vision occurs in the right eye, patient safety and independence are determined by the vision in the left eye. A white pupil in the operative eye would not be unusual for a patient scheduled for cataract removal and lens implantation. The length of time that the patient has had the cataract will not affect the perioperative care. Cataract surgery is done using local anesthetics rather than general anesthetics.

Which information will the nurse include for a patient contemplating a cochlear implant? a. Cochlear implants require training in order to receive the full benefit. b. Cochlear implants are not useful for patients with congenital deafness. c. Cochlear implants are most helpful as an early intervention for presbycusis. d. Cochlear implants improve hearing in patients with conductive hearing loss.

ANS: A Extensive rehabilitation is required after cochlear implants in order for patients to receive the maximum benefit. Hearing aids, rather than cochlear implants, are used initially for presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be helpful for conductive loss. They are appropriate for some patients with congenital deafness.

A patient with a right retinal detachment had a pneumatic retinopexy procedure. Which information will be included in the discharge teaching plan? a. The purpose of maintaining the head in a prescribed position b. The use of eye patches to reduce movement of the operative eye c. The need to wear dark glasses to protect the eyes from bright light d. The procedure for dressing changes when the eye dressing is saturated

ANS: A Following pneumatic retinopexy, the patient will need to position the head so the air bubble remains in contact with the retinal tear. The dark lenses and bilateral eye patches are not required after this procedure. Saturation of any eye dressings would not be expected following this procedure.

The nurse is providing health promotion teaching to a group of older adults. Which information will the nurse include when teaching about routine glaucoma testing? a. A Tono-pen will be applied to the surface of the eye. b. The test involves reading a Snellen chart from 20 feet. c. Medications will be used to dilate the pupils for the test. d. The examination involves checking the pupil's reaction to light.

ANS: A Glaucoma is caused by an increase in intraocular pressure, which would be measured using the Tono-pen. The other techniques are used in testing for other eye disorders.

The nurse working in the vision and hearing clinic receives telephone calls from several patients who want appointments in the clinic as soon as possible. Which patient should be seen first? a. 71-year-old who has noticed increasing loss of peripheral vision b. 74-year-old who has difficulty seeing well enough to drive at night c. 60-year-old who has difficulty hearing clearly in a noisy environment d. 64-year-old who has decreased hearing and ear stuffiness without pain

ANS: A Increasing loss of peripheral vision is characteristic of glaucoma and the patient should be scheduled for an examination as soon as possible. The other patients have symptoms commonly associated with aging: presbycusis, possible cerumen impaction, and impaired night vision.

A 75-year-old patient with presbycusis is fitted with binaural hearing aids. Which information will the nurse include when teaching the patient how to use the hearing aids? a. Experiment with volume and hearing ability in a quiet environment initially. b. Keep the volume low on the hearing aids for the first week while adjusting to them. c. Add a second hearing aid after making the initial adjustment to the first hearing aid. d. Wear the hearing aids for about an hour a day at first, gradually increasing the time of use.

ANS: A Initially, the patient should use the hearing aids in a quiet environment like the home, experimenting with increasing and decreasing the volume as needed. There is no need to gradually increase the time of wear. The patient should experiment with the level of volume to find what works well in various situations. Both hearing aids should be used.

The nurse is developing a plan of care for an adult patient diagnosed with adult inclusion conjunctivitis (AIC) caused by Chlamydia trachomatis. Which action should be included in the plan of care? a. Discussing the need for sexually transmitted infection testing b. Applying topical corticosteroids to prevent further inflammation c. Assisting with applying for community visual rehabilitation services d. Educating about the use of antiviral eyedrops to treat the infection

ANS: A Patients with AIC have a high risk for concurrent genital Chlamydia infection and should be referred for sexually transmitted infection (STI) testing. AIC is treated with antibiotics. Antiviral and corticosteroid medications are not appropriate therapies. Although some types of Chlamydia infection do cause blindness, AIC does not lead to blindness, so referral for visual rehabilitation is not appropriate.

The nurse is assessing a 65-year-old patient for presbyopia. Which instruction will the nurse give the patient before the test? a. Hold this card and read the print out loud. b. Cover one eye at a time while reading the wall chart. c. You'll feel a short burst of air directed at your eyeball. d. A light will be used to look for a change in your pupils.

ANS: A The Jaeger card is used to assess near vision problems and presbyopia in persons over 40 years of age. The card should be held 14 inches away from eyes while the patient reads words in various print sizes. Using a penlight to determine pupil change is testing pupil response. A short burst of air may be used to test intraocular pressure but is not used for testing presbyopia. Covering one eye at a time while reading a wall chart at 20 feet describes the Snellen test.

The nurse is assessing a patient who has recently been treated with amoxicillin for acute otitis media of the right ear. Which finding is a priority to report to the health care provider? a. The patient has a temperature of 100.6 F. b. The patient complains of popping in the ear. c. The patient frequently asks the nurse to repeat information. d. The patient states that the right ear has a feeling of fullness.

ANS: A The fever indicates that the infection may not be resolved and the patient might need further antibiotic therapy. A feeling of fullness, popping of the ear, and decreased hearing are symptoms of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment.

The occupational health nurse is caring for an employee who is complaining of bilateral eye pain after a cleaning solution splashed into the employees eyes. Which action will the nurse take first? a. Apply ice packs to both eyes. b. Flush the eyes with sterile saline. c. Apply antiseptic ophthalmic ointment to the eyes. d. Cover the eyes with dry sterile patches and shields.

ANS: B Flushing of the eyes immediately is indicated for chemical exposure. Emergency treatment of a burn or foreign-body injury to the eyes includes protecting the eyes from further injury by covering them with dry sterile dressings and protective shields. Flushing of the eyes immediately is indicated only for chemical exposure. In the case of chemical exposure, the nurse should begin treatment by flushing the eyes until the patient has been assessed by a healthcare provider and orders are available.

Which patient arriving at the urgent care center will the nurse assess first? a. Patient with acute right eye pain that occurred while using home power tools b. Patient with purulent left eye discharge, pruritus, and conjunctival inflammation c. Patient who is complaining of intense discomfort after an insect crawled into the right ear d. Patient who has Meniere's disease and is complaining of nausea, vomiting, and dizziness

ANS: A The history and symptoms suggest eye trauma with a possible penetrating injury. Blindness may occur unless the patient is assessed and treated rapidly. The other patients should be treated as soon as possible, but do not have clinical manifestations that indicate any acute risk for vision or hearing loss.

Which information will the nurse provide to the patient scheduled for refractometry? a. You will need to wear sunglasses for a few hours after the exam. b. The surface of your eye will be numb while the doctor does the exam. c. You should not take any of your eye medicines before the examination. d. The doctor will shine a bright light into your eye during the examination.

ANS: A The pupils are dilated using cycloplegic medications during refractometry. This effect will last several hours and cause photophobia. The other teaching would not be appropriate for a patient who was having refractometry.

Assessment of a patient's visual acuity reveals that the left eye can see at 20 feet what a person with normal vision can see at 50 feet and the right eye can see at 20 feet what a person with normal vision can see at 40 feet. The nurse records which finding? a. OS 20/50; OD 20/40 b. OU 20/40; OS 50/20 c. OD 20/40; OS 20/50 d. OU 40/20; OD 50/20

ANS: A When documenting visual acuity, the first number indicates the standard (for normal vision) of 20 feet and the second number indicates the line that the patient is able to read when standing 20 feet from the Snellen chart. OS is the abbreviation for left eye and OD is the abbreviation for right eye. The remaining three answers do not correctly describe the patient's visual acuity.

The nurse is testing the visual acuity of a patient in the outpatient clinic. The nurses instructions for this test include asking the patient to a. stand 20 feet from the wall chart. b. follow the examiners finger with the eyes only. c. look at an object far away and then near to the eyes. d. look straight ahead while a light is shone into the eyes.

ANS: A When the Snellen chart is used to check visual acuity, the patient should stand 20 feet away. Accommodation is tested by looking at an object at both near and far distances. Shining a pen light into the eyes tests for pupil response. Following the examiners fingers with the eyes tests extraocular movements.

Which information about a patient who had a stapedotomy yesterday is most important for the nurse to communicate to the health care provider? a. The patient complains of fullness in the ear. b. The patients oral temperature is 100.8 F (38.1 C). c. The patient says My hearing is worse now than it was right after surgery. d. There is a small amount of dried bloody drainage on the patients dressing.

ANS: B An elevated temperature may indicate a postoperative infection. Although the nurse would report all the data, a temporary decrease in hearing, bloody drainage on the dressing, and a feeling of congestion (because of the accumulation of blood and drainage in the ear) are common after this surgery.

Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of corticosteroid eye drops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 1 to 2 days after the surgery

ANS: B Antibiotic and corticosteroid eye drops are commonly prescribed after cataract surgery. The patient should be able to administer them using safe technique. Pain is not expected after cataract surgery and opioids will not be needed. Coughing and deep breathing exercises are not needed because a general anesthetic agent is not used. There is no bed rest restriction after cataract surgery.

Which nursing activity is appropriate for the registered nurse (RN) working in the eye clinic to delegate to experienced unlicensed assistive personnel (UAP)? a. Instilling antiviral drops for a patient with a corneal ulcer b. Application of a warm compress to a patients hordeolum c. Instruction about hand washing for a patient with herpes keratitis d. Looking for eye irritation in a patient with possible conjunctivitis

ANS: B Application of cold and warm packs is included in UAP education and the ability to accomplish this safely would be expected for UAP working in an eye clinic. Medication administration, patient teaching, and assessment are high-level skills appropriate for the education and legal practice level of the RN.

The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene? a. The nurse leaves the eye shield in place. b. The nurse encourages the patient to cough. c. The nurse elevates the patients head to 45 degrees. d. The nurse applies corticosteroid drops to the right eye.

ANS: B Because coughing will increase intraocular pressure, patients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a patient after having this surgery.

Which statement by a patient with bacterial conjunctivitis indicates a need for further teaching? a. I will wash my hands often during the day. b. I will remove my contact lenses at bedtime. c. I will not share towels with my friends or family. d. I will monitor my family for eye redness or drainage.

ANS: B Contact lenses should not be used when patients have conjunctivitis because they can further irritate the conjunctiva. Hand washing is the major means to prevent the spread of conjunctivitis. Infection may be spread by sharing towels or other contact. It is common for bacterial conjunctivitis to spread through a family or other group in close contact.

A patient arrives in the emergency department complaining of eye itching and pain after sleeping with contact lenses in place. To facilitate further examination of the eye, fluorescein angiography is ordered. The nurse will teach the patient to a. hold a card and fixate on the center dot. b. report any burning or pain at the IV site. c. remain still while the cornea is anesthetized. d. let the examiner know when images shown appear clear.

ANS: B Fluorescein angiography involves injecting IV dye. If extravasation occurs, fluorescein is toxic to the tissues. The patient should be instructed to report any signs of extravasation such as pain or burning. The nurse should closely monitor the IV site as well. The cornea is anesthetized during ultrasonography. Refractometry involves measuring visual acuity and asking the patient to choose lenses that are the sharpest; it is a painless test. The Amsler grid test involves using a hand held card with grid lines. The patient fixates on the center dot and records any abnormalities of the grid lines

A nurse should include which instructions when teaching a patient with repeated hordeolum how to prevent further infection? a. Apply cold compresses at the first sign of recurrence. b. Discard all open or used cosmetics applied near the eyes. c. Wash the scalp and eyebrows with an antiseborrheic shampoo. d. Be examined for recurrent sexually transmitted infections (STIs).

ANS: B Hordeolum (styes) are commonly caused by Staphylococcus aureus, which may be present in cosmetics that the patient is using. Warm compresses are recommended to treat hordeolum. Antiseborrheic shampoos are recommended for seborrheic blepharitis. Patients with adult inclusion conjunctivitis, which is caused by Chlamydia trachomatis, should be referred for sexually transmitted infection (STI) testing.

When teaching a patient about the treatment of acoustic neuroma, the nurse will include information about a. a low sodium diet. b. ways to avoid falls. c. how to apply sunscreen. d. the chemotherapy side effects.

ANS: B Intermittent vertigo occurs with acoustic neuroma, so the nurse should include information about how to prevent falls. Diet is not a risk factor for acoustic neuroma and no dietary changes are needed. Sunscreen would be used to prevent skin cancers on the external ear. Acoustic neuromas are benign and do not require chemotherapy.

To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by a. questioning the patient about blurred vision. b. noting any changes in the patients visual field. c. asking the patient to rate the pain using a 0 to 10 scale. d. assessing the patients depth perception when climbing stairs.

ANS: B POAG develops slowly and without symptoms except for a gradual loss of visual fields. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG.

An 82-year-old patient who is being admitted to the hospital repeatedly asks the nurse to speak up so that I can hear you. Which action should the nurse take? a. Overenunciate while speaking. b. Speak normally but more slowly. c. Increase the volume when speaking. d. Use more facial expressions when talking.

ANS: B Patient understanding of the nurse's speech will be enhanced by speaking at a normal tone, but more slowly. Increasing the volume, overenunciating, and exaggerating facial expressions will not improve the patient's ability to comprehend the nurse.

A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eye drops cause eye burning and visual blurriness for a short time after administration. The best response to the patients statement is a. Those symptoms may indicate a need for an increased dosage of the eye drops. b. The drops are uncomfortable, but it is important to use them to retain your vision. c. These are normal side effects of the drug, which should be less noticeable with time. d. Notify your health care provider so that different eye drops can be prescribed for you.

ANS: B Patients should be instructed that eye discomfort and visual blurring are expected side effects of the ophthalmic drops but that the drops must be used to prevent further visual-field loss. The temporary burning and visual blurriness might not lessen with ongoing use, are not relieved by avoiding systemic absorption, and are not symptoms of glaucoma.

The nurse is performing an eye examination on a 76-year-old patient. The nurse should refer the patient for a more extensive assessment based on which finding? a. The patients sclerae are light yellow. b. The patient reports persistent photophobia. c. The pupil recovers slowly after responding to a bright light. d. There is a whitish gray ring encircling the periphery of the iris.

ANS: B Photophobia is not a normally occurring change with aging and would require further assessment. The other assessment data are common gerontologic differences and would not be unusual in a 76-year-old patient.

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider? a. The patient has questions about the ordered eye drops. b. The patient has eye pain rated at a 5 (on a 0 to 10 scale). c. The patient has poor depth perception when wearing an eye patch. d. The patient complains that the vision has not improved very much.

ANS: B Postoperative cataract surgery patients usually experience little or no pain, so pain at a level 5 on a 10-point pain scale may indicate complications such as hemorrhage, infection, or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching but does not indicate that complications of the surgery may be occurring.

When the patient turns his head quickly during the admission assessment, the nurse observes nystagmus. What is the indicated nursing action? a. Assess the patient with a Rinne test. b. Place a fall-risk bracelet on the patient. c. Ask the patient to watch the mouths of staff when they are speaking. d. Remind unlicensed assistive personnel to speak loudly to the patient.

ANS: B Problems with balance related to vestibular function may present as nystagmus or vertigo and indicate an increased risk for falls. The Rinne test is used to check hearing. Reading lips and louder speech are compensatory behaviors for decreased hearing.

Which equipment will the nurse obtain to perform a Rinne test? a. Otoscope b. Tuning fork c. Audiometer d. Ticking watch

ANS: B Rinne testing is done using a tuning fork. The other equipment is used for other types of ear examinations.

Which action will the nurse take when performing ear irrigation for a patient with cerumen impaction? a. Assist the patient to a supine position for the irrigation. b. Fill the irrigation syringe with body-temperature solution. c. Use a sterile applicator to clean the ear canal before irrigating. d. Occlude the ear canal completely with the syringe while irrigating.

ANS: B Solution at body temperature is used for ear irrigation. The patient should be sitting for the procedure. Use of cotton-tipped applicators to clear the ear may result in forcing the cerumen deeper into the ear canal. The ear should not be completely occluded with the syringe.

Which action can the nurse working in the emergency department delegate to experienced unlicensed assistive personnel (UAP)? a. Ask a patient with decreased visual acuity about medications taken at home. b. Perform Snellen testing of visual acuity for a patient with a history of cataracts. c. Obtain information from a patient about any history of childhood ear infections. d. Inspect a patients external ear for redness, swelling, or presence of skin lesions.

ANS: B The Snellen test does not require nursing judgment and is appropriate to delegate to UAP who have been trained to perform it. History taking about infection or medications and assessment are actions that require critical thinking and should be done by the RN

A patient diagnosed with external otitis is being discharged from the emergency department with an earwick in place. Which statement by the patient indicates a need for further teaching? a. I will apply the eardrops to the cotton wick in the ear canal. b. I can use aspirin or acetaminophen (Tylenol) for pain relief. c. I will clean the ear canal daily with a cotton-tipped applicator. d. I can use warm compresses to the outside of the ear for comfort.

ANS: C Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other patient statements indicate that the teaching has been successful.

The nurse developing a teaching plan for a patient with herpes simplex keratitis should include which instruction? a. Apply antibiotic drops to the eye several times daily. b. Wash hands frequently and avoid touching the eyes. c. Apply a new occlusive dressing to the affected eye at bedtime. d. Use corticosteroid ophthalmic ointment to decrease inflammation.

ANS: B The best way to avoid the spread of infection from one eye to another is to avoid rubbing or touching the eyes and to use careful hand washing when touching the eyes is unavoidable. Occlusive dressings are not used for herpes keratitis. Herpes simplex is a virus and antibiotic drops will not be prescribed. Topical corticosteroids are immunosuppressive and typically are not ordered because they can contribute to a longer course of infection and more complications.

The nurse evaluates that wearing bifocals improved the patients myopia and presbyopia by assessing for a. strength of the eye muscles. b. both near and distant vision. c. cloudiness in the eye lenses. d. intraocular pressure changes.

ANS: B The lenses are prescribed to correct the patients near and distant vision. The nurse may also assess for cloudiness of the lenses, increased intraocular pressure, and eye movement, but these data do not evaluate whether the patients bifocals are effective.

A patient who underwent eye surgery is required to wear an eye patch until the scheduled postoperative clinic visit. Which nursing diagnosis will the nurse include in the plan of care? a. Disturbed body image related to eye trauma and eye patch b. Risk for falls related to temporary decrease in stereoscopic vision c. Ineffective health maintenance related to inability to see surroundings d. Ineffective denial related to inability to admit the impact of the eye injury

ANS: B The loss of stereoscopic vision created by the eye patch impairs the patients ability to see in three dimensions and to judge distances. It also increases the risk for falls. There is no evidence in the assessment data for ineffective health maintenance, disturbed body image, or ineffective denial.

Which prescribed medication should the nurse give First to a patient who has just been admitted to a hospital with acute angle-closure glaucoma? a. Morphine sulfate 4 mg IV b. Mannitol (Osmitrol) 100 mg IV c. Betaxolol (Betoptic) 1 drop in each eye d. Acetazolamide (Diamox) 250 mg orally

ANS: B The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly with IV administration of a hyperosmolar diuretic such as mannitol. The other medications are also appropriate for a patient with glaucoma but would not be the first medication administered.

A patient complains of dizziness when bending over and of nausea and dizziness associated with physical activities. The nurse will plan to teach the patient about a. tympanometry. b. rotary chair testing. c. pure-tone audiometry. d. bone-conduction testing.

ANS: B The patients clinical manifestations of dizziness and nausea suggest a disorder of the labyrinth, which controls balance and contains three semicircular canals and the vestibule. Rotary chair testing is used to test vestibular function. The other tests are used to test for problems with hearing.

A patient who has bacterial endophthalmitis in the left eye is restless, frequently asking whether the eye is healing, and whether removal of the eye will be necessary. Based on the assessment data, which nursing diagnosis is most appropriate at this time? a. Grieving related to current loss of functional vision b. Anxiety related to the possibility of permanent vision loss c. Situational low self-esteem related to loss of visual function d. Risk for falls related to inability to see environmental hazards

ANS: B The patients restlessness and questioning of the nurse indicate anxiety about the future possible loss of vision. Because the patient can see with the right eye, functional vision is relatively intact. There is no indication of impaired self-esteem at this time.

A patient with a head injury after a motorcycle crash arrives in the emergency department (ED) complaining of shortness of breath and severe eye pain. Which action will the nurse take first? a. Administer the ordered analgesic. b. Check the patients oxygen saturation. c. Examine the eye for evidence of trauma. d. Assess each of the cranial nerve functions.

ANS: B The priority action for a patient after a head injury is to assess and maintain airway and breathing. Because the patient is complaining of shortness of breath, it is essential that the nurse assess the oxygen saturation. The other actions are also appropriate but are not the first action the nurse will take.

The nurse is observing a student who is preparing to perform an ear examination for a 30-year-old patient. The nurse will need to intervene if the student a. pulls the auricle of the ear up and posterior. b. chooses a speculum larger than the ear canal. c. stabilizes the hand holding the otoscope on the patients head. d. stops inserting the otoscope after observing impacted cerumen.

ANS: B The speculum should be smaller than the ear canal so it can be inserted without damage to the external ear canal. The other actions are appropriate when performing an ear examination.

Which action could the registered nurse (RN) who is working in the eye and ear clinic delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Evaluate a patients ability to administer eye drops. b. Use a Snellen chart to check a patients visual acuity. c. Teach a patient with otosclerosis about use of sodium fluoride and vitaminD d. Check the patients external ear for signs of irritation caused by a hearing aid.

ANS: B Using standardized screening tests such as a Snellen chart to test visual acuity is included in LPN education and scope of practice. Evaluation, assessment, and patient teaching are higher-level skills that require RN education and scope of practice.

Unlicensed assistive personnel (UAP) perform all the following actions when caring for a patient with Meniere;s disease who is experiencing an acute attack. Which action by UAP indicates that the nurse should intervene immediately? a. UAP raise the side rails on the bed. b. UAP turn on the patients television. c. UAP turn the patient to the right side. d. UAP place an emesis basin at the bedside.

ANS: B Watching television may exacerbate the symptoms of an acute attack of Menieres disease. The other actions are appropriate because the patient will be at high fall risk and may suffer from nausea during the acute attack.

A nurse should instruct a patient with recurrent staphylococcal and seborrheic blepharitis to a. irrigate the eyes with saline solution. b. apply cool compresses to the eyes three times daily. c. use a gentle baby shampoo to clean the lids as needed. d. schedule an appointment for surgical removal of the lesion.

ANS: C Baby shampoo is used to soften and remove crusts associated with blepharitis. The other interventions are not used in treating this disorder.

A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patient's treatment? a. I use aspirin when I have a sinus headache. b. I have had frequent episodes of conjunctivitis. c. I take metoprolol (Lopressor) daily for angina. d. I have not had an eye examination for 10 years.

ANS: C It is important to note whether the patient takes any b-adrenergic blockers because this classification of medications is also used to treat glaucoma, and there may be an increase in adverse effects. The use of aspirin does not increase intraocular pressure and is safe for patients with glaucoma. Although older patients should have yearly eye examinations, the treatment for this patient will not be affected by the 10-year gap in eye care. Conjunctivitis does not increase the risk for glaucoma.

The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient for many years. During the initial assessment of the patient, it is most important for the nurse to a. obtain more information about the cause of the patients vision loss. b. obtain information from the spouse about the patients special needs. c. make eye contact with the patient and ask about any need for assistance. d. perform an evaluation of the patients visual acuity using a Snellen chart.

ANS: C Making eye contact with a partially sighted patient allows the patient to hear the nurse more easily and allows the nurse to assess the patients facial expressions. The patient (rather than the spouse) should be asked about any need for assistance. The information about the cause of the vision loss and assessment of the patients visual acuity are not priorities during the initial assessment.

The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? a. The patient has had blurred vision for 3 years. b. The patient has not eaten anything for 8 hours. c. The patient takes 2 antihypertensive medications. d. The patient gets nauseated with general anesthesia.

ANS: C Mydriatic medications used for pupil dilation are sympathetic nervous system stimulants and may increase heart rate and blood pressure. Using punctal occlusion when administering the mydriatic and monitoring of blood pressure are indicated for this patient. Blurred vision is an expected finding with cataracts. Patients are expected to be NPO for 6 to 8 hours before the surgical procedure. Cataract extraction and intraocular lens implantation are done using local anesthesia.

The nurse recording health histories in the outpatient clinic would plan a focused hearing assessment for adult patients taking which medication? a. Atenolol (Tenormin) taken to prevent angina b. Acetaminophen (Tylenol) taken frequently for headaches c. Ibuprofen (Advil) taken for 20 years to treat osteoarthritis d. Albuterol (Proventil) taken since childhood to treat asthma

ANS: C Nonsteroidal antiinflammatory drugs (NSAIDs) are potentially ototoxic. Acetaminophen, atenolol, and albuterol are not associated with hearing loss.

Which action should the nurse take when providing patient teaching to a 76- year-old with mild presbycusis? a. Use patient education handouts rather than discussion. b. Use a higher-pitched tone of voice to provide instructions. c. Ask for permission to turn off the television before teaching d. Wait until family members have left before initiating teaching.

ANS: C Normal changes with aging make it more difficult for older patients to filter out unwanted sounds, so a quiet environment should be used for teaching. Loss of sensitivity for high-pitched tones is lost with presbycusis. Because the patient has mild presbycusis, the nurse should use both discussion and handouts. There is no need to wait until family members have left to provide patient teaching.

When the nurse is taking a health history of a new patient at the ear clinic, the patient states, I have to sleep with the television on. Which follow-up question is most appropriate to obtain more information about possible hearing problems? a. Do you grind your teeth at night? b. What time do you usually fall asleep? c. Have you noticed ringing in your ears? d. Are you ever dizzy when you are lying down?

ANS: C Patients with tinnitus may use masking techniques, such as playing a radio, to block out the ringing in the ears. The responses Do you grind your teeth at night? and Are you ever dizzy when you are lying down? would be used to obtain information about other ear problems, such as vestibular disorders and referred temporomandibular joint (TMJ) pain. The response What time do you usually fall asleep? would not be helpful in assessing problems with the patients ears.

Which action will the nurse include in the plan of care for a patient with benign paroxysmal positional vertigo (BPPV)? a. Teach the patient about use of medications to reduce symptoms. b. Place the patient in a dark, quiet room to avoid stimulating BPPV attacks. c. Teach the patient that canalith repositioning may be used to reduce dizziness. d. Speak slowly and in a low-pitch to ensure that the patient is able to hear instructions.

ANS: C The Epley maneuver is used to reposition ear rocks in BPPV. Medications and placement in a dark room may be used to treat Mnires disease, but are not necessary for BPPV. There is no hearing loss with BPPV.

To decrease the risk for future hearing loss, which action should the nurse who is working with college students at the on-campus health clinic implement? a. Arrange to include otoscopic examinations for all patients. b. Administer influenza immunizations to all students at the clinic. c. Discuss the importance of limiting exposure to amplified music. d. Perform tympanometry on all patients between the ages of 18 to 24.

ANS: C The nurse should discuss the impact of amplified music on hearing with young adults and discourage listening to very amplified music, especially for prolonged periods. Tympanometry measures the ability of the eardrum to vibrate and would not help prevent future hearing loss. Although students are at risk for the influenza virus, being vaccinated does not help prevent future hearing loss. Otoscopic examinations are not necessary for all patients.

The charge nurse must intervene immediately if observing a nurse who is caring for a patient with vestibular disease a. speaking slowly to the patient. b. facing the patient directly when speaking. c. Encourage the patient to ambulate independently. d. administering Rinne and Weber tests to the patient.

ANS: C Vestibular disease affects balance, so the nurse should monitor the patient during activities that require balance. The other actions might be used for patients with hearing disorders.

A patient who received a corneal transplant 2 weeks ago calls the ophthalmology clinic to report that his vision has not improved with the transplant. Which action should the nurse take? a. Suggest the patient arrange a ride to the clinic immediately. b. Ask about the presence of floaters in the patients visual field. c. Remind the patient it may take months to restore vision after transplant. d. Teach the patient to continue using prescribed pupil-dilating medications.

ANS: C Vision may not be restored for up to a year after corneal transplant. Because the patient is not experiencing complications of the surgery, an emergency clinic visit is not needed. Because floaters are not associated with complications of corneal transplant, the nurse will not need to ask the patient about their presence. Corticosteroid drops, not mydriatic drops, are used after corneal transplant surgery.

The nurse performing an eye examination will document normal findings for accommodation when a. shining a light into the patient's eye causes pupil constriction in the opposite eye. b. a blink reaction follows touching the patient's pupil with a piece of sterile cotton. c. covering one eye for 1 minute and noting pupil constriction as the cover is removed. d. the pupils constrict while fixating on an object being moved closer to the patients eyes

ANS: D Accommodation is defined as the ability of the lens to adjust to various distances. The pupils constrict while fixating on an object being moved far away to near the eyes. The other responses may also be elicited as part of the eye examination, but they do not indicate accommodation.

Which statement by the patient to the home health nurse indicates a need for more teaching about self- administering eardrops? a. I will leave the ear wick in place while administering the drops. b. I should lie down before and for 5 minutes after administering the drops. c. I will hold the tip of the dropper above the ear while administering the drops. d. I should keep the medication refrigerated until I am ready to administer the drops.

ANS: D Administration of cold eardrops can cause dizziness because of stimulation of the semicircular canals. The other patient actions are appropriate.

The nurse in the eye clinic is examining a 67-year-old patient who says I see small spots that move around in front of my eyes. Which action will the nurse take First? a. Immediately have the ophthalmologist evaluate the patient. b. Explain that spots and floaters are a normal part of aging. c. Inform the patient that these spots may indicate retinal damage. d. Use an ophthalmoscope to examine the posterior eye chambers.

ANS: D Although floaters are usually caused by vitreous liquefaction and are common in aging patients, they can be caused by hemorrhage into the vitreous humor or by retinal tears, so the nurses first action will be to examine the retina and posterior chamber. Although the ophthalmologist will examine the patient, the presence of spots or floaters in a 65-year-old is not an emergency. The spots may indicate retinal damage, but the nurse should assess the eye further before discussing this with the patient

Which information will the nurse include when teaching a patient with keratitis caused by herpes simplex type 1? a. Correct use of the antifungal eyedrops natamycin (Natacyn) b. How to apply corticosteroid ophthalmic ointment to the eyes c. Avoidance of nonsteroidal antiinflammatory drugs (NSAIDs) d. Importance of taking all of the ordered oral acyclovir (Zovirax)

ANS: D Oral acyclovir may be ordered for herpes simplex infections. Corticosteroid ointments are usually contraindicated because they prolong the course of the infection. Herpes simplex I is viral, not parasitic, or fungal. Natamycin may be used for Acanthamoeba keratitis caused by a parasite. NSAIDs can be used to treat the pain associated with keratitis.

The nurse is completing the admission database for a patient admitted with abdominal pain and notes a history of hypertension and glaucoma. Which prescribed medications should the nurse question? a. Morphine sulfate 4 mg IV b. Diazepam (Valium) 5 mg IV c. Betaxolol (Betoptic) 0.25% eyedrops d. Scopolamine patch (Transderm Scop) 1.5 mg

ANS: D Scopolamine is a parasympathetic blocker and will relax the iris, causing blockage of aqueous humor outflow and an increase in intraocular pressure. The other medications are appropriate for this patient

When assessing a patients consensual pupil response, the nurse should a. have the patient cover one eye while facing the nurse. b. observe for a light reflection in the center of both corneas. c. instruct the patient to follow a moving object using only the eyes. d. shine a light into one pupil and observe the response of both pupils.

ANS: D The consensual pupil response is tested by shining a light into one pupil and observing for both pupils to constrict. Observe the corneal light reflex to evaluate for weakness or imbalance of the extraocular muscles. In a darkened room, ask the patient to look straight ahead while a penlight is shone directly on the cornea. The light reflection should be located in the center of both corneas as the patient faces the light source. To perform confrontation visual field testing, the patient faces the examiner and covers one eye, then counts the number of fingers that the examiner brings into the visual field. Instructing the patient to follow a moving object only with the eyes is testing for visual fields and extraocular movements.

When obtaining a health history from a 49-year-old patient, which patient statement is most important to communicate to the primary health care provider? a. My eyes are dry now. b. It is hard for me to see at night. c. My vision is blurry when I read. d. I cant see as far over to the side.

ANS: D The decrease in peripheral vision may indicate glaucoma, which is not a normal visual change associated with aging and requires rapid treatment. The other patient statements indicate visual problems (presbyopia, dryness, and lens opacity) that are considered a normal part of aging.

A 75-year-old patient who lives alone at home tells the nurse, I am afraid of losing my independence because my eyes dont work as well they used to. Which action should the nurse take first? a. Discuss the increased risk for falls that is associated with impaired vision. b. Explain that there are many ways to compensate for decreases in visual acuity. c. Suggest ways of improving the patients safety, such as using brighter lighting. d. Ask the patient more about what type of vision problems are being experienced.

ANS: D The nurses initial action should be further assessment of the patients concerns and visual problems. The other actions may be appropriate, depending on what the nurse finds with further assessment.

Which finding in an emergency department patient who reports being struck in the right eye with a fist is a priority for the nurse to communicate to the health care provider? a. The patient complains of a right-sided headache. b. The sclera on the right eye has broken blood vessels. c. The area around the right eye is bruised and tender to the touch. d. The patient complains of a curtain over part of the visual field.

ANS: D The patients sensation that a curtain is coming across the field of vision suggests retinal detachment and the need for rapid action to prevent blindness. The other findings would be expected with the patients history of being hit in the eye.

A 72-year-old patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective? a. I will need to use bright lights to read for at least the next week. b. I will use drops to keep my pupils dilated until my appointment. c. I will not use facial lotions near my eyes during the recovery period. d. I will cover up with long-sleeved shirts and pants for the next 5 days.

ANS: D The photosensitizing drug used for photodynamic therapy is activated by exposure to bright light and can cause burns in areas exposed to light for 5 days after the treatment. There are no restrictions on the use of facial lotions, medications to keep the pupils dilated would not be appropriate, and bright lights would increase the risk for damage caused by the treatment.

Which teaching point should the nurse plan to include when caring for a patient whose vision is corrected to 20/200? a. How to access audio books b. How to use a white cane safely c. Where Braille instruction is available d. Where to obtain specialized magnifiers

ANS: D Various types of magnifiers can enhance the remaining vision enough to allow the performance of many tasks and activities of daily living (ADLs). Audio books, Braille instruction, and canes usually are reserved for patients with no functional vision.

When assisting a blind patient in ambulating to the bathroom, the nurse should a. take the patient by the arm and lead the patient slowly to the bathroom. b. have the patient place a hand on the nurses shoulder and guide the patient. c. stay beside the patient and describe any obstacles on the path to the bathroom. d. walk slightly ahead of the patient and allow the patient to hold the nurses elbow.

ANS: D When using the sighted-guide technique, the nurse walks slightly in front and to the side of the patient and has the patient hold the nurses elbow. The other techniques are not as safe in assisting a blind patient.

A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic and weak. Five minutes after administering a half cup (120-mL) of orange juice the clients signs and symptoms have not changed. What action would the nurse take next?

Administer another half cup of orange juice

A nurse cares for a client experiencing DKA who presents with Kussmaul respirations. What action would the nurse take?

Administer of intravenous insulin

Presbyopia-

Age related vision loss of things that are nearby

Presbycusis-

Age repeated hearing loss, high pitched sound occur

Which assessment finding informs a nurse that a pt is at risk for type 2 diabetes?

Answer mentioned extremely high FASTING BG (over 200+)

Raynaud Syndrome-

Associated with underlying disease such as an autoimmune- give up smoking (vasoconstriction)

Graves disease-

Autoimmune disorder, often occurring after an episode of thyroid inflammation, in which the production of autoantibodies that attach to the thyroid- stimulating hormone (TSH) receptors on the thyroid gland greatly increases thyroid hormone production.

A nurse teaches a client with type two diabetes mellitus who is prescribed Glipizide (glucotrol). Which statement with the nurse is included in the clients teaching?

Avoid taking NSAID *NSAIDs cause low blood sugar when taken with Glipizide.

Which assessment finding in a client with long-standing diabetes will the nurse interpret as an early sign of diabetic nephropathy? A. Positive urine red blood cells B. Microalbuminuria C. Positive urine glucose D. Positive urine white blood cells

B Microalbuminuria is the most common and reliable indicator of diabetic nephropathy. Red blood cells and white blood cells in the urine are indicators of urinary tract infection and not specific to nephropathy. Presence of glucose in the urine is more of an indication of hypergly-cemia and not of the early stages of diabetic nephropathy.

Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "Somogyi phenomenon" to achieve better control? A. "Avoid eating any carbohydrate with your evening meal." B. "Eat a bedtime snack containing equal amounts of protein and carbohydrates." C. "Inject the insulin into your arm rather than into the abdomen around the navel." D. "Take your evening insulin dose right before going to bed instead of at supper time."

B The client with "Somogyi phenomenon," diagnosed by checking blood glucose levels during the night, has morning hyperglycemia caused by the counterregulatory response to nighttime hypoglycemia. Eating a bedtime snack to pre-vent nighttime hypoglycemia can result in sup-pression of counterregulatory hormone release. A client with "dawn phenomenon," diagnosed by checking blood glucose levels during the night, has morning hyperglycemia that results from a nighttime release of adrenal hormones causing blood glucose elevations at about 5 to 6 a.m. It is managed by providing more insulin for the overnight period (e.g., giving the evening dose of intermediate-acting insulin at 10 p.m. instead of with the evening meal). Changing the injection site would not prevent morning hyperglycemia. Not eating any carbohydrate with a meal is more likely to cause severe hypoglycemia during the night and is dangerous.

Which priority instruction does the nurse teach a client with glaucoma who is prescribed eyedrops to decrease intraocular pressure (IOP)? A. Wait 15 minutes between eyedrop drug instillations. B. Perform punctal occlusion after using eyedrops for glaucoma therapy. C. If a dose is missed, skip it and administer the next dose when it is due. D. Blink several times after each eyedrop installation.

B The nurse teaches the client the technique of punctal occlusion (placing pressure on the corner of the eye near the nose) immediately after eyedrop instillation to prevent systemic absorption of the drug. The time between drugs should be 5 to 10 minutes. To decrease IOP, it is essential that the client does not miss doses. After each dose, the client is instructed to close the eyes but not blink them several times.

Which assessment action is a priority for the nurse to perform first to prevent harm for a client with diabetes whose blood osmolarity is 345 mOsm/L? A. Checking skin turgor B. Measuring blood pressure C. Testing for ketones in the urine D. Checking the most recent serum electrolyte values

B All the assessment actions are important for this client who is likely to be severely dehy-drated. The priority assessment action is to measure blood pressure because the severe de-hydration can cause profound hypotension with orthostatic hypotension leading to dan-gerously reduced organ perfusion and increasing the risk for falls.

Which finding does the nurse expect to see when examining a client with a mature cataract using an ophthalmoscope? A. Dilated pupil B. Bluish-white pupil C. Yellow tinge to sclera D. Enlarged retina

B As a cataract matures, the opacity makes it difficult to see the retina, and the red reflex may be absent. When this occurs, and the nurse ex-amines the client with an ophthalmoscope, the pupil is bluish white.

For which client complication of diabetes will the nurse expect to administer glucagon intramuscularly? A. Diabetic retinopathy B. Severe hypoglycemia C. Diabetic ketoacidosis (DKA) D. Hyperglycemic-hyperosmolar state (HHS)

B Glucagon injections are administered to raise blood glucose levels when severe hypoglycemia is present. This drug breaks down liver glycogen stores into glycogen that is converted into glucose.

Which first sign will the nurse expect when evaluating a client for primary open-angle glaucoma (POAG)? A. Brow pain with nausea and vomiting B. Gradual loss of visual fields C. Seeing halos and floaters D. Sudden severe pain around the eyes

B Primary open-angle glaucoma (POAG), the most common form of primary glaucoma, usually affects both eyes and has no signs or symptoms in the early stages. It develops slowly, with gradual loss of visual fields that may go unnoticed because central vision at first is unaffected.

Which signs and symptoms will the nurse in-struct the client and family to immediately report to the eye health care provider after cataract surgery? Select all that apply. A. Mild eye itching B. Sharp sudden pain in the eye C. Bleeding or increased discharge from the eye D. Flashes of light or floating shapes seen in the eye E. Decreased vision in the eye that had surgery F. Green or yellow, thick drainage from the eye

B, C, D, E, F All of these signs and symptoms must be re-ported to the eye health care provider except option A. Mild eye itching is a normal and expected finding after a client's cataract surgery.

Which signs and symptoms will the nurse expect when a client is in the early stage of cataract development? Select all that apply. A. Photophobia B. Decreased color perception C. Double vision D. Blurred vision E. Decreased depth perception F. Pain and eye redness

B, D Early signs and symptoms of cataracts are slightly blurred vision and decreased color perception. As lens cloudiness continues, blurred vision worsens and double vision occurs. The client may have difficulty with ADLs. Clients commonly report increasing difficulty seeing at night, especially while driving. No pain or eye redness is associated with age-related cataract formation.

Which lifestyle changes will the nurse suggest to a 35-year-old client who has prediabetes to reduce the risk for developing type 2 diabetes? Select all that apply. A. Increasing fluid intake B. Increasing physical activity C. Quitting smoking and vaping D. Eliminating all dietary carbohydrates E. Reducing consumption of empty calories F. Keeping body weight at or slightly below ideal

B, E, F The two most important lifestyle changes to reduce the risk for development of type 2 diabetes are increasing activity and maintaining a healthy weight. Part of weight control is reducing consumption of surgery drinks and other sources of "empty" calories that increase overall weight and have minimal nutritional values. Increasing fluid intake and quitting smoking and vaping help prevent complications from diabetes but do not reduce the risk for developing the disorder. Eliminating all dietary carbohydrates is not part of a well-balanced diet, can cause other problems, and is not recommended for prevention of type 2 diabetes.

The nurse is planning teaching for a client who is starting acarbose for diabetes mellitus type 2. Which statement will the nurse include in the teaching?

Be sure to take the drug with each meal ***Type 2 diabetic med

Hyperthyroidism

Blood TSH level o Elevated in hypothyroidism o Decreased in Graves' disease Heat intolerance→ Keep the patient's room cool. T3 & T4 o Increased o Elevated

S/S of hyperglycemia

Blurred vision, weakness, (polydipsia) increased thirst, headache, (polyuria) ( frequent urination, dry mouth, increased hunger (polyphagia)

What is the next management action the nurse expects when a client with glaucoma does not respond to prescribed eyedrops with a decrease in intraocular pressure (IOP)? A. Insertion of an implanted shunt B. A scleral buckling procedure C. A laser trabeculoplasty D. Visual field testing

C Surgery can be performed when drugs for open-angle glaucoma are not effective at con-trolling IOP. Two common procedures are laser trabeculoplasty and trabeculectomy. A laser trabeculoplasty burns the trabecular mesh-work, scarring it and causing the meshwork fibers to tighten. Tight fibers increase the size of the spaces between the fibers, improving out-flow of aqueous humor and reducing IOP. Trabeculectomy is a surgical procedure that creates a new channel for fluid outflow. Both are ambulatory surgery procedures

Which serum electrolyte level is most important for the nurse to monitor closely to prevent harm in a client who has hyperglycemia? A. Sodium B. Chloride C. Potassium D. Magnesium

C Although all electrolytes can change as a result of hyperglycemia, potassium changes with either hyperkalemia or hypokalemia cause excitable membrane alterations that can be life threatening, especially in cardiac conduction and skeletal muscle contraction. The nurse must evaluate serum potassium levels most closely to prevent harm.

What is the nurse's best response when a client who has type 1 diabetes asks why he shouldn't try to keep his blood glucose level as close to zero (0) as possible? A. "That would only frustrate you because there are many ways your body prevents your blood glucose level from going below 50 mg/L (2.8 mmol/L)." B. "You would have to eat absolutely no carbohydrates to accomplish this and just about all food contains some carbohydrates." C. "Glucose is an important nutrient, especially for your brain, and you cannot live if your blood glucose level gets too low." D. "Maintaining such a low glucose level would require a lot of very expensive drugs and not reduce the complications."

C Glucose is a critical nutrient for all cells and tissues. Although chronically high blood glu-cose levels cause many serious problems, low blood glucose levels can rapidly (within minutes) lead to neuron injury and death. There-fore, the desired outcome of diabetes management is to keep blood glucose levels in the range of 60 to 100 mg/dL (3.3 to 5.6 mmol/L) to support brain function and prevent death.

Which instruction will the nurse teach a client with bilateral eye infections and two bottles of the same antibiotic solution are prescribed? A. Obtain one bottle from the pharmacy and return for the second bottle if the infection does not clear. B. Obtain one bottle for both eyes because a second bottle is not necessary. C. Obtain both bottles and label one for the right eye and the other for the left eye. D. Obtain both bottles but save the second because the infection will likely recur.

C If both eyes are infected, separate bottles of drugs are needed for each eye. The nurse teaches the client to clearly label the bottles "right eye" and "left eye" and not to switch the drugs from eye to eye.

With which classes of antidiabetic drugs will the nurse most emphasize to the client with diabetes how to recognize and manage hypoglycemia? A. Alpha-glucosidase inhibitors B. Biguanides C. Insulin D. Incretin mimetics E. Meglitinide analogs F. Second-generation sulfonylureas

C, D, E, F Insulin, incretin mimetics, meglitinide analogs, and sulfonylureas all increase blood insulin levels or insulin action and greatly increase the risk for hypoglycemia if the client does not match his or her food intake with peak drug action. Alpha-glucosidase inhibitors and bigua-nides have different mechanisms of action and do not increase the risk for hypoglycemia when taken alone.

A patient has blurred vision, difficulty distinguishing color, what is the patient at risk for?

Cataracts

Insulin pump

Change every 2-3 days

The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation?

Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily *Hypothyroidism exacerbates dementia and neuro status→ Levothyroxine targets cognitive symptoms of dementia making this patient the most stable.

Which activities will the nurse instruct a client receiving discharge teaching after cataract surgery are acceptable? A. Vacuuming or mopping are OK, but do not bend over to scrub. B. Driving during the day is acceptable, but do not drive at night. C. Having sexual intercourse with a familiar partner is acceptable. D. Meal preparation and washing dishes are acceptable activities.

D The nurse teaches the client about activity re-strictions after cataract surgery. Cooking and light housekeeping are permitted, but vacuuming is avoided for several weeks because of the forward flexion involved and the rapid, jerky movements required. Advise the client to refrain from driving until vision is clear. The client is taught to avoid activities that increase IOP such as having sexual intercourse. For additional activities to avoid, see Table 42.5 in your text.

Which client admitted to a surgical unit will the nurse recognize as having a higher risk for having type 2 diabetes? A. 30-year-old Hispanic female runner B. 36-year-old white female who has rheumatoid arthritis C. 40-year-old black male who is 10 lb (4.5 kg) underweight D. 48-year-old obese male American Indian

D The type 2 diabetes rate is about 13% among blacks and 12% in the Hispanic population, which is higher than that of non-Hispanic white Ameri-cans. At nearly 15.1%, American Indians and Alaska Indians have the highest age-adjusted prevalence of DM among U.S. racial and ethnic groups. The American-Indian client has an increased risk of obesity. The Hispanic female and black male have high activity levels or reduced weight, which decreases the risk.

How will the nurse respond to the client newly diagnosed with type 2 diabetes who asks, "What does having metabolic syndrome and diabetes mean for me?" A. "Metabolic syndrome is helpful to anyone with diabetes because it increases the sensitivity of your cells to the presence of insulin." B. "People with diabetes and metabolic syndrome usually need to use insulin rather than oral antidiabetic drug to manage their blood glucose levels." C. "Metabolic syndrome is a problem in eliminating drugs from your body, so you will need to be on lower doses of your antidiabetic drugs to prevent severe side effects." D. "Your risk for having cardiovascular disease and a possible heart attack is higher and will require good control of your diabetes, blood pressure, and cholesterol to prevent them."

D Metabolic syndrome is the simultaneous presence of metabolic factors that increase risk for developing type 2 DM and cardiovascular disease. Features include insulin resistance, higher blood lipid levels, abdominal obesity, and hypertension. The risk for atherosclerosis, along with heart disease and strokes is greatly increased. The two disorders together make blood glucose levels harder to control.

A nurse assesses a pt who is experiencing diabetic ketoacidosis (DKA). for which assessment findings would the nurse monitor for the client? SATA

Deep & fast respirations Tachycardia Orthostatic hypotension

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

Diabetes can cause blindness, so I should see an ophthalmologist yearly

A 42-year-old woman with Ménière's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan?

Dim the lights in the patients room

A nurse teaches a patient about self-monitoring of blood glucose levels which statement with the nurse includes in this clients teaching to prevent blood borne infections?

Do not share your monitoring equipment

The nurse is caring for a newly admitted client who is diagnosed with hyperglycemic - hyperosmolar state (HHS). What is the nurse's priority action at this time?

Establish intravenous access to provide fluids

A nurse is assessing a client who has a 15 year history of diabetes and notes decreased tactile sensation in both feet. What action should the nurse take first?

Examine the clients feet for signs of injury

A patient with a high IOP is at risk for

Glaucoma

Rinnes test-

Hearing test that compares the perception of sounds thru mastoid process used with webers test (fork)

A client is taking timolol eye drops. The nurse assesses the client's pulse at 48 beats/min. Which action by the nurse is priority?

Hold the eyedrops and notify the PCP *Beta-blocker reduces the heart rate.

Which of the following are short and rapid-acting insulin?

Humanlin regular Novolog Lispro - Humalog

The nurse is caring for a newly admitted older adult who has a blood glucose of 300 mg/dL, a urine output of 185 mL in the past 8 hours, and a blood urea nitrogen (BUN) of 44 mg/dL. what diabetic complication does the nurse suspect?

Hyperglycemic - hyperosmolar state HHS

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital signs and assessment: Blood pressure 120 beats/min Pulse: 120 beats/min Respiratory Rate: 28 breaths/min urine output: 20 mL/hr via a catheter Laboratory results: Serum potassium: 2.6 mEq/L Medications: Potassium Chloride 40 mEq/L IV bolus STAT Increase IV fluid to 100 mL/her Which action would the nurse take?

Increase the intravenous rate and then consult with the primary health care provider about the potassium prescription

The nurse assesses a client with diabetic ketoacidosis. Which assessment finding would the nurse correlate with this condition?

Increased rate and depth of respiration

A nurse assesses a client with diabetes mellitus who self-administered subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. What action would the nurse take?

Instruct the client to rotate sites for insulin injections

During the examination of the ear, a dark yellow substance is noted in the ear canal. The tympanic membrane is not visible. The patient's wife complains that he never hears what she says lately. These findings would suggest that the nurse prepare the patient for which procedure?

Irrigation of the ear

What ethnicity does Glaucoma affect the most?

Leading cause of blindness in African Americans Overall: 2nd cause of blindness (bc cataracts is #1 cause of blindness)

Medication for hypothyroidism

Levothyroxine (Synthroid)

A nurse teaches a client who is diagnosed with diabetes Mellitus. Which statement would the nurse include in this clients plan of care to delay the onset of microvascular and macrovascular complications?

Maintain tight glycemic control and prevent hyperglycemia

Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma?

Mannitol (Osmitrol) 100 mg IV *because it reduces pressure and swelling of the eye.

What med should you inform the doctor of before doing a CT procedure?

Metformin -Interacts w/ contrast dye

S/S of hypoglycemia

Nervous Irritability Diaphoresis Anxiety Palpitations Neurological changes Seizures Unconsciousness

Glaucoma-

Peripheral Vision loss

A patient came to the ER with hearing loss. What do you document?

Presbycusis

A nurse assesses a client with diabetes mellitus. Which assessment finding would alert the nurse to decrease kidney function in this client?

Presence of protein in urine

Which of the following documentation entries is most accurate?

Pt walked 50 feet and back down the hallway with assistance from the nurse. HR 88 and regular before exercise.

A nurse is preparing to administer eardrops to an adult client. The nurse administers the eardrops by?

Pulling the pinna up and back

Thyroid Storm/Crisis

Results from sudden surge of large amounts of thyroid hormones into the bloodstream Causes increase in body metabolism Medical emergency! High mortality rate! Precipitated by uncontrolled hyperthyroidism or thyroidectomy Hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachycardia, chest pain, dyspnea, palpitations

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which would alert the nurse to intervene immediately?

Serum potassium level of 2.5 mEq/L (2.5 mmol/L) *An increase in insulin leads to a decrease in potassium→ they are opposites.

Visual acuity and distance is tested with or 20 feet away

Snellen chart

An 82-year-old patient who is being admitted to the hospital repeatedly asks the nurse to speak up so that I can hear you. Which action should the nurse take?

Speak normally but more slowly

A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? SATA

Stroke Kidney failure Blindness

A client;s intraocular pressure (IOP) is 28 mm Hg. What action would the nurse anticipate?

Teach about drugs for glaucoma * Because the normal range for IOP is 10-21 mm Hg→ >21 IOP means the patient has glaucoma.

After teaching a client with diabetes mellitus to inject insulin the nurse assesses the clients understanding. Which statement made by the client indicates a need for further teaching?

The lower abdomen is the best location because it's closest to the pancreas

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider?

The patient has eye pain rated at a 5 (on a 0 to 10 scale). *Not a painful procedure and condition→ so if the patient is experiencing pain, it could be a sign of infection.

Hallmark sign of hyperthyroidism

Thermoregulation

Meunière disease-

Tinnitus, vertigo, hearing loss

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in the clients teaching to prevent injury?

Use a bath thermometer to test water temperature

To determine whether treatment is effective for a patient with primary open angle glaucoma (POAG), the nurse will evaluate the patient for improvement in

Visual field

A pt states, "I would like to see what is written in my medical records".

You have the right to read your record.

A nurse is teaching a client with diabetes mellitus who asks, "why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)? How would the nurse respond?

Your brain needs a constant supply of glucose because it can't store it

A nurse cares for a client who has a family history of diabetes mellitus. The client states my father has type one diabetes mellitus. Will I develop this disease as well? how would the nurse respond?

Your risk of diabetes is higher than the general population but it may not occur

Glaucoma test-

tonometry to measure IOP

Hyperopia-

farsightedness; difficulty seeing close objects when light rays are focused on a point behind the retina

Parathyroid hormone

major controller of blood calcium levels

Myopia-

nearsightedness; difficulty seeing distant objects when light rays are focused on a point in front of the retina

Macular degeneration-

o Lack of depth perception o Objects appear distorted o Floating spots o Blurred vision o Blind spots o Loss of central vision o Blindness o Blurred vision, darkened vision o Scotomas (blind spots) o Metamorphopsia (distortion)

Primary angle glaucoma-

reduced outflow of tears increases IOP

Primary angle closed glaucoma-

sudden onset (no tears flow out) EMERGENCY

Slit Lamp test-

test for cataracts

Hypothyroidism

​​T3 and T4 o Decreased TSH o High in primary disease o Low in secondary or tertiary disease Blood cholesterol increased