sensory NCLEX

A nurse is reinforcing home-care instructions to a client and family regarding care after cataract removal from the right eye. Which of the following statements, if made by the client, would indicate an understanding of the instructions?

"I will not sleep on my right side."

A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about the purpose of the medication. The nurse tells the client that:

"The medication causes the pupil to constrict and will lower the pressure in the eye."

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures will the nurse include in the plan? Select all that apply.

1. To avoid activities that require bending over 3. To place an eye shield on the surgical eye at bedtime 5. To contact the surgeon if a decrease in visual acuity occurs 6. To take acetaminophen (Tylenol) for minor eye discomfort

A nurse is assigned to care for a client with a detached retina. Which finding would the nurse expect to be documented in the client's record?

A sense of a curtain falling across the field of vision

A nurse notes that the health care provider has documented a diagnosis of presbycusis on the client's chart. The nurse understands that this condition is accurately described as:

A sensorineural hearing loss that occurs with aging

The client is receiving an eyedrop and an eye ointment to the right eye. The nurse should:

Administer the eyedrop first, followed by the eye ointment.

A client sustains a contusion of the eyeball after a traumatic injury with a blunt object. The nurse takes which action immediately?

Applies ice to the affected eye

The nurse is caring for a client with glaucoma. Which of the following medications, if prescribed for the client, would the nurse question?

Atropine sulfate (Isopto Atropine)

A client with Ménière's disease is experiencing severe vertigo. The nurse instructs the client to do which of the following to assist in controlling the vertigo?

Avoid sudden head movements.

A client is diagnosed with glaucoma. Which data gathered by the nurse indicate a risk factor associated with glaucoma?

Cardiovascular disease

A nurse is assigned to care for a client with a diagnosis of detached retina. Which finding would indicate that bleeding has occurred as a result of retinal detachment?

Complaints of a burst of black spots or floaters

In preparation for cataract surgery, the nurse is to administer cyclopentolate (Cyclogyl) eyedrops. The nurse administers the eyedrops, knowing that the purpose of this medication is to:

Dilate the pupil of the operative eye.

A nurse is assisting in developing a teaching plan for the client with glaucoma. Which instruction should the nurse suggest to include in the plan of care?

Eye medications will need to be administered for the rest of your life.

A client arrives at the emergency department with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially?

Instillation of mineral oil or diluted alcohol

A client sustains a chemical eye injury from a splash of battery acid. The nurse prepares the client for which immediate measure?

Irrigating the eye with sterile normal saline

A nurse is assigned to care for a client hospitalized with Ménière's disease. The nurse expects that which of the following would most likely be prescribed for the client?

Low-sodium diet

Betaxolol hydrochloride (Betoptic SR) eye drops have been prescribed for the client with glaucoma. Which nursing action is most appropriate related to monitoring for the side effects of this medication?

Monitoring blood pressure

The nurse is providing instructions to a client who will be self-administering eyedrops. To minimize the systemic effects that eyedrops can produce, the client is instructed to:

Occlude the nasolacrimal duct with a finger over the inner canthus for 30 to 60 seconds after instilling the drops.

A client arrives in the emergency department after an automobile crash. The client's forehead hit the steering wheel and a hyphema has been diagnosed. The nurse would prepare to position the client:

On bedrest in a semi-Fowler's position

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

Pulling the pinna up and back

A nurse is caring for a client after enucleation and notes the presence of bright red drainage on the dressing. The nurse takes which appropriate action?

Reports the finding to the registered nurse (RN)

A nurse is caring for a client who is hearing-impaired and takes which approach to facilitate communication?

Speaks in a normal tone

The nurse is preparing to communicate with an older client who is hearing impaired. Which intervention should be implemented initially?

Stand in front of the client.

Which intervention should be implemented for the older client with presbycusis who has a hearing loss?

Use low-pitched tones

The nurse prepares the client for ear irrigation as prescribed by the health care provider. In performing the procedure, the nurse:

Warms the irrigating solution to 98° F