143 FINAL - Mod 9: Eye & Ear (PRACTICE QUESTIONS)

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear? A. Inner ear B. Middle ear C. Tympanic membrane D. External ear

A. A client with vertigo experiences problems with the inner ear, which is responsible for maintaining equilibrium. The external ear collects sound; the middle ear conducts sound. The tympanic membrane (eardrum) vibrates in response to sound stimulation.

Which type of glaucoma presents an ocular emergency? A. Acute angle-closure glaucoma B. Normal tension glaucoma C. Chronic open-angle glaucoma D. Ocular hypertension

A. Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added at a later time.

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client? A. Amsler grid B. Slit lamp C. Visual field D. Ishihara polychromatic plates

A. Clients with macular problems are tested with an Amsler grid. It is made up of a geometric grid of identical squares with a central fixation point. The examiner instructs the client to stare at the central fixation spot on the grid and report if they see any distortion of the squares. Clients with macular problems may say some of the squares are faded or wavy. An Ishihara polychromatic plate, visual field, or slit lamp test will not diagnose macular degeneration.

When caring for a client with chronic glaucoma, the nurse sets the goal of drug therapy to slow disease progression by reducing IOP. What are the first-line drugs used to treat glaucoma? A. Topical beta-blockers B. Mydriatics C. Antibacterials D. Topical ACE inhibitors

A. For chronic glaucoma, the goal of drug therapy is to slow disease progression by reducing IOP. Topical beta-blockers are first-line drugs and are commonly used.

An independent client with bilateral macular degeneration is preparing to eat lunch. Where should the nurse place the client's food tray? A) Place the client's tray to the periphery of his visual field B) Place the client's tray in the center of his visual field C) Place the client's tray to the center right of his visual field D) Place the client's tray to the center left of his visual field

A. Macular degeneration is caused by damage to the center of the retina called the macula. Clients may experience blurred central vision and the inability to see small details while reading. A client with bilateral macular degeneration who is independent should have the food tray placed to the periphery of his visual field. Central vision is blurred so the client should not have anything placed in his central vision. The nurse should stand and talk to the client on his peripheral side of his visual field.

A pediatric nurse practitioner has diagnosed a 4-year-old girl with otitis media. The nurse should understand that infectious microorganisms likely entered the girl's middle ear by what means? A) Through an alteration in the eustachian tube B) Through the external ear C) From within the cochlea or vestibule D) From the interstitial spaces in the middle ear

A. The causative pathogens implicated in otitis media include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. They enter the middle ear as a result of an alteration in the eustachian tube, not from the inner ear, external ear, or interstitial spaces.

A nurse who provides care in an ophthalmology clinic has an order to instill atropine eye drops to a patient prior to the patient's clinical examination. What health education should the nurse provide prior to this intervention? A) These drops might sting a little bit, and they will make you temporarily sensitive to light. B) These eye drops will make it more difficult to close your eyes, but this will pass in a few hours. C) These drops will make your pupil temporarily constrict so that your eye can be examined more closely. D) These drops will make your eyes very bloodshot and sensitive, but this is only temporary.

A. The nurse instructs patients about the effects of atropine such as photophobia and stinging on administration. Atropine does not make it difficult to close the eyes, and it causes pupil dilation, not constriction.

A patient's medication administration record include daily timolol maleate eye drops. The nurse should identify what goal of therapy when planning this patient's care? A) Decrease intraocular pressure. B) Constrict pupils. C) Promote lacrimation. D) Improve visual acuity.

A. The purpose of the administration of beta- blocking drugs such as timolol is to decrease the IOP. Beta-blockers are not used to promote lacrimation, improve vision, or constrict the pupils.

A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do? A. Stand about 1 to 2 feet away from the ear to be tested. B. Stand at a position diagonal to the client. C. Have the client use a finger to occlude the ear to be tested. D. Speak a phrase in a low normal tone of voice.

A. When performing the whisper test, the nurse covers the untested ear with the palm of the hand and then whispers softly from a distance of 1 to 2 feet from the unoccluded ear and out of the client's sight. The client with normal hearing can correctly repeat what was whispered.

The nurse is discussing the results of a client's diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss? A. The sound is heard better in the ear in which hearing is better. B. The sound is heard equally in both ears. C. The sound is heard better in the ear in which hearing is poorer. D. The sound is heard longer in the ear in which hearing is better.

ANS: A Rationale: A client with sensorineural hearing loss hears the sound better in the ear in which hearing is better. The Weber test assesses bone conduction of sound and is used for assessing unilateral hearing loss. A tuning fork is used. A client with normal hearing hears the sound equally in both ears or describes the sound as centered in the middle of the head. A client whose hearing loss is conductive hears the sound better in the affected ear.

A nurse is teaching a client with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the client to perform what action? A. Instill the medication in the conjunctival sac. B. Maintain a supine position for 10 minutes after administration. C. Keep the eyes closed for 1 to 2 minutes after administration. D. Apply the medication evenly to the sclera

ANS: A Rationale: Eye drops should be instilled into the conjunctival sac, where absorption can best take place, rather than distributed over the sclera. It is unnecessary to keep the eyes closed or to maintain a supine position after administration.

The nurse is admitting a 55-year-old client diagnosed with a left eye retinal detachment. While assessing this client, what characteristic symptom would the nurse expect to find? A. Flashing lights in the visual field B. Sudden eye pain C. Loss of color vision D. Colored halos around lights

ANS: A Rationale: Flashing lights in the visual field is a common symptom of retinal detachment.Clients may also report spots or floaters or the sensation of a curtain being pulled across the eye. Retinal detachment is not associated with eye pain, loss of color vision, colored halos around lights.

A client is postoperative day 6 following tympanoplasty and mastoidectomy. The client has phoned the surgical unit and states experiencing occasional sharp, shooting pains in the affected ear. How should the nurse best interpret this client's report? A. These pains are an expected finding during the first few weeks of recovery. B. The client's report is suggestive of a postoperative infection. C. The client may have experienced a spontaneous rupture of the tympanic membrane. D. The client's surgery may have been unsuccessful.

ANS: A Rationale: For 2 to 3 weeks after surgery, the client may experience sharp, shooting pains intermittently as the eustachian tube opens and allows air to enter the middle ear. Constant, throbbing pain accompanied by fever may indicate infection and should be reported to the primary care provider. The client's pain does not suggest tympanic perforation or unsuccessful surgery.

A client develops a perforated eardrum. When teaching the client about this condition, the nurse would identify which condition as a most likely cause? A. infection B. otosclerosis C. Meniere disease D. cholesteatoma

ANS: A Rationale: Perforation of the tympanic membrane is usually caused by infection or trauma. Sources of trauma include skull fracture, explosive injury, or a severe blow to the ear. Less frequently, perforation is caused by foreign objects (e.g., cotton-tipped applicators, bobby pins, keys) that have been pushed too far into the external auditory canal. A perforated eardrum is not associated with Meniere's disease, otosclerosis, or cholesteatoma.

An advanced practice nurse has performed a Rinne test on a new client. During the test, the client reports that air-conducted sound is louder than bone-conducted sound. How should the nurse best interpret this assessment finding? A. The client's hearing is likely normal. B. The client is at risk for tinnitus. C. The client likely has otosclerosis. D. The client likely has sensorineural hearing loss.

ANS: A Rationale: The Rinne test is useful for distinguishing between conductive and sensorineural hearing loss. A person with normal hearing reports that air-conducted sound is louder than bone-conducted sound.

The nurse is providing discharge education for a client with a new diagnosis of Ménière disease. What food should the client be instructed to limit or avoid? A. Sweet pickles B. Frozen yogurt C. Shellfish D. Red meat

ANS: A Rationale: The client with Ménière disease should avoid foods high in salt and/or sugar; sweet pickles are high in both. Milk products are not contraindicated. Any type of meat, fish, or poultry is permitted, with the exception of canned or pickled varieties. In general, the client with Ménière disease should avoid or limit canned and processed foods.

The nurse should recognize the greatest risk for the development of blindness in which of the following clients? A. A 58-year-old Caucasian woman with macular degeneration B. A 28-year-old Caucasian man with astigmatism C. A 58-year-old black woman with hyperopia D. A 28-year-old black man with myopia

ANS: A Rationale: The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. The 58-year-old Caucasian woman with macular degeneration has the greatest risk for the development of blindness related to her age and the presence of macular degeneration. Individuals with hyperopia, astigmatism, and myopia are not in a risk category for blindness.

The advanced practice nurse is attempting to examine the client's ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the client's ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure? A. Maintain the irrigation fluid at a warm temperature. B. Instill short, sharp bursts of fluid into the ear canal. C. Follow the procedure with insertion of a cerumen curette to extract missed ear wax. D. Have the client stand during the procedure.

ANS: A Rationale: Warm water (never cold or hot) and gentle, not forceful, irrigation should be used to remove cerumen. Too forceful irrigation can cause perforation of the tympanic membrane, and ice water causes vomiting. Cerumen curettes should not be routinely used by the nurse. Special training is required to use a curette safely. It is unnecessary to have the client stand during the procedure.

A client is scheduled for audiometry to evaluate hearing. When teaching the client about this test, which characteristic would the nurse include as being evaluated? Select all that apply. A. pitch B. frequency C. intensity D. compliance E. postural control capabilities

ANS: A, B, C Rationale: When evaluating hearing, three characteristics are important: frequency, pitch, and intensity. Frequency refers to the number of sound waves emanating from a source per second, measured as cycles per second, or Hertz (Hz). Pitch is the term used to describe frequency; a tone with 100 Hz is considered of low pitch, and a tone of 10,000 Hz is considered of high pitch. The unit for measuring loudness (intensity of sound) is the decibel (dB), the pressure exerted by sound. Compliance refers to the tympanic membrane function and is measured by a tympanogram. A platform post-urography is used to measure postural control capabilities.

A nurse suspects that an older adult client may be experiencing hearing loss. Which finding would support the nurse's suspicion? Select all that apply. A. Dropping of word endings B. Disinterest in conversations C. Social withdrawal D. Domination of conversations E. Quick decision making

ANS: A, B, C, D Rationale: The person who slurs words or drops word endings, or produces flat-sounding speech, may not be hearing correctly. The ears guide the voice, both in loudness and in pronunciation. It is easy for the person who cannot hear what others say to become depressed and disinterested in life in general. Not being able to hear causes a person who is hearing-impaired to withdraw from situations that might prove embarrassing. Lack of self-confidence and fear of mistakes create a feeling of insecurity in many people who are hearing-impaired. No one likes to say the wrong thing or do anything that might appear foolish. Loss of self-confidence makes it increasingly difficult for a person who is hearing-impaired to make decisions. Many people who are hearing-impaired tend to dominate the conversation, knowing that as long as it is centered on them and they can control it, they are not so likely to be embarrassed by some mistake.

The nurse on the medical-surgical unit is reviewing discharge instructions with a client who has a history of glaucoma. The nurse should anticipate the use of what medications? A. Potassium-sparing diuretics B. Cholinergics C. Antibiotics D. Loop diuretics

ANS: B Rationale: Cholinergics are used in the treatment of glaucoma. The action of this medication is to increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis and opening the trabecular meshwork. Diuretics and antibiotics are not used in the management of glaucoma.

A client has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the client should be kept in a prone position until otherwise ordered. What should the nurse do? A. Clarify the order with the surgeon. B. Follow the order because this bed position is correct. C. Reposition the client after the first dressing change. D. Ask the client to lie in a semi-Fowler position.

ANS: B Rationale: For care of the client after surgical retina detachment repair, postoperative positioning of the client is critical because the injected bubble must float into a position overlying the area of detachment, providing consistent pressure to reattach the sensory retina. The client must maintain a prone position that would allow the gas bubble to actas a tamponade for the retinal break. Clients and family members should be made aware of these special needs beforehand so that the client can be made as comfortable as possible. It would be inappropriate to deviate from this order and there is no obvious need to confirm the order.

A client has been diagnosed with glaucoma and the nurse is preparing health education regarding the client's medication regimen. The client states that eagerness to beat this disease and looks forward to the time that the client will no longer require medication. How should the nurse best respond? A. You have a great attitude. This will likely shorten the amount of time that you need medications. B. In fact, glaucoma usually requires lifelong treatment with medications. C. Most people are treated until their intraocular pressure goes below 50 mm Hg. D. You can likely expect a minimum of 6 months of treatment.

ANS: B Rationale: Glaucoma requires lifelong pharmacologic treatment. Normal intraocular pressure is between 10 and 21 mm Hg.

A child goes to the school nurse and reports being unable to hear the teacher. What test could the school nurse perform that would preliminarily indicate hearing loss? A. Audiometry B. Rinne test C. Whisper test D. Weber test

ANS: C Rationale: A general estimate of hearing can be made by assessing the client's ability to hear a whispered phrase or a ticking watch, testing one ear at a time. The Rinne and Weber tests distinguish sensorineural from conductive hearing loss. These tests, as well as audiometry, are not usually performed by a registered nurse in a general practice setting.

When administering a client's eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal? A. Ensure that the client is well hydrated at all times. B. Encourage self-administration of eye drops. C. Occlude the puncta after applying the medication. D. Position the client supine before administering eye drops.

ANS: C Rationale: Absorption of eye drops by the nasolacrimal duct is undesirable because of the potential systemic side effects of ocular medications. To diminish systemic absorption and minimize the side effects, it is important to occlude the puncta. Self-administration,supine positioning, and adequate hydration do not prevent this adverse effect.

The nurse is assessing a new adult client. What characteristic of this client's status should the nurse identify as increasing the client's risk for glaucoma? A. The client uses over-the-counter NSAIDs. B. The client has a history of stroke. C. The client has diabetes. D. The client has Asian ancestry.

ANS: C Rationale: Diabetes is a risk factor for glaucoma, but Asian ancestry, NSAIDs, and stroke are not risk factors for the disease.

A client has been diagnosed with hearing loss related to damage of the cochlea. What term is used to describe this condition? A. Exostoses B. Otalgia C. Sensorineural hearing loss D. Presbycusis

ANS: C Rationale: Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing (cochlea) or cranial nerve VIII. Exostoses refer to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Presbycusis is the term used to refer to the progressive hearing loss associated with aging. Both middle and inner ear age-related changes result in hearing loss.

A client has informed the home health nurse that he/she has recently noticed distortions when looking at the Amsler grid that is mounted on the refrigerator. What is the nurse's most appropriate action? A. Reassure the client that this is an age-related change in vision. B. Arrange for the client to have his/her visual acuity assessed. C. Arrange for the client to be assessed for macular degeneration. D. Facilitate tonometry testing.

ANS: C Rationale: The Amsler grid is a test often used for clients with macular problems, such as macular degeneration. Distortions would not be attributed to age-related changes and there is no direct need for testing of intraocular pressure or visual acuity.

A 6-month-old infant is brought to the ED by the parents for inconsolable crying and pulling at the right ear. When assessing this infant, the advanced practice nurse is aware that the tympanic membrane should be what color in a healthy ear? A. Yellowish-white B. Pink C. Gray D. Bluish-white

ANS: C Rationale: The healthy tympanic membrane appears pearly gray and is positioned obliquely at the base of the ear canal. Any other color is suggestive of a pathologic process.

The nurse is planning the care of a client with a diagnosis of vertigo. What nursing diagnosis risk should the nurse prioritize in this client's care? A. Risk for disturbed sensory perception B. Risk for unilateral neglect C. Risk for falls D. Risk for ineffective health maintenance

ANS: C Rationale: Vertigo is defined as the misperception or illusion of motion, either of the person or the surroundings. A client suffering from vertigo will be at an increased risk of falls. For most clients, this is likely to exceed the client's risk for neglect, ineffective health maintenance, or disturbed sensation.

An older adult client has been diagnosed with macular degeneration and the nurse is assessing for changes in visual acuity since last visit. When assessing the client for recent changes in visual acuity, the client states that the lines on an Amsler grid as being distorted. What is the nurse's most appropriate response? A. Ask if the client has been using OTC vasoconstrictors. B. Instruct the client to repeat the test at different times of the day when at home. C. Arrange for the client to visit an ophthalmologist . D. Encourage the client to adhere to prescribed drug regimen.

ANS: C Rationale: With a change in the client's perception of the grid, the client should notify the ophthalmologist immediately and should arrange to be seen promptly. This is a priority over encouraging drug adherence, even though this is also important. Vasoconstrictors Are not a likely cause of this change and repeating the test at different times is not relevant.

An older adult with a recent history of mixed hearing loss has been diagnosed with a cholesteatoma. What should this client be taught about this diagnosis? Select all that apply. A. Cholesteatomas are benign and self-limiting, and hearing loss will resolve spontaneously. B. Cholesteatomas are usually the result of metastasis from a distant tumor site. C. Cholesteatomas are often the result of chronic otitis media. D. Cholesteatomas, if left untreated, result in intractable neuropathic pain. E. Cholesteatomas usually must be removed surgically.

ANS: C, E Rationale: Cholesteatoma is a tumor of the external layer of the eardrum into the middle ear, often resulting from chronic otitis media. They usually do not cause pain; however, if treatment or surgery is delayed, they may burst or destroy the mastoid bone. They are not normally the result of metastasis and are not self-limiting.

The nurse is administering eye drops to a client with glaucoma. After instilling the client's first medication, how long should the nurse wait before instilling the client's second medication into the same eye? A. 30 seconds B. 1 minute C. 3 minutes D. 5 minutes

ANS: D Rationale: A 5-minute interval between successive eye drop administrations allows for adequate drug retention and absorption. Any time frame less than 5 minutes will not allow adequate absorption.

Which of the following nurse's actions carries the greatest potential to prevent hearing loss due to ototoxicity? A. Ensure that clients understand the differences between sensory hearing loss and conductive hearing loss. B. Educate clients about expected age-related changes in hearing perception. C. Educate clients about the risks associated with prolonged exposure to environmental noise. D. Be aware of clients' medication regimens and collaborate with other professionals accordingly.

ANS: D Rationale: A variety of medications may have adverse effects on the cochlea, vestibular apparatus, or cranial nerve VIII. All but a few, such as aspirin and quinine, cause irreversible hearing loss. Ototoxicity is not related to age-related changes, noise exposure, or the differences between types of hearing loss.

A client with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education? A. Risk factors for postoperative cytomegalovirus (CMV) B. Compensating for vision loss for the next several weeks C. Nonpharmacologic pain management strategies D. Signs and symptoms of increased intraocular pressure

ANS: D Rationale: Clients must be educated about the signs and symptoms of complications,particularly of increasing IOP and postoperative infection. CMV is not a typical complication and the client should not expect vision loss. Vitreoretinal procedures are not associated with high levels of pain.

The public health nurse is addressing eye health and vision protection during an educational event. What statement by a participant best demonstrates an understanding of threats to vision? A. I'm planning to avoid exposure to direct sunlight on my next vacation. B. I've never exercised regularly, but I'm going to start working out at the gym daily. C. I'm planning to talk with my pharmacist to review my current medications. D. I'm certainly going to keep a close eye on my blood pressure from now on.

ANS: D Rationale: Hypertension is a major cause of vision loss, exceeding the significance of inactivity, sunlight, and adverse effects of medications.

A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered? A. Ossiculoplasty B. Insertion of a cochlear implant C. Stapedectomy D. Insertion of a ventilation tube

ANS: D Rationale: If AOM recurs and there is no contraindication, a ventilating, or pressure-equalizing, tube may be inserted. The ventilating tube, which temporarily takes the place of the eustachian tube in equalizing pressure, is retained for 6 to 18 months. Ossiculoplasty is not used to treat AOM and stapedectomy is performed to treat otosclerosis. Cochlear implants are used to treat sensorineural hearing loss.

A client with chronic open-angle glaucoma is being taught to self-administer pilocarpine. After the client administers the pilocarpine, the client states that the client's vision is blurred. Which nursing action is most appropriate? A. Holding the next dose and notifying the health care provider B. Treating the client for an allergic reaction C. Suggesting that the client put on her glasses D. Explaining that this is an expected adverse effect

ANS: D Rationale: Pilocarpine, a miotic drug used to treat glaucoma, achieves its effect by constricting the pupil. Blurred vision lasting 1 to 2 hours after instilling the eye drops is an expected adverse effect. The client may also note difficulty adapting to the dark. Because blurred vision is an expected adverse effect, the drug does not need to be withheld, nor does the health care provider need to be notified. Likewise, the client does not need to be treated for an allergic reaction. Wearing glasses will not alter this temporary adverse effect.

The nurse is conducting a support group for people suffering with Meniere's disease. The nurse is providing information on triggers for flare-ups of Meniere's disease. What information will the nurse include regarding the triggers of Meniere's disease? Select all that apply. A) Relaxation B) Being overworked C) Emotional wellness D) Pressure change E) High sodium diet

B, D, E. Triggers associated with Meniere's disease may include stress, being overworked, emotional distress, climate pressure changes, and consuming a diet high in sodium. Many clients discover that certain events, situations, additional illnesses, and specific foods cause a flare-up of Meniere's disease. Additional triggers may include inner ear infection, middle ear infection, allergies, side effects of specific medications, alcohol use, smoking, head injury, and anxiety. Factors that may affect the client's fluid in the ear to become worse may include an anatomic abnormality or blockage, compromised immune response, a viral infection, or a genetic predisposition.

A nurse is assessing a client who was diagnosed with macular degeneration. Which of these symptoms would the nurse expect the client would be experiencing? Select all that apply. A) Clear central vision B) Blurred central vision C) Blurred peripheral vision D) Inability to see small details E) Clarity of precise details when reading

B, D. Macular degeneration is caused by damage to the center of the retina called the macula. The macula maintains the sharpest vision. Clients may experience blurred central vision and the inability to see small details while reading. Blurred peripheral vision may be caused by glaucoma. Clear vision and clarity of precise details when reading is the goal for all clients. Blood vessels may leak fluid and blood into the client's retina causing distorted vision. Straight line may appear wavy. The client may experience blind spots and central vision loss. The bleeding blood vessels cause a scar to form causing permanent central vision loss. No cause exists for macular degeneration, but thought to be caused by heredity plus environmental factors such as diet, smoking, and obesity.

A client with bacterial conjunctivitis is prescribed erythromycin ophthalmic solution. The first time the client places the drops in the eye the drop burns, itches, and the eye becomes more red, increased photosensitivity and swelling. When the client reports this occurrence to the nurse, what is the appropriate response? A) Use the drops every other day B) Stoop using the drops C) This is expected. Continue using the drops. D) You will not be able to place many drops in that eye.

B. Allergic reaction to ophthalmic drops should be reported. The medication should be discontinued until the health care provider (HCP) is contacted and likely, a different antibiotic class of drops prescribed. Localized allergic reaction to an antibiotic has symptoms including increased pain, burning, itching, increased redness, photosensitivity, and swelling. Since ophthalmic drops can absorb into the system, a systemic reaction could occur, including rash to even anaphylactic symptoms of airway obstruction.

Which statement is consistent with acute otitis media? A. It is usually caused by a fungal infection. B. Conductive hearing loss may occur. C. The infection usually lasts more than 6 weeks. D. It is a relatively uncommon childhood infection.

B. Approximately three in four children experience an ear infection by the time they are 3 years of age. The infection usually lasts less than 6 weeks. Conductive hearing loss may occur due to a purulent exudate. Bacteria and viruses, not fungi, are the most common causes of otitis media.

Which medication classification increases aqueous fluid outflow in the client with glaucoma? A. Carbonic anhydrase inhibitors B. Cholinergics C. Beta-blockers D. Alpha-adrenergic agonists

B. Cholinergics increase aqueous fluid outflow by contracting the ciliary muscle, causing miosis, and opening the trabecular meshwork. Beta-blockers decrease aqueous humor production. Alpha-adrenergic agonists decrease aqueous humor production. Carbonic anhydrase inhibitors decrease aqueous humor production.

The nurse is caring for a client in the triage section of a walk-in clinic. Which triad of common symptoms suggests a diagnosis of Ménière disease? A. Blurred vision, vertigo, nausea B. Hearing loss, vertigo, tinnitus C. Disorientation, vertigo, nausea D. Syncope, vertigo, ear pain

B. Hearing loss, vertigo, and tinnitus are common symptoms of many disease processes but, when placed together, indicate Ménière disease. The other options do not include the accurate triad of symptoms.

A young adult has been diagnosed with otitis media. When planning this patient's care, what nursing diagnosis is the most likely priority? A) Hyperthermia related to infectious process B) Infection related to presence of microorganisms C) Disturbed auditory sensory perception related to otitis media D) Chronic pain related to otitis media

B. Infection is the essence of otitis media, and would be a priority over other diagnoses such as hyperthermia or temporary hearing loss. The pain associated with this disorder would be acute, not chronic.

A client diagnosed with Meniere's disease stated that she has had sudden attacks more often over the past year. The client asked the nurse if experiencing more attacks with hearing loss progressively getting worse during attacks indicates that she will eventually have permanent hearing loss. What is the nurse's best response? A) Hearing loss comes and goes, but would never be permanent. B) Hearing loss comes and goes during attacks, but results in permanent hearing loss. C) Hearing loss usually occurs during attacks, but during remission hearing is repaired. D) Hearing loss is minimal during attacks and does not result in permanent hearing loss.

B. Meniere's disease is caused by a collection of major fluid within the ear typically affecting only one side. Meniere's disease affects the ear labyrinth membranes causing permanent hearing loss with flare-ups of vertigo and ringing of the ears. Symptoms of Meniere's disease may include tinnitus, unilateral hearing loss, vertigo, vomiting, and increased pressure within the ear. With Meniere's disease, hearing loss comes and goes in sudden attacks resulting in permanent hearing loss. Surgical intervention to remove the endolymphatic sac causes reversal of the pressure problem in the inner ear.

Which of the following is an involuntary rhythmic movement of the eyes that is also associated with vestibular dysfunction? A. Tinnitus B. Nystagmus C. Vertigo D. Presbycusis

B. Nystagmus is an involuntary rhythmic movement of the eyes; pathologically it is an ocular disorder but is also associated with vestibular dysfunction. Nystagmus can be horizontal, vertical, or rotary, and can be caused by a disorder in the central or peripheral nervous system. Vertigo is defined as the misperception or illusion of motion of the person or their surroundings. Tinnitus is ringing in the ears. Presbycusis is a progressive hearing loss.

The client asks the nurse, Why is open-angle glaucoma considered the silent stealer of vision? Which response by the nurse explains this condition correctly? A) Open angle glaucoma causes gradual central vision loss. It often goes unnoticed until it becomes severe. B) Open angle glaucoma causes gradual peripheral vision loss. It often goes unnoticed until it is severe. C) Open angle glaucoma causes a cloud blur, which is so insidious, the client often just attributes it to dirty glasses. D) Open angle glaucoma has no warning. Suddenly, there is vision loss with severe pain in the eye and head.

B. Open-angle glaucoma occurs when the pathway of drainage between the cornea and the iris stays open, yet the trabecular network is partly blocked. Eye pressure builds up causing damage to the client's optic nerve. The most common type of glaucoma is open-angle glaucoma. Open-angle glaucoma causes gradual peripheral vision loss. It often goes unnoticed until it is severe. Other symptoms may include mild eye pain and tunnel vision. The client gradually loses peripheral vision. Gradual central vision loss is a symptom of cataracts.

Which action by the nurse will most impact the effectiveness of the client's ophthalmic solution prescribed to prevent infection post cataract surgery? A) Teaching the client to wash their hands prior to using the ophthalmic solution B) Teaching the client how to place the solution in the eye C) Teaching the client to wear the eyepatch during sleeping hours D) Teaching the client the importance of returning for the follow up visit

B. Ophthalmic drops need to be properly instilled to be effective. This is especially important when antibiotics and intraocular pressure lowering drops are prescribed. Permanent vision loss and systemic infection can occur if the prescribed medication is not properly placed in the eye. Proper placement techniques with return demonstration is important. The nurse's role in teaching how to instill eye drops can not be overemphasized.

A nurse is obtaining a history from a new client with glaucoma. The client indicates having read about the diagnosis and understanding that this type of glaucoma is due to the degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the aqueous humor. The loss of absorption will lead to an increased resistance, and thus a chronic, painless buildup of pressure in the eye. Which type of glaucoma has the client described? A. secondary B. open angle C. angle closure D. congenital

B. The client described open-angle glaucoma. This type of glaucoma develops painlessly, and visual changes occur slowly. As the IOP rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve.

The nurse caring for a client with Ménière's disease needs to assist with what when the client is experiencing an attack? A. Sleeping B. ADLs C. Coughing D. URIs

B. The client with Ménière's disease requires a great deal of emotional support because of the unpredictability of the attacks and the resulting impairments. During an attack, the nurse administers prescribed drugs, limits movement, and promotes the client's safety. He or she assists the client with activities of daily living because the least amount of motion can produce severe vertigo. The nurse cannot assist with sleeping, coughing. Option D is a distractor for this question.

The nurse recognizes the following as marker(s) of medication effectiveness in glaucoma control except: A. Visual field B. Opacity of the lens C. Lowering intraocular pressure to the target pressure D. Stable appearance of the optic nerve head

B. The main markers of the efficacy of the medication in glaucoma control are lowering of the intraocular pressure to the target pressure, stable appearance of the optic nerve head, and the visual field. Opacity of the lens relates to cataract formation.

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear? A. Phacoemulsification B. Scleral buckle C. Pneumatic retinopexy D. Pars plana vitrectomy

B. The scleral buckle is a procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. The other surgeries do not use this type of procedure.

Which question is most important for the nurse to ask the client before beginning timolol ophthalmic drops? A) Have you taken timolol before? B) Do you have a history of heart problems? C) Do you have a history of migraine headaches? D) Did you receive the flu vaccine?

B. Timolol is a beta-blocker that decreases the pressure of the eyes. The nurse should inquire about the client's history of heart problems because adverse side effects of timolol may include bradycardia, orthostatic hypotension, heart conduction problems, and syncope. Timolol should be avoided in asthma and chronic obstructive pulmonary disease clients due to timolol causing bronchospasms. Timolol is used to treat open-angle glaucoma. Severe allergic reactions to timolol may include a rash, face/tongue/throat swelling, difficulty breathing, and severe dizziness.

The client with chronic open-angle glaucoma is receiving timolol eye drops. Which evaluation finding would indicate to the nurse the treatment is working? A. Halos around lights B. Intraocular pressure 15 mm Hg C. Reduced peripheral vision D. Decrease in nausea and vomiting

B. Timolol is a beta-blocker that is used topically to decrease the flow rate of aqueous humor in the eye. As flow rate decreases, the intraocular pressure decreases. IOP of 12 to 21 mm Hg is within normal range. Reduced peripheral vision, halos around lights, and blurred vision are all symptoms of open-angle glaucoma. Nausea and vomiting are more likely to occur with acute angle-closure glaucoma.

A client is prescribed timolol ophthalmic drops to decrease the intraocular eye pressure associated with glaucoma. Which comorbidity should the nurse notify the health care provider about? Select all that apply. A) Cataracts B) Diabetes C) Asthma D) Heart failure E) Bradycardia

C, D, E. Timolol ophthalmic drops are utilized to decrease the elevated intraocular eye pressure of a person with glaucoma. can easily enter the bloodstream and impose a systemic effect on the body. When beta blocker medications enter the body systemically, they lower the heart rate, blood pressure, and can narrow the bronchioles. This can cause a negative outcome if a client has asthma, severe COPD, severe heart failure, bradycardia, and other serious heart conditions (e.g., 2nd and 3rd degree heart block).

An older adult client is admitted with the diagnosis of retinal detachment and is scheduled for laser surgery and scleral buckling procedure. The nurse anticipates which symptom(s) to be exhibited in this client? Select all that apply. A. Complete loss of vision in both eyes B. Arcus senilis C. Cobwebs in vision field D. Flashing lights E. Loss of central vision F. Eye pain

C, D. Many clients with detached retina experience a sensation of a curtain or veil lowering over vision field, flashing of lights, floaters, cobwebs, or spots. Complete vision loss can occur in the affected eye. Loss of central vision, eye pain, and arcus senilis is not indicated in this disorder.

The nurse is conducting a class for new parents and gives what instruction to help prevent the development of otitis media? A. If the baby takes a bottle to bed, only put water in it. B. Lie the baby down at least halfway through a feeding to prevent the formula from leaking out of his mouth. C. Never let the baby sleep drinking a bottle. D. Place the baby on his side if he takes a bottle to bed.

C. A baby should never be allowed to sleep while drinking a bottle because of the short, straight eustachian tube of the infant, which allows fluid to enter the ear when the child is lying down.

A patient is scheduled for an ophthalmic examination. Which of the following medications will be administered? A) Pseudoephedrine hydrochloride B) Epoetin alfa (Epogen) C) Atropine D) Pilocarpine (Pilocar)

C. Atropine is used to dilate the pupil before ophthalmic examinations. Pseudoephedrine hydrochloride is used to relieve nasal congestion. Epoetin alfa is used to treat bone marrow depression. Pilocarpine reduces intraocular pressure.

The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma? A. Diminished acuity B. Pain associated with a purulent discharge C. The presence of halos around lights D. A significant loss of central vision

C. Glaucoma is often called the silent thief of sight because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or halos around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.

The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform? A. Applies gentle pressure to the upper eyelid to keep the lid open while telling the client to gaze upward B. Holds down the lower lid of the eye by applying pressure on the eyeball and the cheekbone C. Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye D. Applies firm pressure to the upper and lower eyelids at the outer edges to keep eyelids in approximation

C. Punctal occlusion is done by applying gentle pressure to the inner canthus of each eye for 1 to 2 minutes immediately after eye drops are instilled. The nurse does not apply pressure to the eyeball when administering medications. The lower eyelid is held down to expose the conjunctival sac. The other action described will not aid in the retention or absorption of medication.

A patient is administering eye drops. What should the patient be taught in order to decrease systemic absorption of eye drops? A) Lie supine for 1 minute after instillation. B) Apply pressure for 2 minutes over the tear duct. C) Apply pressure for 5 minutes over the tear duct. D) Remain still for 10 minutes after instillation

C. Systemic absorption of eye drops can be decreased by closing the eye and applying pressure over the tear duct for 3 to 5 minutes after instillation. Pressure should not be applied to the tear duct for less than 3 minutes or greater than 5 minutes. It is unnecessary to remain still or supine after instillation.

A nurse is providing care for a patient who is on the third day of her prescribed course of ciprofloxacin eye drops. The nurse should conclude that this patient most likely has a diagnosis of what health problem? A) Astigmatism B) Cataracts C) Conjunctivitis D) Increased IOP

C. Uses of ciprofloxacin include the treatment of corneal ulcer and bacterial conjunctivitis. This drug is not used to treat cataracts, increased IOP, or astigmatism.

Which symptom is related to vertigo? A. Loss of consciousness B. Fainting C. Spinning sensation D. Syncope

C. Vertigo is defined as the misperception or illusion of motion of the person or the surroundings. Most people with vertigo describe a spinning sensation or say they feel as though objects are moving around them.

While providing home care instructions to the mother of a child diagnosed with allergic conjunctivitis, the registered nurse (RN) anticipates the healthcare provider to prescribe which drug therapy? Select all that apply. A) Sulfacetamide B) Fluoroquinolone C) Erythromycin D) Corticosteroid E) Antihistamine

D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. The selected drug therapy will be dependent upon the type of conjunctivitis. In the presence of a bacterial infection, the drug therapy can include sulfacetamide or fluoroquinolone. In the presence of an infection related to allergies, the drug therapy can include steroids and antihistamines.

Several residents of a long-term care facility have developed signs and symptoms of viral conjunctivitis. What is the most appropriate action of the nurse who oversees care in the facility? A. Arrange for the administration of prophylactic antibiotics to unaffected residents. B. Instill normal saline into the eyes of affected residents two to three times daily. C. Swab the conjunctiva of unaffected residents for culture and sensitivity testing. D. Isolate affected residents from residents who have not developed conjunctivitis.

D.

The nursing instructor is teaching the Level 1 nursing students the proper way to instill eye drops in a patient's eye. How long would the instructor teach the students to wait between successive eye drops in the same eye to achieve adequate eye drop drug retention and absorption? A. 30 seconds B. 3 minutes C. 1 minute D. 5 minutes

D. A 5-minute interval between successive eye drop administration allows for adequate drug retention and absorption. Any time frame less than 5 minutes will not allow adequate absorption.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as: A. Chronic open-angle. B. Chronic angle-closure. C. Normal tension. D. Acute angle-closure.

D. Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain.

The nurse is developing a plan of care for a patient with severe vertigo. What expected outcome statement would be a priority for this patient? A. Patient will perform exercises as prescribed. B. Patient will have decreased fear and anxiety. C. Patient will take medications as prescribed. D. Patient will experience no falls due to balance disorder.

D. Although all of these are expected outcomes for a patient with vertigo, the priority expected outcome is that the patient will experience no falls due to the balance disturbance, as falls poses the greatest risk to the patient's health.

A nurse is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal? A. Umbo in the center of the tympanic membrane B. Tympanic membrane pearly gray C. Manubrium superior to the umbo D. External auditory canal erythema

D. An erythematous external auditory canal would be considered an abnormal finding. The tympanic membrane is normally pearly gray and translucent. The umbo, which is located in the center of the eardrum, extends from the superior manubrium.

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate? A. Sensorineural B. Central C. Mixed D. Conductive

D. Conductive hearing loss occurs from an obstruction in the outer or middle ear such as from cerumen. Mixed hearing loss is a combination of conductive and sensorineural problems. Central hearing loss involves injury or damage to the nerves or the nuclei of the central nervous system. Sensorineural involves damage to the inner ear.

The registered nurse (RN) is concerned about what hearing problem if otitis media is not treated promptly or if it occurs frequently? A) Sensorineural hearing loss B) Mixed hearing loss C) Noise-induced hearing loss D) Conductive hearing loss

D. Conductive or middle ear hearing loss results from interference with transmission of sound to or by the middle ear. It is the most common of all types of hearing loss. Conductive hearing loss most frequently is a result of recurrent serous otitis media. The causes of hearing loss with otitis media are negative middle ear pressure, effusion in the middle ear, or structural damage of the tympanic membrane. Conductive hearing impairment mainly involves interference with the loudness of sound.

A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure? A. Restore vision B. To relieve pain C. Reverse optic nerve damage D. Improve outflow drainage

D. Laser iridotomy or standard iridotomy is a surgical procedure that provides additional outlet drainage of aqueous humor. This is done to lower the IOP as quickly as possible since permanent vision loss can occur in 1 to 2 days. Once optic nerve damage occurs, it cannot be reversed, and vision is not restored. Pain that occurs with rising IOP will be controlled once pressure is lowered through improved outflow drainage.

Which diagnostic test distinguishes between conductive and sensorineural hearing loss? A. Weber test B. Whisper test C. Audiometry D. Rinne test

D. Rinne test is useful for distinguishing between conductive and sensorineural hearing loss. In the whisper test, the client with normal acuity can correctly repeat what was whispered from 1 to 2 feet away. Audiometry is used to detect hearing loss. The Weber test uses bones conduction to test lateralization of sound.

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification? A. Amsler grid B. Retinoscope C. Tonometer D. Ophthalmoscope

D. The nurse is correct to provide an ophthalmoscope to the surgeon for examination of the optic disc. A retinoscope is used to determine errors in refraction. A tonometer measures intraocular pressure. An Amsler grid tests for problems with the macula.

Which of these client symptoms should the nurse report immediately to the health care provider (HCP)? A) Gradual central vision changes B) Gradual peripheral vision blur C) Sudden onset of watering eyes D) Sudden onset of extreme eye pain

D. The nurse should report the sudden onset of extreme eye pain immediately to the health care provider (HCP). This is a sign of closed-angle glaucoma and is a medical emergency. Closed-angle glaucoma is sudden onset of intraocular pressure that occurs when there is closure or blockage of drainage between the iris and cornea causing pressure to build up in the eye where fluid has accumulated and cannot circulate throughout the eye. The trabecular network becomes obstructed and damaged. Symptoms may include nausea, vomiting, sudden headache, extreme eye pain, and blurred vision. Closed-angle glaucoma is like closing a door suddenly with your fingers inside. The client may see halos surrounding lights. Symptoms are sudden and severe and a medical emergency, so the health care provider (HCP) should be notified immediately.

What explanation will the registered nurse (RN) implement to best explain conjunctivitis to the mother of a 5 year old diagnosed with this infection? A) Conjunctivitis is the inflammation of the conjunctiva of the eye. B) Conjunctivitis is irritation of the sclera and conjunctiva of the eye. C) Conjunctivitis is distortion of the covering of the eyelid and eyeball. D) Conjunctivitis is swelling of the lining of the inner eyelid and eyeball.

D. This answer is correct because the explanation conjunctivitis is swelling of the lining of the inner eyelid and eyeball is the best explanation for the RN to provide to the mother. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms.

The nurse has administered a scheduled dose of atropinne to a patient. The nurse would recognize that a therapeutic effect has been achieved by which of the following assessment findings? A) The cornea can be manipulated without causing the patient to blink. B) The patient acknowledges an improvement in visual acuity. C) The patient's pupils either dilate or constrict in response to light. D) The inner aspect of the patient's eye can be visualized.

D. Uses of atropine (ophthalmic) include mydriasis prior to ophthalmic procedures. Consequently, the nurse assesses whether the inner aspect of the eye can be visualized 15 minutes after administration. Atropine does not inhibit blinking, improve vision, or eliminate light accommodation.

An ophthalmologist is working with a client who believes his macular degeneration has progressed. Which diagnostic test might be implemented to confirm progression diagnosis? A) Visual acuity test B) Tonometry C) Autofluorescence D) Amsler grid

D. When an ophthalmologist suspects progression of macular degeneration, the health care provider (HCP) might conduct an amsler grid test. An Amsler grid test checks the client's eyes to detect lines that might look distorted or wavy and to assess for areas of the client's visual field that may be missing. The grid should be taped at the client's eye level so the client has consistent non-glaring light. This grid can help the health care provider (HCP) detect progression of dry AMD to wet AMD early while the disease is still treatable. The grid appears to look like graph paper and has a small dot at the center of the graph. Dry AMD is when the eye blood vessels don't drain or leak. Wet AMD is the worst type of AMD and is caused by eye growth of irregular blood vessels that leak into the retinal center or the macular. The bleeding and leaking of blood vessels creates permanent loss of vision.

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is: A. Reporting that a straight line appears crooked. B. The abrupt onset of symptoms. C. Reporting that letters in words appear broken. D. The appearance of tiny, yellow spots in the field of vision.

The test bank says "D" is the correct answer, but I don't think the patient can see the drusen spots in their field of vision. I think "A" is a better answer, because it references the Amsler grid test.

A family member of a client diagnosed with macular degeneration asked the nurse about ways to prevent the disease. Which of these options should the nurse include? Select all that apply. A) Do not smoke B) Eat a healthy diet C) Take ARED vitamins D) Sustain a healthy weight E) Keep blood pressure under control

A, B, C, D, E. Macular degeneration can be prevented or slowed if the client catches the problem early. Regular scheduled eye exams are essential; the client should not smoke; eat a healthy diet; take the ARED vitamins; sustain a healthy weight; and keep blood pressure and any other diseases under control. Macular degeneration is age-related. Smoking does increase the client's risk for developing macular degeneration. Clients who smoke will likely develop the disease around 10 years sooner than others who never smoked a cigarette or used tobacco. Eating a healthy diet high in green leafy veggies, orange and yellow fruits, whole grains and fish are recommended.Sustaining a healthy weight is important because obesity contributes to developing macular degeneration. Take Age-Related Eye Disease (AREDS) vitamins. AREDS formulation may decrease the possibility of developing the disease. Vitamin A is essential for retinal pigment cells and vitamins C and E function as antioxidants. Blood pressure and other disease processes should be controlled to prevent this disease. It is important to exercise routinely. Wear sunglasses and hats when out in the sun to protect the eyes.

A flight attendant is hospitalized and diagnosed with Meniere's disease. What symptoms will be exhibited by the client upon being assessed by the nurse? Select all that apply. A) Tinnitus B) Vertigo C) Vomiting D) Headaches E) Unilateral hearing loss

A, B, C, E. A flight attendant diagnosed with Meniere's disease may exhibit tinnitus (ringing in the ears), vertigo (spinning sensation), ear pressure, severe nausea, motion sickness, rapid unconscious eye movement, vomiting, imbalance, and dizziness. The client's ear may have a full feeling. Meniere's disease has multiple phases: the aura, the early phase, the attack or flare-up stage, and the inbetween or late stage. During the final stage of Meniere's disease, vertigo attacks decrease, but hearing loss is increased. Clients develop discomfort from loud noises or specific sound distortions resulting in permanent damage in the organ that keeps us balanced.

A home health nurse is providing education to her client with Meniere's disease on safety measures. What should the nurse include in her education? Select all that apply. A) Fall precautions B) Slow position changes C) Low-sodium diet D) Reduce smoking E) Decrease alcohol consumption

A, B, C. Safety measures for Meniere's disease may include fall precautions, slow position changes, and a low-sodium diet. Vertigo causes imbalances in clients with Meniere's disease, so the client should change positions very slowly and not make quick sudden moves. Restricting sodium in the diet reduces fluid accumulation in the inner ear. Performing exercises to enhance balance helps to ease vertigo symptoms. Alcohol, caffeine, and smoking should be avoided to help prevent sudden attacks and flare-ups. Food with high sugar content may worsen Meniere's flare-ups. An elevated glucose triggers insulin to respond and sodium is retained by insulin.

A client with continual flare-ups of Meniere's disease asked the nurse how to prevent future flare-ups. What nursing instructions should be provided to the client to prevent future flare-ups? Select all that apply. A) Stop smoking. B) Manage stress C) Avoid alcohol D) Consume a high sodium diet E) Consume a high caffeine diet

A, B, C. The best options to prevent flare-ups of Meniere's disease may include to stop smoking, decrease sodium in the diet, avoid alcohol, loud noises, caffeine, manage stress, and use fall precautions. Medications utilized to control symptoms involved in Meniere disease flare-ups may include diuretics and antihistamines such as acetazolamide, triamterene, hydrochlorothiazide, promethazine, and meclizine. Other options may include lifestyle modifications such as avoiding monosodium glutamate (MSG), performing balance exercises, and taking medications to treat the symptoms may decrease future flare-ups. Diagnosis of Meniere's disease may include ordering a hearing test, assessing the client's balance, and conducting a magnetic resonance imaging (MRI) of the inner ear. Most health care provider (HCP)s rule out multiple sclerosis or a brain tumor when diagnosing Meniere's disease.

A novice nurse asks the emergency room nurse how to know if a client has closed-angle glaucoma. Which symptoms are most associated with closed angle glaucoma? Select all that apply. A) Nausea and vomiting B) Gradual onset eye pain C) Sudden headache D) Unilateral facial droop E) Central vision loss

A, C. Closed-angle glaucoma is sudden onset of intraocular pressure that occurs when there is closure or blockage of drainage between the iris and cornea causing pressure to build up in the eye where fluid has accumulated and cannot circulate throughout the eye. The trabecular network becomes obstructed and damaged. Symptoms may include nausea, vomiting, sudden headache, extreme eye pain, and blurred vision. Closed-angle glaucoma is like closing a door suddenly with your fingers inside. The client may see halos surrounding lights. Symptoms are sudden and severe and a medical emergency, so the health care provider (HCP) should be notified immediately.

A client is ready to be discharged home after a cataract extraction with intraocular lens implant and the nurse is reviewing signs and symptoms that need to be reported to the ophthalmologist immediately. Which of the client's statements best demonstrates an adequate understanding? A. I need to call the doctor if I get nauseated. B. I need to call the doctor if I have a light morning discharge. C. I need to call the doctor if I get a scratchy feeling. D. I need to call the doctor if I see flashing lights.

ANS: D Rationale: Postoperatively, the client who has undergone cataract extraction with intraocular lens implant should report new floaters in vision, flashing lights, decrease invision, pain, or increase in redness to the ophthalmologist. Slight morning discharge and scratchy feeling can be expected for a few days. Blurring of vision may be experienced for several days to weeks.

A client is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this client's care? A. Antioxidant supplements, vitamin C and E, beta-carotene, and selenium B. Eyeglasses or magnifying lenses C. Corticosteroid eye drops D. Surgical intervention

ANS: D Rationale: Surgery is the treatment option of choice when the client's functional and visual status is compromised. No nonsurgical (medications, eye drops, eyeglasses)treatment cures cataracts or prevents age-related cataracts. Studies recently have found no benefit from antioxidant supplements, vitamins C and E, beta-carotene, or selenium.Corticosteroid eye drops are prescribed for use after cataract surgery; however, they increase the risk for cataracts if used long-term or in high doses. Eyeglasses and magnification may improve vision in the client with early stages of cataracts, but have limitations for the client with impaired functioning.

The nurse is discharging a client home after mastoid surgery. What should the nurse include in discharge teaching? A. Try to induce a sneeze every 4 hours to equalize pressure. B. Be sure to exercise to reduce fatigue. C. Avoid sleeping in a side-lying position. D. Don't blow your nose for 2 to 3 weeks.

ANS: D Rationale: The client is instructed to avoid heavy lifting, straining, exertion, and nose blowing for 2 to 3 weeks after surgery to prevent dislodging the tympanic membrane graft or ossicular prosthesis. Side-lying is not contraindicated; sneezing could cause trauma.

The registered nurse (RN) is providing care for a 5 year old female client and recognizes which behavior as a possible indicator of hearing impairment? Select all that apply. A) Wants to sit on the RN's lap B) Difficulty forming words C) Loud, monotone voice D) Shy, timid, withdrawn E) Inattentive to the TV in the room

B, C, D, E. As the child continues to grow, hearing impairment becomes more apparent. Clinical manifestations for hearing impairment in the toddler include: failure to develop intelligible speech by age 24 months, monotone speech quality, unintelligible speech, and/or lessened laughter. A child with a mild conductive hearing loss may speak fairly clearly, but in a loud monotone voice. A child with a sensorineural defect usually has difficulty with articulation. Other clinical manifestations that may be observed with the child is avoidance of social interaction and appears unable to communicate with others in this setting, an appearance of marked inattentiveness in a sound environment, as well as a shy, timid, and withdrawn behavior.

Which intervention will the registered nurse (RN) educate the mother to implement in the care of her child diagnosed with conjunctivitis? Select all that apply. A) Clean the eye from the outer to inner canthus four times daily B) Apply warm or cool compresses to the eye for comfort as needed C) Correct technique for eye drop instillation and frequency D) Importance of handwashing before and after instilling eye drops E) Clean the eye from the inner to outer canthus four times daily

B, C, D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. For this reason it is imperative that strict hand washing be implemented before and after instilling eye drops. It is equally important to avoid touching the eye drop dispenser to the eye and implement the correct administration technique. Warm or cool compresses applied frequently throughout the day can reduce discomfort. Cleansing the eye from clean to dirty (inner to outer canthus) can help prevent the spread of the infection.

While providing care for a 12-year old child diagnosed with conjunctivitis, which clinical manifestation will the registered nurse (RN) anticipate assessing? Select all that apply. A) Report of excessive blinking of the affected eye B) Redness of the conjunctiva of the affected eye C) Report of itchiness of the affected eye D) Purulent discharge from the affected eye E) Report of crustiness of the affected eye after sleeping

B, C, D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. The clinical manifestations may vary depending upon the cause of the infection. The generalized presentation includes erythema, pruritus, edema, and purulent drainage from the affected eye. There is also a development of cutaneous crust on the outer aspect of the eye after prolonged eye closing.

The mother of an 8 month old son is at the clinic and verbalizes which concern that alerts the registered nurse (RN) of a hearing impairment in the infant? Select all that apply. A) He seems to know my face and smiles at me B) He seems to only want to sleep and drink C) He does not seem to even know my voice D) He does not make any voice sounds at all E) He does not turn his head toward any sounds

C, D, E. Assessment of children for hearing impairment is a critical nursing responsibility. Identification of hearing loss within the first 3 to 6 months of life is essential to facilitate language and educational development for children with hearing impairment. To best assess for hearing impairment, it is important to know the expected milestones for the infant. By age 6 months the infant should localize a source of sound and by 7 months the infant should begin babbling or make voice sounds. The absence of either or both of these milestones can be an indicator of hearing impairment. Other clinical manifestations of hearing impairment in infants include: general indifference to sound, lack of response to the spoken word, or responding to loud sounds only.

The registered nurse (RN) will educate the mother of a 5-year old son as to which issue can result in conjunctivitis? Select all that apply. A) Excessive shampoo getting in his eyes during bathing B) Excessive rubbing of the eyes in his sleep C) Environmental allergies affecting the eye D) Bacterial infection affecting the eye E) Viral infection affecting the eye

C, D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. This infection can be related to viral or bacterial infection, as well as allergic agents, such as pollen.

Postoperative health teaching for a patient who has had an intraocular lens implant is a vital nursing responsibility. Which of the following statements applies to this situation? Select all that apply. A. Avoid lying on the side of the affected eye for 72 hours. B. Avoid shampooing your hair for 48 hours. C. Wipe the closed eye from the inner canthus outward. D. Do not lift, pull, or push objects heavier than 15 pounds. E. Avoid bending the head forward for an extended time.

C, D, E. Hair shampooing may resume in 24 hours, if done cautiously. It is only necessary to avoid lying on the side of the affected eye for the first night after surgery. Refer to Box 49-7 in the text.

A 10 year old child has otitis media and ofloxacin otic solution, 0.3% is prescribed to be administered by placing 5 drops in each affected ear once a day for 7 days. Which instruction by the nurse is appropriate regarding otic drop placement? Select all that apply. A) Pull ear down and back for proper placement B) Cool drops in refrigerator before placement C) Do not double dose, unless instructed by prescriber D) Tilt head or lie down with affected ear upward E) Wash hands before and after use

C, D, E. Wash hands before and after (to reduce spread of infection) Warm drops by placing in hand for at least 1 minute (cool drops can cause pain) Tilt head to the side or lie down with affected ear upward (to assure drop gets in ear) Pull ear down and back for children under 3 or pull ear up and back for anyone 3 and over (to make sure drop gets to eardrum) Take medications as directed, do not double the dose, unless instructed by the prescriber (for more effective treatment with less side effects)

Which term refers to an altered sensation of orientation in space? A. Tinnitus B. Ataxia C. Nystagmus D. Dizziness

D. Dizziness may be associated with inner ear disturbances. Tinnitus refers to a subjective perception of sound with internal origin. Nystagmus refers to involuntary rhythmic eye movement. Ataxia is the failure of muscle coordination and may be present in clients with vestibular disease.