Chapter 38: Disorders of Special Sensory Function: Vision, Hearing, and Vestibular Function- Patho http://thepoint.lww.com/Book/Show/ Level 3

The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states which of the following? a) "I will take my allergy medication as it has been prescribed." b) "I will use the eardrops as prescribed for me." c) "I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." d) "I'll wear ear plugs each time I swim."

"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." Otitis externa treatment usually includes the use of eardrops containing an appropriate antimicrobial or antifungal agent. -Use of ear plugs is recommended to prevent moisture. Cotton-tipped applicators and other devices should be avoided.

The father of a third grade girl has brought his daughter to a walk-in clinic because he believes the girl has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which follow-up explanation by the nurse is most accurate? a) "An antibiotic ointment will likely resolve her infection, but pain control will be necessary in the mean time." b) "The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." c) "It's important to aggressively treat this in children, since damage to her sight can result if it's not treated." d) "The insides of her eyelids have become infected. This often produces severe discomfort."

"The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." Conjunctivitis often spontaneously resolves. The pain associated with conjunctivitis usually produces only mild discomfort compared with severe discomfort associated with corneal lesions or deep and severe pain associated with acute glaucoma. Conjunctivitis may spread to other family members. - The corneal surface is not primarily involved and pain that is severe suggests corneal involvement rather than conjunctivitis. Sight damage is not likely to result.

The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually which of the following? a) Asymptomatic and requires the administration of antivirals b) Very symptomatic and requires immediate intervention c) Symptomatic and the tympanic membrane is blue d) Asymptomatic and often self-limiting

Asymptomatic and often self-limiting It is very important to distinguish appropriately AOM from OME to ensure the proper treatment and to avoid the unnecessary use of antimicrobials. AOM often presents with sudden onset of ear pain, fever, hearing loss, and middle ear infection, whereas OME often presents as an asymptomatic effusion of the middle ear.

The nurse is working at a first aid station in an amusement park. A 45-year-old client arrives reporting severe dizziness after a ride on the roller coaster. The nurse understands that a common cause of this sensation is which of the following? a) Barotrauma b) Acute otitis media c) Benign paroxysmal positional vertigo d) Otosclerosis

Benign paroxysmal positional vertigo Benign paroxysmal positional vertigo is the most common cause of pathologic vertigo and usually develops after the fourth decade of life. It commonly occurs when the person is getting in and out of bed, bending over and straightening up, or extending the head to look up. It also can be triggered by amusement rides that feature turns and twists. The other conditions are not manifested by severe sudden vertigo.

The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which of the following medications will be prescribed to manage the symptoms? a) Promethazine (Phenergan) b) Chlorpropamide (Diabenase) c) Clopidogrel (Plavix) d) Pantoprazole (Protonix)

Promethazine (Phenergan) Pharmacologic management includes suppressant drugs such as promethazine (Phenergan). -The other medications are not used to treat Meniere disease.

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be: a) Tympanostomy tube insertion b) Monitoring for complications of OM c) The child will need a hearing aid d) Retreating with a stronger antibiotic

Tympanostomy tube insertion Tympanostomy tubes should be the next course of action with the child having hearing loss and OM persisting for 4 months or longer. The parents should be taught to continue to monitor for signs of OM.

A female client with rheumatoid arthritis has taken high doses of aspirin for several years to control inflammatory pain. Which of the following statements leads the health care provider to suspect the client has developed ototoxicity?

"I've been getting dizzy and light-headed. I seem to have a constant ringing in my ear." Ototoxicity results in sensorineural hearing loss. Vestibular symptoms of ototoxicity include light-headedness, giddiness, and dizziness; if toxicity is severe, cochlear symptoms consisting of tinnitus or hearing loss occur. -The symptoms of drug-induced hearing loss may be transient, as often is the case with salicylates and diuretics, or they may be permanent. -Hearing loss in the elderly is further characterized by reduced hearing sensitivity and speech understanding in noisy environments, slowed central processing of acoustic information, and impaired localization of sound sources. -High-frequency warning sounds, such as beepers, turn signals, and escaping steam, are not heard and localized, with potentially dangerous results. -Clinical measures for hearing loss such as whispered voice tests and finger friction tests are reportedly imprecise and are not reliable methods for screening.

A 69-year-old patient comes to the clinic for a routine checkup. Upon examination the nurse practitioner informs the patient that she has cataracts. The patient then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner? a) "Strong bifocal lenses can often cure cataracts." b) "Surgery is the only effective treatment for cataracts." c) "The doctor was correct and you are doing everything you can to help with this condition." d) "You are wrong and should not listen to your doctor."

"Surgery is the only effective treatment for cataracts." There is no effective medical treatment for cataract. -Strong bifocal lenses, magnification, appropriate lighting, and visual aids may be used as the cataract progresses, but surgery is the only treatment for correcting cataract-related vision loss. -Telling the patient that bifocals will cure cataracts is false as well as telling her that her doctor was correct. -The other option is not a therapeutic response by the nurse.

A 70 year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? a) "Unfortunately there aren't any proven treatments for your condition." b) "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." c) "We usually don't actively treat BPPV unless it starts to affect your hearing." d) "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo."

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option and even in the absence of hearing loss, treatment is warranted.

Which of the following individuals is most likely to be diagnosed with a central vestibular disorder? a) A woman who has ongoing difficulty balancing herself when walking. b) A man who states that he feels car sick whenever he rides in the back seat of a vehicle. c) A man who got up quickly from his bed and sustained an injury after he "blacked out". d) A woman who suffered a loss of consciousness after being struck on the head during a soccer game.

A woman who has ongoing difficulty balancing herself when walking. Central vestibular disorders are marked by a sensation of motion that interferes with balance, but that is mild and constant and chronic in duration. It should be differentiated from postural hypotension, loss of balance from a head injury or motion sickness.

A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing: a) Primary open-angle glaucoma b) Acute-onset wide-angle glaucoma c) Acute angle-closure glaucoma d) Subacute angle-closure glaucoma

Acute angle-closure glaucoma The sudden onset of eye pain, blurred vision, and a headache on the affected side indicate acute angle-closure glaucoma, which is an ophthalmic emergency. -Subacute angle-closure glaucoma manifests as recurrent short episodes of unilateral pain, conjunctival redness, and blurring of vision associated with halos around lights. -Open-angle glaucoma is usually asymptomatic and chronic.

The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located? a) Anterior segment of the globe b) Posterior segment of the globe c) Retina d) Choroid

Anterior segment of the globe The anterior chamber is in the anterior segment of the globe, not the posterior segment of the globe, choroid or retina.

The nurse is performing a Romberg test on a client. Select the statement that best describes purpose of the test. a) Assess for neurological weakness b) Assess for transient ischemic attacks c) Assess for static vestibular function d) Assess for conductive hearing loss

Assess for static vestibular function The Romberg test is used to demonstrate disorders of static vestibular function. It is done by having a person stand with his or her feet together and arms extended forward so that the degree of sway and arm stability can be observed. (less)

The nurse is assessing a patient's risk for sensorineural hearing loss. Which of the following places the patient at greatest risk? a) Impacted earwax b) Nystagmus c) Chronic noise exposure d) Otitis media

Chronic noise exposure Chronic exposure to noise is a risk factor for sensorineural hearing losses. Impacted earwax and otitis media are risk factors for conductive hearing loss.

The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to which of the following? a) Conduction disorder b) Sensorineural disorder c) Mixed sensorineural and conduction disorder d) Infection

Conduction disorder Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.

A patient's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the patient has which of the following? a) Pain in the middle ear b) Drainage from the ear c) Build up of cerumen d) Cystlike mass in the middle ear

Cystlike mass in the middle ear Cholesteatoma is a cystlike mass of the middle ear that often extends to involve the temporal bone.

The nurse is caring for a client who has been diagnosed with presbycusis. The nurse understands that with this disorder, the client experiences which of the following? a) Difficulty hearing high-pitched frequencies b) Chronic ear drainage c) Severe pain in the mastoid area d) Fluid in the inner ear without infection

Difficulty hearing high-pitched frequencies Presbycusis is used to describe degenerative hearing loss that occurs with advancing age. It is characterized by high-frequency hearing loss.

The nurse understands that a distinguishing pathology of benign paroxysmal positional vertigo is which of the following? a) Proprioception deficit b) Orthostatic hypotension c) Visual deficit d) Disorder of otoliths

Disorder of otoliths Benign paroxysmal positional vertigo is caused by the otoliths or free-floating debris causing a portion of the vestibular system to become more sensitive, such that any movement of the head in the plane parallel to the posterior duct may cause vertigo and nystagmus.

Which of the following nursing interventions is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo implement? a) Adminster ordered antibiotic b) Weber test c) Skin assessment d) Fall precautions

Fall precautions The patient with benign paroxysmal positional vertigo experiences brief periods of vertigo when getting in and out of bed, bending over and straightening up, and extending head to look up. This places the patient at increased risk for falls and necessitates implementation of fall precautions. -The Weber test and administration of an antibiotic are not indicated when caring for a patient with benign paroxysmal positional vertigo. -Skin assessment, while always a part of the nursing assessment, has a lower priority than implementation of safety measures for this client.

The nurse is caring for an elderly client with a suspected diagnosis of presbycusis. Select the most likely manifestation that the nurse would note. a) Inability to understand words during a conversation b) Feeling of continuous pressure in both ears c) Feeling a continuous drainage coming from both ears d) Buzzing or ringing in the ears

Inability to understand words during a conversation Presbycusis is a common report among the elderly. It is manifested by the inability to understand or hear what is being said in a conversation that progresses to not being able to hear. Pressure may result from increased fluid, and buzzing or ringing may be a complication of medication.

The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as: a) Fixed eye movements that preserve eye fixation on unstable objects in the visual field b) Voluntary eye movements that preserve eye fixation on stable objects in the visual field c) Involuntary eye movements that preserve eye fixation on stable objects in the visual field d) Unilateral eye movement that preserve eye fixation on unstable objects in the visual field

Involuntary eye movements that preserve eye fixation on stable objects in the visual field Nystagmus refers to the involuntary eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. As the body rotates, the vestibuloocular reflexes cause a slow compensatory drifting of eye movement in the opposite direction, thus stabilizing the binocular fixation point.

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they are understanding the education? a) It is another name for swimmer's ear. b) It can be caused by a bacterial infection. c) The tympanic membrane appears cloudy. d) Breastfed babies have a higher incidence of this condition.

It can be caused by a bacterial infection. The nurse determines that the participants are understanding the information when they state that acute otitis media can be caused by a bacterial infection. -Breast fed babies have a lower incidence of acute otitis media. -The tympanic membrane appears cloudy in otitis media with effusions. -Acute otitis media is not another name for swimmer's ear

A patient has been diagnosed with hemianopia. The patient asks the nurse what this is describing concerning the eye?

Loss of half of the visual field in one eye Blindness in one eye is called anopia. If half of the visual field for one eye is lost, the defect is called hemianopia; - if a quarter of the field is lost, it is called quadrantanopia. - Loss of the temporal or peripheral visual fields on both sides results in a narrow binocular field, commonly called tunnel vision.

Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on what? a) The child has to be older than 5 years. b) Maturity of the visual system at time of onset c) The child has to have bilateral congenital cataracts. d) The child has to be able to wear contact lenses.

Maturity of the visual system at time of onset The reversibility of amblyopia depends on the maturity of the visual system at the time of onset and the duration of the abnormal experience. The other answers are incorrect

Select the statement that best describes Meniere disease. a) Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss, vertigo, and tinnitus. b) Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear: the client will be asymptomatic. c) Meniere disease is a disorder of the middle ear due to constriction of the endolymphatic compartment of the inner ear, causing hearing loss. d) Meniere disease is a bacterial infection of the outer inner ear due to distention of the endolymphatic compartment.

Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss, vertigo, and tinnitus.

A young teenager is brought to the clinic for an eye exam. She has been complaining that she is having difficulty in school as she cannot see the blackboard as clearly as she used to. She tells the nurse that it is blurry. What should the nurse suspect is wrong with this child? a) Myopia b) Hyperopia c) Presbyopia d) Immature cataracts

Myopia Myopia is a condition also referred to as nearsightedness where the person can see close objects without problems, but distant objects are blurred. It can be corrected with an appropriate concave-surface lens. -Hyperopia is when near images are blurred. -Presbyopia refers to a decrease in accommodation and is usually seen due to aging. - Immature cataracts deal with a change in the lens opacity which leads to interference of the transmission of light to the retina.

Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss? a) Huntington disease b) Paget disease c) Parkinson disease d) Alzheimer disease

Paget disease More permanent causes of hearing loss are thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear due to otosclerosis or Paget disease. -Huntington, Alzheimer, and Parkinson diseases are not associated with conductive hearing loss.

Which type of receptor is mediated through vision in dim light? a) Mechanoreceptors b) Chemoreceptors c) Osmoreceptors d) Photoreceptors

Photoreceptors Vision in dim light is mediated through photoreceptors. - Hair cells are classified as mechanoreceptors. -The sensation of taste is recognized by ligand binding to chemoreceptors. -Osmoreceptors are not associated with vision

Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder? a) Inability to localize sounds b) Reduction in ability to identify sounds c) Reduction in ability to understand speech d) Inability to detect sound

Reduction in ability to understand speech The disorder first reduces the ability to understand speech and, later, the ability to detect, identify, and localize sounds.

The nurse takes a patient's blood pressure in the primary care provider's office. The last three times the patient has been in the office it has been high. What structure in the eye is this adverse effect of hypertension most likely to affect? a) Ciliary body b) Lens c) Retina d) Iris

Retina The retina is the structure in the eye that the adverse effect of hypertension most likely to affect. -The lens is affected with a cataract. -The iris and ciliary body are not impacted.

The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which of the following measures will the nurse recommend during changes in air pressure? a) Swallowing b) Mouth breathing c) Forcefully coughing d) Cupping the ears with one's hands

Swallowing Swallowing, yawning, and chewing gum are measures that open the eustachian tube, which equalizes air pressure in the middle ear.

It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss? a) Audioscope b) Tuning fork c) Tone analysis d) Audiometer

Tuning fork Tuning forks are used to differentiate conductive and sensorineural hearing loss. -Audioscope, audiometer, and tone analysis do not differentiate between conductive and sensorineural hearing loss.

The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which of the following symptoms? a) Strabismus b) Vertigo c) Otalgia d) Diplopia

Vertigo A surgical method to treat Meniere disease includes the creation of an endolymphatic shunt in which excess endolymph from the inner ear is diverted into the subarachnoid space or the mastoid area. This relieves symptoms associated with Meniere disease, such as vertigo. The other symptoms are not manifestations of Meniere disease.

A patient is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is which one of the following? a) Cochlea b) Malleus c) Tympanic membrane d) Vestibular apparatus

Vestibular apparatus The vestibular system maintains and assists recover of stable body and head position and balance through control of postural reflexes. The vestibular system includes the three semicircular canals.

A patient has been diagnosed with bacterial conjunctivitis. This type of infection is usually characterized by large amounts of what color drainage? a) Serous b) Yellow-green c) Blue-yellow d) Pink-red

Yellow-green The infection usually is characterized by large amounts of yellow-green drainage. The eyelids are sticky, and there may be excoriation of the lid margins.

The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor which fills the anterior and posterior chambers of the eye as which disease? a) cataract b) glaucoma c) retinopathy d) amblyopia

glaucoma Glaucoma is a chronic degenerative optic neuropathy characterized by optic disk cupping and visual field loss. It is usually associated with an elevation in intraocular pressure. Amblyopia is lazy eye while retinopathy is a disorder of the retinal vessels which interrupt blood flow to the visual receptors leading to visual impairment. A cataracts is a lens opacity that interferes with the transmission light to the retina

An elderly woman comes to the clinic complaining of seeing flashing lights and small spots. She tells the nurse that this has been going on for over 24 hours but now it is as if she sees a dark curtain whenever she opens her eyes. She asks the nurse if this means she is going to be blind. What diagnosis should the nurse suspect ? a) conjunctivitis b) retinal detachment c) cataracts d) glaucoma

retinal detachment The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the filed of vision occur. As the detachment progresses the person perceives a shadow or dark curtain across the visual field.

A mother brings her toddler to the clinic and tells the nurse that she thinks something is wrong with the baby's eyes. Upon further assessment the nurse notices that the child has upper deviation in movement in only one eye. What should the nurse suspect is wrong with the child? a) cataract b) glaucoma c) amblyopia d) strabismus

strabismus Strabismus or squint, refers to any abnormality of eye coordination or alignment that results in loss of binocular vision. -Amblyopia refers to lazy eye. -Glaucoma is a chronic degenerative optic neuropathy and - cataract affects the lens of the eye.

Which of the following clients are at risk for developing and acute episode of angle-closure glaucoma? Select all that apply.

• A 60-year-old female emotionally devastated after divorcing her husband of 35 years • A soldier ordered to stay in a pitch-black cave to observe enemy militants for an extended period of time • A surgical client who has received many doses of IV atropine to keep heart rate above 50 Manifestations of acute angle-closure glaucoma are related to sudden, intermittent increases in intraocular pressure. These occur after prolonged periods in the dark, emotional upset, and other conditions that cause extensive and prolonged dilation of the pupil. Administration of pharmacologic agents, such as atropine, that cause pupillary dilation (mydriasis) also can precipitate an acute episode. -Age-related macular degeneration (AMD) is the most common cause of reduced vision in the elderly. In addition to older age, identifiable risk factors include cigarette smoking, obesity, and low dietary intake of lutein, omega 3 fatty acids, zinc, and vitamins A, C, and E. Persons with high grades of myopia or nearsightedness may have abnormalities in the peripheral retina that predispose to sudden detachment.

Stepping out of a mall and into the sunshine has caused a man's pupils to constrict. Place the following anatomical components of the man's pupillary reflex in the ascending chronological order that they responded to the light. Use all the options. a) Retinal ganglionic cells b) Oculomotor nuclei c) Pretectal nuclei d) Preganglionic neurons

• Retinal ganglionic cells • Oculomotor nuclei • Pretectal nuclei • Preganglionic neurons Pretectal areas on each side of the brain are connected, explaining the binocular aspect of the light reflex. The afferent stimuli for pupillary constriction arise in the ganglionic cells of the retina and are transmitted to the pretectal nuclei at the junction of the thalamus and the midbrain, and from there to preganglionic neurons in the oculomotor (CN III) nuclei via the pretecto-oculomotor tract