Prep U 63 & 64
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?
NSAIDs
A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included?
eyelids
A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?
"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."
A nurse is preparing to assess a client's gross auditory acuity. Which of the following would be most appropriate to use?
Ticking watch
During a pharmacology class, the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?
Tinnitus and sensorineural hearing loss
A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition?
hyperopia
The nurse is explaining metastatic rhabdomyosarcoma to a group of parents with children diagnosed with the disease. The most common site of metastasis in clients diagnosed with rhabdomyosarcoma is the
lung.
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?
open angle
Which term refers to swelling of the optic disc due to increased intracranial pressure?
papilledema
A client with multiple sclerosis is being seen by a neuro-ophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a:
perimetry test
The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client:
pulls the tissue near the cheek downward to instill medication
A nurse is performing an eye examination. Which question would not be included in the examination?
"Are you able to raise both eyebrows?"
Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?
"My eyelids were stuck together this morning."
Which type of glaucoma presents an ocular emergency?
Acute angle-closure glaucoma
Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important?
Avoid any activity that can increase intraocular pressure.
Which medication is used to treat glaucoma by pulling the iris away from the drainage channels so that aqueous fluid can escape?
Carbachol
Which symptom is related to vertigo?
Spinning sensation
A client has noticed needing to hold printed material at arms length to make the print readable. What is the term used to describe this visual condition?
presbyopia
The nurse identifies the nursing diagnosis of deficient knowledge related to a new hearing aid for a client. After teaching a client about caring for his new hearing aid, the nurse determines that the outcome has been achieved when the client states which of the following?
"I need to keep my ear canal clean and dry."
After surgery for removal of cataract, a client is being discharged, and the nurse has completed discharge instruction. Which client statement indicates that the outcome of the teaching plan has been met?
"I should avoid pulling or pushing any object that weighs more than 15 lbs."
A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse?
"Prescriptions of this medication are generally not given because it can cause corneal problems."
The nurse is supervising a family member who instilling ear drops into the client's ear. Which of the following statements, made by the family member, would require further nursing instruction?
"These drops are cold from being on the window sill."
The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer?
"This test measures peripheral vision and detects gaps in the visual field."
A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?
"You'll need to use the drops for the rest of your life to control the glaucoma."
A client is receiving phenylephrine eye drops in preparation for ophthalmoscopy. The client receives the final dose of drops at 10:30 a.m. The nurse informs the client that he will begin to notice the effects of the drug beginning to wear off around what time?
1:30 p.m.
A nurse practitioner examines a patient and documents a best corrected visual acuity (BCVA) ratio in his better eye that qualifies him for government financial assistance based on the definition of legal blindness. What is that ratio?
20/200
When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following?
20/50-3
A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage?
21 mmHg or higher
A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal?
25 mm Hg
The nurse is assisting the client in planning care during exacerbations of Ménière's disease. Which diet would the nurse identify as appropriate at this time?
A low-sodium diet
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:
Acute angle-closure
A client has a history of hearing loss and is returning for an annual hearing examination. During client education, the nurse explains that hearing involves which areas of the ear?
All sections
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?
Amsler Grid
Which term refers to the absence of the natural lens?
Aphakia
The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform?
Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye
High doses of which medication can produce bilateral tinnitus?
Aspirin
A nurse is caring for a client scheduled to have angiography of the right eye in 1 hour. What is the highest priority nursing intervention?
Assess blood urea nitrogen (BUN) and creatinine levels.
A mother brings her daughter to the clinic for an evaluation because the child is complaining of ear pain. Which of the following would lead the nurse to suspect that the child is experiencing otitis externa and not otitis media?
Aural tenderness
Students are reviewing information about orbital and ocular tumors. They demonstrate understanding of the material when they identify which of the following as the most common malignant tumor of the eyelid?
Basel Cell carcinoma
A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale?
Blinking causes the eye drop to be expelled from the conjunctival sac.
An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by:
Blurred distance vision
Edema of the conjunctiva is termed which of the following?
Chemosis
Which of the following medication classifications increases aqueous fluid outflow in the patient with glaucoma?
Cholinergic
Which statement is consistent with acute otitis media?
Conductive hearing loss may occur
A client is color blind. The nurse understands that this client has a problem with:
Cones
A client is being discharged after successful same-day cataract surgery. The nurse instructs the client about permitted activities and which activities to avoid. Which of the following activities would be permitted in the postoperative instructions by the client?
Cooking
Which of the following is the main refracting surface of the eye?
Cornea
Nursing assessment of hearing loss in an older adult client includes evaluation of age-related changes, as well as a history of current illnesses and medications. Which of the following factors are associated with ototoxic effects? Select all that apply.
Diabetes mellitus Bacterial meningitis Loop diuretics (e.g., Lasix) Gentamicin
Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests?
Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss
A nurse is reviewing a client's medication history. Which drug would the nurse identify as placing the client at risk for ototoxicity.
Erythromycin
Which portion of the middle ear equalizes pressure?
Eustachian tube
A nurse is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal?
External auditory canal erythema
If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone causing which of the following?
Facial nerve paralysis
Which precautions should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance?
Grasp the siderails when rising to a standing position.
The nurse should monitor for which manifestation in a client who has had LASIK surgery?
Halos and Glare
The nurse should monitor for which manifestation in a client who has undergone LASIK?
Halos and Glares
The nurse is working in the triage section of a walk-in clinic. Which triad of common symptoms, when placed together, indicate Ménière's disease?
Hearing loss, vertigo, tinnitus
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?
Hemangioma
Loud, persistent noise has what effect on the body?
Increased BP
A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother?
Instill a few drops of warmed mineral oil to cover the insect.
A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear?
Instillation of mineral oil
A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness?
Ishihara
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella?
Laser-assisted in situ keratomileusis (LASIK)
A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following?
Listening skills
A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing:
Loss of accommodative power in the lens.
A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication?
Lowering intraocular pressure to target pressure
The nurse is explaining metastatic rhabdomyosarcoma to a group of parents with children diagnosed with the disease. The most common site of metastasis in clients diagnosed with rhabdomyosarcoma is the
Lung
Which group of medications causes pupillary constriction?
Miotics
Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following?F
Myopia
Nursing students are reviewing the structure and function of the ears in preparation for class the next day. The students demonstrate understanding of the information when they describe which of the following as a middle ear structure?
Ossicles
Which condition is characterized by the formation of abnormal spongy bone around the stapes?
Otosclerosis
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?
Patient will experience no falls due to balance disorder.
Which nursing suggestion would be most helpful to the client with recurrent otitis externa?
Place ear plugs into the ears before swimming
A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the:
Stapes
A nurse notices that a client's left upper eyelid is drooping. The nurse has observed:
Ptosis
The nurse is instructing the client with dried cerumen blocking the ear canal on potential methods to reduce symptoms. Which at-home methods of cerumen removal are discouraged?
Removing the cerumen by means of a cotton tip applicator
Which of the following is the treatment of choice for acoustic neuromas?
Surgery
The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal?
Retinal Angiography
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?
Scleral buckle
When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision:
Sees an object from 20 feet away that a person with normal vision sees from 200 feet away
The parent of a young client with severe hearing loss is quite concerned about the child's future independence because of impaired hearing. Which type of hearing loss is usually irreversible?
Sensorineural
What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids?
Serous otitis media
Which phrase defines ossiculoplasty?
Surgical reconstruction of the middle ear bones
The nurse is working in the emergency department when a physician asks for help as the client is performing a Romberg test. In which position would the nurse stand to be most helpful?
The nurse would stand laterally to the client, opposite side to where the physician is standing.
The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment?
The power of the lens to accommodate will be decreased.
A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign?
The presence of halos around lights
The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma?
The presence of halos around lights
A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection?
To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.
A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment?
To prevent vision loss
The nurse is doing discharge teaching with a client newly diagnosed with Ménière's disease. Why would the nurse advise a low-sodium diet to this client?
To reduce the production of fluid in the inner ear
To straighten the ear canal in an adult for examination, the nurse practitioner would grasp the auricle and pull it:
Upward and Backward
A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following?
Vertigo
A client who comes to the ambulatory care facility states, "It feels like things are moving or spinning around me." The nurse interprets this as indicating which of the following?
Vertigo
Which manifestation is the most problematic for the client diagnosed with Ménière disease?
Vertigo
Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection?
Viral
A nurse needs to change a dressing on an abdominal wound for a patient who is hearing-impaired and whose speech is difficult to understand. Which of the following is the best approach for the nurse?
Write down the steps of the procedure for the patient to read before beginning the treatment.
A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:
demonstrate eyedrop instillation
After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms?
retinal detachment
When the client tells the nurse that his vision is 20/200 and then asks what that means, the nurse informs the client that a person with 20/200 vision
sees an object from 20 feet away that a person with normal vision sees from 200 feet away.
