Chp 21 Eye and ear
A patient is being provided with discharge instructions after undergoing cataract extraction and intraocular lens implantation. What should the nurse include in the teaching? 1 Avoid straining during bowel movements. 2 Keep consuming a full-liquid diet for 24 hours. 3 Refrain from reading or watching TV for at least 12 hours. 4 Keep a patch over the affected eye until the follow-up appointment with the surgeon.
1 After cataract surgery, coughing, bending at the waist, and straining during bowel movements should be avoided because these activities increase intraocular pressure. It is not necessary to maintain dietary restrictions, refrain from reading or watching TV, or wear a patch.
A patient reports sudden, severe pain in the eye accompanied by nausea and vomiting. The assessment findings of the patient indicated optic nerve atrophy and peripheral visual field loss. Which drug will the nurse expect to be prescribed by the primary health care provider? 1 Betaxolol 2 Besifloxacin 3 Tropicamide 4 Ranibizumab
1 Glaucoma is a group of disorders characterized by increased intraocular pressure and optic nerve atrophy and peripheral visual field loss. The symptoms of glaucoma are pain in or around the eye, nausea, and vomiting. Betaxolol is an antiglaucoma drug that decreases intraocular pressure. Besifloxacin is an antibiotic that is used to treat acute bacterial conjunctivitis. Tropicamide is a cycloplegic that is used to produce pupillary dilation. Ranibizumab is a selective inhibitor of endothelial growth factor that is used to slow vision loss in age-related macular degeneration.
On a home visit to a patient who underwent cataract surgery, the nurse finds that the patient has intense pain in the operated eye. What should be the immediate nursing action? 1 Notify the surgeon. 2 Administer eyedrops. 3 Administer analgesics. 4 Apply a cold compress.
1 In the postoperative period after a cataract surgery, the pain is usually mild. However, if the patient complains of intense pain, it should be immediately communicated to the surgeon because it may indicate hemorrhage, infection, or increased intraocular pressure and thus may need prompt intervention. Analgesics can be administered after receiving a surgeon's prescription. Applying a cold compress or administering eye drops may not decrease the pain.
The nurse is discussing glaucoma prevention with a 52-year-old African American patient. Which statement by the patient reflects a correct understanding of glaucoma prevention? 1 "I will visit my eye doctor every one to two years." 2 "I will wear protective sunglasses while outside." 3 "I will take lutein and vitamin E supplements for eye health." 4 "There is nothing that can be done to prevent vision loss from glaucoma."
1 Loss of vision as a result of glaucoma is a preventable problem. Teach the patient and the caregiver about the risk of glaucoma and that it increases with age. Stress the importance of early detection and treatment in preventing visual impairment. A comprehensive ophthalmic examination is important in identifying persons with glaucoma or those at risk of developing glaucoma. The current recommendation is for an ophthalmologic examination every two to four years for persons between ages 40 and 64 years, and every one to two years for persons age 65 years or older. African Americans in every age category should have examinations more often because of the increased incidence and more aggressive course of glaucoma in these individuals. Wearing protective sunglasses while outside may help to reduce the development of cataracts, not glaucoma. Lutein and vitamin supplements may be helpful for preventing macular degeneration, not glaucoma.
Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? 1 Absence of pain or pressure 2 Blurred vision in the morning 3 Seeing colored halos around lights 4 Eye pain accompanied with nausea and vomiting
1 Primary open-angle glaucoma is typically symptom free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed. Primary angle-closure glaucoma manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.
A patient has a prescription to receive timolol two drops to both eyes every 12 hours. The nurse would withhold the dose and question the prescription if the patient had which condition? 1 Asthma 2 Urinary retention 3 Cluster headaches 4 Chronic constipation
1 Timolol is a nonselective beta-adrenergic blocking agent that can cause bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with severe chronic obstructive pulmonary disease (COPD) or asthma. Timolol will not increase urinary retention; that commonly is seen with use of anticholinergics. It will not cause or worsen headaches or constipation.
In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder? 1 Pressure damage to the optic nerve may occur because of clogged drainage channels. 2 The retinal nerve is damaged by an abnormal increase in the production of aqueous humor. 3 The pupillary opening is blocked secondary to decreased aqueous humor in the anterior chamber. 4 The lens enlarges with normal aging, pushing the iris forward, blocking the outflow of aqueous humor.
1 With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain properly from the eye. This leads to damage to the optic nerve over time. The iris is not affected, the retinal nerve is not damaged, and the aqueous humor builds up because of blockage.
What instruction should the nurse include when teaching a caregiver ways to communicate better with a patient who has hearing loss? Select all that apply. 1 Maintain eye contact. 2 Speak normally and slowly. 3 Move closer to the better ear. 4 Overenunciate whatever you say. 5 Write out names or difficult words. 6 Do not draw attention with hand movements.
1,2,3,5 The family and caregivers can help the patient with hearing loss by using strategies for improving verbal and nonverbal communication. These strategies include maintaining eye contact when talking, speaking normally and slowly, moving closer to the better ear, and writing out names and words that are difficult to understand. Hand movements can be used to draw attention. Overenunciating should be avoided.
Identify risk factors associated with development of cataracts. Select all that apply. 1 Advanced age 2 History of diabetes mellitus 3 Exposure to ultraviolet light 4 Eating a diet high in lutein 5 History of eye chronic open-angle glaucoma 6 History of prolonged therapy with systemic corticosteroids
1,2,3,6 Risk factors for developing cataracts include advanced age, exposure to ultraviolet light, and conditions in which blood glucose levels are elevated, such as diabetes mellitus, or patients receiving long-term corticosteroid medications. These conditions alter metabolic processes and lead to the lens becoming cloudy and then opaque. A diet high in lutein is thought to decrease the risk of age-related macular degeneration. Patients with chronic glaucoma are not at higher risk for cataracts. However, some patients develop glaucoma after having cataract surgery or having an artificial lens implanted.
A nurse provides education to a group of people about eye health care. Which statements by group indicate that the teaching has been understood? Select all that apply. 1 "Wash hands regularly to prevent the spread of diseases." 2 "Avoid removing contact lenses if there is redness and pain in the eye." 3 "Wear sunglasses and ensure proper nutrition to prevent cataract development." 4 "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." 5 "Regular eye checkups help in early detection of disease and prevent further loss of vision."
1,3,4,5 Proper care of the eye plays a vital role in maintaining eye health. Regular hand washing helps to prevent the spread of disease from one eye to the other. Wearing sunglasses and eating a proper diet help to prevent cataract development and age-related diseases. Wearing eye protection during hazardous work helps to reduce the risk of eye injuries. Regular eye checkups help in the early detection of diseases and prevent further loss of vision. Contact lenses should be removed if there is redness and pain in the eye.
The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider
the patient reports eye pain rated 5
The patient is given an oral dose of glycerol followed by serial audiograms over three hours. Which symptom did the nurse assess in the patient? 1 Presence of positive Schwartz's sign 2 Aural fullness and fluctuating sensorineural hearing loss 3 Reduction in touch sensation in the posterior ear canal 4 A painless condition with hearing loss, nausea, and episodes of dizzines
2 A glycerol test is a diagnostic test aimed to confirm Ménière's disease. The symptoms of this disorder include aural fullness and fluctuating sensorineural hearing loss. A series of audiograms over three hours is done after the patient is given an oral dose of glycerol. Improvement in hearing or speech discrimination occurs due to the osmotic effect of glycerol that pulls fluid from the inner ear. An otoscopic examination, the Rinne test, the Weber test, audiometry, and tympanometry are the diagnostic tests used to confirm otosclerosis. Such patients show positive Schwartz's sign. Patients with acoustic neuroma have reduced touch sensation in the posterior ear canal. Diagnostic tests to confirm acoustic neuroma include neurologic, audiometric, and vestibular tests; CT scans; and MRI. A mastoid x-ray is one of the tests used to diagnose chronic otitis media. This is a painless auditory disorder with hearing loss, nausea, and episodes of dizziness
When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, on what should the nurse focus? 1 Giving anticipatory guidance about the eventual loss of central vision that will occur 2 Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision 3 Recognizing that eye damage caused by glaucoma can be reversed in the early stages 4 Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies
2 Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, the patient should be encouraged to remain compliant with drug therapy. Glaucoma cannot be reversed. Central vision usually is unaffected with open-angle glaucoma. Pain management is important throughout the course of the disease.
An asthmatic patient is diagnosed with chronic glaucoma. The patient is prescribed timolol (Istalol). In regard to patient safety, what action should the nurse take? 1 Explain to patient that carteolol may cause vomiting. 2 Do not administer istalol, and notify the health care provider. 3 Ask the health care provider to decrease the dose of carteolol. 4 Suggest the patient only use carteolol for a short period of time.
2 In an asthmatic patient, administration of timolol should be avoided because it causes bronchospasm. Decreasing the dose and suggesting that the patient only use the medicine for a short period of time do not reduce the risk of bronchospasm. Vomiting is not a side effect of timolol.B
Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? 1 "You may feel some palpitations after instilling these eye drops." 2 "You may have a temporary headache after instilling these drops." 3 "You should withhold this medication if your blood pressure becomes elevated." 4 "You should keep your eyes closed for 15 minutes after instilling these eye drops."
2 It is common for patients to have a temporary headache when instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow and blood pressure is more likely to decrease if absorbed systemically. asthmatic patient, administration of timolol should be avoided because it causes bronchospasm. Closing the eyes for 15 minutes after instilling the eye drops is not necessary.
A patient experiences an attack of Ménière's disease. Which intervention is most important for the nurse to include in the patient's plan of care? 1 Increased fluid intake 2 Decreased environmental stimuli 3 Provision of the patient's regular diet 4 Assessment for orthostatic hypotension
2 The etiology of Ménière's disease is not well understood, but stress and excessive sensory stimulation are possible causes. Decreasing environmental stimuli is one approach to treatment and controlling the severity of the symptoms. Fluid intake should be decreased; this may ease the symptoms because in Ménière's disease there is an increase in the endolymphatic fluid of the inner ear. It is believed this causes disease symptoms. If there is no nausea and vomiting, the patient may eat a regular diet as tolerated, but this is not as high a priority as decreasing environmental stimuli is. Patients may experience tinnitus and vertigo, but the blood pressure is not affected, so orthostatic hypotension does not occur.
The nurse has completed patient teaching for a patient who had cataract surgery on the left eye. Which statement by the patient indicates a need for further teaching? 1 "I might feel some scratchiness in my left eye." 2 "I should notice an improvement in my vision in a few days." 3 "I will call my health care provider if I notice white drainage or redness in my left eye." 4 "I will call my health care provider if I notice white drainage or redness in my left eye."
2 The patient will notice an improvement in vision after surgery not in a few days. Cataract surgery typically results in little to no pain, but the patient may have some scratchiness in the operative eye. Mild analgesics are usually sufficient to relieve any discomfort, but if the pain is sudden or intense, the patient should notify the health care provider because this may indicate hemorrhage, infection, or increased intraocular pressure (IOP). The patient should be instructed to call the health care provider if redness or drainage occurs in the affected eye. These can be signs of infection.
A patient is using dipivefrin (propine) for the treatment of glaucoma. What side effects should the nurse educate the patient to monitor? Select all that apply. 1 Depression 2 Tachycardia 3 Hypertension 4 Bronchospasm 5 Taste alteration
2,3 Dipivefrin is an α-adrenergic agonist and is converted to epinephrine inside the eye. It decreases aqueous humor production and enhances outflow facility. Dipivefrin causes tachycardia and hypertension. Depression and bronchospasm are side effects of the antiglaucoma drug carteolol. Taste alteration is a side effect of carbonic anhydrase inhibitors.
A patient, discharged after eye surgery, is told to avoid activities that will increase intraocular pressure. Which activities should the patient avoid? Select all that apply. 1 Eating 2 Lifting 3 Coughing 4 Bending over 5 Breathing deeply
2,3,4 Activities such as coughing, bending over, and lifting increase the pressure within the eye. Eating and breathing deeply do not involve straining or lowering the head, so the pressure within the eye is not increased.
A patient has undergone cataract surgery. What nursing interventions help to prevent postoperative complications? Select all that apply. 1 Antiviral medications are given to prevent infections. 2 Teach the patient to instill medicine following aseptic techniques. 3 Teach the patient about proper hygiene and eye care techniques. 4 Ask the patient to discontinue all prescribed medicine two days after surgery. 5 Advise the patient to avoid actions that can cause increased intraocular pressure.
2,3,5 Postoperative care of the eye is essential for proper wound healing. Increased intraocular pressure may break the sutures and increases the risk of complications; therefore, it should be prevented. Proper hygiene and eye care techniques prevent contamination of the wound. Medicines should be instilled in the eye using aseptic techniques to prevent infection. The full course of medicine should be completed to obtain the therapeutic effect. Antibiotic drops, not antiviral medications, are given to prevent infections.
What instructions should the nurse include when teaching a patient how to administer ear drops? Select all that apply. 1 Administer cold, not warm, drops. 2 The tip of the dropper should not touch the ear. 3 The ear should be positioned so that the drops can run into the canal. 4 The drops should not be put in using a cotton wick placed in the ear canal. 5 The position of the ear should be maintained for two minutes to let the drops spread.
2,3,5 When administering ear drops, the patient should position the ear so that the drops run into the canal, and this position should be maintained for two minutes to let the drops spread. The dropper should not touch the ear; avoiding contact reduces the spread of infection. The ear drops should be at room temperature when administered. Cold drops can cause vertigo; very warm drops can burn the tympanic membrane. Sometimes the drops are placed onto a wick of cotton that is placed in a canal.
Which criteria should the nurse consider for the placement of an implanted hearing system in a patient to treat moderate to severe sensorineural hearing loss? Select all that apply. 1 Loss of sensory hair cells 2 Normal middle ear anatomy 3 Bilateral hearing impairment 4 Normally functioning Eustachian tube 5 Stable bilateral sensorineural hearing loss
2,4,5 An implanted hearing system treats moderate to severe sensorineural hearing loss. Criteria for placement of this device include normal middle ear anatomy, a normally functioning Eustachian tube, and stable bilateral sensorineural hearing loss. Loss of sensory hair cells leads to sensory presbycusis that responds well to sound amplification. Patients with bilateral hearing impairment require binaural hearing.
A nurse reviews the medical record for a patient with acute glaucoma for which acetazolamide has been prescribed. The patient has a history of high-dose aspirin therapy. Considering the concomitant use of the medications, the nurse expects what change in medication prescriptions? 1 The dose of acetazolamide will be decreased. 2 There will be no change in prescriptions of either medication. 3 The patient cannot take both medications due to gastric disturbances. 4 The patient will be advised to take acetazolamide at a different time than aspirin.
3 Acetazolamide is a carbonic anhydrase inhibitor used in the treatment of glaucoma. The patient is on high-dose aspirin therapy; therefore, acetazolamide is avoided because it increases the risk of gastric disturbances. Decreasing the dose of acetazolamide may not decrease the risk of developing complications. A combination of acetazolamide and aspirin is not recommended because it can cause GI upset. Taking acetazolamide at a different time than aspirin does not prevent drug interactions and should be avoided.
A 68-year-old patient has undergone a total hip replacement and has glaucoma. The nurse forms a nursing diagnosis of disturbed sensory perception related to increased intraocular pressure. The plan of care should focus on which main element? 1 Restriction of driving privileges immediately 2 Use of occupational and physical therapy for visual deficits 3 Encouraging medication compliance to reduce the risk of vision loss 4 Managing the pain using oral antiinflammatories and opioids as needed
3 Drug therapy is necessary to prevent the eventual vision loss that accompanies glaucoma. For this reason, the nurse should encourage the patient to remain compliant with drug therapy. Physical therapy will not improve or treat visual deficits. Glaucoma does not cause pain, and unless the vision is severely impaired, driving restrictions are not necessary.
A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient? 1 Glaucoma leads to detachment of the retina. 2 Glaucoma results from chronic eye inflammation. 3 Glaucoma results in increased intraocular pressure. 4 Glaucoma is caused by decreased blood flow to the retina.
3 In chronic open-angle glaucoma the outflow of aqueous humor is obstructed, leading to increased intraocular pressure. The increased intraocular pressure eventually causes destruction of the nerve fibers of the retina and painless vision loss, beginning in the periphery. Glaucoma does not cause detachment of the retina, result from chronic inflammation, or result from decreased retinal blood flow.
Which auditory disorder is caused by an excessive accumulation of endolymph in the membranous labyrinth? 1 Otitis Media 2 Otosclerosis 3 Ménière's disease 4 Acoustic neurom
3 Ménière's disease, also called endolymphatic hydrops, results in an excessive accumulation of endolymph in the membranous labyrinth. The volume of endolymph increases until the membranous labyrinth ruptures. Otitis media is caused by an infection of the tympanum, ossicles, and space of the middle ear. Otosclerosis is a hereditary autosomal dominant disease caused by the vascular and bony changes in the middle ear. Otoscopic examination may reveal Schwartz's sign. Acoustic neuroma is a disorder of cranial nerve VIII, on which a unilateral benign tumor grows.
Which instruction given by the nursing student during ear care training needs correction by the registered nurse? 1 "Do not put anything in your ear canal." 2 "Report itching if it becomes a problem." 3 "Dry the ear with cotton-tipped applicators." 4 "Report chronic excessive cerumen if it impairs your hearing."
3 The ears should be kept as dry as possible. However, cotton-tipped applicators should not be used for drying the ears. Rather, a hair dryer set to low and held at least 6 inches from the ear can be used to evaporate the water from the ear. Unless requested by the health care provider, nothing should be put in the ear canal. The health care provider should be consulted if consistent itching occurs or if excessive cerumen impairs hearing.
An otoscopic examination of a patient reveals a positive Schwartz's sign. A tuning fork test and an audiogram demonstrate air-bone gaps. Which statement describes the disorder these tests are used to diagnose? 1 Free-floating debris in the semicircular canal causes vertigo with specific head movements. 2 A unilateral benign tumor grows where the vestibulocochlear nerve enters the internal auditory canal. 3 The spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window. 4 The patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.
3 The patient has otosclerosis, which can be diagnosed with otoscopic examination revealing a positive Schwartz's sign along with tuning fork tests and an audiogram identifying air-bone gaps. In otosclerosis, spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window, thereby reducing the transmission of vibrations to the inner ear fluids. This results in conductive hearing loss. In benign paroxysmal positional vertigo (BPPV), free-floating debris in the semicircular canal causes vertigo with specific head movements, such as getting out of bed, rolling over in bed, and sitting up from lying down. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve enters the internal auditory canal. The tumor can compress the trigeminal and facial nerves and arteries within the internal auditory canal. In Ménière's disease, the patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.
The registered nurse is preparing to teach a group of nursing students about the use of verbal aids when communicating with hearing-impaired patients. Which information does the nurse include in the teaching plan? 1 Refrain from having light behind the patient. 2 Speak in a clear voice and shout at the patient. 3 Use simple sentences and rephrase sentences if required. 4 Maintain eye contact and draw the attention of the patient with hand movements.
3 The use of simple sentences is an example of a verbal aid that the nurse can use while communicating with a hearing-impaired patient. If required, the nurse should rephrase the sentence and use different words to help the patient understand. As a nonverbal aid, the nurse should avoid light behind the speaker, not the patient. As a verbal aid, the nurse should speak in a normal voice directly into the better ear. The nurse should not shout to make the patient understand. As a nonverbal aid, the nurse should maintain eye contact and draw attention of the patient with hand movements.
Which nursing intervention is most appropriate for facilitating communication with a patient who has a hearing impairment? 1 Speaking loudly and shouting if necessary 2 Asking the patient questions that can be answered with a yes or no response 3 Standing close to the patient and speaking slowly and clearly in a normal tone 4 Standing to one side of the patient when speaking and directing the voice directly into the patient's ear
3 Standing close to and directly in front of the patient will greatly facilitate communication. The nurse also should ensure that the patient can see the nurse's mouth to help facilitate lip-reading. Shouting at the patient with a hearing impairment distorts the voice and further hinders understanding. Asking yes-or-no questions and standing to one side and speaking directly into the patient's ear are not appropriate or effective means of communicating with the patient who has a hearing impairment.
When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? 1 Apply pressure to each eyeball for a few seconds after administration. 2 Have the patient close the eyes and move them back and forth several times. 3 Have the patient put pressure on the inner canthus of the eye after administration. 4 Have the patient try to blink out excess medication immediately after administration.
3 Systemic absorption can be minimized by applying pressure to the inner canthus of the eye. Applying pressure to each eyeball, having the patient close the eyes and move them back and forth, and having the patient try to blink out excess medication will not minimize systemic effects of the medication.
A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching? 1 Restrict activity at home. 2 Wear a nighttime eye shield. 3 Do not bend, stoop, cough, or lift. 4 Wash hands before touching the eye.
3 When teaching postoperative home care for cataract surgery, the nurse should instruct the patient to avoid activities such as bending, stooping, coughing, or lifting because these activities can raise the intraocular pressure, which in turn can adversely affect the newly implanted lens. All other activities are permissible. Wearing a nighttime eye shield is not necessary. Washing hands before touching the eye is a general hygiene practice and not specific to postoperative care.
The nursing instructor is teaching a group of nursing students about the treatment of cerumen and foreign bodies in the external ear canal. Which statements made by the nursing student indicate an understanding regarding the instruction? Select all that apply. 1 "The canal should be irrigated with cold solutions." 2 "The ear canal should be completely occluded with the syringe tip." 3 "Use of cotton-tipped applicators to clean the ears should be avoided." 4 "Mild lubricant drops should be used as initial treatment for cerumen removal." 5 "Mineral oil can be used with microscopic guidance to kill an insect before removal."
3,5 Mineral oil or lidocaine drops can be used to kill an insect before removal with microscope guidance. Ears should be cleaned with a washcloth and finger, and never with cotton-tipped applicators. This is because penetration of the middle ear by a cotton-tipped applicator can cause serious injury to the tympanic membrane (TM) and ossicles, and can also cause cerumen to become impacted against the TM and impair hearing. Management of cerumen involves irrigation of the canal with body temperature solutions to soften the cerumen. When irrigating the ear canal to soften the cerumen, it is important to make sure that the ear canal is not completely occluded with the syringe tip. Mild lubricant drops may be used to soften the earwax only if irrigation does not remove the wax, and not as the initial step for cerumen removal.
The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching? 1 "I'll limit my fluid intake." 2 "I'll change positions slowly." 3 "I'll use my eye drops until my vision clears." 4 "I'll check the labels on my nonprescription drugs."
4 Nonprescription drugs, even caffeine, may increase intraocular pressure, resulting in enough pressure to cause damage. Therefore it is important for the patient to check the contents of all drug labels. Limitation of fluid intake and slow position changes will not affect intraocular pressure. Eye drop medications for glaucoma must be taken as prescribed. Stopping these medications could cause a rebound increase in intraocular pressure.
The nurse is admitting a patient with glaucoma who states that he or she is allergic to all sulfa drugs. Which medication order should the nurse question and immediately report to the primary care provider? 1 Carteolol 2 Dipivefrin 3 Carbachol 4 Acetazolamide
4 Acetazolamide is an antiglaucoma drug and a carbonic anhydrase inhibitor that may cause immunologically mediated reactions and result in sulfa-type allergic reactions in patients allergic to sulfa. Carteolol is a nonselective beta blocker and may cause blurred vision, photophobia, and bradycardia. Dipivefrin is sympathomimetic and may cause side effects such as ocular discomfort and redness. Carbachol is an antiglaucoma drug and a cholinergic agent that may cause transient ocular discomfort, headache, and blurred vision.
A patient with glaucoma is taking timolol drops. What should the nurse include while reinforcing principles of medication administration with the patient? 1 The patient will notice an improvement in vision within one month. 2 The patient should use these on an as needed basis for eye irritation. 3 The patient should maintain a supine position for 30 minutes after the drops are instilled. 4 The patient may experience blurred vision after administration of the drops lasting several minutes.
4 It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should be no cause for concern to the patient. This medication should be used on a fixed schedule to reduce intraocular pressure. Glaucoma is asymptomatic and may not result in vision loss. It is not necessary to lie flat following eye drop administration.
Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention? 1 Tobacco smoking cessation 2 Yearly ophthalmic examination 3 Eating a diet high in green leafy vegetables and lysine 4 Strict adherence to prescribed eye drop medication schedule
4 Strict adherence to prescribed medication regimen to treat glaucoma will keep the intraoptic pressure at safe levels to avoid optic nerve damage. Tobacco cessation is healthy but will not treat glaucoma. Yearly eye examinations are important but will measure only any damage done if the patient does not follow treatment. A diet high in lutein, found in green leafy vegetables, is thought to improve eye health. Lysine is an amino acid that has some antiviral properties.
A nurse is comparing otosclerosis and otitis media with effusion. Which statement is correct regarding these two diseases? 1 Otosclerosis can be caused by changes in air pressure, whereas otitis media with effusion follows chronic sinus infections. 2 Otosclerosis is an inflammation of the middle ear, whereas otitis media with effusion is a hereditary recessive disease. 3 Otosclerosis may be accompanied by a reddish blush of the tympanum, whereas otitis media with effusion is accompanied by purulent discharge from the ear. 4 Otosclerosis is treated by oral administration of sodium fluoride, with vitamin D and calcium carbonate, whereas otitis media with effusion does not require antibiotic therapy.
4 The hearing loss associated with otosclerosis may be stabilized by the oral administration of sodium fluoride, with vitamin D and calcium carbonate. These medications slow bone resorption and encourage the calcification of bony lesions. Otitis media with effusion usually resolves without treatment but may recur. Chronic sinus infections can lead to otitis media with effusion; so can barotrauma caused by pressure change. Otosclerosis is not associated with a change in air pressure. Otosclerosis is a hereditary autosomal dominant disease, whereas otitis media with effusion is an inflammation of the middle ear with a collection of fluid in the middle ear space. In a patient with otosclerosis, an otoscopic examination may reveal a reddish blush of the tympanum known as Schwartz's sign; this is caused by the vascular and bony changes within the middle ear. In otitis media with effusion, the patient does not experience pain, fever, or discharge from the ear.
Which nonverbal aids can the nurse adopt to effectively communicate with a patient with hearing loss? 1 Refraining from touching the client 2 Having a light source behind the speaker 3 Maintaining equal distance from both ears 4 Refraining from covering the mouth or face with hands
4 The nurse should not cover his or her mouth or face with the hands to communicate effectively with a patient with hearing loss. Using touch can be an effective strategy in this situation. The nurse should refrain from having light behind the speaker. The nurse should move close to the better ear while communicating with the patient with hearing loss.
What is important for the nurse to include in the postoperative care of the patient following a stapedectomy to correct otosclerosis? Select all that apply. 1 Check the gag reflex. 2 Encourage independence. 3 Avoid changing the cotton padding. 4 Instruct patient to refrain from lifting or bending. 5 Inform patient that nausea and dizziness may occur.
4,5 The patient may experience dizziness, nausea, and vomiting as a result of stimulation of the labyrinth during surgery. The patient should take care to avoid sudden movements that may bring on or exacerbate vertigo. Actions that increase inner ear pressure, such as coughing, sneezing, lifting, bending, and straining during bowel movements, should be avoided. Place a cotton ball in the ear canal, and cover the ear with a small dressing. It is not necessary to check a gag reflex. The patient will need assistance early postoperatively for safety reasons, so the nurse should not promote independence. The cotton padding may need to be changed if there is excess drainage. Topics
An elderly patient with a history of bilateral cataracts is admitted to the hospital with pneumonia. What intervention will facilitate the patient's ability to see? Select all that apply. 1 Administer prescribed analgesics. 2 Patch the eye that has less visual acuity. 3 Obtain dark glasses for the patient to wear. 4 Increase the amount of light for near vision. 5 Obtain teaching materials with enlarged print.
4,5 The patient with intact cataracts will see better with the use of increased lighting and magnifiers, including enlarged print. Receiving prescribed analgesics will relieve discomfort. Patching an eye will lessen vision. Wearing dark glasses decreases the patient's visual acuity.
A patient with Meniere's disease is admitted with vertigo, dizziness, nausea and vomiting. Which nursing intervention will be included in the plan of care Dim the lights in the patient's room. Encourage increased oral fluid intake. Change the patient's position every 2 hours. Keep the head of the bed elevated 45 degrees.
Dim the lights in the patients room
To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by
noting any changes in the patient's visual field
Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma? Morphine sulfate 4 mg IV Mannitol (Osmitrol) 100 mg IV Betaxolol (Betoptic) 1 drop in each eye Acetazolamide (Diamox) 250 mg orally
Mannitol (Osmitrol) 100 mg IV
The charge nurse observes a newly hired nurse performing all the interventions for a patient who just undergone right cataract removal and intraocular lens implant. Which one requires that the charge nurse intervene?
The nurse encourages the patient to cough
During the preoperative assessment of a patient scheduled for a right cataract extraction and intraocular lens implantation, it is important for the nurse to assess The patient requests a prescription refill for next week. The patient feels uncomfortable wearing an eye patch. The patient complains that the vision has not improved. The patient reports eye pain rated 8 (on a 0 to 10 scale).
The patient reports eye pain rated 8 (on a 0 to 10 scale).
Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of corticosteroid eye drops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 1 to 2 days after the surgery
b. Administration of corticosteroid eye drops
The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? a. The patient has had blurred vision for 3 years. b. The patient has not eaten anything for 8 hours. c. The patient takes 2 antihypertensive medications. d. The patient gets nauseated with general anesthesia.
c. The patient takes 2 antihypertensive medications.
