Health Assessment Eyes and Ears

While assessing a patient, the nurse suspects the patient has labyrinthitis. Which question would the nurse ask the patient during the assessment?

"Do you ever feel like the room is spinning around you?" Labyrinthitis is associated with the inflammation of the labyrinth and results in labyrinth dysfunction, which may impair body balance and result in vertigo. Therefore, during the assessment, the nurse would ask the patient whether he or she feels as if the room is spinning, which is a sign of vertigo. The nurse would ask about ear discharge if the patient had a middle ear infection, such as acute or chronic otitis media. The Eustachian tube

The nurse suspects that a 40-year old patient has age-related macular degeneration after observing yellow deposits under the patient's retina. What should the nurse ask the patient to evaluate the condition further?

"Do you have any difficulty in reading?" "Do you have any difficulty in sewing?" Neovascularity in the macula leads to macular degeneration. Age-related macular degeneration causes loss of central vision in the patient. Central vision is lost due to the presence of yellow deposits in the macular region. The patient may also feel discomfort while reading and sewing. Therefore, the nurse assesses the patient's condition by asking about these activities. A patient with conjunctivitis may have sticky eyelids due to bacterial or viral infection and may find it difficult to open the eyelids. A patient with strabismus has extraocular muscle dysfunction. Therefore, the nurse should assess the eye movements in a patient with strabismus. A patient with age-related macular degeneration might not experience the loss of peripheral vision. Therefore, the nurse would not ask the patient about his or her side vision.

While examining a patient with an eye infection, the nurse observes red, scaly, greasy flakes on the edge of the eyelids. The nurse asks the patient to describe the discomfort. What description is the patient most likely to provide?

"I feel like I have sand particles in my eyes." Blepharitis is the inflammation of the eyelids, with red, scaly, and greasy flakes on the edge of the eyelids. This condition occurs with staphylococcal infections or seborrheic dermatitis, and the patient may feel the presence of a foreign particle in the eyes. A patient with strabismus perceives two images of a single object. A patient with myopia may feel floaters or spots moving in front of the eyes. A patient with conjunctivitis may have purulent drainage, which appears thick and yellow in color.

The nurse is teaching the parents of a newborn infant about precautions to prevent middle ear infections. Which statement by the parent indicates a need for further teaching?

"I should place my baby in the supine position while feeding with a bottle." When an infant is fed in the supine position, some milk may flow into the ear and may increase the bacterial growth, which increases the risk of ear infection. Therefore, the nurse should advise the parents to avoid bottle-feeding the infant in the supine position and should suggest an inclined position instead while feeding. Pacifier use has also been linked to the risk of infection, so parents should not be encouraged to give pacifiers to their infants. Infants who are placed in daycare have an increased risk of infection because day care providers may not supervise bottle feeding as closely or devote as much attention to infection prevention. Breast milk provides antibodies and improves the immunity of the infant. Giving only breast milk to the infant for the first 3 months provides the best protection against ear infections.

The nurse is teaching a class on anatomy and physiology of the human eye. Which statement by a student indicates effective learning?

"The autonomic nervous system (ANS) determines the size of the pupil." Parasympathetic and sympathetic chains of the autonomic nervous system determine the size of the pupil. Stimulation of the parasympathetic nerve causes constriction, and stimulation of the sympathetic nerve dilates the pupil. The sclera is a tough, protective, white covering that is continuous anteriorly with the smooth, transparent cornea, which covers the iris and pupil. The palpebral conjunctiva lines the lids and is clear, with many small blood vessels. The cranial nerves, rather than spinal nerves, stimulate the movement of extraocular muscles. The three cranial nerves that move the extraocular muscles are the abducens, trochlear, and oculomotor nerves.

A nurse is teaching a class on the pathology and physiology of the eye. Which statement by the nurse about eversion of the eyelids during physical examination is accurate?

"The lashes need to be grasped between the examiner's thumb and forefinger." During the eversion of the upper lid, the lashes should be grasped between the thumb and forefinger and gently pulled down and outward. The patient should keep both eyes open and look down; closing the eyes would tense the orbicularis muscle. The upper lid should be slid up along the bony orbit to lift up the eyelashes. Eversion of the upper lid is done to inspect the conjunctiva of the upper lid. That is the reason the applicator stick should be placed on the upper lid above the level of the internal tarsal plates.

The nurse is caring for a patient who has undergone a tympanostomy. The patient asks the nurse, "What will happen to the tubes in my ear?" Which response by the nurse is best?

"These tubes usually fall out in about 12 to 18 months." During tympanostomy surgery the primary health care provider inserts tubes in the patient's ear to drain the excess fluid present in the middle ear. These tubes are made of polyethylene and remain in place for approximately 12 to 18 months, after which they spontaneously eject or fall out. Because these tubes fall out after 12 to 18 months, the nurse would not inform the patient that they would remain forever. Because these tubes are made of polyethylene, they do not dissolve in the ear within a year. Because the tympanostomy tubes fall out on their own, the patient will not undergo further surgery for the removal of the tubes.

What is the approximate length of the external auditory canal in an adult?

2.5 to 3 cm

Which of the following findings is associated with Horner syndrome?

A unilateral small regular pupil that reacts to light and accommodation Horner syndrome is caused by a lesion of the sympathetic nerve. An individual with Horner syndrome has a unilateral small regular pupil that reacts to light and accommodation. There is unilateral ptosis and absence of sweat on the same side.

The nurse observes a health care provider assessing a patient. During the exam, the provider presses against the patient's lacrimal sac and a clear fluid is expelled through the puncta. What can the nurse deduce from this finding?

A variation from normal that may indicate a blocked nasolacrimal duct The tears wash across the eye and are drawn up evenly as the lid blinks. The tears drain into the puncta, which are visible on the upper and lower lids at the inner canthus. They then drain into the nasolacrimal sac, through the half-inch-long nasolacrimal duct, and empty into the inferior meatus inside the nose. If the tear is expelled through the puncta, then a blockage in the nasolacrimal duct is indicated. Normally, the fluid should empty into the inferior meatus inside the nose. Hordeolum is an acute staphylococcal infection manifested at the margins of the eyelids. It causes intense pain and is not a variation. Aqueous humor is located in both the anterior chamber and posterior chamber of the eyes. It is unlikely that leakage of aqueous will be detected by pressing the lacrimal duct.

While assessing the eyes of a patient using an ophthalmoscope, the nurse finds that the patient has a scleral crescent. What could cause this finding in the patient?

Absence of pigment in the choroid layer A scleral crescent is a grey-white, new moon-shaped patch that appears at the disc margin. Absence of pigment in the choroid layer of the eyeball may lead to the occurrence of a scleral crescent. Extension of the cup, accumulation of pigment, and elevated yellow nodules on sclera are not associated with a scleral crescent. Extension of the cup into the disc border may increase the cup-disc ratio, which occurs in optic disc abnormalities. An excessive cup-disc ratio is common in patients with open-angle glaucoma. The accumulation of pigment in the choroid layer causes pigment crescent, but not scleral crescent. Excessive exposure to sunlight may result in the formation of pingueculae, or elevated yellow nodules on the sclera.

A patient reports to the nurse that he is having trouble seeing nearby objects. Which type of reflex is associated with this type of adaptation?

Accommodation A person who has a problem adapting the eyes to see objects nearby may have a problem in accommodation. Accommodation is adaptation of the eye for near vision. It is done by increasing the curvature of the lens through movement of the ciliary muscles. When one of the pupils is exposed to a bright light, a direct light reflex causes constriction of that pupil, and a consensual light reflex causes simultaneous constriction of the other pupil. Fixation is a reflex direction of the eye toward an object attracting our attention.

An older adult patient reports sudden, intense eye pain and sees halos around lights. On examination, the nurse observes a cloudy cornea and a dilated pupil. What does the nurse suspect from the patient's signs and symptoms?

Acute glaucoma Acute glaucoma occurs with a sudden increase in intraocular pressure from blocked outflow from the anterior chamber. The person experiences a sudden clouding of vision, sudden eye pain, and halos around lights. Infection of the conjunctiva is conjunctivitis and is due to a viral or bacterial infection. In iritis or circumcorneal redness, a deep, dull-red halo is observed around the iris and cornea; it is a vascular disorder caused by trauma or an infection. Horner's syndrome is a lesion of the sympathetic nerve.

A slight protrusion of the eyeballs may be noticed when examining individuals who come from which ethnic/cultural group?

African American African Americans normally may have a slight protrusion of the eyeball beyond the supraorbital ridge.

The nurse shows a preschool child seven cards with pictures of familiar objects kept at a distance of 15 feet. Which tool is the nurse using to evaluate the child's vision?

Allen test The Allen test helps to assess vision in children between 2 to 2.5 years of age. While performing this test, the nurse uses seven cards containing pictures of familiar objects and places these cards at a distance of 15 feet. A child with normal vision names at least three of them in three to five trials. The cover test detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel. In this test, the nurse asks the child to stare straight ahead at a familiar puppet and covers one eye with an opaque card. The child with normal vision has fixed gaze. Ishihara's test helps to assess color vision in children. In this test, the nurse uses a series of polychromatic cards. Each card has a pattern of dots printed against a background of many colored dots. The child with normal vision identifies each pattern. The Hirschberg test helps to assess the eye alignment of the eye axis by shining the light towards the patient's eyes. The nurse asks the patient to stare ahead, flashes the light on the eye, and notes the symmetry of corneal reflections.

While caring for a 4-year-old child with strabismus, the nurse finds that the child has not received proper treatment for this condition. What complication does the nurse expect to find in the child?

Amblyopia Strabismus refers to the improper alignment of the eyes, which results in squinting or crossed eyes. In a child with strabismus, the brain may suppress the functioning of the weak eye to prevent diplopia. This leads to disconjugate vision or lack of central vision in the weak eye, which is known as amblyopia. Therefore, if strabismus is left untreated, it can lead to amblyopia. Strabismus will not lead to myopia, esotropia, or exotropia in the child. Myopia is an ophthalmic condition in which the child can see close objects clearly but objects far away appear blurred. The child with myopia may not suffer from loss of central vision and may not be able to visualize distant objects clearly. Esotropia is a form of strabismus in which one or both the eyes turn inward due to extraocular muscle dysfunction. Exotropia is a form of strabismus in which one or both the eyes turn outward due to extraocular muscle dysfunction.

The nurse is assessing an elderly patient and notices a white ring along the patient's cornea. The patient states, "I can see things clearly." What can the nurse conclude from the findings?

Arcus senilis In aged adults, the cornea may look cloudy. A gray-white arc or circle caused by lipid deposition around the limbus can be noticed. This is called arcus senilis; there is no effect on vision. Xanthelasma are soft, raised, yellow plaques occurring on the lids at the inner canthus and are frequently seen in women . Pingueculae are yellowish, elevated nodules caused by thickening of the bulbar conjunctiva from sustained exposure to sun. Abnormal pterygium is also opacity on the bulbar conjunctiva, but it grows over the cornea.

The nurse shines a light straight toward the bridge of the nose of the patient. A bright dot of light appears at the 3 o'clock position in the left eye and the 9 o'clock position in the right eye. What can the nurse interpret from the finding?

Asymmetry in corneal light reflex The nurse uses the corneal light reflex to assess parallel alignment of the eye axes by shining a light toward the person's eyes. If a light is focused toward the bridge of the nose, a bright dot should appear at exactly the same position in both the eyes. Here, the dots appear at different positions in different eyes, so there is an asymmetry in the corneal light reflex in the patient. Epicanthal folds in a child can give a false appearance of malalignment that is called pseudostrabismus. Red reflex is caused by the reflection of the ophthalmoscope light off the inner retina. Consensual light reflex is assessed during the assessment of papillary light reflex and is not a part of corneal light reflex.

The nurse is preparing to perform otoscopy in a patient with an earache. The nurse finds that the patient's ear canal is filled with cerumen, along with discharge of yellow-colored fluid. What is an appropriate nursing action in this situation?

Avoid irrigating the patient's ear Otoscopic examination helps the nurse inspect the patient's external auditory canal and evaluate the tympanic membrane. During the examination, the nurse should check whether the patient's ear canal is filled with cerumen and should clean it in order to ensure a clear view of the tympanic membrane. However, if the patient has symptoms of infection (such as yellow discharge and earache) or a perforated tympanic membrane, the nurse should avoid irrigating the patient's ear canal, which could worsen the patient's symptoms. The nurse can instill the eardrops as prescribed by the primary health care provider to alleviate the symptoms of the infection. Irrigating the patient's ear canal with warm water can cause further damage and may cause perforations in the tympanic membrane. Cleaning the patient's ear with a cotton bud may push the ear discharge and cerumen deeper into the ear, so the nurse would apply gentle suction with a syringe to remove the fluids instead.

A patient with a staphylococcus eye infection has seborrheic dermatitis of the eyelid. The patient also reports burning and the sensation of a foreign body in the eye. Which eyelid infection should the nurse look for in the patient?

Blepharitis The patient with a staphylococcus infection and seborrheic dermatitis may have blepharitis. Blepharitis manifests itself as red, scaly, greasy, and thickened margins of the eyelid. The patient may also have burning and a foreign body sensation in the eye. Chalazion appears as a beady nodule over the eyelid. It is not associated with seborrheic dermatitis. Hordeolum is an acute localized infection that may be due to staphylococcus infection. However, the patient with hordeolum will have an elevated pustule at the lid margin. Dacryocystitis is the presence of infection or blockage in the nasolacrimal duct. A patient with dacryocystitis will have purulent discharge from the eye. However, a staphylococcal infection or seborrheic dermatitis will not cause dacryocystitis.

The nurse is preparing for a lecture on cerumen. Which information regarding cerumen would the nurse include in the lecture?

Cerumen is generally dry in Asians. Glands present in the external auditory canal produce cerumen. Chromosome number 16 determines the type of cerumen produced. It can be dry or wet. Dry cerumen is more frequent in Asians and American Indians, whereas wet cerumen is seen mostly in whites and blacks. Cerumen is normally produced as a lubricant, and it is not related to ear infection. Wet cerumen is soft, moist, and can be honey-brown to dark brown in color. Dry cerumen is gray and flaky.

Which chromosome helps determine the presence of wet or dry cerumen in a newborn?

Chromosome 16

A patient is experiencing conductive hearing loss and is given an exam. What structure would not be examined because of its location and disassociation with conductive hearing loss?

Cochlea Conductive hearing loss involves a mechanical dysfunction of the external or middle ear. This is considered a partial loss because the person can hear if the sound amplitude is increased enough to reach the inner ear. The cochlea is located in the inner ear; its impairment would lead to sensorineural hearing loss. Otosclerosis, a decrease in the mobility of the ear ossicles, may cause conductive hearing loss. A perforated tympanic membrane or impacted cerumen in the ear canal may also lead to conductive hearing loss.

During an assessment, the nurse documents that the patient's preauricular lymph node is swollen and painful. The nurse learns that the patient had a previous history of respiratory infections. Which eye complication should the nurse screen for in this patient?

Conjunctivitis The presence of a swollen and painful preauricular lymph node and a history of an upper respiratory tract infection indicate a bacterial or viral infection. The preauricular lymph node is swollen due to the accumulation of fluid in the nodes. It is common in the patient with conjunctivitis who had a previous history of upper respiratory tract infection. Hyphema, hypopyon, and pterygium may not occur in conjunction with bacterial or viral infections. The clogging of blood in the anterior chamber of eye is hyphema. A blunt injury of the eye may cause hyphema in the patient. The presence of inflammation in the anterior chamber of the eyes is the characteristic finding of hypopyon. The growth of benign tissue over the sclera towards the nose indicates pterygium. Chronic exposure to ultraviolet light may cause pterygium in the patient.

A patient tells the nurse, "Something is stuck in my eye, and I can't see anything." On examination, no foreign body is seen. The patient also reports tearing and sensitivity to light. What condition would the nurse suspect?

Corneal abrasion The patient feels pain, foreign body sensation, tearing, and photophobia. The symptoms indicate corneal abrasion. A corneal abrasion occurs due to damage to the cornea caused by injury, blunt trauma, scratches, or poorly fitting contact lens. Because the area has several nerve endings, the person feels excruciating pain. In aged adults, the cornea may look cloudy. A gray-white arc or circle caused by lipid deposition around the limbus can be noticed. This is called arcus senilis. Dacryocystitis is infection and blockage of lacrimal sac and duct. It is characterized by pain, warmth, redness, and swelling that occurs below the inner canthus toward the nose. Cataract formation is clouding of the crystalline lens from the clumping of proteins. It is caused by thickening of the transparent fibers of the lens.

Which response stimulates blinking in both eyes?

Corneal reflex The cornea is a thin, transparent, sensitive part of the eyes. Contact with any substance stimulates the blinking reflex of the eyes called the corneal reflex. Parasympathetic and sympathetic chains of the autonomic nervous system control the size of the pupil. Stimulation of the parasympathetic branch, through the third cranial nerve, causes constriction of the pupil. Stimulation of the sympathetic branch dilates the pupil and elevates the eyelid. The thickness of the lens is controlled by ciliary bodies.

Hypothyroidism

Could lose eyebrows and protruding eyes

After reviewing the medical records of a patient, the nurse finds that the patient has hearing impairment caused by damage to the cranial nerve. Which cranial nerve is damaged?

Cranial nerve VIII Cranial nerve VIII is the auditory, or vestibule-cochlear, nerve. This nerve transmits the impulses of sound to the brain and aids in hearing. Damage to this cranial nerve can cause hearing impairment and result in deafness. The optic nerve is the second cranial nerve, which aids in vision. The facial nerve is the seventh cranial nerve, which controls facial expressions. The vagus is the tenth cranial nerve; it controls the heartbeat. Therefore, damage to the second, seventh, or tenth cranial nerves will not result in deafness.

The nurse observes that a patient has a swollen and reddened upper eyelid. The nurse learns that the patient recently had infectious mononucleosis. Which condition does the nurse expect to see in the patient?

Dacryoadenitis Infection may cause inflammation of the lacrimal glands, resulting in dacryoadenitis in the patient. It manifests as pain, swelling, and redness in the outer third of the upper eyelid. It is common in the patient with infectious mononucleosis. The presence of red, scaly greasy flakes on the edge of eyelids indicates blepharitis, which occurs with staphylococcal infection or seborrheic dermatitis of the eyelid. The patient with blepharitis may not have a swollen eyelid. Hordeolum refers to the acute localized staphylococcal infection of the hair follicles at the eyelid margins. The presence of a painful, red, swollen, superficial, elevated pustule at the lid margin indicates hordeolum. Basal cell carcinoma manifests as a small, painless nodule, which often occurs at the lower eyelid. However, it is not associated with any infectious conditions. Excessive exposure to ultraviolet light may cause basal cell carcinoma in the patient.

A patient with an eye infection reports pain, warmth, and redness in the part of the eye closest to the nose. The nurse notices that the patient has purulent discharge when applying pressure on the conjunctival sac. Which condition does this patient likely have?

Dacryocystitis Pain, warmth, redness, and purulent discharge are the manifestations of dacryocystitis. Infection or blockage of the nasolacrimal duct may cause dacryocystitis. The presence of red scaly crusts on the eyelids indicates blepharitis. The patient with blepharitis will not have purulent discharge from the eye sac. The localized infection of the hair follicles at the eyelid indicates a hordeolum. This may occur due to the presence of staphylococcal infection. The patient with ptosis may have a sleepy appearance but will not have pain and purulent discharge from the conjunctival sac.

While assessing a newborn, the nurse finds epicanthal folds and large spacing between the eyes. Based on this finding, which condition is this infant at risk for?

Down syndrome Down syndrome is a congenital disorder and is characterized by skin folds of the upper eyelid (also known as epicanthal folds), white spots around the iris edges, and hypertelorism. Hypertelorism is an abnormal distance between two eyes. Therefore, an infant with Down syndrome may have epicanthal folds and hypertelorism. Frontal bossing may cause hypertelorism in the infant with Down syndrome. Meningitis is the inflammation of the protective membranes of the brain, and affects the development of the child. Therefore, the infant with meningitis may have bilaterally irregular pupils. Sympathetic nerve damage may cause Horner's syndrome in the infant. However, it manifests as a drooped eyelid, also known as ptosis, but not hypertelorism and epicanthal folds. The infant with central nervous system injury may not have hypertelorism, which is a developmental abnormality.

Which sign does the nurse observe in a patient with Horner's syndrome?

Drooping eyelids Horner's syndrome occurs due to the interruption of sympathetic nerve supply to the eye. It is characterized by constricted pupils and ptosis, or drooping eyelids. Sunken eyes, protruding eyes, and periorbital edema do not characterize Horner's syndrome. Enophthalmos, or sunken eyes, may occur in the patient who has chronic wasting illness or dehydration. Exophthalmos, or protruding eyes, may occur in the patient with thyrotoxicosis. Periorbital edema is the condition in which the lids appear swollen and puffy. The patient with hypothyroidism may have periorbital edema.

If one pupil is a different size

Emergency-Inner cranial pressure

A patient with a chronic illness has a cachectic appearance. Which eyelid abnormality would this patient most likely have?

Enophthalmos The patient who has sustained a severe loss of body mass due to a chronic illness may have sunken or recessed eyeballs, or enophthalmos. Ptosis, entropion, and periorbital edema are not associated with a cachectic appearance. The presence of drooping eyelids due to neuromuscular weakness or damage to cranial nerve II is ptosis. The inward rolling of the lower eyelid is entropion. It may cause irritation due to constant rubbing. Periorbital edema refers to the swollen and puffy appearance of eyes due to excess fluid in the tissues. It is one of the manifestations of hypothyroidism.

After an otoscopic examination, the nurse suspects otitis media in the patient. What observation would support this?

Fluid behind the tympanic membrane Fluid visible behind the tympanic membrane indicates otitis media. This makes the color of the tympanic membrane amber yellow. If the fluid of the middle ear is infected, it causes acute otitis media. A perforated tympanic membrane or impacted cerumen may cause conductive hearing loss. The tympanic membrane may not be visible by an otoscope if cerumen becomes dry and gets impacted. A shiny and translucent tympanic membrane is a normal finding.

The nurse performs a cover test to measure a patient's eye muscle strength. Which condition can be assessed with the cover test?

Esophoria Esophoria is the nasal inward drift of the eye. The cover test helps the nurse to assess the deviation in the alignment of the eye. The extraocular muscle weakness is more severe in esotropia than esophoria. A patient with esotropia has constant inward deviation of the eye. Esotropia can be determined by visually inspecting the eye. Entropion is the condition in which the lower lid rolls in because of spasm of lids or contraction of scar tissue. Entropion of the eye can be determined through the Schirmer tear test. Enophthalmos refers to sunken eyes, but not deviation in eye alignment. It is determined by the diplopia field test.

The nurse is evaluating a student nurse who is examining the pupillary light reflex in a patient. Which action by the student nurse needs correction?

Focusing the light from in front of the patient The nurse assesses the pupillary light reflex to assess the response of the pupil to light. The nurse advances the light from the side of the patient to assess the pupillary light reflex. The nurse should not advance the light from the front of the patient, because this may accommodate the pupils for near vision. The nurse should assess the pupillary light reflex of the patient in a dark room. This allows the nurse to record the accurate response of the pupil to light. The nurse instructs the patient to gaze into the distance to promote dilation of the pupil. The patient should not shift his or her gaze during the procedure and should properly follow the directions given by the nurse. This intervention prevents errors while assessing the patient's vision.

While doing the diagnostic position test, the nurse is still able to see the top portion of the iris while the patient is looking in the downward position. What complication should the nurse watch for in this patient?

Hyperthyroidism These findings are indicative of lid lag. Lid lag is an abnormal finding. When a patient has lid lag, the examiner will be able to see the top portion of the sclera between the eyelid and the iris. In a patient without lid lag, this will not be seen. Exophthalmia, or bulging eyes, is a common clinical manifestation of hyperthyroidism and this may cause lid lag in the patient. Nystagmus refers to the fine oscillating involuntary movements of the eye, best seen around the iris. Cranial nerve dysfunction and extraocular muscle dysfunction will not cause lid lag in the patient. The patient with cranial nerve dysfunction or extraocular muscle dysfunction may not have parallel eye movement.

During the diagnostic positions test, a patient's eye does not move to the down and nasal positions. Which cranial nerve may be affected in the patient?

IV Cranial nerve IV innervates the muscles that control the down and nasal movements of the eye. If this cranial nerve is paralyzed, the eye will not move to either the nasal or the down positions. Cranial nerve III is responsible for the straight and nasal, up and nasal, up and temporal, and down and temporal movements of the eye. Cranial nerve V is not responsible for any eye movement; it is responsible for facial movements and sensation. Cranial nerve VI is responsible for straight temporal movement of the eye.

The primary health care provider orders the insertion of tympanostomy tubes for a patient who has otitis media. What outcomes does the nurse expect in the patient after this procedure?

Improved ventilation in the middle ear Increased outflow of fluid from the middle ear Reduced risk of recurrent middle ear infection Otitis media is an inflammation of the middle ear caused by dysfunction of the eustachian tube, which results in the accumulation of fluid in the middle ear, decreased ventilation, and increased risk of infection. Surgical insertion of tympanostomy tubes helps drain the accumulated fluid from the ear, which results in increased outflow of fluid from the middle ear, improved ventilation, and reduced risk of middle ear infection. The accumulated fluid in the middle ear increases pressure in the ear, so tympanostomy tubes are designed to decrease the pressure in the middle ear. The tympanostomy tube helps drain the fluid but does not enhance the circulation of the blood, so the patient would not have increased blood supply to the middle ear.

Which statement accurately describes the signs and symptoms of iritis?

In iritis, or circumcorneal redness, a deep, dull-red halo is observed around the iris and cornea. It is a vascular disorder caused by a trauma or an infection. The pupil shape becomes irregular from the swelling of the iris. Other signs and symptoms include blurred vision, sensitivity to light, and pain. Unlike conjunctivitis, in which the redness is prominent at the periphery, the redness is more around the iris in the case of iritis. Conjunctivitis is infection of the conjunctiva, manifested by red, beefy-looking vessels at the periphery.

Which are the bones of the middle ear?

Incus Malleus Stapes The middle ear contains three ear bones, or auditory ossicles. These are the malleus, incus, and stapes. The cochlea is the part of the inner ear that contains the central hearing apparatus. It is not an ear bone. The vestibule of the ear is an oval cavity in the middle of the bony labyrinth; it is located in the inner ear, not the middle ear.

Which group of individuals has a higher risk of middle ear infections?

Infants The Eustachian tube of the infant is shorter, wider, and straight than in other age groups. This enables microorganisms to enter the middle ear through the nasopharynx more easily, which means infants are more prone to middle ear infections. In adults, adolescents, and geriatric patients, the Eustachian tube is long, narrow, and slightly curved so microorganisms may not pass as easily into the middle ear and cause infection.

The nurse is caring for a patient with impaired hearing and impaired balance. Which part of the ear is affected in this patient?

Inner ear The inner ear is responsible for hearing and balance. The organ of Corti, present in the inner ear, is the sensory organ of hearing. The numerous fibers along the basilar membrane of the organ of Corti are the receptor hair cells. These hair cells bend to mediate the sound vibrations into electric impulses that are carried to the brain. The labyrinth, in the inner ear, helps to maintain balance. Pinnae and the external auditory canal are the parts of the external ear, which carries sound waves to the middle ear. The ear ossicles, present in the middle ear, conduct sound vibrations into the inner ear. The auricle or the pinna, located externally, helps to perceive the direction of the source of sound.

Which technique does the nurse use to assess the vision of a 7-year-old child?

Ishihara's test Ishihara's test helps to assess color vision in children. In this test, the nurse uses a series of polychromatic cards. Each card has a pattern of dots printed against a background of multicolored dots. The child with normal color vision identifies each pattern. The cover test detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel. In this test, the nurse asks the child to stare straight ahead at a familiar puppet. The Hirschberg test helps to assess the alignment of the eye axis. The nurse performs this test by advancing a light towards the patient's eyes. The confrontation test helps to assess the peripheral vision in the children older than 3 years of age. In this test, the nurse asks the child if he or she can see the moving target.

What is the function of the auricle?

It helps to funnel sound waves into the external auditory canal. The external ear is called the auricle or pinna. It has a characteristic shape that helps to funnel sound waves into the external auditory canal for transmission to the middle ear. The semicircular canals of the inner ear help to maintain equilibrium. Sounds need not be amplified; rather, the middle ear helps to protect the inner ear by reducing the amplitude of the loud sounds.

A patient reports spinning and whirling sensations to the nurse. Which part of the ear does the nurse suspect to be damaged in this patient?

Labyrinth

While collecting the subjective data of a patient, the nurse finds that the patient has a previous history of glaucoma. The nurse also finds pilocarpine ophthalmic drops on the patient's prescription list. Which eye abnormality could this patient be at risk for?

Miosis Glaucoma is a condition that involves increased intraocular pressure within the eyeball, resulting in the gradual loss of sight. Chronic use of pilocarpine (Carpine) eye drops constricts the iris muscles, leading to miosis or constricted pupils in the patient. Tonic pupils react to the light slowly and may have sluggish accommodation, but have no pathologic significance. Unequal pupil size is referred to as anisocoria. This condition is observed in some central nervous system disorders. Inflammation of the lacrimal gland may result in dacryocystitis in the patient. Dacryocystitis manifests as pain and redness in the eye, but it may not involve constricted pupils or miosis.

The nurse is caring for a patient who has been administered deep anesthesia. What visual response would the nurse find in the patient?

Mydriasis The presence of dilated or fixed pupils is mydriasis. Anesthesia medication acts through the sympathetic nervous system and causes dilation of pupils or mydriasis. Administration of anesthesia does not cause miosis, anisocoria, or Adie's pupil. The presence of constricted pupils is miosis. Opioids may cause such constriction of pupils. Anisocoria refers to the presence of unequal pupil sizes. Adie's pupil makes one pupil appear larger and is unilateral; the pupil reacts slowly to light.

Which conditions may cause periorbital edema in a patient?

Myxedema Renal failure Congestive heart failure Periorbital edema is a condition in which excess fluid accumulates around the eyes, resulting in a swollen or puffy appearance of the eyelids. A patient with myxedema or hypothyroidism has low levels of thyroid hormones. Low thyroid hormone levels may result in accumulation of excessive fluids in the tissues around the eyes, leading to periorbital edema. During renal failure, the filtration capacity of the kidney is decreased and results in retention of fluids. Therefore, the patient with renal failure may have periorbital edema. The patient with congestive heart failure has low cardiac output. This results in decreased blood supply to the kidneys. Therefore, the kidneys may not be able to filter the blood properly, resulting in edema. Albinism is a genetic disorder, characterized by the absence of melanin pigment, which gives color to skin, hair, and eyes. It does not cause periorbital edema. The patient with thyrotoxicosis has protruding eyes or exophthalmos, not swollen eyelids or periorbital edema.

The nurse assesses the eye movements of a patient using the diagnostic positions test and finds that the patient is unable to turn his or her eyes in three cardinal positions of gaze—up and nasal, straight nasal, and down and temporal positions. Based on these findings, which cranial nerve paralysis could the patient have?

Oculomotor cranial nerve III The diagnostic positions test helps to detect the paralysis of eye muscles. In this test, the nurse assesses the eye movements of a patient through six cardinal positions of gaze. The patient with cranial nerve III or oculomotor nerve paralysis may not be able to turn the eyes in the straight nasal, up and nasal, and down and temporal positions. The oculomotor nerve innervates the muscles of the eye. The patient with cranial nerve IV or trochlear nerve paralysis may not be able to turn the eyes in down and nasal cardinal position of gaze. Paralysis of the abducens nerve or the cranial nerve VI may not allow the patient to move the eyes in a straight temporal position. The trigeminal nerve or the cranial nerve V carries the afferent sensory impulses to the brain. This nerve does not influence the functioning of the eye muscles.

Which are the two cranial nerves (CN) that are responsible for the pupillary light reflex?

Optic Oculomotor The pupillary light reflex is the normal constriction of the pupils when bright light shines on the retina. It is controlled by a subcortical reflex arc. The sensory afferent link of the reflex arc is the optic nerve (CN II), and the motor efferent link is the oculomotor nerve (CN III). The abducens nerve (CN VI) innervates the lateral rectus muscle and stimulates extraocular muscles. The trochlear nerve (CN IV) has no function in the reflex arc; it innervates the superior oblique muscle and controls extraocular muscles. The trigeminal nerve (CN V) carries the afferent sensation into the brain, and the facial nerve (CN VII) carries the efferent message that stimulates the blink; they do not play any role in papillary light reflex.

Which condition may cause conductive hearing loss in a patient?

Otosclerosis Conductive hearing loss is caused by the mechanical dysfunction of the external and middle ear. Otosclerosis is associated with a decrease in the mobility of ossicles present in the middle ear and may result in dysfunction of the middle ear; therefore otosclerosis is associated with conductive hearing loss. Presbycusis is caused by degeneration of the nerve located in the inner ear, which may damage the cochlear hair cells and result in sensorineural hearing loss. Inflammation of the labyrinth may cause inner ear dysfunction and may result in sensorineural hearing loss, but not conductive hearing loss. Damage to the eighth cranial nerve may result in sensorineural hearing loss.

Damage to which lymph nodes lead to the accumulation of lymph in the external ear?

Parotid lymph node Mastoid lymph node Superficial cervical lymph node The parotid, mastoid, and superficial cervical nodes drain the lymph from the external ear, so damage to these lymph nodes may cause accumulation of lymph in the external ear. The axillary lymph nodes help to drain the lymph from the upper arm, not from the ear. The lingual node helps to drain the lymph from the tongue, so damage to these nodes does not cause accumulation of lymph in the external ear.

The nurse is caring for four patients admitted in the emergency care unit. Which patient will require immediate medical attention?

Patient A has sudden onset of pain in the eye, headache, nausea, and rainbow-colored halos. These symptoms indicate that the patient has acute closed angle glaucoma. The patient with acute closed angle glaucoma should receive treatment within 2 to 3 hours to prevent permanent loss of vision. Presence of blood in the anterior chamber, or hyphema, indicates damage to the sclera. This condition may not cause permanent loss of vision quickly. Therefore, Patient B may not require immediate medical attention. Yellow-green branching on the cornea after a blunt injury indicates corneal abrasion. Patient C, who has corneal abrasion, may not require immediate medical attention. A red-colored patch on the sclera indicates a subconjunctival hemorrhage in the patient. A subconjunctival hemorrhage may not cause permanent blindness within 3 hours. Therefore, Patient D may not require immediate medical attention.

After examining the tympanic membrane of a patient, the nurse concludes that the patient is normal and does not have hearing impairment. Which finding supports the nurse's conclusion?

Presence of pearly gray-colored tympanic membrane According to research, the tympanic membrane of healthy individuals appears shiny and translucent with a pearly gray color, so this finding indicates that the patient is normal and does not have any risk of hearing impairment at present. Presence of obstruction in the eustachian tubes may create a negative pressure in the ear that causes retraction of the tympanic membrane, which can result in hearing impairment. The presence of white dots on the tympanic membrane indicates that the patient has a fungal infection. The presence of air bubbles on the tympanic membrane is a characteristic symptom of otitis media with effusion, which is not a normal finding.

After examining a patient, the nurse documents that the patient has arcus senilis. Which finding in the patient enabled the nurse to reach this conclusion?

Presence of thickened and raised corneas Presence of a gray-white arc around the limbus Deposition of lipids in the cornea may result in arcus senilis in the patient. Arcus senilis appears as a thickened and raised cornea. The patient may also have a grayish white-colored arc at the edges of cornea or limbus, which is generally found in the aging patient. The presence of yellow plaques at the edges of the cornea indicates xanthelasma. The presence of elevated yellow nodules on the sclera indicates pingueculae. They occur due to excessive exposure to sunlight. Benign degenerative hyaline deposits appear as yellow scattered dots on the retina. These are known as drusen.

What are the different functions of the eyelids?

Prevention of injury Protection from dust Protection from bright light The primary function of eyelids is to protect the eye from external agents and irritants. It shields the eyes from injury and protects from dust. The eyelids are closed as a reflex to strong light, which protects the eye from damage. The lacrimal gland, in the upper outer corner over the eye, secretes tears. The tears wash across the eye and are drawn up evenly with each blink. The eyelashes are short hairs in multiple rows that curve outward from the lid margins, filtering out dust and dirt.

What action should the nurse take during an otoscopic examination of an adult patient?

Pull the auricle up and back The nurse should pull the auricle up and back for an adult or an older child. This helps straighten the S-shape of the canal. In case of an infant or a child younger than 3 years of age, the nurse should pull the auricle downward. The nurse should insert the speculum slowly and carefully along the axis of the canal. The nurse should avoid touching the inner "bony" section of the canal wall. It is covered by a thin epithelial layer and is sensitive to pain. The nurse should also tilt the patient's head slightly away toward the opposite shoulder. This method brings the obliquely sloping eardrum into better view.

The nurse is performing an otoscopic examination in an adult patient. What would the nurse do to straighten the patient's ear canal during the test?

Pull the patient's pinna up and back While performing the otoscopic examination in an adult patient, the nurse should pull the patient's ear up and back, which helps straighten the S-shaped ear canal. Pulling the ear straight out or leaving it undisturbed does not straighten the ear canal, and could hinder the examination. Pulling the patient's pinna down and back is only effective on children under the age of three, because their ear canals are much shorter.

A patient develops sudden clouding of vision, severe eye pain, and halos around light. What should be the nurse's first intervention?

Report this to the primary health care provider. Sudden clouding of vision, severe eye pain, and halos around light may indicate primary angle-closure glaucoma. It is caused by a sudden increase in the intraocular pressure from a blocked outflow from the anterior chamber. Such symptoms should be reported immediately to the primary health care provider, because a delay in getting medical attention may lead to blindness. Analgesics, referring the patient to the optician, and making the patient rest in a dark room will not relieve the obstruction of the outflow from the anterior chamber of the eye.

The nurse is caring for a patient who was in an accident. The nurse notices that the patient has clear, watery drainage from the ear. What is the priority nursing intervention in this situation?

Report to the primary health care provider about the patient When caring for a patient who was in an accident or has trauma, the nurse should carefully monitor the patient to identify the internal injuries. If a patient has a clear, watery drainage from the ear, it indicates that the patient has cerebrospinal fluid drainage due to a basal skull fracture, which requires immediate treatment to prevent further damage. Therefore, the nurse should report to the primary health care provider immediately. Instilling 2% of acetic acid solution helps kill microorganisms. It does not help prevent cerebrospinal fluid drainage. Antibiotic solutions help prevent ear infections, but not prevent cerebrospinal fluid drainage. Irrigation of ear canal with warm solution helps remove cerumen from the ear canal, but does not stop the watery drainage from the ears.

On reviewing the medication history of a patient, the nurse finds that the patient is on long-term gentamicin (Garamycin) therapy. Which risk does the nurse expect the patient to have?

Sensorineural hearing loss Sensorineural hearing loss is caused by gradual degeneration of the nerves with aging or because of ototoxic drugs such as gentamicin (Garamycin). This medication may affect the hair cells in the cochlea, resulting in sensorineural hearing loss. Gentamicin (Garamycin) is an aminoglycoside antibiotic used to treat bacterial infection, but it does not cause middle ear infections such as acute otitis media. Conductive hearing loss is caused by external and middle ear disorders; it is a partial loss of hearing. Gentamicin (Garamycin) would not cause mechanical dysfunction of the middle ear and would not cause conductive hearing loss. Chondrodermatitis nodularis helicis is caused by increased pressure and trauma in the middle ear, but not by gentamicin (Garamycin).

After reviewing the diagnostic reports of a patient with hearing impairment, the nurse concludes that the patient has sensorineural hearing loss. Which finding supports the nurse's conclusion?

Sensorineural hearing loss is caused by damage to cranial nerve VIII. This results in hearing impairment, because there is an impaired transmission of the impulses produced by sound. Foreign objects affect the external ear, but would not cause sensorineural hearing loss. Pus in the middle ear and perforated tympanic membranes may result in conductive hearing loss due to the dysfunction of the middle ear. Because these conditions do not impair the transmission of impulses, they do not cause sensorineural hearing loss.

When inspecting the eyeballs of an African American individual, which of the following might the examiner expect to observe?

Small brown macules on the sclera Dark-skinned people may normally have small brown macules on the sclera.

Which parameters would the nurse assess in an elderly patient by performing the Romberg test?

Standing balance, Proprioception, Intactness of the cerebellum The Romberg test assesses the functional ability of the vestibular apparatus in the inner ear, which helps maintain standing balance. The Romberg test can also assess proprioception, which is the ability to sense the stimuli that arise within the body, such as position and motion. Deep tone reflex indicates the intactness of the cerebellum, which can be assessed with the Romberg test. Unlike the tuning fork test, the Romberg test does not measure the ability of hearing by determining air and bone conduction.

While collecting data on a patient, the nurse observes bright red blood on the patient's left eyeball. On further examination, the nurse finds a round, bright red 1-mm patch over the lateral aspect of the globe. What condition does the nurse suspect in the patient?

Subconjunctival hemorrhage A subconjunctival hemorrhage occurs when a tiny blood vessel breaks just underneath the clear surface of the eye, or conjunctiva. It appears as a bright red patch on the eyeball. The presence of bright red blood may be due to hemorrhage. A bacterial or viral infection may cause conjunctivitis in the patient. The presence of a pink eye and red, beefy-looking blood vessels at the periphery are the characteristics of conjunctivitis. A corneal abrasion is the condition in which the top layer of the corneal epithelium wears off due to blunt eye injury. It appears as a scar on the cornea. A vitreous hemorrhage is an extravasation, or the leakage of blood into the areas in and around the vitreous humor of the eye. Loss of vision and retinal detachment are the characteristic signs of vitreous hemorrhage. Neovascularization may increase the risk of vitreous hemorrhage in the patient with diabetic retinopathy.

Confrontation

Test peripheral vision using confrontation. Confrontation can help identify such abnormalities as homonymous hemianopsia and bitemporal hemianopsia.

Rosenbaum Card

The Rosenbaum card is used to evaluate near-vision. This small, handheld card has a series of numbers, E's, X's, and O's in graduated sizes. Visual acuity is indicated on the right side of the chart in either distance equivalents or Jaeger equivalents.

Which of the following is an expected response on the cover test?

The covered eye maintains its position when uncovered. A normal response to the cover test is a steady fixed gaze. If muscle weakness is present, the covered eye will drift into a relaxed position. A normal response to the cover test is a steady fixed gaze. When the eye is uncovered, if it jumps to reestablish fixation, eye muscle weakness exists.

Which part of the ear does the tympanic membrane separate?

The external and the middle ear The tympanic membrane separates the external ear and the middle ear. The tympanic membrane does not separate the middle and the inner ear or the middle and the Eustachian tube. The auricle is situated externally, and the cochlea is located deep inside the ear. These two structures are not separated by the tympanic membrane.

The nurse is assessing a 1-month-old and documents that the infant has a doll's eye reflex. Which finding led the nurse to reach this conclusion?

The infant shift the eyes to opposite direction after quick beats of nystagmus. The doll's eye reflex happens in infants from birth to about 2 months of age. The reflex involves infants turning their eyes in the same direction to which their bodies are turned. When someone turns the baby back and forth, the eyes move in the same direction as the body moves. The infant shifts the eyes to the opposite direction after quick beats of nystagmus when someone stops turning the infant. The direct light reflex refers to pupillary constriction in response to light exposure. The infant fixing his or her vision towards a bright light for few seconds indicates the fixation reflex. The infant opens his or her eyes but will not have a doll's eye reflex when the head is gently lowered in a supine position.

Which of the following statements regarding the results obtained from use of the Snellen chart is true?

The larger the denominator, the poorer the vision. Using the Snellen chart, the larger the denominator, the poorer the vision.

A patient has a beady nodule protruding from the eyelid. The nurse discovers the presence of swelling over the nodule that moves freely. What should the nurse infer from these findings?

The patient has a chalazion A chalazion refers to a beady protruding nodule over the eyelid. Retention or infection cyst of the meibomian gland may lead to the formation of a chalazion. The patient who has a chronic chalazion may have a swelling over the freely moving nodule. Blepharitis is the clinical manifestation of seborrheic dermatitis. Blepharitis does not manifest as a nodule on the eyelid. The presence of swelling and pain at the inner canthus along with purulent discharge indicates dacryocystitis. It may occur due to the infection or blocking of the nasolacrimal duct. A hordeolum is an acute localized staphylococcal infection of an eyelash hair follicle.

After assessing a patient, the nurse believes that the patient has labyrinthitis. Which finding is consistent with inflammation of the labyrinth?

The patient has a staggering gait. Labyrinthitis is associated with inflammation of the labyrinth and may impair body balance and cause vertigo. Therefore, the presence of a staggering gait, loss of balance, and spinning or whirling sensations may indicate that the patient has labyrinthitis. Unlike the external ear, the labyrinth does not have wax glands that produce cerumen, so labyrinthitis does not lead to accumulation of earwax in the ear canal that causes cerumen impaction. The presence of whitish discharge from the ear indicates that the patient has external otitis, which is not associated with labyrinthitis. The eustachian tube, which is a part of the middle ear, equalizes the air pressure on both sides of eardrum and prevents the feeling of uneasiness at higher altitudes. Therefore, damage to the eustachian tube can cause difficulty while traveling in a flight.

During the otoscopic examination of a patient, the nurse sees that the superior part of the patient's eardrum is bright red and bulging. What does the nurse infer from this finding?

The patient has acute otitis media. Acute otitis media is an acute inflammation of the middle ear, which may result in vasodilatation and accumulation of fluid. This may cause a bright red and bulging eardrum. Skull fracture may result in bleeding from the inner ear and may cause a bluish or dark red discoloration of the eardrum. Chronic otitis media is characterized by the presence of a thick, yellow amber-colored eardrum due to severe inflammation and the formation of pus. Fungal ear infections are characterized by the presence of black or white spots on the eardrum.

While examining a patient with a middle ear infection, the nurse avoids performing middle ear insufflations. What is the rationale behind this intervention?

The patient has an upper respiratory tract infection. The patient with a middle ear infection may have drum hypermobility or hypomobility. To evaluate drum mobility in the patient, the nurse would ask the patient to perform insufflation by holding the breath. The patient with an upper respiratory tract infection may have difficulty in breathing, so the nurse should avoid performing this intervention in the patient with an upper respiratory tract infection to prevent breathlessness. In patients with ophthalmic, gastrointestinal, and urinary tract infections, the nurse can insufflate the middle ear, because it will not propel infectious matter into the middle ear.

After assessing a patient, the nurse concludes that the patient has strabismus. Which finding supports the nurse's conclusion?

The patient has deviation in the eye axis. Strabismus refers to the improper alignment of the eyes, resulting in squinting or crossed eyes. In the child with strabismus, the brain may suppress the functioning of the weak eye to prevent diplopia. This may lead to disconjugate vision in the patient. A patient with retinal damage may observe blind spots in his or her line of vision. A patient with a neuromuscular disorder may have diplopia or the perception of double vision. Photophobia refers to the patient's inability to tolerate high light intensity. It may occur due to the overstimulation of the photoreceptors, corneal abrasion, or allergic conjunctivitis.

A patient tells the nurse, "I got an eye injury while playing baseball." The nurse notices blood in the anterior chamber of the eye. What should the nurse conclude from these findings?

The patient has hyphema. Blunt trauma to the eye may cause hyphema in the patient. Hyphema refers to the presence of blood in the anterior chamber of the eye. Hypopyon refers to the presence of purulent matter but not blood in the anterior chamber of the eye. Triangular opaque bulbar conjunctival growth towards the cornea indicates pterygium. The patient with pterygium may not have blood in the anterior chamber of the eye. The patient who has a corneal abrasion may have a scar on the cornea but not blood in the anterior chamber of the eye.

During an eye examination, the nurse finds yellowish elevated nodules on the conjunctiva of the patient's eyes. The nurse learns that the patient works in the wood recycling industry. What does the nurse infer from these findings?

The patient has pingueculae. Pingueculae are yellow elevated nodules present on the eyeball. Excessive exposure to sunlight, wind, and dust may cause pingueculae. The patient who works in a wood recycling center may have an excessive exposure to the dust. Therefore, the nurse expects pingueculae in the patient. Arcus senilis refers to the grey-white arc around the cornea. An accumulation of lipids on the corneal layer of the eye may cause arcus senilis. The presence of raised yellow plaques on the inner canthus on the lids indicates xanthelasma. This may occur due to an increase in the cholesterol levels of blood. Inflammation of the lacrimal gland may cause dacryocystitis in the patient. This condition manifests as pain, warmth, redness, and swelling below the inner canthus. Dacryocystitis occurs with measles and infectious mononucleosis or from trauma.

The nurse is assessing a pregnant patient who is in the seventh week of gestation. After reviewing the patient's laboratory and diagnostic reports, the nurse suspects the fetus is at risk of hearing impairment. Which finding supports this assumption?

The patient has rubella infection. Usually, the internal ears of the fetus develop during the fifth week of gestation. If the mother has rubella infection during the first trimester of the pregnancy, the virus could invade the fetus and impair the development of the internal ear, causing hearing impairment later. Vitamin A is essential for vision but not for hearing, so vitamin A deficiency would not cause hearing impairment in the fetus. An increase in estrogen levels is a normal finding during pregnancy, and this would not increase the risk of hearing impairment in the fetus. A high platelet count increases the risk of clotting, but not hearing impairment in the fetus.

While performing otoscopic examination in a patient with gout, the nurse finds that the patient has small, whitish-yellow nodules and uric acid crystals in the ear helix. What information will the nurse document in the patient's chart?

The patient has tophi. The presence of small, whitish-yellow, hard nodules in the helix indicates that the patient has tophi. These lumps are caused by deposition of uric acid crystals, which is common in patients with uric acid gout. A keloid is an outgrowth of scar tissue around the wound, and in the ear, keloids develop mostly at the ear lobule. Battle sign is characterized by the presence of blood in the tympanic membrane and discoloration of posterior side of the pinna and mastoid process. A sebaceous cyst is a black-colored nodule that blocks sebaceous glands. Keloids, battle signs, and sebaceous cysts are not signs of gout, so these would not be documented as such in the patient's chart.

The nurse is assessing a patient using the diagnostic positions test. Based on which finding does the nurse document paralysis of cranial nerve VI?

The patient is unable to turn the eye straight temporal. The diagnostic positions gaze test helps to the detect paralysis of eye muscles. In this test, the nurse assesses the eye movements of a patient through six cardinal positions of gaze. These positions include straight nasal, up and nasal, up and temporal, straight temporal, down and temporal, and down and nasal. The damage to the cranial nerve VI may not allow the patient to turn the eyes straight temporal. The patient who has a damage to the cranial nerve III may not be able to turn the eyes in up and nasal and straight nasal positions. The patient with cranial nerve IV paralysis may be unable to turn the eyes in the down and nasal cardinal position.

The nurse is examining a patient who has open angle glaucoma and concludes that the patient has tunnel vision. Which finding supports the nurse's conclusion?

The patient may have decreased peripheral vision The patient with open-angle glaucoma makes the proper amount of aqueous humor, but there may be clogging of the canals that drain excess aqueous humor. This, in turn, causes an increase in the intraocular pressure. The patient with open-angle glaucoma may gradually lose peripheral vision. As a result, the patient may have decreased peripheral vision. This is called tunnel vision. Asymmetric corneal light reflex in a patient may be a result of eye weakness or paralysis. This will not cause tunnel vision in the patient. Small and bilaterally irregular pupils will not lead to tunnel vision in the patient. Fine oscillating movements of the eye around the iris indicate nystagmus. Nystagmus is not associated with open-angle glaucoma and does not cause tunnel vision.

After reviewing a patient's Hirschberg test results, the health care provider instructs the nurse to do the cover test. What is the rationale for doing this test?

The patient presents with an asymmetric light reflex in both eyes. The Hirschberg test helps to assess the alignment of the eye axis. Asymmetric light reflex indicates improper eye alignment in the patient. It may occur due to the weakness or paralysis of the muscles. Therefore, the nurse should perform the cover test to confirm the ocular deviation. The patient who has light reflection at the same spot in both the eyes may not need a cover test because it is a normal finding. The patient with cranial nerve dysfunction may not be able follow certain eye directions when asked because the cranial nerve innervates the muscles of the eye and helps in the movement of the eyeball. However, the cover test will not be helpful to detect the cranial nerve dysfunction in the patient. The patient with photophobia is unable to tolerate bright lights. The nurse would not do a cover test to assess for photophobia in the patient.

While assessing the visual acuity of a patient by means of a Snellen chart, the nurse records the finding of the patient as having 20/100 vision. What does the finding indicate?

The patient sees at 20 feet what normal eyes would see at 100 feet. Test of visual acuity is performed using the Snellen eye chart. The Snellen chart has lines of letters arranged in decreasing size. The patient is asked to stand on a mark exactly 20 feet from the chart. If the person cannot see the largest letters, then the distance is reduced and checked until the person is able to see an object at a distance of 10 feet that should be seen from a distance of 200 feet. 20/100 vision indicates that the person can read at 20 feet what the normal eye can see from 100 feet away. For correct analysis, the person is asked to stand 20 feet from the chart, not 100 feet. Normal visual acuity is 20/20; that means the person can see an object at a distance of 20 feet that should be viewed at that distance only. The finding of 20/100 is a deviation from the standard and is an abnormal finding. Visual acuity is expressed in a fraction and is not expressed in percentage.

After performing the otoscopic examination of a patient, the nurse concludes that the patient has an infection. Which findings enabled the nurse to reach this conclusion?

The presence of yellow/amber-colored tympanic membrane The presence of yellow/amber-colored tympanic membrane indicates otitis media with effusion, which is a middle ear infection. The normal tympanic membrane is shiny, translucent, and pearl gray in color. Usually, the annulus appears white in color and denser at the periphery. Therefore, it does not indicate that the patient has an infection. In a healthy individual, the malleus is visible through the tympanic membrane.

The nurse is examining the hearing of an elderly patient using the whisper voice test. Which intervention would the nurse follow to properly administer this test?

Whisper a set of three random numbers and letters while standing 2 feet behind the patient. To perform the whisper voice test, the nurse would stand 2 feet behind the patient and whisper a set of three random numbers and letters while the patient holds one ear closed. Then the nurse asks the patient to repeat the numbers and letters. This helps the nurse to assess the hearing ability of the patient and provide appropriate treatment. If the nurse stands in front of the patient and whispers the numbers, the patient may be able to understand them by lip reading. The nurse might thus make an inaccurate assessment that the patient has normal hearing. If the nurse stands 10 feet away and whispers the numbers and letters, even an individual with normal hearing would not be able to hear them. Therefore, the nurse needs to stand closer to the patient. The patient may not be able to hear if both ears are closed so the nurse should inform the patient to close only the ear that is not being assessed.

Which of the following groups of individuals need to be tested for the presence of color blindness (deficiency)?

White boys between the ages of 4 and 8 years Color blindness is an inherited recessive X-linked trait affecting about 8% of white boys and 4% of black boys. Test only boys for color vision once between the ages of 4 and 8 years.

The normal color of the optic disc is

creamy yellow-orange to pink. The color of a normal optic disc ranges from creamy yellow-orange to pink.

After assessing a patient who has been in an accident, the nurse concludes that the patient has a basal skull fracture. Which findings support the nurse's conclusion?

frank blood and watery discharge or CSF discharges from the ear An injury to the skull may damage the meninges and blood vessels of the brain, which can result in leakage of cerebrospinal fluid (CSF) and active hemorrhage. Therefore, the patient with basal skull fracture may have frank blood and watery discharge or CSF discharges from the ear. The presence of redness in the ear with purulent discharge indicates that the patient has otitis externa. The presence of gray-colored, foul discharge from the ear indicates that the patient has cholesteatoma, which is caused by continuous growth of tissue in the middle ear. The reddish-blue discoloration of the ear with necrosis indicates that the patient has frostbite.

A patient tells the nurse, "I feel a throbbing pain in my eyes when I look at bright light." The nurse sees a dull red halo around the iris and cornea of the patient's eye. Which condition does this patient likely have?

iritis The presence of a dull red halo around the iris and cornea indicates that the patient has iritis. The patient with iritis may have the symptoms of marked photophobia and throbbing pain. The presence of a dull halo around the iris and cornea does not indicate glaucoma, conjunctivitis, or a corneal abrasion in the patient. A patient with glaucoma may have a headache, pain in the eyes, oval and dilated pupils, a steamy cornea, and a shallow anterior chamber. A bacterial or viral infection may cause conjunctivitis in the patient. A patient with conjunctivitis may have red beefy-looking vessels around the iris, which are more prominent at the periphery. A patient with a corneal abrasion will feel intense pain in the eyes and may have a scar on the cornea, but not a dull halo around the iris.

Decreased vision in an elderly patient may be due to which of the following conditions?

macular degeneration Decreased vision in elderly patients is most commonly caused by cataracts, glaucoma, or macular degeneration. Retinoblastoma is a malignant tumor of the retina that usually affects children younger than 6 years old. Fixation is a reflex direction of the eye toward an object attracting a person's attention; fixation is impaired by drugs, alcohol, fatigue, and inattention. The lens in an older adult loses elasticity and becomes hard and glasslike; this decreases the lens' ability to change shape to accommodate for near vision and is called presbyopia.

A patient has decreased visual acuity and decreased color vision. The nurse observes a grayish discoloration on the optic disc. Which abnormality will the nurse most likely find in the patient?

optic atrophy Grayish discoloration of the optic disc may occur due to optic atrophy. Optic atrophy happens as a result of partial or complete death of the optic nerve. The patient with optic atrophy may experience a decrease in visual acuity and color vision and decreased contrast sensitivity. Congestion and elevation of the optic disc results in papilledema. The patient with papilledema would not have a decrease in color vision. Narrowing of the artery decreases the diameter of the artery, thereby decreasing the light reflex. However, a narrowed artery may not result in grayish discoloration of the optic disc. The arteriovenous crossing disrupts the blood flow to the eye. Less blood flow results in thickening of the arterial wall and makes it opaque in appearance. Grayish discoloration of the optic disc does not characterize the arteriovenous crossing.

The location in the brain where optic nerve fibers from the temporal fields of vision cross over is identified as the:

optic chiasm. At the optic chiasm, nasal fibers (from both temporal visual fields) cross over. The fovea centralis is the area of the retina that has the sharpest and keenest vision. The optic disc is the area in which fibers from the retina converge to form the optic nerve. The choroid is the middle vascular layer of the eye; the choroid has dark pigmentation to prevent light from reflecting internally and is heavily vascularized to deliver blood to the retina.

While assessing a patient, the nurse finds that the patient's ears are 3 cm in length and have a small, painless nodule at the helix. What does the nurse infer from these findings?

patient has microtia and Darwin's tubercle When a patient has smaller ears, the length of which is less than 4 cm vertically, it indicates that the patient has microtia. The presence of a small painless nodule at the helix is indicative of Darwin's tubercle. It is a congenital variation and is not significant. Therefore, the nurse concludes that the patient has microtia and Darwin's tubercle. If the patient's ears are more than 10 cm in length, then it indicates that the patient has macrotia. Swimmer's ear is also known as otitis externa; it is caused by accumulation of water in the ear. It causes inflammation, earache, and redness. Because the patient does not have symptoms of otitis externa, the nurse does not conclude that the patient has microtia and swimmer's ear. Because the patient's ears are not more than 10 cm long and do not have inflammation and pain, the nurse does not conclude that the patient has macrotia and swimmer's ear. A small painless nodule is present in the patient; thus, the patient has Darwin's tubercle. Because the patient's ears are not more than 10 cm long, the nurse does not conclude that the patient has macrotia.

The extraocular muscles consist of four straight or __ muscles and two slanting or __ muscles.

rectus; oblique The four straight, or rectus, muscles are the superior, inferior, lateral, and medial rectus muscles. The two slanting, or oblique, muscles are the superior and inferior muscles.

The lens of the eye functions as a:

refracting medium. The lens serves as a refracting medium, keeping a viewed object in continual focus on the retina. The muscle fibers of the iris function as the mediator of light. The cornea is very sensitive to touch. The intraocular pressure is determined by a balance between the amount of aqueous humor produced and resistance to its outflow at the angle of the anterior chamber.

The nurse is assessing a patient with cholesteatoma. Which signs and symptoms would the nurse find in the patient?

tinnitus, otorrhea, and a pearly white tympanic membrane Cholesteatoma is an overgrowth of the epidermal tissue in the middle ear. The signs and symptoms include tinnitus, a ringing, crackling, or buzzing in the ears, and otorrhea occurs from marginal perforation of the eardrum. Due to infection, the patient may also have a cheesy and pearly white tympanic membrane. Therefore, the nurse would find the symptoms of tinnitus, otorrhea, and a pearly white tympanic membrane in the patient. Inflammation of the pinna is caused by the enlargement of the lymph nodes, not by the overgrowth of epidermal tissue. Therefore, the nurse would not find this symptom in the patient. Reddish-blue discoloration of the auricle is caused by frostbite, but not by cholesteatoma.