Med Surg 2 Ch. 20, 21, 55, 56

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A patient is diagnosed with astigmatism and asks what this will mean for their vision. What is the best response by the nurse? "Astigmatism is a clouding of the lens causing problems with glare." "Astigmatism causes distorted vision because of corneal unevenness." "Astigmatism limits visual acuity because of damage to the optic nerve." "Astigmatism is elevated pressure within the eye caused by excess fluid."

"Astigmatism causes distorted vision because of corneal unevenness." Astigmatism, a refractive error causing distorted vision, occurs when the surface of the cornea is not smooth. Damage to the optic nerve results in loss of part or all of the visual field. Cataracts, the clouding of the lens, often occur with age and leads to problems seeing, including glare. Glaucoma is a disease causing damage to the optic nerve from elevated intraoptic pressure. p. 358

A patient comes to the clinic reporting a ringing sensation in the ears. Which questions should a nurse ask to find out more about the patient's problem? Select all that apply. A patient comes to the clinic reporting a ringing sensation in the ears. Which questions should a nurse ask to find out more about the patient's problem? Select all that apply. "Can you describe the type of ringing?" "When do you usually have this sensation?" "Have you ever collapsed due to dizziness?" "Do you get ear pain if you strain while defecating?" "What measures have you taken to resolve this complaint?"

"Can you describe the type of ringing?" "When do you usually have this sensation?" "What measures have you taken to resolve this complaint?" A ringing sensation in the ears is known as tinnitus. While assessing a patient for tinnitus, the nurse should try to get sufficient information about the complaint. Tinnitus may present as a buzzing, roaring, or ringing noise. Knowing the time or circumstances in which ringing occurs helps to know the cause or any concomitant modality. Asking the patient about the measures that have been taken for the complaints gives an insight to the severity of the problem and knowledge of any medications taken by the patient. Straining to defecate is not related to tinnitus. Dizziness is not seen in tinnitus because tinnitus doesn't affect the brain or blood supply to the brain. p. 362

A patient comes to the clinic for an ophthalmic checkup. A nurse performs an assessment of visual acuity using a Snellen chart. The patient should be positioned how many feet away from the Snellen chart? 6 feet away 20 feet away 24 feet away 30 feet away

20 feet away The distance to be maintained between the patient and the Snellen chart is 20 feet, or 6 meters. This chart is used to check the visual acuity of an individual. Any distance closer or further than this will not provide an accurate assessment of visual acuity. p. 356

A patient with acute-angle glaucoma has a new prescription for eye drops. The nurse will question the patient about which of these conditions? Symptoms of dry eyes Use of corrective lenses A history of heart or lung disease Sensitivity to sulfonamide antibiotics

A history of heart or lung disease It is particularly important to determine whether the patient has any history of cardiac or pulmonary disease because β-adrenergic blockers often are used to treat glaucoma. These medications can slow heart rate, decrease blood pressure, and exacerbate asthma or chronic obstructive pulmonary disease (COPD). Dry eyes, use of corrective lenses, and sensitivity to sulfonamide antibiotics are incorrect. p. 354

What is the function of the structure labeled 1 in the image? Processes and interprets sound Acts as a receptor organ for hearing Keeps the ear canal free from debris Acts as an instrument for sound transmission

Acts as an instrument for sound transmission The structure labeled 1 in the image is the tympanic membrane, a part of the external ear that acts as an instrument of sound transmission between the external auditory canal and the tympanic membrane. The vestibulocochlear nerve and temporal lobe help in processing and interpret the sound transferred in the form of an electrochemical impulse. The cochlea present in the inner ear functions as a receptor organ for hearing. The cilia, sebaceous oils, and ceruminous wax help in keeping the ear canal free from debris. p. 360

The nurse assesses a bulging, red eardrum on otoscopic examination with a middle ear filled with pus and blood. What does the nurse infer from this finding? The nurse assesses a bulging, red eardrum on otoscopic examination with a middle ear filled with pus and blood. What does the nurse infer from this finding? Acute otitis media Serous otitis media Seborrheic dermatitis Eustachian tube blockage

Acute otitis media A bulging red eardrum and middle ear filled with pus and blood indicate that the patient has acute otitis media. Serous otitis media, caused by transudation of blood and serum, manifests as yellow-amber bubbles above the fluid level. Seborrheic dermatitis is marked by scaling or lesions on the skin. Eustachian tube blockage is indicated by retraction of the eardrum and the cone of light is bent. p. 365

The patient has described a loss of central vision. What test should the nurse teach the patient about to identify changes in macular function? Amsler grid test B-scan ultrasonography Fluorescein angiography Intraocular pressure testing with Tono-pen

Amsler grid test The Amsler grid test is self-administered and regular testing is necessary to identify any changes in macular function. B-scan ultrasonography is used to diagnose ocular pathologic conditions (e.g., intraocular foreign bodies or tumors, vitreous opacities, retinal detachments). Fluorescein angiography is used to diagnose problems related to the flow of blood through pigment epithelial and retinal vessels. Intraocular pressure testing with a Tono-pen is done to test for glaucoma. p. 359

The nurse performs an otoscopic examination of the patient's left ear, which indicates the presence of an exostosis. What does the nurse anticipate will occur after this finding? Surgery No intervention Electrocochleography Irrigation of the ear canal

No intervention An exostosis is a bony growth into the ear canal that normally does not require intervention or correction. Therefore, surgery, electrocochleography, or irrigation of the ear canal are unnecessary. p. 365

A patient sustained an eye injury, and the nurse assesses blood in the anterior chamber as well as redness of the sclera. What is a priority nursing action for this patient? A patient sustained an eye injury, and the nurse assesses blood in the anterior chamber as well as redness of the sclera. What is a priority nursing action for this patient? Applying pressure on the eye Giving oral fluids to the patient Instructing the patient to blow the nose Elevating the head of bed to 45 degrees

Elevating the head of bed to 45 degrees Eye injuries may be caused due to trauma, foreign bodies, chemical burns, or thermal burns and can be a serious threat to vision if not treated appropriately. The assessment findings include pain, photophobia, redness, swelling, and blood in the anterior chamber of the eye. Elevating the head of the patient's bed to 45 degrees helps minimize edema and swelling, thereby preventing the obstruction of vision. The nurse should avoid applying pressure on the eye. Oral fluids and food should not be given to the patient. The patient should be instructed not to blow the nose because it may cause black eyes. p. 371

A patient is diagnosed with a collapsed ear canal. What type of complication does the nurse associate with this diagnosis? Calcification of ossicles Increased hair growth Loss of cartilage elasticity Reduced blood supply to the cochlea

Loss of cartilage elasticity Loss of cartilage elasticity results in collapse of the ear canal, which in turn causes the canal to lose the ability to transmit sound waves. Calcification of ossicles results in tinnitus (ringing in the ears) because ossicles transmit sound waves. Increased hair growth results in visible hair in the ear. Reduced blood supply to the cochlea results in impaired speech reception because the cochlea is the center for reception. p. 364

Which abnormality does the nurse suspect if, while performing an otoscopic examination, a nurse has trouble visualizing the tympanum because of the presence of a bony growth? Tophi Exostosis Swelling of pinna Impacted cerumen

Exostosis Interference with visualization of the tympanum by a bony growth indicates that the patient has exostosis. The presence of hard nodules in the helix or antihelix indicates tophi. Swelling of the pinna is associated with infection of the glands of skin, which in turn is associated with trauma. A patient with impacted cerumen will have impaired hearing because the wax is not properly excreted from the ear. p. 365

Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos? Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos? Strabismus Keratoconus Exposure keratitis Keratoconjunctivitis sicca

Exposure keratitis Exposure keratitis is an inflammation or infection of the cornea that occurs when the patient has exophthalmos due to thyroid disease or masses behind the globe. Therefore the nurse will suspect exposure keratitis. Strabismus is not associated with inadequately closed eyelids, and there is no inflammation. Instead the patient with strabismus cannot consistently focus the two eyes on same object simultaneously. Keratoconus is a noninflammatory condition in which the patient experiences blurred vision. Keratoconjunctivitis sicca is a condition of dry eyes, particularly seen in older adults and individuals with certain systemic diseases such as scleroderma and systemic lupus erythematosus. p. 372

A patient is due for rotary chair testing to assess vestibular function. What action by the nurse is most appropriate? A patient is due for rotary chair testing to assess vestibular function. What action by the nurse is most appropriate? Observe the patient for vomiting. Instruct the patient to fast before the test. Explain to the patient that the test is time consuming. Keep the patient alone in the room to avoid distraction.

Observe the patient for vomiting. Rotary chair testing is done to evaluate the peripheral vestibular system. Testing is usually done in the dark; therefore, in order to ensure safety, the nurse should not leave the patient alone. The patient should be advised to eat a light meal before the test to avoid nausea. The nurse should monitor the patient for vomiting. The length of the test is not relevant. p. 365

Which tool is used in the physical assessment of the retina and optic nerve? Penlight Refractometry Ultrasonography Ophthalmoscope

Ophthalmoscope An ophthalmoscope is used to examine the retina and optic nerve. A penlight is used to examine pupillary function and reaction to light. Refractometry is a measure of refractive error. This is performed with the patient looking through apertures at a Snelling acuity chart. Ultrasonography determines the correct power of a lens implant before cataract surgery. p. 358

The nurse is performing an assessment of a patient's ear with an otoscope and finds that the light reflex is fuzzy. How does the nurse interpret this finding? The nurse is performing an assessment of a patient’s ear with an otoscope and finds that the light reflex is fuzzy. How does the nurse interpret this finding? Degeneration of the hair cells Blockage of the eustachian tube Retraction of the tympanic membrane Degeneration of the neurons of the auditory nerve

Retraction of the tympanic membrane Retraction of the tympanic membrane will cause the edges of the light reflex to appear fuzzy. Degeneration of hair cells will reduce sensitivity to sound. Blockage of the eustachian tube results in a retracted eardrum but does not make the light reflex appear fuzzy. Degeneration of auditory neurons will reduce sensitivity to high-pitched sound. p. 364

The patient calls the clinic about a sty that the patient has had for some time on the upper eyelid. The patient says warm moist compresses have been used, but it is no better. What should the nurse tell the patient to do? The patient calls the clinic about a sty that the patient has had for some time on the upper eyelid. The patient says warm moist compresses have been used, but it is no better. What should the nurse tell the patient to do? "Go to the pharmacy to get some eye drops." "Come in so the ophthalmologist can remove the lesion for you." "The health care provider will need to inject it with an antibiotic." "Wash the lid margins with baby shampoo to remove the crusting."

"Come in so the ophthalmologist can remove the lesion for you." A chalazion may evolve from a sty, or hordeolum, as it did for this patient. Initial treatment is with warm compresses, but when they are ineffective, the lesion may be surgically removed or injected with corticosteroids. Washing the lid margins with baby shampoo is done with blepharitis. p. 370

The nurse is interviewing a patient diagnosed with glaucoma. What question is most relevant to the patient's condition? "Have you ever had surgery?" "When was the last test for visual acuity done?" "Do you have a history of cardiac or pulmonary disease?" "Has there been any recent change in your eyeglasses or contact lenses?"

"Do you have a history of cardiac or pulmonary disease?" When collecting a health history for a patient diagnosed with glaucoma, the nurse should ask about cardiac or pulmonary disease. Glaucoma is often treated with beta-adrenergic blockers, which may decrease heart rate, decrease blood pressure, and exacerbate asthma or chronic obstructive pulmonary disease (COPD). Information regarding a visual acuity test, previous surgeries, and a change in lens prescription is gathered as general data but is not specifically related to glaucoma. p. 355

A nurse is interviewing a patient with visual impairment. Which question related to elimination should the nurse ask to determine changes in intraocular pressure? "Do you pass stools regularly?" "How many stools do you have in a day?" "What are the characteristics of the stools?" "Do you have to strain while passing stools?"

"Do you have to strain while passing stools?" It is important for the nurse to ask the patient if the patient has to strain during stools. Straining during defecation increases the intraocular pressure. While assessing the elimination pattern in relation to eye complaints, knowing the characteristics of stools is not important. The regularity, characteristic, and frequency of stools are important parameters while assessing the gastrointestinal system. However, they are not related to visual impairment. p. 355

While completing a health history, the nurse learns that a patient has symptoms of tinnitis. Which follow-up question should the nurse ask? While completing a health history, the nurse learns that a patient has symptoms of tinnitis. Which follow-up question should the nurse ask? "Do you wash your hands before touching your face?" "Do you use cotton-tipped applicators to clean the ear canal?" "Have you been constipated or straining with bowel movements lately?" "Do you routinely take aspirin or have you increased your aspirin intake lately?"

"Do you routinely take aspirin or have you increased your aspirin intake lately?" Tinnitis, a sensation of ringing or buzzing in the ears, may result from high aspirin intake. Hand washing prevents infection. Cotton-tipped applicators should not be inserted inside the ear canal because this could impact cerumen or traumatize the ear canal. Straining is not a causative factor of tinnitus. p. 361

A nurse is obtaining a health history from a patient with decreased visual acuity. Which question related to sexuality is relevant for this patient? "Do you use birth control pills?" "Do you have regular periods?" "How many children do you have?" "Do you and your partner use condoms during intercourse?"

"Do you use birth control pills?" Birth control pills have some side effects. Some pills may cause blurred vision, double vision, or floaters in the visual field. Such cases should be immediately reported to the health care practitioner. Eye complaints are not dependent on the number of children or the menstrual period. Similarly, condom use does not affect vision. p. 354

To determine if a patient has ocular problems, what questions should the nurse ask during the patient assessment? Select all that apply. "Does your eye problem hamper your daily activities?" "How much do you appreciate the fact that you can see?" "Do you wear contact lenses? How do you care for them?" "How do your eye problems make you feel about yourself?" "Have you participated in any activity that may be harmful to your eyes?"

"Does your eye problem hamper your daily activities?" "Have you participated in any activity that may be harmful to your eyes?" The nurse has to assess the patient's activity in order to assess the severity of the disorder. Assessing occupational hazards may help to understand the possible cause of the eye disorder. Asking the patient if daily activities are disturbed due to eye issues helps in assessing severity. The nurse should ask if the patient has participated in any harmful activity that may have caused eye damage. Asking how the patient cares for contact lenses helps in understanding how the patient cares for the eyes. Asking how the eye problem makes the patient feel about self helps to explore the patient's psychologic sphere. Asking how much the patient appreciates being able to see only reveals the patient's attitude. p. 354

The nurse is assessing an older adult patient who just has been transferred to a long-term care facility. Which question will best allow the nurse to assess the woman for the presence of presbycusis? The nurse is assessing an older adult patient who just has been transferred to a long-term care facility. Which question will best allow the nurse to assess the woman for the presence of presbycusis? "Do you ever experience any ringing in your ears?" "Have you ever fallen down because you became dizzy?" "Do you ever have pain in your ears when you're chewing or swallowing?" "Have you noticed any change in your hearing in recent months and years?"

"Have you noticed any change in your hearing in recent months and years?" Presbycusis is an age-related change in auditory acuity. Ringing in the ears is termed tinnitus, whereas dizziness and falls are related to balance and the function of the vestibular system. Presbycusis is not associated with pain during chewing and swallowing. p. 361

A nurse is interviewing a patient with irritation of the eyes. To assess eye health, the nurse should ask what sleep hygiene-related question? "What time do you go to sleep at night?" "What position do you generally sleep in?" "What kind of dreams do you generally have?" "How many hours of sleep do you get in 24 hours?"

"How many hours of sleep do you get in 24 hours?" The health of the eyes depends on various lifestyle factors. One important parameter is sleep. An adequate duration of sleep is required for optimum eye health. Asking how many hours the patient sleeps gives information about the duration of sleep. Bedtime is not an important factor in determining eye health, but duration is important. Position of sleep doesn't affect eye health. Similarly, information about dreams may be used in psychologic and emotional assessment, but is not related to eye health. p. 355

A patient has an ophthalmic condition resulting in decreased tear production in the eyes. The nurse expects that the patient will report which symptom? "I see a double of every object." "I cannot see clearly in dim light or at night." "I have a sandy, gritty, and irritating sensation in my eyes." "I cannot read books, newspapers, or anything close to me."

"I have a sandy, gritty, and irritating sensation in my eyes." Tears act as a lubricant in the eyes. In the absence or deficiency of tears, the patient has a dry, gritty, sandy, and irritating sensation in the eyes. Double vision is caused by an abnormality in the extraocular muscles because they regulate the vision. Tear production does not affect vision. Vision and night vision are regulated by the retina. Night blindness is caused due to damage to structures known as rods, which are present in the retina. Stiffening of the ciliary muscles affects the acuity of a patient's near vision. p. 352

The nurse is educating a patient with Ménière's disease about care management after discharge. Which statement by the patient indicates effective learning about care management? "I should eat a low-sodium diet." "I should exercise in the evening." "I should choose solid foods over liquids." "I should limit alcohol intake to 2 ounces a day."

"I should eat a low-sodium diet." Ménière's disease is a middle ear infection associated with an increase of fluid in the ear. A low-sodium diet reduces the risk of water retention, which lowers the risk of Ménière's disease. Performing exercise in the evening will be tedious for patients with Ménière's disease. The patient will have difficulty with solid foods because chewing may cause ear pain. The patient with Ménière's disease should completely avoid alcohol, which causes dizziness and vertigo. p. 363

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? 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? "I might feel some scratchiness in my left eye." "I should notice an improvement in my vision in a few days." "I will call my health care provider if I notice white drainage or redness in my left eye." "I will call my health care provider if I notice white drainage or redness in my left eye."

"I should notice an improvement in my vision in a few days." 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. pp. 373-375

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? 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? "I will visit my eye doctor every one to two years." "I will wear protective sunglasses while outside." "I will take lutein and vitamin E supplements for eye health." "There is nothing that can be done to prevent vision loss from glaucoma."

"I will visit my eye doctor every one to two years." 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. p. 380

The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching? The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching? "I'll limit my fluid intake." "I'll change positions slowly." "I'll use my eye drops until my vision clears." "I'll check the labels on my nonprescription drugs."

"I'll check the labels on my nonprescription drugs." 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. p. 379

A nurse is assessing a patient with chronic tinnitus. Which question is appropriate to ask when exploring the patient's sleep habits? A nurse is assessing a patient with chronic tinnitus. Which question is appropriate to ask when exploring the patient's sleep habits? "In what position do you sleep?" "At what time do you go to bed?" "Is your sleep disturbed by ringing in your ears?" "Do you wake up frequently for urination at night?"

"Is your sleep disturbed by ringing in your ears?" While assessing a patient with tinnitus, it is necessary to ask if tinnitus causes sleeplessness. This gives a clue about the seriousness of the disorder. The position and time of sleep is irrelevant in tinnitus. Whether the patient wakes up frequently for urination at night is not related to tinnitus. p. 362

When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement? When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement? "Prolonged eye irritation is an expected adverse effect of this medication." "This medication will help to raise intraocular pressure to a near normal level." "This medication needs to be continued for at least five years after the initial diagnosis." "It is important not to do activities requiring visual acuity immediately after administration."

"It is important not to do activities requiring visual acuity immediately after administration." Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Prolonged eye irritation is not an expected adverse effect of pilocarpine. Pilocarpine will stimulate iris sphincter contraction. At least five years is not an appropriate amount of time to estimate to the patient. p. 381

The nurse has a suspicion that a patient is experiencing nystagmus. Which statement made by a patient supports the nurse's suspicion? The nurse has a suspicion that a patient is experiencing nystagmus. Which statement made by a patient supports the nurse’s suspicion? "I suddenly got dizzy and fell down." "My vision blurs when I move my head." "I need white noise to get a good night's sleep." "I need assistance to bend down or to lift things."

"My vision blurs when I move my head." Abnormal eye movement indicates nystagmus. Blurring of vision with eye or head movement also indicates nystagmus. The patient with vertigo will have balance problems, which may result in dizziness and falls. Patients with tinnitus and ringing ears require white noise for distraction and peaceful sleep. Patients with Ménière's disease need assistance with activities such as bending and lifting objects. p. 361

Which statement by the student nurse indicates the need for further teaching regarding age-related macular degeneration (AMD)? Which statement by the student nurse indicates the need for further teaching regarding age-related macular degeneration (AMD)? "AMD is related to retinal aging." "Family history is a major risk factor for AMD." "People with dark-colored eyes are more at the risk for AMD." "Long-term exposure to ultraviolet light is a risk factor for AMD."

"People with dark-colored eyes are more at the risk for AMD." Age-related macular degeneration is the most common cause of irreversible central vision loss in people above 60 years of age. People with light-colored eyes, not dark-colored eyes, are more at risk for AMD because light eyes have less pigment, which makes them sensitive to light, causing AMD. The student making this statement requires further teaching. AMD is related to retinal aging because changes in astrocytes in retinal aging cause retinal ischemia, which leads to AMD. Genetic factors play a major role in AMD, and family history is a major risk factor for AMD because multiple genetic variants are involved in AMD. Long-term exposure to ultraviolet light is a risk factor for AMD because long-term exposure may cause retinal detachment. p. 378

A patient is having refractometry as part of the visual assessment. Which of these instructions from the nurse is correct? Select all that apply. "Are you allergic to iodine or contrast media?" "You will feel slight burning during this procedure." "Please try to hold your head still during the examination." "You may find it difficult to focus on near objects for three to four hours." "You might notice that your urine will turn a darker yellow-orange color today."

"Please try to hold your head still during the examination." "You may find it difficult to focus on near objects for three to four hours." The patient may need help to hold the head still during the examination. Pupil dilation makes it difficult to focus on near objects, and dilation may last three to four hours. The refractometry procedure is painless. Concerns about iodine/contrast media allergy and the possibility of urine color changes occur with fluorescein angiography, not refractometry. p. 359

A nurse assessing vestibular function places electrodes near the patient's eye to record specific eye movement. What does the nurse instruct the patient to do before performing the test? A nurse assessing vestibular function places electrodes near the patient’s eye to record specific eye movement. What does the nurse instruct the patient to do before performing the test? "You should eat a light meal." "You should consume ice cream." "You should gargle for 15 minutes." "You should drink eight glasses of water."

"You should eat a light meal." By recording eye movement through electrodes, electronystagmography aids diagnosis of diseases of the vestibular system. The nurse instructs the patient to eat a light meal before the test to reduce the risk of nausea caused by electrode movement near the eye. The nurse will not instruct the patient to consume ice cream, because electronystagmography will not cause inflammation or irritation of the trachea. Gargling helps clear the throat and mouth but does not affect the eyes. Electronystagmography does not require excess hydration. p. 365

A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? "Papilledema is caused by irritants and microorganisms." "Papilledema is fluid accumulation between two layers within the retina." "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

"Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." Sustained, severe hypertension can cause sudden visual loss from swelling of the optic disc and nerve. This condition is known as papilledema. It is not caused by the development of abnormal blood vessels in or around the macula, nor is it caused by microorganisms. Papilledema is not fluid accumulation between two layers within the retina. The development of abnormal blood vessels in or near the macula is known as macular degeneration. p. 376

An older adult patient reports hearing loss. During the assessment, a student nurse is teaching the patient about normal changes of aging of the auditory system. Which statement requires correction from the nursing instructor? An older adult patient reports hearing loss. During the assessment, a student nurse is teaching the patient about normal changes of aging of the auditory system. Which statement requires correction from the nursing instructor? "There is a reduced production of cerumen." "There is a decreased ability to filter sound to hear." "The tympanic membranes atrophy, or reduce in size." "There is an increased growth of hair in the auditory canal."

"There is a reduced production of cerumen." The production of cerumen increases, not decreases, with age and dries out, which causes difficulty hearing. A patient's ability to filter sound is reduced as he or she ages. In addition, the tympanic membrane atrophies with aging, and there is an increase in hair growth in the auditory canal when a patient ages. p. 361

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

"There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This leads to damage to the optic nerve over time. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber. p. 379

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. 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. "Wash hands regularly to prevent the spread of diseases." "Avoid removing contact lenses if there is redness and pain in the eye." "Wear sunglasses and ensure proper nutrition to prevent cataract development." "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." "Regular eye checkups help in early detection of disease and prevent further loss of vision."

"Wash hands regularly to prevent the spread of diseases." "Wear sunglasses and ensure proper nutrition to prevent cataract development." "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." "Regular eye checkups help in early detection of disease and prevent further loss of vision." 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. p. 370

Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? "You may feel some palpitations after instilling these eye drops." "You may have a temporary headache after instilling these drops." "You should withhold this medication if your blood pressure becomes elevated." "You should keep your eyes closed for 15 minutes after instilling these eye drops."

"You may have a temporary headache after instilling these drops." 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. Closing the eyes for 15 minutes after instilling the eye drops is not necessary. p. 381

Which instruction should the nurse give the patient who is prescribed verteporfin for age-related macular degeneration? Which instruction should the nurse give the patient who is prescribed verteporfin for age-related macular degeneration? "You should avoid direct exposure to sunlight while on treatment." "You can wear clothes with short sleeves after receiving treatment." "You should avoid lutein-containing, green, leafy vegetables while on treatment." "You should consume vitamin E-containing foods but avoid vitamin C-containing foods after receiving treatment."

"You should avoid direct exposure to sunlight while on treatment." Age-related macular degeneration is an eye condition that leads to the deterioration of the macula, leading to loss of central vision. Verteporfin is a photosensitizing drug that becomes active when exposed to a low-level laser light wave or sunlight and may cause thermal burns. Therefore the nurse instructs the patient to avoid direct exposure to sunlight. The patient should cover the body completely, rather than wear short sleeves, because any exposure of the skin to sunlight could activate the medication in that area, resulting in a thermal burn. Lutein-containing, green, leafy vegetables do not react with verteporfin. Therefore there is no need of avoiding lutein-containing, green, leafy vegetables. Vitamins C and E are helpful in reducing the risk of age-related macular degeneration. 379

A patient is advised to undergo a caloric test stimulus. How should a nurse explain the test to the patient? Select all that apply. A patient is advised to undergo a caloric test stimulus. How should a nurse explain the test to the patient? Select all that apply. "You will be in a standing position for the test." "You will be sitting or lying down for the test." "The test involves pouring cold or warm solution into your ears." "The test is performed to determine conductive or sensorineural hearing loss." "The test may result in nausea and vertigo after stimulation of semicircular canals."

"You will be sitting or lying down for the test." "The test involves pouring cold or warm solution into your ears." "The test may result in nausea and vertigo after stimulation of semicircular canals." This test is carried out to diagnose diseases of the labyrinth and vestibular systems. The patient is positioned in a sitting or supine position. In the process, a warm or cold solution is poured in the ear of the patient to stimulate the semicircular canals. If there is abnormality of the labyrinth, it may be manifested as nystagmus or nausea. Any abnormal response by the patient is recorded. This test is not performed with the patient standing. A tuning fork test is done to differentiate between conductive and sensorineural loss. p. 365

The nurse, who is reinforcing medication teaching before administering the scheduled dose of pilocarpine, would include which statement? The nurse, who is reinforcing medication teaching before administering the scheduled dose of pilocarpine, would include which statement? "You will need someone to drive you home." "This medication should be used as needed to reduce eye pain." "Eye irritation is to be expected during the first two weeks of use." "This medication will help to raise intraocular pressure to a near normal level."

"You will need someone to drive you home." Pilocarpine causes blurred vision and difficulty focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Pilocarpine will not reduce eye pain, will not cause eye irritation, and will decrease, not increase, intraocular pressure. 381

The nurse is preparing a patient for ultrasonography of the eye. What should the nurse inform the patient while explaining the test procedure? "You will not experience pain during the test." "You may have nausea and yellow-orange urine after the test." "You may have difficulty focusing on near objects for three to four hours after the test." "You should fixate on the center dot and record abnormalities of the grid lines during the test."

"You will not experience pain during the test." Ultrasonography involves corneal anesthetization and is not painful. During refractometry, the patient's eyes are dilated to visualize the retina and optic nerve. Therefore the patient may have difficulty focusing on near objects for three to four hours after refractometry. Fluorescein angiography involves administering a dye into the patient's body via the intravenous route. Therefore the patient may have nausea and yellow-orange discoloration of the urine after fluorescein angiography. The Amsler grid test assesses the patient's vision by asking the patient to report the abnormalities he or she finds in the grids. During the Amsler grid test, the patient should fixate on the center dot and record the abnormalities of the grid lines. p. 359

A nurse is conducting a tuning fork test on a patient. The nurse has 4 forks, each with a different frequency: 500 Hz; 506 Hz; 512 Hz; and 520 Hz. Which fork should the nurse use? A nurse is conducting a tuning fork test on a patient. The nurse has 4 forks, each with a different frequency: 500 Hz; 506 Hz; 512 Hz; and 520 Hz. Which fork should the nurse use? 500 506 512 520

512 The tuning fork test helps to differentiate between conductive and sensorineural hearing loss. The frequency of the fork is specific in order to get the desired effect. The fork that is used in this test is 512 Hz. p. 364

The nurse is assessing four patients with visual problems. Which patient does the nurse determine is exhibiting signs of retinal detachment? A: everything looks like a cobweb to me B: I am unable to distinguish colors because they have too much glare. C: I am unable to tolerate light and have a sensation of a foreign body in my eyes D: I have itching and burning sensations in my reddened eyes

A: everything looks like a cobweb to me Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers. Patients with a detaching retina describe symptoms that include a "cobweb," "hairnet," or ring in the field of vision. Therefore the nurse will expect that Patient A has retinal detachment. For Patient B, abnormal color perception and glares indicate cataracts. Redness, photophobia, and foreign body sensation indicates epidemic keratoconjunctivitis for Patient C. Itching, burning, redness, and tearing indicate allergic conjunctivitis in Patient D. pp. 376-377

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? Absence of pain or pressure Blurred vision in the morning Seeing colored halos around lights Eye pain accompanied with nausea and vomiting

Absence of pain or pressure 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. p. 379

A patient has received a prescription for ketoconazole eyedrops. The nurse recognizes that the probable reason for the medication is that the patient is experiencing what? A patient has received a prescription for ketoconazole eyedrops. The nurse recognizes that the probable reason for the medication is that the patient is experiencing what? Myopia Astigmatism Acanthamoeba keratitis Generalized poor hygiene of the eye

Acanthamoeba keratitis Ketoconazole is an antifungal eyedrop that is prescribed for the treatment of Acanthamoeba keratitis because the causative organism is resistant to other drugs. Myopia is an inability to accommodate for objects at a distance; it is not a fungal infection. Astigmatism is caused by an irregular corneal curvature and is not a fungal infection. Ketoconazole is not used for general hygiene of the eye. p. 372

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? 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? Carteolol Dipivefrin Carbachol Acetazolamide

Acetazolamide 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. p. 381

A patient presenting with an itching, burning sensation and redness in the eye is diagnosed with allergic conjunctivitis. What interventions are most important to ease the symptoms? Select all that apply. A patient presenting with an itching, burning sensation and redness in the eye is diagnosed with allergic conjunctivitis. What interventions are most important to ease the symptoms? Select all that apply. Administer artificial tears, as prescribed. Instruct the patient to wash hands regularly. Instruct the patient to avoid the allergen if it is known. Administer topical antihistamines and corticosteroids. Instruct the patient to use individual or disposable towels.

Administer artificial tears, as prescribed. Instruct the patient to avoid the allergen if it is known. Administer topical antihistamines and corticosteroids. Allergic conjunctivitis is caused by exposure to any allergen. If the allergen is known, the patient should be instructed to avoid the allergen as much as possible. Artificial tears can be used to dilute the allergen and wash it from the eye. Topical antihistamines and corticosteroids can be used to further decrease the symptoms. Hand washing and using individual or disposable towels are general measures to prevent the spread of infection, but they are not specific to allergic conjunctivitis. pp. 371-372

dentify risk factors associated with development of cataracts. Select all that apply. Identify risk factors associated with development of cataracts. Select all that apply. Advanced age History of diabetes mellitus Exposure to ultraviolet light Eating a diet high in lutein History of eye chronic open-angle glaucoma History of prolonged therapy with systemic corticosteroids

Advanced age History of diabetes mellitus Exposure to ultraviolet light History of prolonged therapy with systemic corticosteroids 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. pp. 373-374

The nurse is testing a patient for hearing acuity using a whisper test. Which actions by the nurse are appropriate? Select all that apply. The nurse is testing a patient for hearing acuity using a whisper test. Which actions by the nurse are appropriate? Select all that apply. Test both ears together. Stand directly in front of the patient. After exhaling, speak in a low whisper. Ask the patient to repeat numbers or words. Whisper loudly if the patient does not respond correctly.

After exhaling, speak in a low whisper. Ask the patient to repeat numbers or words. Whisper loudly if the patient does not respond correctly. When testing for hearing acuity, the nurse should stand 12 to 24 inches to the side of the patient and, after exhaling, speak in a low whisper. Ask the patient to repeat numbers or words or answer questions. Use a louder whisper if the patient does not respond correctly. Test each ear separately. The ear not being tested is covered by the patient. p. 365

A patient reports to the nurse that there is a sandy, gritty sensation in the eye along with irritation and discomfort. What medication should the nurse determine might be causing these symptoms? Corticosteroids Antihistamines Aminoglycosides β-adrenergic blockers

Antihistamines A sandy, gritty sensation in the eye that is accompanied by irritation and discomfort indicates corneal dryness. Decongestants and antihistamines cause ocular dryness. Long-term use of corticosteroids may result in glaucoma or cataracts. Medications that are used over-the-counter usually have ocular effects. Aminoglycosides are ototoxic and, therefore, can cause hearing loss, tinnitus, or vertigo. β-adrenergic blockers are used for treating glaucoma. p. 354

The nurse assesses a patient with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin. What action does the nurse anticipate providing to assist with the relief of discomfort due to this condition? The nurse assesses a patient with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin. What action does the nurse anticipate providing to assist with the relief of discomfort due to this condition? Administration of artificial tears Insertion of intacs on the cornea Application of a warm, moist compress four times a day Administration of nonsteroidal antiinflammatory eye drops

Application of a warm, moist compress four times a day Hordeolum is an infection of the sebaceous glands in the lid margin. The symptoms of hordeolum are a red, swollen, circumscribed, and acutely tender area near the eye. The only treatment that may be necessary for this patient is to apply warm, moist compresses four times a day, which will decrease the swelling and redness of the eye. Administering artificial tears is the treatment for allergic conjunctivitis to dilute the allergen and wash it away. Insertion of intacs on the cornea is the treatment for keratoconus. Administration of nonsteroidal antiinflammatory eye drops is the treatment given if the patient has inflammation. p. 370

A patient has a milky white and grayish ring encircling the periphery of the cornea, and the laboratory reports of the patient reveal a total serum cholesterol of 220 mg/dL. Which condition is present? Pterygium Glaucoma Blepharitis Arcus senilis

Arcus senilis A total serum cholesterol of less than 180 mg/dL is considered optimal. The patient's serum total cholesterol of 220 mg/dL is high. Arcus senilis is an abnormality of the eye associated with high cholesterol levels. Cholesterol is deposited in the eye margin; therefore, the patient will see a milky white and grayish ring encircling the periphery of the cornea. Pterygium is an abnormality of the cornea that is associated with chronic exposure to sunlight, which manifests as thickened, triangular, pale tissue extending from the inner canthus to the nasal border. A patient who has glaucoma will have increased intraocular pressure, not cholesterol levels. Blepharitis is a bacterial infection in lid margins, which manifests as redness, swelling, and crusting along the lid margins. p. 353

The nurse is assessing a patient's hearing problems. What actions should the nurse take in order to perform the assessment? Select all that apply. The nurse is assessing a patient's hearing problems. What actions should the nurse take in order to perform the assessment? Select all that apply. Ask if the patient wears earrings. Ask if the patient is feeling any ear pain. Assess if the patient can hear a clock ticking. Determine if the patient can hear loud noises. Check the external auditory meatus for any discharge.

Ask if the patient is feeling any ear pain. Assess if the patient can hear a clock ticking. Check the external auditory meatus for any discharge. While assessing any patient with hearing problems, it is important to collect subjective data as well as objective data. Subjective data are what the patient says regarding complaints. These consist of modalities of pain or discharge. Objective information is the information that the nurse can see or perceive. The nurse can assess the patient's ability to hear by testing for the ability to hear a clock ticking in the room. Checking the external auditory meatus helps the nurse observe if any discharge is present. The patient's auditory ability is assessed based on the ability to hear low sounds. There is no test for checking hearing ability based on loud noises. Wearing ear jewelry may cause inflammation but does not affect hearing capacity. p. 362

A nurse is assessing the pupillary function of a patient. Which steps should be performed when assessing accommodation? Select all that apply. Ask the patient to look at the nurse's finger. Ask the patient to focus on a distant object. The nurse places a finger at a distance of 20 feet from the patient's nose. The nurse places a finger at a distance of 3 inches from the patient's nose. The nurse places a finger at a distance of 6 meters from the patient's nose.

Ask the patient to look at the nurse's finger. Ask the patient to focus on a distant object. The nurse places a finger at a distance of 3 inches from the patient's nose. In order to check the accommodation capacity of the patient's eyes, the nurse has to first ask the patient to focus on a distant object. The patient is then instructed to focus on the nurse's finger, which is placed 3 inches from the patient's nose. The normal response is convergence and constriction of the eyes. A Snellen chart is used for testing visual acuity. The distance of 20 feet, or 6 meters, is maintained while reading a Snellen chart. p. 358

A nurse is assessing a patient with hearing loss that gives a history of taking various medications in the past few years. Which drugs taken by the patient may be ototoxic? Select all that apply. A nurse is assessing a patient with hearing loss that gives a history of taking various medications in the past few years. Which drugs taken by the patient may be ototoxic? Select all that apply. Aspirin Antibiotics Domperidone Antimalarial drugs Nutritional supplements

Aspirin Antibiotics Antimalarial drugs Many drugs are ototoxic. They can damage the hearing of an individual. They can cause hearing loss, tinnitus, and other problems. These drugs include aspirin, chemotherapy drugs, antibiotics, antimalarial drugs, nonsteroidal antiinflammatory drugs (NSAIDs), and diuretics. Domperidone is an antiemetic drug and is not ototoxic. Similarly, nutritional supplements are food supplements to ensure adequate nutrition. Nutritional supplements are not ototoxic. p. 362

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing intervention should be the nurse's priority? A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing intervention should be the nurse's priority? Teach about visual enhancement techniques. Teach nutritional strategies to improve vision. Assess coping strategies and support systems. Assess impact of vision on normal functioning.

Assess impact of vision on normal functioning. The most important nursing intervention is to assess the patient's ability to function with the visual impairment. The nurse will use this information to plan nursing care, including assessment of the patient's coping strategies and teaching about vision enhancement techniques and nutrition. pp. 378-379

A patient has lost an eye after an industrial accident. Which action by the nurse is most appropriate during this time? A patient has lost an eye after an industrial accident. Which action by the nurse is most appropriate during this time? Speak louder when talking to the patient. Avoid making eye contact during a conversation. Introduce the patient to other visually impaired persons. Assist the patient with the same grieving process that is associated with other losses.

Assist the patient with the same grieving process that is associated with other losses. When the patient has lost visual function or even the entire eye, he or she will grieve the loss. The nurse should help the patient through the grieving process. The patient lost an eye, not an ear, so speaking louder is not necessary. The nurse should still make eye contact with the patient. Introducing the patient to other visually impaired persons is not recommended early in the grieving process. 382

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? 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? Asthma Urinary retention Cluster headaches Chronic constipation

Asthma 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. p. 381

A patient reports visual distortion and is assessed to have an uneven cornea. What refractive error does the nurse determine is most likely present? Myopia Hyperopia Presbyopia Astigmatism

Astigmatism Visual distortion that is associated with an uneven cornea indicates that the patient has astigmatism. Myopia is a refractive error in which the patient is not be able to view objects that are far away. Hyperopia is an impairment in vision in which the patient is not be able to see clearly see close objects. Presbyopia is the inability to focus on objects that are near and the condition increases with age. Myopia, hyperopia, and prebyopia are associated with an elongation or shortening of the eyeball, but not an uneven cornea. p. 351

The nurse is reviewing refractive errors of the eye. Which statement does the nurse identify as being true? The nurse is reviewing refractive errors of the eye. Which statement does the nurse identify as being true? Presbyopia occurs when the eyeball elongates. Astigmatism is caused by an irregular corneal curvature. Myopia is an inability to accommodate for near objects. Hyperopia is an inability to accommodate for objects at a distance.

Astigmatism is caused by an irregular corneal curvature. Astigmatism is caused by an irregular corneal curvature. Presbyopia is the loss of accommodation associated with age. As the eye ages, the lens becomes larger, firmer, and less elastic. Myopia (nearsightedness) is an inability to accommodate for objects at a distance. Hyperopia (farsightedness) is an inability to accommodate for near objects. 368

A patient is found to have acoustic neuromas. Which diagnostic test will the nurse prepare the patient for to aid in assessment? Posturography Electrocochleography Pure-tone audiometry Auditory brainstem response

Auditory brainstem response An acoustic neuroma is a tumor that develops in the nerve of the inner ear. Auditory brainstem response is the diagnostic test used to assess the inner pathway of the ear or detect tumors in the inner ear. Posturography is a balance test, useful in assessing vestibular function. Electrocochlography allows electrical activity in the cochlea to be recorded and analyzed. Pure-tone audiometry is useful in assessing sensorineural hearing loss. p. 365

Which diagnostic study is the nurse performing if, while performing an auditory assessment in a darkened room, the nurse places electrodes over the mastoid process, at the vertex, and on the forehead? Which diagnostic study is the nurse performing if, while performing an auditory assessment in a darkened room, the nurse places electrodes over the mastoid process, at the vertex, and on the forehead? Rotary chair testing Electrocochleography Electronystagmography Auditory evoked potential

Auditory evoked potential Auditory evoked potential is conducted in a darkened room and electrodes are placed over the mastoid process, vertex, and forehead to isolate auditory activity from other activities. Rotary chair testing is performed in a dark room to evaluate the peripheral vestibular system, but in this test the patient is seated in a chair driven by a motor under computer control. Electrocochleography records electrical activity in the cochlea and auditory nerves. Electronystagmography, in which specific eye movements are recorded, is used to diagnose diseases of the vestibular system. p. 365

A patient is being provided with discharge instructions after undergoing cataract extraction and intraocular lens implantation. What should the nurse include in the teaching? A patient is being provided with discharge instructions after undergoing cataract extraction and intraocular lens implantation. What should the nurse include in the teaching? Avoid straining during bowel movements. Keep consuming a full-liquid diet for 24 hours. Refrain from reading or watching TV for at least 12 hours. Keep a patch over the affected eye until the follow-up appointment with the surgeon.

Avoid straining during bowel movements. 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. p. 376

The nurse is assessing four patients with different refractive errors. Which patient will the nurse suspect to have hyperopia? A: inability to accommodate for objects at a distance B: inability to accommodate for near objects C: loss of accommodation which is associated with age D: irregular corneal curvature

B: inability to accommodate for near objects Hyperopia, or farsightedness, is an inability to accommodate near objects. It causes the light rays to focus behind the retina and requires the patient to use accommodation to focus the light rays on the retina for near objects; therefore, patient B is suspected to have hyperopia. Myopia or nearsightedness is an inability to accommodate objects at a distance; therefore, Patient A has myopia. Presbyopia is the loss of accommodation associated with age; therefore, Patient C has presbyopia. Astigmatism is caused by an irregular corneal curvature; therefore, Patient D has astigmatism. p. 368

A nurse is observing different behaviors in patients who are scheduled for an ophthalmic examination. Which patient should the nurse expect to have double vision? A: patient is dressed in an unusual color combination B: patient is holding his or her head in a skewed position C: patient covers his or her eyes with the hand to block the light in the room D: patient is making eye contact with the nurse while speaking

B: patient is holding his or her head in a skewed position Patient B is holding his or her head in skewed or oblique position, which is indicative of the patient having diplopia. Patients who have diplopia have double vision and hold the head in a skewed position in an attempt to see a single image. Patient A has dressed himself or herself in an unusual color combination, which is indicative of color blindness. Patient C covers his or her eyes to block the light, which is indicative of photophobia. Patient D is making eye contact with the nurse, which is positive behavior. p. 374

During visual examination of a patient, the nurse notices that the patient has a red, watery eye and inflammation of the conjunctiva. What does the nurse anticipate the cause to be? Bacterial or viral infection Increased intraocular pressure Intraocular or periorbital tumors Inflammation of the anterior uvula tract

Bacterial or viral infection A red, watery eye and inflammation of the conjunctiva are the manifestations of conjunctivitis. It is caused by a bacterial or viral infection. Glaucoma is associated with increased ocular pressure. An increase in intraocular pressure does not cause the eye to become red and watery; rather, it begins with peripheral loss of vision and later results in complete blindness. Intraocular or periorbital tumors cause protrusion of the globe of the eye, called exophthalmos. Inflammation of the anterior uvula tract causes photophobia, or intolerance to light. p. 357

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? 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? Betaxolol Besifloxacin Tropicamide Ranibizumab

Betaxolol 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. 381

Which visual problem will the nurse suspect in the patient who has symptoms of itching, irritation, intolerance towards light, with crusts on the lid margins and lashes? Which visual problem will the nurse suspect in the patient who has symptoms of itching, irritation, intolerance towards light, with crusts on the lid margins and lashes? Cataract Blepharitis Retinal detachment Allergic conjunctivitis

Blepharitis Blepharitis is a common chronic bilateral inflammation of the lid margins associated with crusts on the lid margins. Blepharitis is also associated with itching, irritation, and photophobia. Cataract is a clouding of the lens in the eye, which affects vision by abnormal color perception and glaring. Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium. The symptoms of retinal detachment are photopsia and seeing a ring or cobwebs in the field of vision. Allergic conjunctivitis is caused by exposure to an allergen and is associated with itching and swelling. pp. 370-371

Which structural impairment of the ear does the nurse suspect in a patient who has a nasopharyngeal infection? Which structural impairment of the ear does the nurse suspect in a patient who has a nasopharyngeal infection? Damage to cranial nerve VII Damage to cranial nerve VIII Blockage of eustachian tube Reduced blood supply to cochlea

Blockage of eustachian tube The eustachian tube continues from the nasal pharynx, where the presence of a nasopharyngeal infection may result in blockage. Damage to cranial nerve VII results in loss of voluntary facial movement. Damage to cranial nerve VIII is associated with excess calcium deposition, but not nasopharyngeal infection. A nasopharyngeal infection does not result in impairment such as reduced blood supply to the cochlea. p. 364

The nurse cares for a patient with a detached retina. The patient says, "Before my eye was patched, I saw a lot of spots." The nurse explains that the symptoms are caused by what? The nurse cares for a patient with a detached retina. The patient says, "Before my eye was patched, I saw a lot of spots." The nurse explains that the symptoms are caused by what? Contamination of the aqueous humor Pieces of the retina floating within the eye Blood cells released into the eye by the detached retina Spasms of the retinal blood vessels traumatized by the detached retina

Blood cells released into the eye by the detached retina The spots commonly reported by patients with retinal detachment are blood cells released into the vitreous humor in the detachment. These are also referred to as "floaters." Contamination, retinal fragments, and spasms of the retinal blood vessels are not the cause of floaters in the field of vision of a person with a detached retina. pp. 376-377

A patient is having retinal hemorrhages, anoxic cotton-wool spots, and macular swelling in the eye. What should the nurse closely monitor that is a contributing factor to this disorder? A patient is having retinal hemorrhages, anoxic cotton-wool spots, and macular swelling in the eye. What should the nurse closely monitor that is a contributing factor to this disorder? Glucose level Blood pressure Intraocular pressure Thyroid hormone levels

Blood pressure Hypertensive retinopathy is caused by high blood pressure that creates blockages in retinal blood vessels. The eye examination of a patient with hypertensive retinopathy reveals retinal hemorrhages, anoxic cotton-wool spots, and macular swelling. If the eye examination shows capillary microaneurysms, retinal swelling, and hard exudates, then the nurse will suspect nonproliferative retinopathy and high blood glucose level. Exposure keratitis is seen in patients who cannot close their eyes adequately because of protruding eyeballs, which is caused by increased thyroid hormone. Angle-closure glaucoma occurs because of pupil dilation. When the pupil remains partially dilated long enough, it may result in increased intraocular pressure. p. 376

While examining the eye of a patient, the nurse finds a cone-shaped anterior cornea. Which other finding is associated with this condition? While examining the eye of a patient, the nurse finds a cone-shaped anterior cornea. Which other finding is associated with this condition? Pain Blurred vision Corneal inflammation Abnormal color perception

Blurred vision Keratoconus is a noninflammatory eye disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape. The only symptom associated with keratoconus is blurred vision. Pain is a symptom of corneal ulcer. Corneal inflammation is a symptom of keratitis. Abnormal color perception is associated with cataracts. 373

The nurse is caring for a patient suspected of having age-related macular degeneration. What symptoms should the nurse document and report regarding this disorder? The nurse is caring for a patient suspected of having age-related macular degeneration. What symptoms should the nurse document and report regarding this disorder? Blurred, darkened vision Itching, burning, and redness Sudden, excruciating pain in the eye Decreased vision, abnormal color perception

Blurred, darkened vision Age-related macular degeneration (AMD) is an eye condition that leads to the deterioration of the center of the retina, called the macula, leading to loss of central vision. The patient with AMD has blurred and darkened vision, scotomas, and metamorphopsia. The symptoms of cataract are decreased vision, abnormal color perception, and glare. The symptoms of glaucoma are sudden, excruciating pain in or around the eye. The symptoms of allergic conjunctivitis are itching, burning, and redness. p. 378

A patient tells a nurse, "I'm becoming more and more sensitive to loud noises." Which auditory system change does the nurse suspect? Brain Inner ear Middle ear External ear

Brain The brain is the main component of the auditory system, filtering unwanted and unnecessary sounds. A patient with increased sensitivity to sound will have changes in the brain. The inner ear is involved in reception of sound, balance, and body orientation. A patient with impaired middle ear function will have conductive loss of hearing. Damage to the external ear will result in collapse of the ear canal and, potentially, hearing loss. p. 363

A patient seeks assistance from the primary health care provider because of episodes of vertigo. Which diagnostic test will determine whether the vertigo is related to a problem of the inner ear? A patient seeks assistance from the primary health care provider because of episodes of vertigo. Which diagnostic test will determine whether the vertigo is related to a problem of the inner ear? Carotid ultrasound Caloric stimulus test Pure-tone audiometry Tympanometry (impedance audiometry)

Caloric stimulus test Vertigo is the sensation that one is whirling in space and often is associated with nausea and vomiting. In the caloric stimulus test, cold or warm water is inserted in the ear canal to stimulate the semicircular canals in the labyrinth of the inner ear. The response to the stimulation causes nystagmus (eye ball jerking movement), nausea and vomiting, and vertigo, and is used to determine disease of the vestibular system. The carotid ultrasound determines the patency of the carotid arteries and adequate circulation to the brain. Audiometry is a screening test for hearing acuity and determines the severity and type of hearing loss. Tympanometry is used to diagnose middle ear effusion (fluid in the middle ear), which causes noncompliance and conductive hearing loss. p. 365

The nurse suspects a disease of the vestibular system after an assessment of a patient's auditory system that involves instilling a warm solution into the ears to irrigate them. Which diagnostic test has the nurse performed? The nurse suspects a disease of the vestibular system after an assessment of a patient’s auditory system that involves instilling a warm solution into the ears to irrigate them. Which diagnostic test has the nurse performed? Posturography Rotary chair testing Caloric test stimulus Electronystagmography

Caloric test stimulus Caloric test stimulus helps determine the patient's vestibular function by stimulating the endolymph of semicircular canal. The nurse introduces a warm solution into the patient's ears to irrigate them and watches for nystagmus to stimulate the endolymph. Posturography is a balance test that is performed in a boxlike device. Rotary chair testing is used to evaluate the peripheral vestibular system. Electronystagmography, in which electrodes track the movements of the eye over a graph, is used to assess the vestibular system. p. 365

The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom? The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom? Carteolol Dipivefrin Carbachol Latanoprost

Carbachol Carbachol is a cholinergic agent that stimulates iris sphincter contraction and results in miosis. Carteolol is a nonselective beta-adrenergic blocker and decreases intraocular pressure but does not cause miosis. Dipivefrin is a sympathomimetic agent that decreases aqueous humor production but does not cause miosis. Latanoprost is a prostaglandin F2-alpha analog that does not stimulate contraction of the iris sphincter; therefore, it does not cause miosis. p. 381

The nurse is educating a patient about the importance of wearing sunglasses when exposed to ultraviolet light. Which abnormality is associated with the chronic exposure of the eye lens to ultraviolet light? Cataract Presbyopia Blepharodermachalasis Yellow discoloration of the sclera

Cataract Chronic exposure of the eye lens to ultraviolet light reduces the function of the retina and results in cataract. Presbyopia is the loss of near vision, which may increase with age. Blepharodermachalasis is the presence of excessive skin in the upper lid, which is associated with a prolapse of fat into the eyelid tissue. Yellow discoloration of the sclera is associated with lipid deposition on the sclera. p. 354

Before administrating timolol eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine? Before administrating timolol eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine? Sinusitis Migraine headaches Chronic urinary tract infection Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches and does not affect sinusitis or chronic urinary tract infections. p. 381

A patient expresses concern about the effect of vision loss on reading. This is an example of which component of a visual health history? Cognitive-perceptual Coping-stress tolerance Self-perception-self-concept Health perception-health management

Cognitive-perceptual A visual deficit that affects a patient's ability to read is an example of a cognitive-perceptual problem. The coping-stress tolerance component explores how a patient is tolerating and coping with changes in vision. A self-perception-self-concept response is related to how a patient feels about himself or herself. Health perception-health management allows the healthcare professional to assess the patient's awareness of his or her visual health and self-care. p. 354

The nurse is performing an assessment of the auditory system for a patient diagnosed with sensorineural hearing loss. Which findings should the nurse expect to assess? Select all that apply. The nurse is performing an assessment of the auditory system for a patient diagnosed with sensorineural hearing loss. Which findings should the nurse expect to assess? Select all that apply. Ringing in the ears Complete hearing loss Inability to understand speech Distortion or faintness of sound Difficulty in understanding meaning of words being heard.

Complete hearing loss Inability to understand speech Distortion or faintness of sound Sensorineural hearing loss is caused by damage to or an abnormality of the inner ear or the nerve pathways. This condition is characterized by distortion or faintness of sound or inability to understand speech, and it can cause complete hearing loss. Patients with central hearing loss experience difficulty in understanding the meaning of spoken speech. Patients with tinnitus hear a ringing in the ears. p. 360

Which part of the eye is inflamed in keratitis? Which part of the eye is inflamed in keratitis? Sclera Cornea Conjunctiva Eyelid margins

Cornea Keratitis is an infection or inflammation of the cornea. Scleritis involves inflammation of the sclera. Inflammation of the conjunctiva is a clinical manifestation of conjunctivitis. Blepharitis is associated with inflammation of the margins of both eyelids. p. 372

The nurse is preparing a patient for penetrating keratoplasty. What disorder does the nurse determine the patient is being treated for? The nurse is preparing a patient for penetrating keratoplasty. What disorder does the nurse determine the patient is being treated for? Retinopathy Corneal scars Chronic open-angle glaucoma Age-related macular degeneration

Corneal scars A corneal scar is the chronic inflammation of the corneal stroma. Penetrating keratoplasty is the procedure performed to treat corneal scars. While performing surgery, the ophthalmic surgeon removes the full thickness of the patient's cornea and replaces it with a donor cornea that is sutured into place. Retinopathy is treated by laser photocoagulation. Chronic open-angle glaucoma is treated by argon laser trabeculoplasty. Age-related macular degeneration is treated by photodynamic therapy. p. 373

A patient is having a surgical procedure that involves using extreme cold to create an inflammatory response to produce a sealing scar. What procedure will the nurse educate the patient regarding? A patient is having a surgical procedure that involves using extreme cold to create an inflammatory response to produce a sealing scar. What procedure will the nurse educate the patient regarding? Cryopexy Scleral buckling Pneumatic retinopexy Laser photocoagulation

Cryopexy Cryopexy is a procedure used to seal retinal breaks. This procedure involves using extreme cold to create the inflammatory reaction that produces the sealing scar. Scleral buckling is an extraocular surgical procedure that involves indenting the globe so that the pigment epithelium, the choroid, and the sclera move toward the detached retina. It involves suturing a silicone implant against the sclera. Pneumatic retinopexy is the intravitreal injection of a gas to form a temporary bubble in the vitreous that closes retinal breaks and provides apposition of the separated retinal layers. Laser photocoagulation involves using an intense, precisely focused light beam to create an inflammatory reaction. p. 377

Which assessment finding supports the nurse's conclusion that a patient has altered function of the external ear? Which assessment finding supports the nurse’s conclusion that a patient has altered function of the external ear? Damage to the cochlea Damage to the auditory canal Damage to the eustachian tube Damage to the auditory ossicles

Damage to the auditory canal The auditory canal is located in the external ear, so damage to the auditory canal results in altered function of the external ear. The cochlea and eustachian tube are located in the middle ear. Damage to the cochlea will result in altered function of the middle ear, not the external ear. The auditory ossicles are the bones in the middle ear; damage to the auditory ossicles results in altered function of the middle ear, not the external ear. p. 364

A patient is diagnosed with sensorineural hearing loss. What potential causes of this disorder should the nurse discuss with the patient? Select all that apply. A patient is diagnosed with sensorineural hearing loss. What potential causes of this disorder should the nurse discuss with the patient? Select all that apply. Damage to the inner ear An increase in cerumen output Damage to the tympanic membrane Impairment of the auditory pathway Damage to the vestibulocochlear nerve

Damage to the inner ear Damage to the vestibulocochlear nerve Damage to the inner ear or damage to the vestibulocochlear nerve that lines the inner ear results in sensorineural hearing loss. An increase in cerumen will result in central loss of hearing because the auditory canal is blocked. The tympanic membrane is found in the external ear; impairment of the tympanic membrane is associated with impaired transmission of sound waves. Impairment of the auditory pathway will result in central loss of hearing. p. 360

After an ophthalmic examination, a primary health care provider finds that the ciliary muscles of a patient have become smaller and stiffer than normal muscles. The nurse recalls that the patient will experience what change as a result of this condition? Clouding in the lens Decrease in near vision Decreased diameter of pupils Difficulty in perception of colors

Decrease in near vision Ciliary muscles are the muscles responsible for near vision. If these muscles become smaller or stiffer, the person has difficulty in adjusting near vision. A cataract is a very common age-related disorder. This is formed due to biochemical changes in the lens proteins, which results in clouding of the lens. Changes in perception of colors are not related to the dilator muscle. The diameter of the pupil is regulated by the muscle called the iris. Stiffening or rigidity of the iris causes decreased diameter of pupils. Color perception is carried by cones in the retina. A decrease in the number of cones causes difficulty in perception of colors. p. 351

While evaluating a patient the nurse suspects primary open-angle glaucoma if which classic symptom is present? While evaluating a patient the nurse suspects primary open-angle glaucoma if which classic symptom is present? Vacillating pupil Constant tearing Decreased peripheral vision Colored halos around lights

Decreased peripheral vision Primary open-angle glaucoma (POAG) develops slowly and without symptoms. The gradual loss of peripheral vision is one of the diagnostic criteria for primary open-angle glaucoma, which manifests as tunnel vision late in POAG. Vacillating pupils and constant tearing are not directly associated with any form of glaucoma. Colored halos around lights are seen in acute-angle closure glaucoma, which is less common than POAG. Acute-angle closure glaucoma is an ocular emergency requiring immediate intervention because intraocular pressure increases rapidly and may cause optic nerve damage and blindness. p. 378

A patient has a hemorrhage in the fundus area of the eye. Where does the nurse determine that blood is accumulating? In the aqueous humor In the retinal background Between the cornea and the lens In the space between the iris and the lens

In the retinal background The fundus is the retinal background. Normally, no hemorrhages or exudates are present in the fundus. The fundus area is not the aqueous humor, between the cornea and the lens, or between the iris and the lens. p. 358

A patient admitted for a total knee replacement has a history of primary open-angle glaucoma. The nurse expects to see which finding recorded in the history and physical examination report? A patient admitted for a total knee replacement has a history of primary open-angle glaucoma. The nurse expects to see which finding recorded in the history and physical examination report? Diplopia Frequent falls Decreased visual acuity Denial of pain or pressure

Denial of pain or pressure Primary open-angle glaucoma is typically symptom-free, which explains why patients can have significant vision loss before diagnosis unless regular eye examinations are performed. Glaucoma does not result in diplopia or frequent falls. p. 379

While interviewing a patient, the nurse finds that the patient keeps the head skewed while talking. The patient could be experiencing what condition? While interviewing a patient, the nurse finds that the patient keeps the head skewed while talking. The patient could be experiencing what condition? Diplopia Color blindness Corneal abrasions Inflammation of the eyes

Diplopia When a person suffers from diplopia, he keeps his head skewed in an attempt to see a single image. Color blindness is tested by asking the patient to identify specific colors. A patient who has corneal abrasion and inflammation of the eyes will try to keep his eyes closed to avoid light. p. 357

Which instruction is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? Which instruction is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? Discard all opened or used lens care products. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. Put all used cosmetics in a plastic bag for one week to kill any bacteria before reusing. Disinfect all lens care products with the prescribed antibiotic drops for one week after infection.

Discard all opened or used lens care products. The patient who wears contact lenses and develops infections should discard all opened or used lens care products and cosmetics to decrease the risk of reinfection from contaminated products. The risk of conjunctivitis is increased with not disinfecting lenses properly, wearing contact lenses too long, or using water or homemade solutions to store and clean lenses. pp. 372-373

A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms? A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms? Itching, burning, irritation, and photophobia Tearing, redness, photophobia, and foreign body sensation Red, swollen, circumscribed, and acutely tender area in the lid margin Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

Discomfort, pruritus, redness, and a mucopurulent drainage in the eye Bacterial conjunctivitis manifests as discomfort, pruritus, redness, and a mucopurulent drainage in the eye. It occurs due to unhygienic conditions. The infection is caused by Staphylococcus aureus. It can be treated with antibiotic drops. Itching, burning, irritation, and photophobia are signs of blepharitis. Tearing, redness, photophobia, and foreign body sensation are symptoms of epidemic keratoconjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum. p. 371

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? 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? Explain to patient that carteolol may cause vomiting. Do not administer istalol, and notify the health care provider. Ask the health care provider to decrease the dose of carteolol. Suggest the patient only use carteolol for a short period of time.

Do not administer istalol, and notify the health care provider 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. p. 381

A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching? A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching? Restrict activity at home. Wear a nighttime eye shield. Do not bend, stoop, cough, or lift. Wash hands before touching the eye.

Do not bend, stoop, cough, or lift. 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. pp. 374-375

A college student has gone to the nurse reporting eye pain after studying for finals. What assessment should the nurse make first in determining the possible cause of this eye pain? Do you wear contacts? Do you have any allergies? Do you have double vision? Describe the change in your vision.

Do you wear contacts? College students frequently wear contact lenses and will be up late or all night studying for finals. If the student wears contacts, the wearing of them while studying, care of them, and length of wear time should be assessed before looking for a corneal abrasion from extended wear with fluorescein dye. There are no manifestations of allergies, diplopia, or visual changes mentioned. p. 355

A patient has ptosis resulting from myasthenia gravis. Which assessment finding would the nurse expect to see in this patient? Redness and swelling of the conjunctiva Drooping of the upper lid margin in one or both eyes Redness, swelling, and crusting along the lid margin Small, superficial white nodules along the lid margin

Drooping of the upper lid margin in one or both eyes Ptosis is the term used to describe drooping of the upper lid margin, which may be either unilateral or bilateral. Ptosis can be a result of mechanical causes, such as an eyelid tumor or excess skin, or from myogenic causes, such as myasthenia gravis. Ptosis is not related to redness and swelling of the conjunctiva or lid margin or small, superficial white nodules along the lid margin. p. 357

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? 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? Giving anticipatory guidance about the eventual loss of central vision that will occur Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision Recognizing that eye damage caused by glaucoma can be reversed in the early stages Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision 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. p. 380

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? 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? Restriction of driving privileges immediately Use of occupational and physical therapy for visual deficits Encouraging medication compliance to reduce the risk of vision loss Managing the pain using oral antiinflammatories and opioids as needed

Encouraging medication compliance to reduce the risk of vision loss 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. pp. 380, 382

A patient reports ocular pain, photophobia, decreased visual acuity, headaches, corneal edema, and conjunctiva that is reddened and swollen. The nurse recognizes that the patient is most likely experiencing which type of inflammation? A patient reports ocular pain, photophobia, decreased visual acuity, headaches, corneal edema, and conjunctiva that is reddened and swollen. The nurse recognizes that the patient is most likely experiencing which type of inflammation? Scotoma Blepharitis Endophthalmitis Cytomegalovirus retinitis

Endophthalmitis Endophthalmitis is an extensive intraocular inflammation of the vitreous cavity. Ocular pain, photophobia, decreased visual acuity, headaches, reddened, swollen conjunctiva, and corneal edema are the symptoms of endophthalmitis. Blepharitis is a common chronic bilateral inflammation of the lid margins. Cytomegalovirus retinitis is an opportunistic infection that occurs in patients who are immunocompromised. Scotoma is presence of blind spots in the visual field; it is not an infection. p. 382

Which condition involves inflammation of the vitreous cavity? Which condition involves inflammation of the vitreous cavity? Uveitis Blepharitis Otitis media Endophthalmitis

Endophthalmitis Endophthalmitis is intraocular inflammation of the vitreous cavity. Uveitis is inflammation of the uvea. Inflammation of the margins of the eyelids is called blepharitis. Infection of the tympanum, ossicles, and space of the middle ear is called otitis media. p. 382

The nurse is assessing a patient with a middle ear infection. Which structure located in the middle ear may cause a middle ear infection when it is blocked? Auricle or pinna Eustachian tubes Sebaceous glands Tympanic membrane

Eustachian tubes Blockage of the Eustachian tubes can occur with a middle ear infection. The tympanic membrane (ear drum), the auricle (pinna), and the sebaceous glands are all located in the external ear. These structures will not cause a middle ear infection. p. 360

The nurse is assessing a patient for esotropia. What sign observed by the nurse is clinically significant related to this disorder? Eye deviating in Eye deviating up Eye deviating out Eye deviating down

Eye deviating in Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object. The condition in which one eye deviates in is called esotropia. If the eye deviates up, it is called hypertropia. If the eye deviates out, it is called exotropia. If the eye deviates down, it is called hypotropia. p. 373

A nurse should instruct a patient who had cataract surgery to contact the surgeon if which condition develops? A nurse should instruct a patient who had cataract surgery to contact the surgeon if which condition develops? Glare Itching Eye pain Blurred vision

Eye pain Pain should not be present after cataract surgery, although there may be slight discomfort that is easily relieved with acetaminophen. The patient should be told that the other symptoms, including glare, itching, and blurred vision, may be present and are expected until healing takes place. p. 375

A patient is diagnosed with strabismus. The nurse expects the patient to exhibit which symptoms? A patient is diagnosed with strabismus. The nurse expects the patient to exhibit which symptoms? Inability to accommodate for near objects Discomfort, pruritus, and redness in the eye Red, swollen, and acutely tender area in the lid margin Inability to focus two eyes simultaneously on the same object

Inability to focus two eyes simultaneously on the same object Strabismus is a condition affecting eye muscles so that the patient cannot consistently focus both eyes simultaneously on the same object. It is caused if the eye muscles are affected. Hyperopia is a condition in which the patient is unable to see near objects. Discomfort, pruritus, redness, and mucopurulent drainage in the eye are the symptoms of bacterial conjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum. p. 373

A patient admitted to the hospital has been taking pilocarpine eye drops at home. What is the desired effect of this medication? Select all that apply. A patient admitted to the hospital has been taking pilocarpine eye drops at home. What is the desired effect of this medication? Select all that apply. Facilitates aqueous humor outflow Reverses damage to the optic nerve Improves the patient's vision in dim light Lessens the amount of pupillary dilation Decreases the amount of fluid within the eye

Facilitates aqueous humor outflow Lessens the amount of pupillary dilation Pilocarpine is a cholinergic (parasympathomimetic) medication used to treat chronic open-angle glaucoma. It causes miosis (pupillary constriction), which improves the flow of the fluid (aqueous humor) within the trabecular meshwork of the eye. This keeps the pressure within the eye low and decreases likelihood of optic nerve damage. Damage to the optic nerve from glaucoma cannot be reversed with treatment. Miotic effects of the medication do not allow for pupil dilation that normally occurs in dim light. Pilocarpine does not decrease the amount of aqueous humor production as do some other medications (beta-adrenergic blockers) used to treat glaucoma. p. 381

While assessing the vision of a patient, a nurse asks the patient to cover one eye and count the number of fingers that the nurse brings into the patient's field of vision. What is the nurse assessing? Full field of vision Pupillary response Intraocular pressure Distance and near visual acuity

Full field of vision A nurse is performing a confrontation visual field test when the nurse asks the patient to cover one eye and count the number of fingers present in the patient's field of vision. This test helps determine the patient's full field of vision. The nurse performs a pupil function test by shining light into the patient's pupil and examining the pupillary response. Intraocular pressure testing with a Tono-pen will help measure intraocular pressure. The nurse performs a visual acuity test using a Snellen chart to determine distance and near visual acuity. p. 355

The nurse is teaching a patient about managing blepharitis. The most important intervention for the patient with blepharitis is which of these? The nurse is teaching a patient about managing blepharitis. The most important intervention for the patient with blepharitis is which of these? Gently cleaning the lid margins with baby shampoo. Monitoring the spread of infection to the opposing eye. Regular instillation of artificial tears to the affected eye. Teaching the patient and family members good hygiene techniques.

Gently cleaning the lid margins with baby shampoo. Blepharitis is a common chronic bilateral inflammation of the eyelid margins. Emphasize thorough cleaning practices of the skin and scalp. Gentle cleansing of the lid margins with baby shampoo can effectively soften and remove crusting. Blepharitis is not contagious nor does it spread unless conjunctivitis is occurring simultaneously. In this case, antibiotic drops may be used, but not artificial tears. It is not necessary to teach the family good hygiene, unless they are touching the eyelids. pp. 370-371

An adult patient has been treated for an ear infection. The nurse plans to examine the ear using an otoscope. What intervention should the nurse employ to lessen anxiety and discomfort associated with the examination? An adult patient has been treated for an ear infection. The nurse plans to examine the ear using an otoscope. What intervention should the nurse employ to lessen anxiety and discomfort associated with the examination? Apply water-soluble lubricant liberally to the otoscope. Place the otoscope under warm water for several minutes. Pull downward on the auricle while inserting the otoscope. Gently palpate the tragus and move the auricle, noting sensitive areas.

Gently palpate the tragus and move the auricle, noting sensitive areas. By touching the tragus and moving the auricle (pinna), the nurse identifies sensitive areas and avoids pain while inserting the otoscope. A speculum slightly smaller than the ear canal is attached to the otoscope base and inserted without lubrication or warming. In adults, the auricle is pulled upward to straighten the ear canal and facilitate introduction of the otoscope. p. 364

The nurse is assessing an adult patient's external ear canal and tympanum. How should the nurse proceed? The nurse is assessing an adult patient's external ear canal and tympanum. How should the nurse proceed? Ask the patient to tip his or her head toward the nurse Identify a pearl gray tympanic membrane as a sign of infection Gently pull the auricle up and backward to straighten the canal Identify a normal light reflex by the appearance of irregular edges

Gently pull the auricle up and backward to straighten the canal When assessing an adult, grasp and gently pull the auricle up and backward to straighten the canal. With children under age three, pull the auricle back and down. When examining a patient's external ear canal and tympanum, ask the patient to tilt the head toward the opposite shoulder. A healthy, normal tympanic membrane will appear pearl gray, white, or pink and have a cone-shaped light reflex. p. 364

A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient? A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient? Glaucoma leads to detachment of the retina. Glaucoma results from chronic eye inflammation. Glaucoma results in increased intraocular pressure. Glaucoma is caused by decreased blood flow to the retina.

Glaucoma results in increased intraocular pressure. 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. p. 379

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? Apply pressure to each eyeball for a few seconds after administration. Have the patient close the eyes and move them back and forth several times. Have the patient put pressure on the inner canthus of the eye after administration. Have the patient try to blink out excess medication immediately after administration.

Have the patient put pressure on the inner canthus of the eye after administration. 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. p. 382

A patient has undergone kidney transplantation surgery and takes immunosuppressant drugs. The patient comes in contact with a person who has chickenpox. The nurse recognizes that the patient is susceptible to which viral ophthalmic infection? A patient has undergone kidney transplantation surgery and takes immunosuppressant drugs. The patient comes in contact with a person who has chickenpox. The nurse recognizes that the patient is susceptible to which viral ophthalmic infection? Blepharitis Hordeolum Astigmatism Herpes zoster ophthalmicus

Herpes zoster ophthalmicus The patient is being treated with immunosuppressant drugs to prevent the rejection of a transplanted kidney. The immunosuppressive drugs tend to decrease the patient's immunity. If the patient comes in contact with a patient with chickenpox, there is the possibility of herpes zoster ophthalmicus infection. It may occur due to reactivation of an endogenous infection. The endogenous infection might have persisted in a latent form after an earlier attack of varicella or by contact with a patient with chickenpox or herpes zoster. It occurs most frequently in older adults and immunosuppressed patients. Blepharitis is a common chronic bilateral inflammation of the lid margins. Hordeolum is an infection of the sebaceous glands in the lid margin. Astigmatism is an eye disorder; it is not a viral infection. p. 372

A patient is to undergo an Amsler Grid test. What instructions about the test should the nurse provide to the patient? Select all that apply. Keep the test card at a distance of 10 feet. Hold the test card at a comfortable distance. Report any abnormality like lines appearing wavy. Focus on the center dot that is present on the card. Focus on all four corners of the card in a clockwise pattern.

Hold the test card at a comfortable distance. Report any abnormality like lines appearing wavy. Focus on the center dot that is present on the card. An Amsler Grid test can be carried out by the patient. This test is done to identify any changes in macular function. The correct procedure for an Amsler Grid test is as follows: The patient holds the card at a comfortable reading distance, and focuses on a dot present in the center of the chart. The test card is held at the same distance a person holds a book for reading. The person has to focus on the center dot and not on the corners. If there is pathology involved, the patient may feel that the lines around the dot are wavy, distorted, or even missing. If the patient finds any abnormality in the surrounding line, he should make a note of it and take advice from a primary health care practitioner. The distance of 10 feet is not required for this test. The patient does not focus on the four corners of the card. p. 359

The nurse assesses a patient has a small, white, superficial nodule along the lid margin. What condition should the nurse consider that is caused by an infection of the sebaceous gland of the eyelid? Blepharitis Strabismus Hordeolum Conjunctivitis

Hordeolum An eye infection that is accompanied by a small, white, superficial nodule along the lid margin and an infection of the sebaceous gland of eyelid indicate that the patient has hordeolum. It is caused by a Staphylococcus infection. Blepharitis is a bacterial infection in the lid margins, which manifests as redness, swelling, and crusting along the lid margins. Strabismus is the deviation in the position of the eye in one or more directions; it is not associated with bacterial infection. Conjunctivitis is a bacterial infection of the eye, which manifests as redness and swelling of the conjunctiva. p. 351

The nurse assesses a patient with protruding eyeballs, and the sclera is above the iris when the eyes are open. The patient reports feeling jittery and losing weight. What condition does the nurse determine correlates with these clinical manifestations? Blepharitis Hordeolum Hyperthyroidism Macular disease

Hyperthyroidism A patient who has hyperthyroidism may have exophthalmos, which manifests with a protruding eyeball and sclera above the iris when the eyelids are open. Blepharitis is the condition that is associated with redness, swelling, and crusting along the lid margins. Hordeolum is an infection of the sebaceous gland of the eyelid; the patient may have a superficial nodule along the lid margin. The patient who has macular disease will have a loss of central vision. p. 357

The nurse is performing an assessment of cranial nerve VII. What determination will the nurse make when assessing this nerve? If the pupil constricts equally to light If there is control of light entering the eye If the patient can close and open the eyelid If there is bending of light entering into the e

If the patient can close and open the eyelid Cranial nerve VII is a facial nerve that controls the actions of facial muscles and helps in blinking or in closing and opening of eyelids. Cranial nerve III is the oculomotor nerve that helps in the constriction of the pupils. Light entering the eye is controlled by dilation of the iris, which is associated with the function of the cranial nerve V. The lens present in the eye will help bend the light entering into the eye. p. 352

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. 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. Administer prescribed analgesics. Patch the eye that has less visual acuity. Obtain dark glasses for the patient to wear. Increase the amount of light for near vision. Obtain teaching materials with enlarged print.

Increase the amount of light for near vision. Obtain teaching materials with enlarged print. 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. pp. 373-374

A patient has diplopia and is prescribed with alternating patching of one eye at a time. The nurse should include teaching about what concern for this patient? Conjuctivitis Increased risk for falls Dryness in the patched eye Increased risk for cataract formation

Increased risk for falls The patient with diplopia (double vision) alternately patches the eye to allow normal vision. The patient will be at increased risk for falls because patching causes impaired stereoscopic (three-dimensional) vision. The patient could fall because of impaired ability to judge distance. Conjunctivitis is redness from infection or inflammation of the conjunctiva, the mucous membrane that covers eyelids and forms a pocket under each eyelid. Dryness is not a usual problem with a patched eye because patching limits exposure to air and the environment. Cataracts occur with the aging process. p. 355

Which auditory system change does the nurse suspect in a patient who has alterations in balance and body orientation? Which auditory system change does the nurse suspect in a patient who has alterations in balance and body orientation? Brain Inner ear Middle ear External ear

Inner ear The vestibular balance system is located in the inner ear. Therefore changes in the inner ear will result in alterations in balance and body orientation. Changes in the brain will increase the difficulty of hearing in a noisy environment and heighten sensitivity to sound. A patient with changes in the middle ear will have conductive hearing loss. A patient with changes in the external ear may have impacted cerumen or a collapsed ear canal. p. 364

A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient? A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient? Instruct the patient to quit smoking. Suggest that the patient consider using supplements of vitamins and minerals. Advise the patient to eat lots of dark green, leafy vegetables containing lutein. Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

Instruct the patient to avoid direct exposure to sunlight for five days after treatment. Verteporfin, used for phototherapy, is a photosensitizing drug. It becomes active in the presence of low-level laser light waves. It can be activated by exposure to sunlight or high-intensity light until it is fully excreted. If activated, it can cause thermal burns in the area. The patient should be instructed to avoid direct sunlight and other intense forms of light for five days after treatment. Taking vitamin and mineral supplements, eating green leafy vegetables high in lutein, and cessation of smoking are measures to decrease the risk of AMD. pp. 378-379

A nurse administered tropicamide in both eyes of a patient in the preoperative room before cataract surgery. What is the most important nursing intervention for this patient? A nurse administered tropicamide in both eyes of a patient in the preoperative room before cataract surgery. What is the most important nursing intervention for this patient? Brighten the room with extra lights. Instruct the patient to wear dark glasses. Monitor for pulmonary effects of the drug. Reassure the patient that the surgery will be uneventful

Instruct the patient to wear dark glasses. Tropicamide is a cycloplegic. It dilates the pupil by blocking the effect of acetylcholine on the iris sphincter muscle. It causes photophobia, so the nurse should instruct the patient to wear dark glasses. The nurse should also dim the lights in the room. The drug may also be absorbed systemically; therefore, the nurse should observe the patient for tachycardia and other effects on the central nervous system. Tropicamide does not cause pulmonary side effects. 374

A patient informs the nurse that allergy symptoms are occurring in the eyes. What symptoms should the nurse ask the patient about when assessing for allergic conjunctivitis? A patient informs the nurse that allergy symptoms are occurring in the eyes. What symptoms should the nurse ask the patient about when assessing for allergic conjunctivitis? Itching Photophobia Protruding eyeball Purulent discharge

Itching Allergic conjunctivitis occurs when the conjunctiva becomes swollen or inflamed due to reaction caused by an allergen. The defining symptom of allergic conjunctivitis is itching. Photophobia is the symptom of epidemic keratoconjunctivitis. Protruding eyeball is the symptom of exophthalmos. Purulent discharge is the symptom of corneal ulcer. p. 371

Which refractive error describes the vision of a patient for whom nearby objects are clear but objects at a distance are blurred? Myopia Hyperopia Presbyopia Astigmatism

Myopia The individual with myopia (nearsightedness) can see nearby objects clearly, but objects at a distance appear blurred. The individual with hyperopia (farsightedness) can see distant objects clearly, but close objects appear blurred. Presbyopia is a loss of accommodation, causing an inability to focus on near objects. Astigmatism is an uneven curvature of the cornea, which results in visual distortion. p. 351

An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect? An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect? Cataract Strabismus Keratoconus Keratoconjunctivitis sicca

Keratoconjunctivitis sicca Keratoconjunctivitis sicca is a dry eye disorder commonly seen in older adults. The patient with keratoconjunctivitis sicca reports irritation and presence of sand in the eye. Cataract is a condition in which there is opacity within the lens and the patient reports decreased vision, abnormal color perception, and glare. Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object and the patient will complain of double vision. Keratoconus is a noninflammatory disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape, and the patient complains of blurred vision. p. 373

While assessing a patient with systemic lupus erythematosus (SLE), the nurse observes the patient rubbing the eyes frequently and decreased tear production. What condition should the nurse educate the patient regarding? While assessing a patient with systemic lupus erythematosus (SLE), the nurse observes the patient rubbing the eyes frequently and decreased tear production. What condition should the nurse educate the patient regarding? Cataract Strabismus Keratoconus Keratoconjunctivitis sicca

Keratoconjunctivitis sicca Keratoconjunctivitis sicca is a dry eye disorder particularly of older adults and individuals with certain systemic diseases such as scleroderma and systemic lupus erythematosus. The patient has decreased tear secretion because of a decrease in the quality or quantity of the tear film. Cataract is a clouding of the lens in the eye, which affects the vision. The symptoms of cataract are decreased vision, abnormal color perception, and glare. Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object and has double vision. Keratoconus is a noninflammatory eye disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape and resulting in blurred vision. 373

A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. On which treatment option does the nurse educate the patient? A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. On which treatment option does the nurse educate the patient? Filtration surgery Photodynamic therapy Laser photocoagulation Argon laser trabeculoplasty

Laser photocoagulation Proliferative retinopathy is a condition associated with the formation of fragile new abnormal blood vessels, which are predisposed to leaks, resulting in severe vision loss. This condition can be treated by laser photocoagulation. Filtration surgery is the treatment for chronic open-angle glaucoma. Photodynamic therapy is the treatment for age-related macular degeneration. Argon laser trabeculoplasty is a noninvasive procedure to lower intraocular pressure in glaucoma. p. 377

When performing an assessment for a patient with glaucoma, the nurse observes brown iris pigmentation. Which antiglaucoma drug does the nurse determine the patient is taking? When performing an assessment for a patient with glaucoma, the nurse observes brown iris pigmentation. Which antiglaucoma drug does the nurse determine the patient is taking? Carteolol Dipivefrin Carbachol Latanoprost

Latanoprost Latanoprost is an antiglaucoma drug that stimulates melanin production in melanocytes and increases the amount of brown pigment in the eye. Carteolol is an antiglaucoma drug that may cause blurred vision, photophobia, and bradycardia. Dipivefrin is an antiglaucoma drug that may cause ocular discomfort and redness in the eye. Carbachol is an antiglaucoma drug that may cause transient ocular discomfort, headache, and blurred vision. p. 381

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. 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. Eating Lifting Coughing Bending over Breathing deeply

Lifting Coughing Bending over 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. p. 376

A patient reports an inability to see near objects. The nurse recalls that which physiologic condition is responsible for this disorder? A patient reports an inability to see near objects. The nurse recalls that which physiologic condition is responsible for this disorder? Cornea having irregular curvature Light rays focusing behind the retina Incoming light rays bending unequally Light rays focusing in front of the retina

Light rays focusing behind the retina The patient with an inability to see near objects suffers from hyperopia or farsightedness. In this case, the light rays focus behind the retina. Normally the light rays should focus on the retina for near objects. This type of refractive error occurs when the cornea or lens does not have adequate focusing power or when the eyeball is too short. Irregular corneal curvature and incoming light rays bending unequally are associated with astigmatism. Focusing light rays in front of the retina is the sign of myopia. p. 368

An older adult patient reports not being able to hear very well. What should the nurse do first to determine the cause of the hearing loss? An older adult patient reports not being able to hear very well. What should the nurse do first to determine the cause of the hearing loss? Look for cerumen in the ear. Assess for increased hair growth in the ear. Tell the patient it is probably related to aging. Ask the patient if he has fallen because of dizziness.

Look for cerumen in the ear. Gerontologic differences in the assessment of the auditory system include increased production of drier cerumen, which can become impacted in the ear canal and contribute to hearing loss. Conductive hearing loss with impacted cerumen may lead to speaking softly because the patient's voice conducted through bone seems loud to the patient. Although increased hair growth occurs, it will not impact the hearing. Presbycusis may be occurring, but it should not be assumed. There is no reason to ask the patient if he has fallen because of dizziness; vertigo is not a normal change of aging of the ear. p. 361

A patient reports, "While I was walking, I got something in my eye." What nursing intervention is most appropriate for a patient with a suspected foreign object in the eye? A patient reports, "While I was walking, I got something in my eye." What nursing intervention is most appropriate for a patient with a suspected foreign object in the eye? Beginning irrigation with sterile normal saline solution Attempting to remove the object without causing further damage to the eye Refraining from doing anything until the patient can be seen by an ophthalmologist Loosely covering the eye with a sterile patch and referring the patient to emergency care

Loosely covering the eye with a sterile patch and referring the patient to emergency care Covering the eye loosely with a sterile patch with referral for emergency care is the safest option for this patient. Eye irrigation and attempting to remove the object are not appropriate in this health care setting. The nurse should never attempt to remove a foreign object from the eye because this could cause further damage. The patient should be seen by the eye specialist, but covering the eye with an eye patch will prevent further trauma and irritation. p. 371

While assessing a patient, the health care practitioner comments that the vestibular apparatus has been damaged. The nurse expects to find what clinical manifestation? Vision loss Hearing loss Loss of balance of the body Increased sensitivity to noise

Loss of balance of the body The vestibular apparatus is a structure present in the inner ear. This structure is responsible for maintaining balance and body orientation. Damage to this structure alters a person's ability to balance the body. Vision loss is caused due to damage to the eye structures. Vestibular apparatus weakening doesn't cause hearing loss. Increased sensitivity to noise is caused due to changes in the brain. p. 361

The nurse is caring for an older adult patient. Which gerontologic findings of the visual system does the nurse anticipate may be present? Select all that apply. Loss of hair pigment Darkened iris pigment Increased tear secretion Increased rigidity of the lens Atrophy of the corneal nerves Increased orbital fat and muscle tone

Loss of hair pigment ncreased rigidity of the lens Atrophy of the corneal nerves There is increased lens rigidity, resulting in presbyopia and loss of hair pigment. This loss is responsible for the graying of the eyebrows and eyelashes. Atrophy of the corneal nerves results in a decrease in the corneal sensitivity and reflex. The change in iris color that occurs in an aging patient is due to loss of pigment, which appears as a lightening of the iris. The older adult also experiences decreased secretion of tears, resulting in dryness of the eyes. Decreases in orbital fat and muscle tone result in entropion, ectropion, and mild ptosis. p. 353

In presbyopia the lens of the eye loses flexibility and is unable to accommodate close vision. The nurse recognizes that this condition generally occurs in which group? In presbyopia the lens of the eye loses flexibility and is unable to accommodate close vision. The nurse recognizes that this condition generally occurs in which group? Adolescents and young adults Men and women older than 40 Men between the ages of 30 and 50 Women between the ages of 20 and 40

Men and women older than 40 Presbyopia is an age-related change in vision that generally occurs in men and women older than 40 years. Adolescents and young adults are not subject to the condition, and it does not affect one gender exclusively. p. 368

The nurse is performing an assessment of the patient's ear and places a probe in the external ear canal, applying positive and negative pressure. What does the nurse determine this will infer? The nurse is performing an assessment of the patient’s ear and places a probe in the external ear canal, applying positive and negative pressure. What does the nurse determine this will infer? Range of hearing Middle ear effusion Disease of vestibular system Etiology of peripheral vestibular system

Middle ear effusion Placing a probe in the external ear canal and applying both positive and negative pressure is the procedure for tympanometry. This test is used to assess compliance of the middle ear and is useful in diagnosis of middle ear effusions. The caloric test stimulus is used to assess range of hearing. Electronystagmography, involving the recording of specific eye movements, aids identification of diseases of the vestibular system. Rotary chair testing, performed with the use of a motor-controlled chair, aids evaluation of the peripheral vestibular system. p. 365

A patient is advised to take acetazolamide for chronic glaucoma. What nursing interventions are appropriate to perform when administering acetazolamide? Select all that apply. A patient is advised to take acetazolamide for chronic glaucoma. What nursing interventions are appropriate to perform when administering acetazolamide? Select all that apply. Monitor electrolyte levels. Ask if the patient is allergic to sulfa drugs. Avoid use if the patient has a history of asthma. Caution the patient about decreased visual acuity. Avoid use if the patient is on high-dose aspirin therapy.

Monitor electrolyte levels. Ask if the patient is allergic to sulfa drugs. Avoid use if the patient is on high-dose aspirin therapy. Acetazolamide is used to decrease production of aqueous humor. The drug may cause allergic reactions in patients sensitive to sulfa drugs; therefore, the nurse should ask the patient if he or she has a history of allergy to sulfa drugs. The drug has a diuretic effect and requires the nurse to monitor the patient's electrolyte levels. The drug should not be given to people on high-dose aspirin therapy because it can have adverse effects. Visual acuity is not affected with acetazolamide, and the drug is not contraindicated in people with asthma. 381

A patient reports pain in the left eye, and the healthcare provider is using a fluorescein stain to assess the eye. What is a priority for the nurse in the care of this patient? Monitor for extravasation Monitor for retinal detachment Monitor the patient for nausea and vomiting Report yellow-orange discoloration of the urine

Monitor for extravasation Fluorescein is toxic to tissue, so it is important to monitor the patient for extravasation at the intravenous site. Retinal detachment is not a complication of fluorescein. Transient nausea and vomiting may occur, and the patient may experience urine discoloration. However, these are not as high-priority concerns as avoiding contact between the fluorescein and surrounding tissue. p. 359

Which condition is caused by a refractive error in the eye? Which condition is caused by a refractive error in the eye? Myopia Cataract Glaucoma Conjunctivitis

Myopia Myopia is a refractive error of the eye characterized by the ability to see close objects clearly, whereas distant objects appear blurred. A cataract manifests as opacity of the lens, leading to decreased vision. It is not a refractive error. Glaucoma is a group of disorders characterized by increased intraocular pressure; it may lead to permanent blindness. Conjunctivitis is an infection of the conjunctiva caused by bacteria or viruses. p. 367

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? 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? Notify the surgeon. Administer eyedrops. Administer analgesics. Apply a cold compress.

Notify the surgeon. 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. p. 375

The nurse completing a focused visual exam includes which assessments? Select all that apply. PERRLA ( pupils equal, round, reactive to light and accommodation) Keratometry Peripheral vision Extraocular movement Distance and near visual acuity

PERRLA ( pupils equal, round, reactive to light and accommodation) Peripheral vision Extraocular movement Distance and near visual acuity The nurse completing a focused visual assessment includes examination using PERRLA, which focuses on whether the pupils are equal, round, reactive to light, and able to focus on objects that are close up and far away (accommodation). The nurse will also perform assessments of peripheral vision, extraocular movement, and distance and near visual acuity. Keratometry measures corneal curvature and is not part of a focused visual assessment. p. 356

A patient suspected of having glaucoma reports blurred vision, headache, and pain. For which diagnostic study will the nurse prepare the patient? Perimetry Keratometry Stereoscopic vision Ultrasonography B-Scan

Perimetry Perimetry (visual field test) is used to diagnose glaucoma. Keratometry measures corneal curvature. It is an assessment, not a diagnostic tool. Stereoscopic vision allows a patient to see objects in three dimensions. Ultrasonography B-scan is used to diagnose pathologic ocular conditions such as foreign bodies, tumors, and retinal detachments. p. 359

A patient has severe myopia. Which type of correction is the patient planning to have if the patient tells the nurse, "I can't wait to be able to see after they implant a contact lens over my lens"? A patient has severe myopia. Which type of correction is the patient planning to have if the patient tells the nurse, "I can't wait to be able to see after they implant a contact lens over my lens"? Photorefractive keratectomy (PRK) Phakic intraocular lenses (phakic IOLs) Refractive intraocular lens (refractive IOL) Laser-assisted in situ keratomileusis (LASIK)

Phakic intraocular lenses (phakic IOLs) Phakic IOL is the implantation of a contact lens in front of the natural lens. PRK is used with low to moderate amounts of myopia; the epithelium is removed, and the laser sculpts the cornea to correct the refractive error. Refractive IOL also is for patients with a high degree of myopia or hyperopia and involves removing the natural lens and implanting an intraocular lens. LASIK surgery is similar to PRK except that the epithelium is replaced after surgery. p. 368

Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells? Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells? Filtration surgery Photodynamic therapy Laser photocoagulation Argon laser trabeculoplasty

Photodynamic therapy Photodynamic therapy treats AMD by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells. Filtration surgery is the treatment for chronic open-angle glaucoma but not for AMD. Laser photocoagulation is used for treatment of proliferative retinopathy. Argon laser trabeculoplasty is a noninvasive procedure to lower the intraocular pressure in glaucoma. pp. 378-379

A patient informs the nurse that he or she is using a homemade saline solution to store contact lenses but is now having irritation and soreness. The nurse assesses inflammation of the cornea. On what medication does the nurse anticipate educating the patient? A patient informs the nurse that he or she is using a homemade saline solution to store contact lenses but is now having irritation and soreness. The nurse assesses inflammation of the cornea. On what medication does the nurse anticipate educating the patient? Tropicamide Besifloxacin Acetazolamide Polyhexamethylene biguanide

Polyhexamethylene biguanide Inflammation of the cornea indicates keratitis. Acanthamoeba keratitis is caused by a parasite that is associated with contact lens wear. Patients who use homemade saline solution are more susceptible to Acanthamoeba contamination. This organism is resistant to most drugs, and polyhexamethylene biguanide is an approved antifungal eye drop. Tropicamide is given during the preoperative phase to produce pupillary dilation. Besifloxacin is beneficial to a patient who has acute bacterial conjunctivitis. Acetazolamide decreases the aqueous humor production and is beneficial to a patient with glaucoma. p. 372

A patient tells the nurse, "I always need my fan on while I'm sleeping." Which ear abnormality may be indicated? Tinnitus Exostosis Otitis media Ménière's disease

Tinnitus Patients with chronic tinnitus often use a fan, radio or television, or some other source of background noise to drown out the tinnitus and help achieve peaceful sleep. Exostosis is a bony growth that causes narrowing of the canal. Otitis media is a chronic ear infection that manifests as fluid in a bulging red or blue eardrum. Ménière's disease is an abnormality of the ear associated with an increase of fluid in the ear. p. 363

Which nursing intervention is the highest priority for a patient who has undergone retinal surgery? Which nursing intervention is the highest priority for a patient who has undergone retinal surgery? Monitoring the blood pressure Preventing fluid volume excess Maintaining a darkened environment Positioning and activity as preferred by surgeon

Positioning and activity as preferred by surgeon Postoperatively, the patient may be on bed rest and may require special positioning to maintain proper positioning to maintain proper position of an intravitreal bubble. The level of activity restriction after retinal surgery varies greatly, depending on the patient and surgeon. Monitoring blood pressure and preventing fluid volume excess are not necessarily related to post-retinal surgery care. Maintaining a darkened environment is not necessary and may present a risk for falling. p. 376

The nurse is assisting with determination of the functioning of the vestibular system. What tests will the nurse prepare the patient for to test this function? Select all that apply. Posturography Caloric test stimulus Electrocochleography Electronystagmography Auditory evoked potential

Posturography Caloric test stimulus Electronystagmography Posturography is a balance test that can isolate one vestibular system from another. The caloric test stimulus helps identify vestibular diseases by stimulating the endolymph of the semicircular canals. Electronystagmography is used to diagnose diseases of the vestibular system by recording specific movement of eyes when the ear is irrigated. In electrocochleography, electrical activity in the cochlea and auditory nerves is recorded. Auditory evoked potential is used to isolate auditory activity from the activity of the brain and is not associated with vestibular function. p. 365

In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder? In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder? Pressure damage to the optic nerve may occur because of clogged drainage channels. The retinal nerve is damaged by an abnormal increase in the production of aqueous humor. The pupillary opening is blocked secondary to decreased aqueous humor in the anterior chamber. The lens enlarges with normal aging, pushing the iris forward, blocking the outflow of aqueous humor.

Pressure damage to the optic nerve may occur because of clogged drainage channels. 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. p. 379

The nurse reviews a patient's health assessment and notes the abbreviation: PERRLA under vision. Which assessment finding is included in this abbreviation? Select all that apply. Pupils are round Retina responds to light Lacrimal apparatus is functioning Intraocular pressure is even and within normal Pupils constrict when the patient focuses on a nearer object

Pupils are round Pupils constrict when the patient focuses on a nearer object The abbreviation for a normal pupillary response is PERRLA (pupils are equal [in size], round, react to light, and accommodation). Accommodation occurs when the pupil constricts when focusing on a nearer object. The retina is examined with use of an ophthalmoscope. The lacrimal apparatus contains the structures involved with tear formation and distribution to maintain eye moisture. Intraocular (within the eye) pressure is measured with various instruments and normally is 10 to 21 mm Hg. p. 358

The nurse is performing an assessment to determine pupillary function. What will the nurse assess when using this test? Perimetry Reaction to light Amsler Grid Test Following six cardinal fields of gaze

Reaction to light Pupil function is determined by inspection and reaction to light. Perimetry is visual field testing. The Amsler Grid Test is a self-administered test used to monitor macular problems. The six cardinal fields of gaze are used to assess extraocular movement and cranial nerves III, IV, and VI. p. 358

The nurse is assessing a patient hearing by testing bone conduction. Which test will the nurse perform? Select all that apply. Rinne test Weber test Audiometry Tympanometry Electrocochleography

Rinne test Weber test Tuning fork tests such as the Rinne and Weber tests help detect hearing loss by differentiating between conductive and sensorineural loss. Audiometry is used to assess hearing acuity and to determine the degree and type of hearing loss. Tympanometry aids diagnosis of middle ear effusions through the application of positive and negative pressure on the probe placed in the ear. Electrocochleography is used to assess electrical activity in the cochlea and auditory nerve. p. 365

When interviewing a patient with hearing loss about past and present medications, which medications should the nurse ask the patient about directly? Select all that apply. When interviewing a patient with hearing loss about past and present medications, which medications should the nurse ask the patient about directly? Select all that apply. Salicylates Herbal drugs Aminoglycosides Antimalarial agents Vitamin supplements

Salicylates Aminoglycosides Antimalarial agents The nurse should ask the patient specifically about salicylates, aminoglycosides, and antimalarial agents, because they may cause ototoxicity and lead to hearing loss. With some medications, the hearing loss may be reversible when treatment is stopped. Herbal drugs and vitamin supplements are not associated with hearing loss. p. 362

The nurse would refrain from administering a prescribed dose of pilocarpine two drops to both eyes if it was documented that the patient has which comorbidity? The nurse would refrain from administering a prescribed dose of pilocarpine two drops to both eyes if it was documented that the patient has which comorbidity? Secondary glaucoma Macular degeneration Benign prostatic hypertrophy Chronic obstructive pulmonary disease (COPD)

Secondary glaucoma Contraindications to the use of pilocarpine include secondary glaucoma, acute iritis, and acute inflammation of the anterior segment of the eye. Benign prostatic hypertrophy, macular degeneration, and COPD are not contraindications to using this medication. p. 380

Which symptom occurs initially with retinal detachment? Which symptom occurs initially with retinal detachment? Redness of the conjunctiva Increased glare with artificial light Seeing flashes of light and floaters Severe pain when moving the eyes

Seeing flashes of light and floaters A detached retina involves the separation of the sensory retina from the underlying pigment epithelium. Fluid accumulates in the space and blocks essential nourishment and circulation to retinal cells. Initially symptoms include seeing flashes of light, an increased amount of floaters, or lines in the vision field. If the detachment advances, there is a loss of vision peripherally or centrally, depending where the detachment has occurred. Eye irritation or infection causes redness of the conjunctiva. Increased glare that interferes with visual acuity is noted by patients with cataracts. Inflammation or infection within the eye causes pain with eye movement. pp. 376-377

A patient comes to a clinic with hairline fluid level in the tympanum. There are yellowish bubbles above the fluid level. The nurse recognizes that what condition is most likely present? A patient comes to a clinic with hairline fluid level in the tympanum. There are yellowish bubbles above the fluid level. The nurse recognizes that what condition is most likely present? Sebaceous cyst Serous otitis media Impacted cerumen Conductive hearing loss

Serous otitis media Serous otitis media is characterized by inflammation of the middle ear and is accompanied by discharge. Inspection of the tympanum reveals presence of fluid, level with the hairline. A sebaceous cyst is seen as a black dot on the skin. Impacted cerumen is accumulated wax in the ear. This accumulation of wax often blocks the canal and makes it difficult to see the tympanum. Conductive hearing loss manifests as an inability to hear and is not associated with symptoms like fluid in the tympanum. p. 365

When assessing for corneal light reflex in a patient, what is an appropriate nursing action? Turn on the lights in the room. Ask the patient to look at the roof. Shine a penlight directly on the cornea. Ask the patient to follow finger movement without moving his or her head.

Shine a penlight directly on the cornea. Corneal light reflex is assessed to determine weakness or imbalance of the extraocular muscles (EOM). The procedure is carried out in a dark room. The patient is asked to look straight ahead while a penlight is shined directly on the cornea. The light reflection should be located in the center of both corneas as the patient faces the light source. The patient is asked to follow finger movement when assessing for intact cranial nerves. p. 358

The nurse is performing an otoscopic examination on a patient. When observing the tympanic membrane, what does the nurse anticipate documenting if considered normal? The nurse is performing an otoscopic examination on a patient. When observing the tympanic membrane, what does the nurse anticipate documenting if considered normal? Shiny, pearl gray in color and translucent Crater appearance with the inner ear visible Retracted in the center with a covering of cerumen Reddened with part of the malleus visible through the membrane

Shiny, pearl gray in color and translucent Tympanic membrane (ear drum) should appear white, pink, or pearly gray in color, shiny, and translucent. The surface should appear intact and smooth. The tympanic membrane has a crater appearance if a rupture from infection has occurred. The inner ear is not visible with an otoscope. The tympanic membrane appears retracted when otitis media with effusion occurs. Cerumen (ear wax) is produced in the ear canal and should not obstruct viewing the tympanic membrane. A reddened tympanic membrane occurs with otitis media (ear infection). The handle of the malleus is visible through the normally transparent tympanic membrane. p. 364

A nurse is assessing a patient with dilator muscle atrophy of the eye. The nurse expects to find what clinical manifestation? Formation of cataracts Excessive dryness of the eyes Slow recovery of pupil size after light stimuli Changes in perception of colors, especially blue and violet

Slow recovery of pupil size after light stimuli Dilator muscle atrophy or weakness affects the ability of the pupils to contract and relax. As age progresses, this muscle becomes weak. Due to weakness or atrophy, the recovery of pupil size after stimulation by light is delayed. Cataracts are formed due to biochemical changes in the lens proteins, which result in clouding of the lens. Excessive dryness is caused due to reduced production of tears or due to malposition of the eyelids. Changes in perception of colors are not related to the dilator muscle. Color perception is carried by cones in the retina. A decrease in the number of cones causes this problem. p. 353

The nurse is evaluating a patient's visual acuity. What tool should the nurse use to correctly evaluate this? Slit-lamp Audiometer Snellen chart Retinal angiography

Snellen chart The Snellen chart, which is used to evaluate the patient's ability to read letters or symbols at a distance of 20 feet, is a tool for measuring a patient's visual acuity. A slit-lamp is a special microscope used to examine the eye. An audiometer is a device used to assess hearing acuity. Retinal angiography is a radiographic procedure used to determine retinal damage. p. 356

The nurse is assessing a patient's distance and near visual acuity. What test should the nurse perform? Ishihara Tonometry Snellen chart Confrontation visual field

Snellen chart The Snellen eye chart is used to test distance and near visual acuity. Ishihara is a test for color vision. Tonometry tests the intraocular pressure. The confrontation visual field test determines if a patient has a full field of vision without scotomas. p. 356

While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team? While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team? Place the patient in a flat supine position. Stabilize the foreign object within the injury site. Instruct the patient to bend over and take deep breaths. Continuously irrigate the eye with sterile saline solution.

Stabilize the foreign object within the injury site. The nurse should stabilize the foreign object penetrating the eye to prevent further damage until the injury can be treated by an emergency medicine specialist and ophthalmologist. The head of the patient should be elevated 45 degrees to prevent excessive pressure within the eye. Bending over is avoided as well. Irrigation of the eye is indicated only if the injury is caused by a chemical exposure. 371

The adult child of a patient with macular degeneration asks the nurse how to avoid developing the condition. Which intervention should the nurse include in teaching? Select all that apply. The adult child of a patient with macular degeneration asks the nurse how to avoid developing the condition. Which intervention should the nurse include in teaching? Select all that apply. Stop smoking or do not start. Avoid exposure to ultraviolet light. Wash hands before touching face or eyes. Wear eye protection while doing yard work. Eat green leafy vegetables such as spinach or kale daily.

Stop smoking or do not start. Avoid exposure to ultraviolet light. Eat green leafy vegetables such as spinach or kale daily. Besides aging and family history, risk factors for macular degeneration include cigarette smoking and long-term exposure to ultraviolet light. A diet rich in lutein, found in green leafy vegetables, may reduce the risk of macular degeneration. Hand hygiene prevents infection. Use of eye protection prevents injury. pp. 378-379

The nurse observes that a child has an asymmetric position of the eye. What condition is suspected? Blepheritis Strabismus Hordeolum Conjunctivitis

Strabismus An asymmetric eye position indicates that the patient has strabismus. Blepharitis is associated with redness, swelling, and crusting along the lid margins. Hordeolum is an infection of the sebaceous gland of the eyelid where the patient may have a superficial nodule along the lid margin. Conjunctivitis is associated with redness or swelling of conjunctiva; it is a bacterial infection. p. 357

A patient is exhibiting deviation of eye position in one or more directions. Which abnormal visual system finding does the nurse document is occurring with this patient? Diplopia Cataract Strabismus Exophthalmos

Strabismus Strabismus results from overreaction or underreaction of one or more extraocular muscles. Abnormality of extraocular muscle action related to muscle or cranial nerve pathologic conditions results in diplopia (double vision). A cataract is an opacification of the lens due to aging, trauma, diabetes, or long-term systemic corticosteroid use. The patient with exophthalmos may have hyperthyroidism, or intraocular or periorbital tumors. This patient presents with protrusion of the globe beyond its normal position within the bony orbit. p. 357

Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention? Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention? Tobacco smoking cessation Yearly ophthalmic examination Eating a diet high in green leafy vegetables and lysine Strict adherence to prescribed eye drop medication schedule

Strict adherence to prescribed eye drop medication schedule 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. pp. 379-380

Upon visual examination of a patient's conjunctiva, a small blood spot is observed on the sclera. Which describes this assessment finding? Anisocoria Conjunctivitis Allergic reaction Subconjunctival hemorrhage

Subconjunctival hemorrhage Subconjunctival hemorrhage is characterized by the appearance of a blood spot on the conjunctiva. The blood spot may be small, or it can affect the entire sclera. Anisocoria describes constricted pupils that are unequal. Conjunctivitis manifests as redness and swelling of the conjunctiva that may be itchy. Allergic reactions are characterized by redness, excessive tearing, and itching of the lid margins. p. 357

A patient complains of a red, swollen, circumscribed, and acutely tender area in the lid margin. After the medical checkup, it is diagnosed as a hordeolum. The nurse should provide what instructions to help the patient care for the affected eye? A patient complains of a red, swollen, circumscribed, and acutely tender area in the lid margin. After the medical checkup, it is diagnosed as a hordeolum. The nurse should provide what instructions to help the patient care for the affected eye? Advise the patient to not perform lid scrubs for 10 days. Suggest wearing glasses to reduce development of the infection. Advise to avoid any treatment because the condition is a normal body protective mechanism. Suggest applying warm, moist compresses at least four times a day until the condition improves.

Suggest applying warm, moist compresses at least four times a day until the condition improves. Hordeolum is an infection caused by the bacteria Staphylococcus aureus. It manifests as a red, swollen, circumscribed, and acutely tender area in the lid margin. Treatment involves applying warm, moist compresses at least four times a day until the condition improves. If it recurs, lid scrubs should be performed daily to aid healing. In addition, appropriate antibiotic ointments or drops are prescribed if required. Wearing glasses may not help in treating hordeolum. It is not a normal body protective mechanism; therefore, treatment should not be deferred. p. 370

A patient is prescribed bimatoprost. What nursing intervention would ensure safe administration of the drug? A patient is prescribed bimatoprost. What nursing intervention would ensure safe administration of the drug? Teach the patient to instill three drops three times a day. Advise the patient to wash hands with water and then instill the medicine. Suggest the patient rinse eyes immediately after instilling the medicine. Suggest the patient remove contact lenses 15 minutes before instilling the drops.

Suggest the patient remove contact lenses 15 minutes before instilling the drops. Bimatoprost is used in the treatment of glaucoma. The patient should be told to remove contact lenses 15 minutes before instilling the eyedrops. Instilling eyedrops with contact lenses on can cause a sensation of a foreign body in the eye. The patient should be instructed to instill one drop per evening in the eye. This is because increasing the dose results in increased brown iris pigmentation, ocular discomfort and redness, dryness, and itching. Instilling the medicine using aseptic techniques prevents infection. Washing eyes immediately after instilling the medicine may affect the therapeutic benefits. p. 381

A patient is diagnosed with epidemic keratoconjunctivitis. How should the nurse help the patient relieve the eye infection? A patient is diagnosed with epidemic keratoconjunctivitis. How should the nurse help the patient relieve the eye infection? Suggest the use of ice packs and dark glasses. Discourage the use of mild topical corticosteroids. Advise to avoid the use of topical antibiotic ointments. Advise to avoid taking any treatment because the condition is self-limiting.

Suggest the use of ice packs and dark glasses. Epidemic keratoconjunctivitis is an ocular adenoviral disease. It is spread by direct contact, including sexual activity. Treatment involves the use of ice packs to reduce irritation. Dark glasses are used to reduce photophobia. Treatment should not be avoided in this condition. In severe cases, therapy can include mild topical corticosteroids and topical antibiotic ointment. p. 372

When examining the patient's ear with an otoscope, there is discharge in the canal and the patient reports pain with the examination. For what should the nurse next assess the patient? When examining the patient's ear with an otoscope, there is discharge in the canal and the patient reports pain with the examination. For what should the nurse next assess the patient? Swimmer's ear Sebaceous cyst Metabolic disorder Serous otitis media

Swimmer's ear Swimmer's ear, an infection of the external ear, probably is the cause of the discharge and pain. Asking the patient about swimming, ear protection, and exposure to types of water can identify contact with contaminated water. A sebaceous cyst and metabolic disorders would not cause drainage or discomfort in the external ear canal. After clearing the discharge, the tympanic membrane can be assessed for otitis media. p. 365

The nurse is assessing a patient's ears. What normal findings should the nurse document? Select all that apply. The nurse is assessing a patient's ears. What normal findings should the nurse document? Select all that apply. The shape of the TM is convex. Fluid level at hairline in the TM Diffuse light reflex over the TM TM that is pearly gray, shiny, and translucent The handle of the malleus and its short process are visible through the TM.

TM that is pearly gray, shiny, and translucent The handle of the malleus and its short process are visible through the TM. The TM is normally pearl gray, white, or pink, shiny, and translucent. The handle (manubrium) of the malleus and its short process (umbo) should be visible through the membrane. The TM is a concave or dome shape normally. Hairline fluid level is indicative of serous otitis media. If the TM is bulging or retracted, the edges of the light reflex will be fuzzy (diffuse) and may spread over the TM. p. 361

A patient is using dipivefrin for the treatment of glaucoma. What side effects should the nurse educate the patient to monitor? Select all that apply. A patient is using dipivefrin for the treatment of glaucoma. What side effects should the nurse educate the patient to monitor? Select all that apply. Depression Tachycardia Hypertension Bronchospasm Taste alteration

Tachycardia Hypertension 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. 381

A patient has undergone cataract surgery. What nursing interventions help to prevent postoperative complications? Select all that apply. A patient has undergone cataract surgery. What nursing interventions help to prevent postoperative complications? Select all that apply. Antiviral medications are given to prevent infections. Teach the patient to instill medicine following aseptic techniques. Teach the patient about proper hygiene and eye care techniques. Ask the patient to discontinue all prescribed medicine two days after surgery. Advise the patient to avoid actions that can cause increased intraocular pressure.

Teach the patient to instill medicine following aseptic techniques. Teach the patient about proper hygiene and eye care techniques. Advise the patient to avoid actions that can cause increased intraocular pressure. 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. pp. 373-375

A patient presents with a sty in the left eye. Which nursing actions are appropriate to manage the patient's condition? Select all that apply. A patient presents with a sty in the left eye. Which nursing actions are appropriate to manage the patient's condition? Select all that apply. Teach the patient to perform lid scrubs daily. Prepare the patient for surgical removal of the sty. Administer appropriate antibiotic ointments or drops, as prescribed. Teach the patient to gently cleanse the lid margins with baby shampoo. Instruct the patient to apply warm, moist compresses at least four times a day.

Teach the patient to perform lid scrubs daily. Administer appropriate antibiotic ointments or drops, as prescribed. Instruct the patient to apply warm, moist compresses at least four times a day. A sty, also called a hordeolum, is caused by a Staphylococcus aureus infection of the sebaceous glands in the lid margin. The infection is manifested as a red, swollen, circumscribed, and acutely tender area. The patient should be instructed to apply warm, moist compresses at least four times a day to decrease the swelling and tenderness. Lid scrubs should be performed daily. Infection should be treated with appropriate antibiotic ointments or drops, as prescribed. Surgical intervention may not be required because a sty may subside with basic interventions. Cleansing with baby shampoo is not required because there are no secretions or crusting. p. 370

A patient reports seeing "spider web- like" formations in the visual field during the past few days. The nurse recognizes that which conditions might lead to these formations? Select all that apply. Tears in the retina Vitreous liquefaction Shortening of the ciliary muscles Hemorrhage in the vitreous humor Overaction of the extraocular muscle

Tears in the retina Vitreous liquefaction Hemorrhage in the vitreous humor Vitreous liquefaction is the most common cause of floaters and "spider web-like" images in the visual field. This can also be caused by trauma to the eye. Tears or holes in the retina and hemorrhage in the vitreous humor can also cause "spider web-like formations" in the visual field. Shortening of ciliary muscles affects the near vision of the person. Overaction of the extraocular muscle causes abnormal movement of the eyes. This is known as strabismus. p. 358

The nurse assesses the eyes of an older adult African American patient and observes the sclera in each eye has a slight yellowish cast with small blood vessels visible along the edges in the conjunctiva. What does the nurse conclude from these assessment findings? The assessment findings are within the normal range. The patient should have serum coagulation tests done. The patient likely has a history of uncontrolled hypertension. The patient needs serum liver function tests to determine hepatic function.

The assessment findings are within the normal range. A slight yellowish cast of the sclerae, a normal assessment finding, is caused by lipid deposits that occur with aging. A yellowish cast is normal in patients with dark skin. Small blood vessels are often visible in the conjunctiva near the periphery. Impaired coagulation or bleeding from trauma in the eye is visible as areas of dark red in the sclera. Effects of hypertension may be visible when observing blood vessels in the retina with an ophthalmoscope. A patient with jaundice displays yellowing of the entire scleral area, indicating the need for liver function tests. p. 351

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? 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? The dose of acetazolamide will be decreased. There will be no change in prescriptions of either medication. The patient cannot take both medications due to gastric disturbances. The patient will be advised to take acetazolamide at a different time than aspirin.

The patient cannot take both medications due to gastric disturbances. 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. p. 381

Upon assessment of the eyes of a patient, the nurse observes a yellowish discoloration in the sclera. What should the nurse conclude from the finding? The patient has a thin sclera. The patient has a normal finding. The patient has a lipid deposition. The patient has a subconjunctival hemorrhage.

The patient has a lipid deposition The excessive deposition of lipids in the sclera may result in a yellowish discoloration of the sclera. A patient who has a thin sclera will have a bluish tinge in the sclera. The presence of a white sclera indicates that the patient has a normal finding. A patient who has a subconjunctival hemorrhage will have the appearance of a blood spot on the sclera. p. 358

The nurse documents a patient's Snellen chart reading as: Right eye: 20/30; Left eye: 20/40. What does the nurse determine is the correct interpretation of this reading? The patient likely has presbyopia. The patient does not have color blindness. The vision acuity is stronger in the left eye. The patient has a refractory error consistent with myopia.

The patient has a refractory error consistent with myopia. Documentation of Snellen test results includes documenting the eye tested, the distance the vision is tested (20 feet), and the line that the patient is able to read correctly. Patients should wear corrective devices while being tested. Myopia is nearsightedness, the ability to see near objects clearly while distant objects are blurred. The findings of 20/30 and 20/40 are consistent with myopia. Presbyopia is a loss of ability to accommodate and focus on near objects that occurs normally with aging. The Ishihara color test assesses the patient's ability to distinguish color patterns and screens for color blindness. The vision acuity is stronger in the right eye (20/30) than the left eye (20/40). p. 356

A patient tells a nurse, "I see two of everything." What should the nurse interpret from this finding? The patient has reduced tear formation. The patient has inflammation of the cornea. The patient has an abnormality in size of the pupils. The patient has an abnormality of the extraocular muscle.

The patient has an abnormality of the extraocular muscle The patient's statement, "I see two of all everything," indicates that the patient has double vision. This indicates that the patient has diplopia, which is associated with an abnormality of the extraocular muscle. Reduced tear formation will result in dry eyes and a gritty sensation, but not double vision. The presence of inflammation in the cornea results in photophobia. An abnormality in pupil size is associated with central nervous system disorders and is referred to as anisocoria. p. 358

A patient who was in a car accident tells a nurse, "I hit the vehicle that was moving in front of me; I thought it was far away and misjudged the distance." What should the nurse interpret from the patient's statement? The patient has hyperopia. The patient has presbyopia. The patient has impaired stereopsis. The patient has an abnormal response to light.

The patient has impaired stereopsis. Stereoscopic vision allows a patient to visualize in three dimensions. A patient who has impaired stereopsis will be unable to judge the distance between vehicles or between steps, which may result in accidents. Hyperopia is farsightedness or a loss of near vision. In this condition, a patient will be able to judge distances. Presbyopia is a loss of near vision that comes with age, but it does not result in the loss of three-dimensional vision. A patient who has an abnormal response to light will have impaired pupil response, but not the inability to judge distances. p. 359

During an auditory assessment, the nurse finds that the patient is able to hear a low whisper at a distance of 30 cm. How does the nurse interpret this information in the patient's report? During an auditory assessment, the nurse finds that the patient is able to hear a low whisper at a distance of 30 cm. How does the nurse interpret this information in the patient’s report? The patient has impaired reception. The patient has mastoid tenderness. The patient has normal auditory function. The patient has sensorineural hearing loss.

The patient has normal auditory function. Ability to hear a low whisper of 20 dB at a short distance of 30 cm indicates that the patient has normal auditory function. Impairment of the cochlea will result in impairment of reception. The nurse palpates the mastoid area to detect tenderness and nodules. The tuning fork test, not the whisper test, helps detect sensorineural hearing loss. p. 364

A patient reports difficulty swallowing and chewing, and the nurse finds purulent drainage from the ear. How does the nurse interpret these findings? The patient has otalgia. The patient has tinnitus. The patient has presbycusis. The patient has impaired speech reception.

The patient has otalgia. The patient with otalgia will have difficulty swallowing and chewing and purulent drainage from the ear. Tinnitus is ringing of the ears that worsens with age because of the calcification of ossicles and may result in loss of hearing. Presbycusis is hearing loss associated with cumulative exposure to noise with increasing age. The patient with reduced blood supply to the cochlea will have impaired speech reception.

A nurse finds that a patient has small, yellowish spots on the conjunctiva. Upon further interaction, the nurse finds that the patient works at a hospital in the radiology department. What should the nurse interpret from these findings? The patient has pterygium. The patient has pinguecula. The patient has presbyopia. The patient has arcus senilis.

The patient has pinguecula. Small, yellowish spots on the medial aspect of the conjunctiva are associated with pinguecula, which occurs as a result of tissue damage related to chronic exposure to ultraviolet light. Because the patient works in the radiology department, the likelihood of exposure to ultraviolet light is high. Pterygium is an abnormality of the cornea that is associated with chronic exposure to sunlight, which manifests as thickened, triangular, pale tissue extending from the inner canthus to the nasal border. Presbyopia is a refractive error that is associated with the loss of near vision. This condition manifests as increased rigidity of the lens, not yellow spots on the conjunctiva. Arcus senilis is an abnormality of the cornea that occurs because of cholesterol deposition in the peripheral cornea and manifests as a milky white and grayish ring around the eye. p. 351

A 40-year-old patient tells a nurse, "I've noticed over the last three months that I have blurred vision of near objects." The ophthalmic consultation report shows that the patient has increased rigidity of the lens. What should the nurse interpret from the finding? The patient has myopia. The patient has hyperopia. The patient has presbyopia. The patient has astigmatism.

The patient has presbyopia. A 40-year-old patient having blurred vision of objects closer to the visual field and rigidity of the lens indicate that the patient presbyopia. Presbyopia is the loss of accommodation, which occurs because of the increased rigidity of the lens. It causes an inability to focus on objects that are near. Presbyopia occurs as a normal process of aging. Myopia is nearsightedness or the loss of vision of faraway objects. This condition does not develop with old age and is found in all age groups. Hyperopia, or farsightedness, is an inability to accommodate for near objects. Astigmatism occurs because of an unevenness of the cornea, which results in distorted vision, but not in the loss of objects that are nearby. p. 351

The nurse observes an inconsistent nonverbal response from the patient as part of an auditory assessment in a soundproof room where sound is provided through headphones. How does the nurse interpret this finding? The nurse observes an inconsistent nonverbal response from the patient as part of an auditory assessment in a soundproof room where sound is provided through headphones. How does the nurse interpret this finding? The patient has otalgia. The patient has vertigo. The patient has tinnitus. The patient has nystagmus.

The patient has tinnitus. Tinnitus is an abnormal ringing of ears that results in an inconsistent response on pure-tone audiometry because the patient will not be able to hear the sound consistently. Otalgia is pain in the ears, which may cause discomfort and result in nutritional disturbance. Vertigo is a spinning sensation, stimulated by motion of the head that results in impaired balance. Nystagmus is abnormal movement of the eye, observed as twitching of the eyeball. p. 362

A nurse is assessing a patient's hearing ability. Which findings would indicate compromised hearing? Select all that apply. A nurse is assessing a patient's hearing ability. Which findings would indicate compromised hearing? Select all that apply. The patient is lip reading. The patient speaks very loudly. The patient feels dizzy when standing up. The patient asks to have certain words repeated. The patient fails to respond to questions when not looking directly at the nurse.

The patient is lip reading. The patient asks to have certain words repeated. The patient fails to respond to questions when not looking directly at the nurse. If the patient is lip reading or asks to have certain words repeated, the patient may have hearing loss. A patient with compromised hearing may look at the examiner intently but may miss a comment when not looking directly at the examiner. If the patient feels dizzy on standing up, it may indicate impaired equilibrium. While some people with hearing loss may speak loudly, this alone is not an indication of hearing loss. pp. 363

A patient with glaucoma is taking timolol drops. What should the nurse include while reinforcing principles of medication administration with the patient? A patient with glaucoma is taking timolol drops. What should the nurse include while reinforcing principles of medication administration with the patient? The patient will notice an improvement in vision within one month. The patient should use these on an as needed basis for eye irritation. The patient should maintain a supine position for 30 minutes after the drops are instilled. The patient may experience blurred vision after administration of the drops lasting several minutes.

The patient may experience blurred vision after administration of the drops lasting several minutes. 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. p. 381

A nurse is caring for a patient after eye surgery and finds that the patient has difficulty passing stools. What should the nurse interpret from this finding? The patient is at risk for anisocoria. The patient is at risk for photophobia. The patient may have increased rigidity of the lens. The patient may have increased intraocular pressure.

The patient may have increased intraocular pressure. After eye surgery, it is important for the patient to resist straining, such as when trying to defecate. Straining from constipation may lead to increased intraocular pressure in the ears and eyes. Anisocoria is the unequal size of the eye pupils, which is a physiologic condition or is associated with trauma. Persistent, abnormal intolerance of the eyes to light is called photophobia, which is associated with infection or inflammation in the uveal tract. Patients who have a loss of near vision that is associated with age will have increased lens rigidity. p. 355

A nurse is obtaining a health history from a patient. The nurse suspects that the patient could have hearing loss. What findings may have led the nurse to this suspicion? Select all that apply. A nurse is obtaining a health history from a patient. The nurse suspects that the patient could have hearing loss. What findings may have led the nurse to this suspicion? Select all that apply. The patient tries to lip read the nurse's words. The patient blinks often and answers questions rapidly. The patient requests that questions be repeated frequently. The patient misses out on words when not looking at the nurse. The patient doesn't look at the nurse and answers questions while looking down.

The patient tries to lip read the nurse's words. The patient requests that questions be repeated frequently. The patient misses out on words when not looking at the nurse. The patient's body language and actions often provide signs of underlying hearing trouble. The patient tries to lip read the nurse's words in order to guess the question. The patient is often unable to hear the question and asks the nurse to repeat it. The patient looks intently at the nurse when trying to lip read. The patient tends to miss out on words when not looking at the nurse. These are some signs which suggest hearing loss. Blinking too often is not a sign of hearing loss. Similarly, if the patient avoids eye contact with the nurse, it is not suggestive of hearing loss. It may suggest that the patient has low confidence or interest or is disoriented. p. 361

A nurse is performing an eye examination on a patient. Which findings should the nurse consider abnormal? Select all that apply. The pupils are equal and round. The right pupil is slightly smaller than the left. The pupils dilate when light stimuli is performed. The pupils constrict when light stimuli is performed. The right pupil constricts faster than the left when light stimuli are performed.

The right pupil is slightly smaller than the left. The pupils dilate when light stimuli is performed. The right pupil constricts faster than the left when light stimuli are performed. Whenever light stimulus is given, the pupils constrict to regulate the amount of light falling on the retina. The iris regulates the size of the pupils. Under normal circumstances, both of the pupils are equal in diameter. The normal shape of pupils is round. Pupils do not dilate when light falls on them. The pupils dilate when the amount of light in the environment is less. Dilation of the pupils enables more light to enter the eye and helps the person to see better. pp. 354-355

The patient needs, but does not want, a corneal transplant because of difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this? The patient needs, but does not want, a corneal transplant because of difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this? If the transplant is done soon after the donor dies, there will not be as much trouble recovering vision. The astigmatism the patient is experiencing may be corrected with glasses or rigid contact lenses. Increasing the amount of light and using a magnifier to read will be helpful if a transplant is not wanted. There are newer procedures in which only the damaged cornea's epithelial layer is replaced, and these procedures have a faster recovery.

There are newer procedures in which only the damaged cornea's epithelial layer is replaced, and these procedures have a faster recovery The new procedures are called Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's membrane endothelial keratoplasty (DMEK). Corneal transplants should be done as soon as possible, but this does not affect the rate of visual recovery. Astigmatism is not experienced with corneal scars and opacities requiring a corneal transplant. Increasing light and magnification helps a person with cataracts to read. p. 373

A patient with suspected hearing loss is advised to undergo a pure-tone audiometry. How should the nurse explain the procedure to the patient? Select all that apply. A patient with suspected hearing loss is advised to undergo a pure-tone audiometry. How should the nurse explain the procedure to the patient? Select all that apply. This test is carried out in a soundproof room. This test helps in diagnosing diseases of the labyrinth. The patient will hear varying sounds through earphones. Electrodes are placed in the ears and the activity is recorded. This test helps in diagnosing conductive and sensorineural hearing loss.

This test is carried out in a soundproof room. The patient will hear varying sounds through earphones. This test helps in diagnosing conductive and sensorineural hearing loss. Pure-tone audiometry is a test carried out to diagnose conductive and sensorineural hearing loss and to determine the patient's hearing range. The patient is placed in a soundproof room and is made to hear varying sounds through earphones. Whenever the patient hears a sound, the patient needs to give a nonverbal response, which is recorded. This test is not used for diagnosing diseases of the labyrinth. Electrodes are used in electronystagmography, not in this test. p. 365

The nurse is assessing the auditory system of a newly admitted older adult patient. Which of these are age-related changes may be anticipated in the auditory system? Select all that apply. The nurse is assessing the auditory system of a newly admitted older adult patient. Which of these are age-related changes may be anticipated in the auditory system? Select all that apply. Tinnitus Collapsed ear canal Increase in cerumen moisture Increased sensitivity to loud sounds Diminished sensitivity to low-pitched sounds

Tinnitus Collapsed ear canal Increased sensitivity to loud sounds Age-related changes in the auditory system include tinnitus, collapsed ear canal, increased sensitivity to loud sounds, diminished sensitivity to high-pitched sounds, and drier cerumen. p. 361

While preparing a patient with a visual problem for surgical therapy, the primary health care provider orders the nurse to administer cycloplegics to the patient. What rationale does the nurse identify for this action? While preparing a patient with a visual problem for surgical therapy, the primary health care provider orders the nurse to administer cycloplegics to the patient. What rationale does the nurse identify for this action? To prevent anxiety To reduce inflammation To minimize photophobia To block the effect of acetylcholine on ciliary body muscles

To block the effect of acetylcholine on ciliary body muscles Cycloplegics are anticholinergic drugs that block the effect of acetylcholine on the ciliary body muscles and produce paralysis of accommodation. Therefore cycloplegics are given in the preoperative phase of surgical therapy to block the effect of acetylcholine on the iris sphincter muscle. Antianxiety drugs are given to the patient to prevent anxiety. Nonsteroidal antiinflammatory drugs are given to reduce inflammation. The patient is advised to wear dark glasses to minimize photophobia. p. 374

A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse? A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse? To decrease pain To prevent anxiety To minimize photophobia To minimize intraocular pressure

To minimize photophobia Pupil dilation medications enlarge the pupil during eye examinations. After administering pupil dilation medications, patients generally have photophobia. Analgesics are administered to decrease pain. Anxiolytics are given to patients to prevent anxiety. Miotics and oral or intravenous hyperosmotic agents such as glycerin liquid, isosorbide solution, and mannitol solution are useful in lowering the intraocular pressure. p. 374

A patient has sustained an injury to the cornea. The nurse assists the primary health care provider in rinsing the eye with saline solution and then instilling a dye into the conjunctiva of the injured eye. What is the purpose of the dye? A patient has sustained an injury to the cornea. The nurse assists the primary health care provider in rinsing the eye with saline solution and then instilling a dye into the conjunctiva of the injured eye. What is the purpose of the dye? To disinfect the injured tissue To help seal and heal the injured tissue To stain the injured tissue so it can more easily be identified To bind with foreign particles, allowing them to be rinsed away from injured tissue

To stain the injured tissue so it can more easily be identified The injured tissue is susceptible to the dye and will remain stained even after the eye is rinsed with saline. Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects and locate foreign objects in the eye. The dye is not used to disinfect the tissue, seal and heal it, or bind with foreign particles. p. 378

The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering? The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering? Oral acyclovir Trifluridine drops Topical corticosteroids Topical vidarabine ointment

Topical corticosteroids Keratitis is an inflammation or infection of the cornea that can be caused by a variety of microorganisms. Topical corticosteroids are contraindicated in this patient because they may cause deeper ulceration of the cornea on prolonged treatment. Oral acyclovir is an antiviral medication that is effective in the treatment of viral keratitis. Trifluridine drops and topical vidarabine ointment are effective in treating viral keratitis. p. 372

The nurse darkens the room and shines a penlight on the cornea and asks the patient to follow finger movement 10 inches from the patient's nose. Which cranial nerve paralysis should be examined? Select all that apply. Facial nerve Troclear nerve Abducens nerve Trigeminal nerve Oculomotor nerve

Troclear nerve Abducens nerve Oculomotor nerve The examiner is assessing the extraocular muscle function by darkening the room and shining the penlight over the cornea. The troclear, abducens, and oculomotor nerves are present near the eyeball, and an abnormality of these cranial nerves results in paralysis of the extraocular muscles. The facial nerve helps in the opening and closing movements of the eyelids. The trigeminal nerve helps in the dilation of the iris. p. 358

During an assessment of near visual acuity of a patient, the nurse finds that there is no Jaeger eye chart available. Which is the most appropriate nursing action? Skip the test, as it is not important. Use Snellen's chart for assessment. Ask the patient to come back the next day. Use a newspaper or the label on a container.

Use a newspaper or the label on a container. If the nurse does not have access to a Jaeger eye chart, the nurse can ask the patient to read a newspaper or the label on a container. The findings should be documented as "reads newspaper headline at X inches." Snellen's chart is used for assessing distant vision. The test should not be skipped, because an assessment of near vision is important to the patient's overall health. The patient does not need to return on a different day, because a near visual acuity assessment can be completed with a newspaper test. p. 358

The nurse is conducting an assessment for a patient with hearing loss. Which cranial nerve is associated with the processing of sound? III VI VII VIII

VIII Cranial nerve VIII is associated with hearing and balance. Cranial nerve III controls eye movement, pupillary constriction, and upper eye lid elevation. Cranial nerve VI controls the sense of smell. Cranial nerve VII controls the expression in the forehead, eyes, and mouth, taste, salivation, and tearing. p. 360

The nurse is performing an assessment of a patient's ear with an otoscope and observes a retracted eardrum. What does the nurse determine the cause of this to be? The nurse is performing an assessment of a patient’s ear with an otoscope and observes a retracted eardrum. What does the nurse determine the cause of this to be? Ear drainage Seborrheic dermatitis Vacuum in middle ear Infection of external ear

Vacuum in middle ear A vacuum in the middle ear will cause the malleus to appear shorter and more horizontal. A patient with sebaceous cysts behind the ear will exhibit drainage from the ear, not a retracted eardrum. A patient with seborrheic dermatitis will have scales and lesions on the skin. Infection of the external ear may result in discharge from the ear canal. p. 364

A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? Use suitable coping strategies to reduce stress Identify patient's strengths and support system Verbalize feelings related to visual impairment Transition successfully to the sudden vision loss

Verbalize feelings related to visual impairment The nurse's priority is to help the patient express feelings about vision loss because the patient is not coping effectively with the situation. Until the patient expresses how he or she feels, the patient will be unable to progress in the rehabilitation process, including using suitable coping strategies to reduce stress, developing strengths and a support system, and transitioning successfully to the sudden vision loss. p. 382

A patient tells a nurse, "I take an aspirin every two days because I'm always getting headaches." Which ear abnormality does the nurse expect? Vertigo Tinnitus Presbycusis Impaired speech reception

Vertigo Tinnitus, a continuous ringing in the ears, is associated with calcification of the ossicles. Heavy intake of aspirin, an analgesic medication, often results in tinnitus because of its toxic effect on cranial nerve VIII. Vertigo is a sense of moving or spinning that is associated with imbalances in the vestibular system. Presbycusis is the loss of hearing with age. A patient who has damage to the cochlea will exhibit impaired speech reception. p. 362

The nurse observes a patient ambulating with a stumbling gait. What conditions should the nurse be aware may cause this patient's condition? Vertigo Tinnitus Nystagmus Presbycusis

Vertigo Vertigo is stimulated by movement; this condition can cause an unsteady gait. Presbycusis is hearing loss due to aging. Nystagmus is an abnormal eye movement or twitching of the eye. Tinnitus is ringing in the ears. pp. 361, 363

Which organs of the auditory system are involved in balance? Select all that apply. Which organs of the auditory system are involved in balance? Select all that apply. Malleus Cochlea Vestibule Tympanum Semicircular canals

Vestibule Semicircular canals The vestibule, an organ in the inner ear, comprises the labyrinth and is an organ of balance. The semicircular canal, a structure present in the inner ear, comprises the membranous labyrinth and is an organ of balance. The malleus, the smallest bone in the human body, is found in the middle ear and aids transmission of sound waves. The cochlea, a coiled structure, is a receptor organ for hearing. The tympanum, in the external ear, collects and transmits sound waves. p. 363

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. Which surgical procedure will be used to relieve traction on the retina and will the nurse educate the patient? A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. Which surgical procedure will be used to relieve traction on the retina and will the nurse educate the patient? Vitrectomy Cryotherapy Photodynamic therapy Ocular coherence tomography

Vitrectomy Vitrectomy is the surgical removal of the vitreous and is used to relieve traction on the retina caused especially by proliferative diabetic retinopathy. Cryotherapy is a procedure used to seal retinal breaks. Photodynamic therapy is a procedure used to treat age-related macular degeneration. Ocular coherence tomography is used to identify fluid in the central retina; it determines the need for continued intravitreal injections. pp. 377-378

A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention? A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention? Walking behind the patient holding the patient's back Describing the environment to the patient while walking Helping the patient to sit by placing the patient's hand on the seat of the chair Standing slightly in front and to one side of the patient and providing elbow for support

Walking behind the patient holding the patient's back While assisting a blind patient using sighted-guide technique, the nurse should walk slightly ahead of the patient, with the patient holding the back of the nurse's arm. This action will help the blind patient to walk easily. The nurse should describe the environment while walking to help orient the patient. The student nurse should help the patient sit by placing one of his or her hands on the seat of the chair. The nurse should stand slightly in front and to one side of the patient and provide an elbow for the patient to hold. pp. 368-370

A patient has undergone a fluorescein angiography. The nurse should observe for what side effects of the procedure? Select all that apply. Redness of the eyes Yellowish discoloration of the skin Yellowish discoloration of the urine Nausea and vomiting after the procedure Red-colored urine indicative of presence of blood

Yellowish discoloration of the skin Yellowish discoloration of the urine Nausea and vomiting after the procedure In fluorescein angiography, fluorescein is injected in the body. This dye is a noniodine and nonradioactive dye. This procedure has some common side effects. The dye can cause yellowish discoloration of skin and urine. This dye can also cause some nausea and vomiting. Presence of blood in urine is a serious sign and is not a common side effect of this procedure. Redness of the eyes can have many causative factors and is unlikely after this procedure. p. 359

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