Patho Exam 2 Ch 38
Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss?
Paget disease.
The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as:
Involuntary eye movements that preserve eye fixation on stable objects in the visual field.
A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?
Limiting the infant's exposure to large group settings.
Which cranial nerve is designated as the vestibulocochlear nerve?
Cranial nerve VIII.
What is ocular muscle imbalance resulting in "lazy eye" called?
Amblyopia.
The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:
"Cut down on takeout meals because of high amounts of monosodium glutamate."
Which of these clients' statements would be most suggestive of retinal detachment?
"I feel like there's a shadow that's blocking my vision."
The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states which of the following?
"I will dry the inside of my ears thoroughly with the cotton-tipped applicators after swimming."
A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate?
"Let's keep a close eye on his condition for a couple of days before starting antibiotics."
A 69-year-old patient comes to the clinic for a routine checkup. Upon examination the nurse practitioner informs the patient that she has cataracts. The patient then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner?
"Surgery is the only effective treatment for cataracts."
The father of a third grade girl has brought his daughter to a walk-in clinic because he believes the girl has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which follow-up explanation by the nurse is most accurate?
"The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away."
Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50 year-old man has visited his healthcare provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which of the following teaching points by the care provider is most appropriate?
"There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."
A 70 year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?
"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."
A patient has shingles. What is the best time frame for the initiation of oral and intravenous antiviral drugs after the appearance of a rash to reduce the incidence of ocular complication?
3 days.
While working at the triage desk in the local emergency department, which of the following patients is likely having a medical emergency and needs to be seen first?
55 year old truck-driver complaining of sudden onset of ocular pain and blurred vision.
A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing:
Acute angle-closure glaucoma.
The eustachian tube connects the nasopharynx and the middle ear. In infants and children with abnormally patent tubes, what enters the eustachian tube when the infant or child cries or blows their nose?
Air and secretions.
The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located?
Anterior segment of the globe.
The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually which of the following?
Asymptomatic and often self-limiting.
A client tells the nurse that when she is in bed, changes position of her head, and rolls into a lateral position, she experiences brief periods of vertigo, usually lasting less than 1 minute. The client is most likely experiencing:
Benign paroxysmal positional vertigo.
The nurse is working at a first aid station in an amusement park. A 45-year-old client arrives reporting severe dizziness after a ride on the roller coaster. The nurse understands that a common cause of this sensation is which of the following?
Benign paroxysmal positional vertigo.
A patient's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the patient has which of the following?
Cystlike mass in the middle ear.
The nurse is educating a patient diagnosed with Meniere's disease on lifestyle modifications to reduce the frequency and/or intensity of exacerbations. Which should the nurse include?
Decrease dietary intake of sodium.
The nurse is caring for a client who has been diagnosed with presbycusis. The nurse understands that with this disorder, the client experiences which of the following?
Difficulty hearing high-pitched frequencies.
The nurse understands that vestibular rehabilitation includes which of the following?
Exercises in balance retraining.
A mother brings her baby in with a possible diagnosis of congential or infantile glaucoma. What are the clinical manifestations that the mother would tell the nurse about the baby? Select all that apply.
Fussy, Poor eating habits, and Rubs his eyes frequently.
Hearing loss in children can be either conductive or sensorineural, as it is in adults. What is the major cause of sensorineural hearing loss in children?
Genetic causes.
The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor which fills the anterior and posterior chambers of the eye as which disease?
Glaucoma.
The parents of a 1-month-old child tell the nurse at the pediatrician's office that their child doesn't seem right; the child doesn't always look toward them when they speak. What assessment does the nurse expect the physician to conduct?
Hearing screening.
The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of:
Imbalance between aqueous production and outflow.
The nurse is caring for a pediatric client who has a diagnosis of acute otitis media (AOM). Which of the following is an appropriate option for pain management associated with this condition?
Incision of the tympanic membrane.
The nurse is conducting a community education class on amblyopia. The nurse determines that the participants are understanding the concepts when they identify which of the following as the time when amblyopia is generally diagnosed?
Infancy.
Why is it important for a patient with a diagnosis of papilledema to follow up?
It indicates a need for diagnosis of the cause.
During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which of the following?
Keratits.
A patient has been diagnosed with hemianopia. The patient asks the nurse what this is describing concerning the eye?
Loss of half of the visual field in one eye.
Select the statement that best describes Meniere disease.
Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss, vertigo, and tinnitus.
When conditions occur that impair retinal blood flow, such as hyperviscosity of the blood or a sickle cell crisis, what can occur in the eye?
Neovascularization.
Stepping out of a mall and into the sunshine has caused a man's pupils to constrict. Place the following anatomical components of the man's pupillary reflex in the ascending chronological order that they responded to the light. Use all the options.
Oculomotor nuclei, retinal ganglionic cells, preganglionic neurons, and pretectal nuclei.
The three layers of the cornea are separated by two important basement membranes. What are characteristics of the Bowman membrane? Select all that apply.
Opaque scar can form that impairs vision, and Acts as a barrier to infection.
A patient has glaucoma. The nurse is taking a health history and knows that the most common form of glaucoma is which type?
Open angle.
Which type of receptor is mediated through vision in dim light?
Photoreceptors.
The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which of the following medications will be prescribed to manage the symptoms?
Promethazine (Phenergan).
Objective tinnitus is tinnitus that someone else can hear. What does the tinnitus that is caused by vascular disorders sound like?
Pulses.
Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder?
Reduction in ability to understand speech.
A college junior calls his mother, a nurse, complaining of, "not being able to see." When questioned further, he describes, "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which of the following conditions and have their teenager go to the emergency department immediately.
Retinal detachment.
When a client reports that he feels like he is spinning but the room is stable, the nurse should document the finding as which of the following?
Subjective vertigto.
A young child is flying on a plane for the first time. As the plane begins its decent for landing, his ears begin to hurt. The flight attendant sees that he is in pain and tells him to swallow until the pain goes away. Which structure is the child using to equalize the pressure and relieve the pain?
Swallowing pulls air through the eustachian tubes, allowing the air pressure to equalize in the inner ear.
The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which of the following measures will the nurse recommend during changes in air pressure?
Swallowing.
A patient suffers from seasonal allergic rhinoconjunctivitis. What is the best treatment for prolonged allergic conjunctivitis?
Systemic antihistamines.
A client has been diagnosed with sensorineural hearing loss. Which should the care team assess to determine a plausible cause?
The client's recent medication use.
The nurse observes nystagmus in a client sitting quietly without head movement. The nurse interprets this finding in which of the following way?
This is a pathological finding.
It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss?
Tuning fork.
A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be:
Tympanostomy tube insertion.
The nurse understands that movement of otoliths may result in which of the following?
Vertigo and nystagmus.
The nurse assessing a patient with Ménière disease expects the patient to have which of the following symptoms?
Vertigo.
A patient is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is which one of the following?
Vestibular apparatus.
A young patient is brought to the clinic with symptoms of a runny nose, small amount of drainage from both eyes, fever, and malaise. The mother states to the nurse, "I knew she was going to be sick. That swimming pool she played in 2 days ago was filthy." What disease should the nurse suspect this child is experiencing?
Viral conjunctivitis.
A patient has been diagnosed with bacterial conjunctivitis. This type of infection is usually characterized by large amounts of what color drainage?
Yellow-green.
A 42-year-old client has sought care because he reports increasing difficulty reading the labels on packages and other small fonts. He states that he has to continually hold it further and further away from his face in order to see the type clearly. The client is most likely experiencing:
an age-related change in accommodation.
The nurse is performing her morning assessment on a 69 year old patient on a medical-surgical unit. Upon assessing her pupils the nurse notices that they are equal and responsive to light but not to accommodation.The nurse is aware that with aging the lens becomes thicker and its capsule less elastic so she believes this to be the case. When accommodation is diminished in an older person as a result of aging this is referred to as what?
presbyopia.
An elderly woman comes to the clinic complaining of seeing flashing lights and small spots. She tells the nurse that this has been going on for over 24 hours but now it is as if she sees a dark curtain whenever she opens her eyes. She asks the nurse if this means she is going to be blind.What diagnosis should the nurse suspect ?
retinal detachment.
The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to which of the following?
Conduction disorder.
The nurse takes a patient's blood pressure in the primary care provider's office. The last three times the patient has been in the office it has been high. What structure in the eye is this adverse effect of hypertension most likely to affect?
Retina.
The father of a third grade girl has brought his daughter to a walk-in clinic because he believes the girl has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which of the follow-up explanation by the nurse is most accurate?
"The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away."
Which of the following nursing interventions is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo implement?
Fall precautions.
