Prep-U Ch. 42 & 43 - Caring for Clients with Eye & Ear Disorders

A client who has a lengthy history of progressive hearing loss is very forthright about the condition, and the nurse wants to develop a communication strategy for this client's hospital stay. Which communication strategy has proven to be the most effective? A. the one the client will use B. speech reading C. signing D. writing

A. the one the client will use - Although there are several communication strategies for clients with significant hearing loss, the only effective method is the one the client will consistently use.

The nurse is admitting a 55-year-old client diagnosed with a left eye retinal detachment. While assessing this client, what characteristic symptom would the nurse expect to find? A. Flashing lights in the visual field B. Sudden eye pain C. Loss of color vision D. Colored halos around lights

A. Flashing lights in the visual field - Flashing lights in the visual field is a common symptom of retinal detachment. Clients may also report spots or floaters or the sensation of a curtain being pulled across the eye. Retinal detachment is not associated with eye pain, loss of color vision, or colored halos around lights.

Why should the nurse encourage a client with otitis externa to eat soft foods? A. Chewing may cause discomfort. B. Chewing may lead to further complications, such as otitis media. C. Chewing may cause excessive drainage. D. Chewy foods, such as red meat, may react with the prescribed analgesics and antibiotics.

A. Chewing may cause discomfort. - The nurse encourages a client with otitis externa to eat soft foods or consume nourishing liquids because chewing may cause discomfort.

A nurse practitioner explains to a patient recently diagnosed with noise-induced hearing loss that the basic altered physiology in the ear is the result of: A. Damage to the hair cells inside the cochlea. B. Stenosis of the semicircular canals. C. Hardening of the tympanic membrane. D. Malfunctioning of the incus and the staples.

A. Damage to the hair cells inside the cochlea. - About 25% of all Americans who have a hearing loss have noise-induced hearing loss caused by damage to the hair cells found inside the cochlea. These cells convert sound energy into electrical signals that travel to the brain. Once damaged, they cannot be repaired.

The nurse is providing education to a client on the correct instillation of eardrops. Which statement would indicate that more instruction is required? A. Direct the flow of the ear drops toward the eardrum. B. Warm the container in warm water. C. Avoid inserting the irrigating syringe too deeply. D. Clean the external ear with a washcloth prior to instillation of eardrops.

A. Direct the flow of the ear drops toward the eardrum. - The flow should be directed toward the roof of the canal rather than the eardrum. Eardrops can be warmed by holding the container in the hand for a few moments or placing it in warm water. The nurse avoids inserting the irrigating syringe too deeply so as to close off the auditory canal. Do not clean the external auditory canal with objects like cotton-tipped swabs or toothpicks, because it is traumatic to the surface and can harm the tympanic membrane.

What is the correct advice regarding food for a client who underwent a cataract surgery? A. Eat soft, easily chewed foods. B. Eat red meat two to four times per week. C. Increase intake of vitamins A and C. D. Eat spinach or collard greens two to four times per week.

A. Eat soft, easily chewed foods. - The nurse should advise clients recovering from cataract surgery to eat soft, easily chewed foods until healing is complete to avoid tearing from excessive facial movements.

People with hyperopia are considered which of the following? A. Farsighted B. Nearsighted C. Normal vision D. Astigmatism

A. Farsighted - People with hyperopia are farsighted. Nearsighted people have myopia. Emmetropia is normal vision. Astigmatism is an irregularity in the curve of the cornea.

The nurse is assessing a new adult client. What characteristic of this client's status should the nurse identify as increasing the client's risk for glaucoma? A. The client uses over-the-counter NSAIDs. B. The client has a history of stroke. C. The client has diabetes. D. The client has Asian ancestry.

C. The client has diabetes. - Diabetes is a risk factor for glaucoma, but Asian ancestry, NSAIDs, and stroke are not risk factors for the disease.

Which type of glaucoma presents an ocular emergency? A. Normal tension glaucoma B. Ocular hypertension C. Acute angle-closure glaucoma D. Chronic open-angle glaucoma

C. Acute angle-closure glaucoma - Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added later.

An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: A. Eyes that are shallow. B. A shorter depth to the eyeball. C. Blurred distance vision. D. Farsightedness.

C. Blurred distance vision. - People who have myopia are said to be nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. Myopic people experience blurred distance vision.

What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil? A. Anti-infectives B. Corticosteroids C. Cycloplegics D. NSAIDs

C. Cycloplegics - Mydriasis, or pupil dilation, is the main objective of the administration of mydriatics and cycloplegics (Table 63-3). These two types of medications function differently and are used in combination to achieve the maximal dilation that is needed during surgery and fundus examinations to give the ophthalmologist a better view of the internal eye structures.

The nurse should monitor for which manifestation in a client who has undergone LASIK? A. Excessive tearing B. Cataract formation C. Halos and glare D. Stye formation

C. Halos and glare - Symptoms of central islands and decentered ablations can occur after LASIK surgery; these include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation.

The nurse should recognize the greatest risk for the development of blindness in which of the following clients? A. A 58-year-old woman with macular degeneration B. A 28-year-old man with astigmatism C. A 58-year-old woman with hyperopia D. A 28-year-old man with myopia

A. A 58-year-old woman with macular degeneration - The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. The 58-year-old woman with macular degeneration has the greatest risk for the development of blindness related to her age and the presence of macular degeneration. Individuals with hyperopia, astigmatism, and myopia are not in a risk category for blindness.

A client reports a sudden onset of tinnitus, hearing loss, and vertigo. The nurse carefully reviews the client's medication list to determine whether the client is taking a medication that might cause ototoxicity. Which medications would the nurse be most concerned with? Select all that apply. A. aspirin B. lasix C. Cisplatin D. cephalexin

A, B, C aspirin, lasix, cisplatin - Salicylates, loop diuretics, and certain chemotherapeutic agents are drugs associated with ototoxicity. Cephalosporins are not known to cause ototoxicity.

A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention?A. Irrigate both eyes. B. Obtain the Material Safety Data Sheet (MSDS). C. Assess visual acuity. D. Assess the pH of the corneal surface.

A. Irrigate both eyes. - The eyes should immediately be irrigated to remove the chemical and preserve the eye. If the chemical is allowed to remain on the eye surface, it may cause ulcerations and permanent damage to the eye. It is appropriate to obtain the MSDS and assess the pH of the corneal surface after irrigation has begun. Irrigation should continue until the pH normalizes. Visual acuity can be assessed once the emergent phase is over.

The nurse is developing a plan of care for a client with Meniere's disease and identifies a nursing diagnosis of excess fluid volume related to fluid retention in the inner ear. Which intervention would be most appropriate to include in the plan of care? A. Limit foods that are high in sodium. B. Encourage intake of caffeinated fluids. C. Administer prescribed antihistamine. D. Restrict high-potassium foods.

A. Limit foods that are high in sodium. - Sodium and fluid retention disrupts the delicate balance between the endolymph and perilymph in the inner ear. Therefore, many clients can control their symptoms by adhering to a low-sodium diet. Caffeinated fluids are to be avoided because of their diuretic effect. Diuretics, not antihistamines, would be prescribed to lower the pressure in the endolymphatic system. Foods high in potassium would be encouraged if the client is prescribed a diuretic that causes potassium loss.

The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack? A. Meclizine (Antivert) B. Furosemide (Lasix) C. Cortisporin otic solution D. Gentamicin (Garamycin) intravenously

A. Meclizine (Antivert) - Pharmacologic therapy for Ménière's disease consists of antihistamines, such as meclizine, which shortens the attack (NIDCD, 2010).

Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following? A. Myopia B. Astigmatism C. Hyperopia D. Emmetropia

A. Myopia - Myopia, or nearsightedness, refers to the condition in which the client can see near objects but has blurred distant vision. Astigmatism is an irregularity in the curve of the cornea, which affects both near and distant vision. Hyperopia, or farsightedness, refers to the client's ability to see distant objects clearly but near objects as blurry. Emmetropia refers to normal eyesight in which the image focuses precisely on the retina.

Which condition is characterized by the formation of abnormal spongy bone around the stapes? A. Otosclerosis B. Middle ear effusion C. Chronic otitis media D. Otitis externa

A. Otosclerosis - Otosclerosis is more common in females than males and is frequently hereditary. A middle ear effusion is denoted by fluid in the middle ear without evidence of infection. Chronic otitis media is defined as repeated episodes of acute otitis media, causing irreversible tissue damage and persistent tympanic membrane perforation. Otitis externa refers to inflammation of the external auditory canal.

Which terms refers to the progressive hearing loss associated with aging? A. Presbycusis B. Exostoses C. Otalgia D. Sensorineural hearing loss

A. Presbycusis - Age-related changes of both the middle and inner ear result in hearing loss. Exostoses refer to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing and/or cranial nerve VIII.

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear? A. Scleral buckle B. Pars plana vitrectomy C. Pneumatic retinopexy D. Phacoemulsification

A. Scleral buckle - The scleral buckle is a procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. The other surgeries do not use this type of procedure.

A client is being treated for glaucoma. What is the rationale for the nurse's instruction to maintain regular bowel habits? A. Straining at stool increases intraocular pressure. B. The client's medications may lead to diarrhea. C. Problems with constipation may compound problems with lens clarity. D. The client's medications may cause constriction of all blood vessels, contributing to hemorrhoids.

A. Straining at stool increases intraocular pressure. - The client should maintain regular bowel habits because straining at stool can raise intraocular pressure (IOP). The other answers are distracters for this question.

Which of the following is the treatment of choice for acoustic neuromas? A. Surgery B. Radiation C. Chemotherapy D. Palliation

A. Surgery - Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherapy. There would be no need for palliation.

Which statement describes benign paroxysmal positional vertigo (BPPV)? A. The vertigo is usually accompanied by nausea and vomiting. B. The onset of BPPV is gradual. C. BPPV is caused by tympanic membrane rupture. D. BPPV is stimulated by the use of certain medications, such as acetaminophen.

A. The vertigo is usually accompanied by nausea and vomiting. - BPPV is a brief period of incapacitating vertigo that occurs when the position of the client's head is changed with respect to gravity. The vertigo is usually accompanied by nausea and vomiting; however, hearing impairment does not generally occur. The onset of BPPV is sudden and followed by a predisposition for positional vertigo, usually for hours to weeks but occasionally months or years. BPPV is thought to be caused by the disruption of debris within the semicircular canal. This debris is formed from small crystals of calcium carbonate from the inner ear structure, the utricle. BPPV is frequently stimulated by head trauma, infection, or other events.

Acoustic neuromas are benign tumors of which of the following cranial nerves? A. VIII B. VII C. VI D. V

A. VIII - Acoustic neuromas are slow-growing, benign tumors of cranial nerve VIII, usually arising from the Schwann cells of the vestibular portion of the nerve.

Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection? A. Viral B. Allergic C. Toxic D. Vernal

A. Viral - Viral conjunctivitis is usually preceded by symptoms of an upper respiratory infection. The other types of conjunctivitis are not usually preceded by symptoms of a respiratory infection.

Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa? A. Wear soft plastic earplugs. B. Wear a scarf. C. Avoid cold water. D. Insert a loose cotton earplug in the external ear.

A. Wear soft plastic earplugs. - The nurse should advise the client to wear soft plastic earplugs to prevent trapping water in the ear while swimming. Wear soft plastic earplugs to prevent trapping water in the ear while swimming. Cotton can be used, but if so it needs to be covered in petroleum jelly to prevent water from entering the external canal. Wearing a scarf does not help prevent or treat otitis externa. Swimming in cold water is not related to otitis externa.

A client has been diagnosed with myopia. In the treatment of myopia, what type of lenses will improve the client's vision? A. concave lenses B. convex lenses C. refractive lenses D. contact lenses

A. concave lenses - During retinoscopy, the vision of myopes improves when concave trial lenses correct the focusing power of the eyes.

A nurse is obtaining a history from a new client with glaucoma. The client indicates having read about the diagnosis and understanding that this type of glaucoma is due to the degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the aqueous humor. The loss of absorption will lead to an increased resistance, and thus a chronic, painless buildup of pressure in the eye. Which type of glaucoma has the client described? A. open angle B. angle closure C. congenital D. secondary

A. open angle - The client described open-angle glaucoma. This type of glaucoma develops painlessly, and visual changes occur slowly. As the IOP rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve.

The parent of a young client with severe hearing loss is quite concerned about the child's future independence because of impaired hearing. Which type of hearing loss is usually irreversible? A. sensorineural B. conductive C. tinnitus D. noise exposure

A. sensorineural - Sensorineural hearing loss usually is irreversible.

A client is scheduled to undergo surgery to remove a cataract in the left eye using phacoemulsification. When phacoemulsification is used, a: A. small portion of the anterior capsule is removed. Ultrasound is emitted through a probe, and suction is used to extract the lens. B. longer incision is made, and a laser is used to eradicate the cataract. Suction is then used to extract the lens. C. longer incision is made, and the lens is extracted in one piece. D. small incision is made, a laser is used to eradicate the cataract, and the lens is extracted in one piece.

A. small portion of the anterior capsule is removed. Ultrasound is emitted through a probe, and suction is used to extract the lens. - Phacoemulsification is the most common surgical procedure for cataract removal, also referred to as small incision cataract surgery. A small portion of the anterior capsule is removed, a small probe is inserted, and ultrasound waves are emitted through this device. Suction is used to extract the lens particles.

During discharge teaching the nurse realizes that the client is not able to read medication bottles accurately and has not been taking her medications consistently at home. How should the nurse intervene? A. Ask the social worker to investigate alternative housing arrangements. B. Ask the social worker to investigate community support agencies. C. Encourage the client to explore surgical corrections for the vision problem. D. Arrange for referral to a rehabilitation facility for vision training.

B. Ask the social worker to investigate community support agencies. - Managing low vision involves magnification and image enhancement through the use of low-vision aids and strategies and referrals to social services and community agencies serving those with visual impairment. Community agencies offer services to clients with low vision, which include training in independent living skills and a variety of assistive devices for vision enhancement, orientation, and mobility, preventing clients from needing to enter a nursing facility. A rehabilitation facility is generally not needed by the clients to learn to use the assistive devices or to gain a greater degree of independence. Surgical options may or may not be available to the client.

High doses of which medication can produce bilateral tinnitus? A. Meclizine B. Aspirin C. Promethazine D. Dimenhydrinate

B. Aspirin - At high doses, aspirin toxicity can produce bilateral tinnitus. Meclizine and dimenhydrinate are used for nausea and vomiting related to motion sickness. Antiemetics, such as promethazine suppositories, help control nausea and vomiting and vertigo through an antihistamine effect.

The nurse and a colleague are performing the Epley maneuver with a client who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action? A. Placing the client in a prone position B. Assisting the client into a sitting position C. Instilling 15 mL of warm normal saline into one of the client's ears D. Assessing the client's baseline hearing by performing the whisper test

B. Assisting the client into a sitting position - The Epley maneuver is performed by placing the client in a sitting position, turning the head to a 45-degree angle on the affected side, and then quickly moving the client to the supine position. Saline is not instilled into the ears and there is no need to assess hearing before the test.

The nurse is providing health education to a client newly diagnosed with glaucoma. The nurse teaches the client that this disease has a familial tendency. The nurse should encourage the client's immediate family members to undergo clinical examinations how often? A. At least monthly B. At least once every 2 years C. At least once every 5 years D. At least once every 10 years

B. At least once every 2 years - Glaucoma has a family tendency and family members should be encouraged to undergo examinations at least once every 2 years to detect glaucoma early. Testing on a monthly basis is excessive.

The nurse is caring for an older adult client who is frail in appearance. The client has been diagnosed with glaucoma and will be started on eye drops for the condition. Which medication would cause the nurse to call the health care provider before administering the first dose? A. Brinzolamide (Azopt) B. Brimonidine (Alphagan-P) C. Travoprost (Travatan-Z) D. Timolol (Betimol)

B. Brimonidine (Alphagan-P) - Brimonidine should be used with caution in frail elderly clients because it may cause confusion.

The nurse on the medical-surgical unit is reviewing discharge instructions with a client who has a history of glaucoma. The nurse should anticipate the use of what medications? A. Potassium-sparing diuretics B. Cholinergics C. Antibiotics D. Loop diuretics

B. Cholinergics - Cholinergics are used in the treatment of glaucoma. The action of this medication is to increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis and opening the trabecular meshwork. Diuretics and antibiotics are not used in the management of glaucoma.

A client has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the client should be kept in a prone position until otherwise ordered. What should the nurse do? A. Call the physician and ask for the order to be confirmed. B. Follow the order because this position will help keep the retinal repair intact. C. Instruct the client to maintain this position to prevent bleeding. D. Reposition the client after the first dressing change.

B. Follow the order because this position will help keep the retinal repair intact. - For pneumatic retinopexy, postoperative positioning of the client is critical because the injected bubble must float into a position overlying the area of detachment, providing consistent pressure to reattach the sensory retina. The client must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break. Clients and family members should be made aware of these special needs beforehand so that the client can be made as comfortable as possible. It would be inappropriate to deviate from this order and there is no obvious need to confirm the order.

The nurse is caring for a client who has undergone a mastoidectomy. In an effort to prevent postoperative infection, what intervention should the nurse implement? A. Teach the client about the risks of ototoxic medications. B. Instruct the client to protect the ear from water for several weeks. C. Teach the client to remove cerumen safely at least once per week. D. Instruct the client to protect the ear from temperature extremes until healing is complete.

B. Instruct the client to protect the ear from water for several weeks. - To prevent infection, the client is instructed to prevent water from entering the external auditory canal for 6 weeks. Ototoxic medications and temperature extremes do not present a risk for infection. Removal of cerumen during the healing process should be avoided due to the possibility of trauma.

A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? A. Changing the opacity of the lens B. Lowering intraocular pressure to target pressure C. Reducing the appearance of optic nerve head D. Increasing the visual field

B. Lowering intraocular pressure to target pressure - The main marker of the efficacy of the medication in glaucoma control is lowering of the intraocular pressure to the target pressure. Opacity of the lenses relates to cataract formation. The appearance of the optic nerve head and the visual field are not goals with glaucoma medication.

During his annual physical examination, a retired airplane mechanic reports noticeable hearing loss. The nurse practitioner prescribes a series of hearing tests to confirm or rule out noise-induced hearing loss, which is classified as a: A. Conduction problem. B. Sensorineural loss. C. Mixed cause. D. Psychogenic issue.

B. Sensorineural loss. - Noise-induced hearing loss refers to hearing loss that follows a long period of exposure to loud noise. It is inherent in jobs that involve heavy machinery, noisy engines, and artillery.

A client with Meniere's disease has a nursing diagnosis of risk for injury related to gait disturbances and vertigo. Which of the following would be most appropriate to include in this client's plan of care? A. Moving the head from side-to-side when vertigo occurs B. Sitting down at the first sign of feeling dizzy C. Closing the eyes when lying down during an episode of vertigo D. Performing self-care activities when the vertigo first starts

B. Sitting down at the first sign of feeling dizzy - For a nursing diagnosis of risk for injury, the client should sit down at the first sign of feeling dizzy. The client also should place a pillow on each side of the head to avoid movement, keep the eyes open, and stare straight ahead when lying down and perform self-care activity during vertigo-free periods.

A client is prescribed pilocarpine. When preparing the client's teaching plan about this drug, which of the following would the nurse integrate? A. It acts to decrease aqueous humor production. B. The client may experience difficulty seeing in the dark. C. The client's pupils will most likely be dilated. D. The client may experience a dry mouth and nose.

B. The client may experience difficulty seeing in the dark. - Pilocarpine is a miotic (cholinergic) agent that causes pupillary constriction and increased aqueous fluid outflow. It does not decrease aqueous humor production. Subsequently, the client may experience difficulty seeing in the dark. Dry nose and mouth are associated with alpha-adrenergic agents, such as apraclonidine or brimonidine.

When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is: A. A significant loss of central vision. B. Diminished acuity. C. Pain associated with a purulent discharge. D. The presence of halos around lights.

D. The presence of halos around lights. - Most patients are unaware that they have glaucoma until they experience visual changes and vision loss. Usually the patient notices blurred vision and the presence of "halos" around lights.

A nurse is giving discharge teaching to a client with an eye injury. Which statement about preventing eye injuries should the nurse include? A. "Use a lighter or matches if you need to look at a car battery at night." B. "When working in a workshop, you don't need to wear safety goggles unless you're the person using the tools." C. "Direct all spray nozzles away from your face before spraying." D. "Make sure you stand next to, not in front, of a moving lawn mower."

C. "Direct all spray nozzles away from your face before spraying." - The nurse should instruct the client to direct all spray nozzles away from his face before spraying. The nurse should instruct the client to use a flashlight if checking a car battery at night to decrease the risk of explosion. Safety goggles should be worn at all times in a workshop by everyone; flying debris can cause injuries at any time. The client should never stand next to or in front of a moving lawn mower. Debris can be ejected from the blades and cause injury.

After surgery for removal of cataract, a client is being discharged, and the nurse has completed discharge instruction. Which client statement indicates that the outcome of the teaching plan has been met? A. "I need to wear sunglasses for the first 3 to 4 days even when I'm inside." B. "Dots or flashing lights in my vision are to be expected for the first few days." C. "I should avoid pulling or pushing any object that weighs more than 15 lbs." D. "I need to keep the eye patch on for about a week after surgery."

C. "I should avoid pulling or pushing any object that weighs more than 15 lbs." - After cataract surgery, the client needs to avoid lifting, pulling, or pushing any object that weighs more than 15 pounds to prevent putting excessive pressure on the surgical site. Sunglasses should be worn when outdoors during the day because the eye is sensitive to light. Dots, flashing lights, a decrease in vision, pain, and increased redness need to be reported to the physician immediately. The eye patch is worn for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks.

The nurse just completed educating a client on hearing aid care. Which statement by the client indicates that the teaching was effective? A. "I will wash the entire hearing aid daily with soap and water." B. "I will notify the hearing aid dealer if the hearing aid whistles." C. "I will use a small pipe cleaner to clean the cannula on the hearing aid." D. "I will dry my ears with a cotton-tipped applicator before inserting the hearing aid."

C. "I will use a small pipe cleaner to clean the cannula on the hearing aid." - The cannula on the hearing aid should be cleaned with a small pipe cleaner or pipe cleaner-like object. Only the ear mold should be cleaned daily using soap and water; no other part of the hearing aid should be cleaned with soap and water. The client should be taught to troubleshoot if the hearing aid whistles. Many times the client can fix the issue when this happens. The ears should not be dried using a cotton-tipped applicator because it can cause trauma and lead to otitis externa.

. A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction? A. "Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours." B. "Try to ambulate independently after about 24 hours." C. "Shampoo your hair every day for 10 days to help prevent ear infection." D. "Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."

D. "Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days." - The nurse should instruct the client to avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes) for 30 days after a stapedectomy. Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The client's first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoid shampooing and swimming to keep the dressing and the ear dry.

Which symptoms may a client with Ménière disease report before an attack? A. Nystagmus B. Low blood pressure C. Photosensitivity D. A full feeling in the ear

D. A full feeling in the ear - Clients with Ménière disease experience symptoms of headache and a full feeling in the ear before an attack. Nystagmus is an episodic symptom that occurs during an attack, and, at times, the client is symptom free. Ménière disease does not cause low blood pressure or photosensitivity.

A client is being discharged home from the ambulatory surgical center after cataract surgery. In reviewing the discharge instructions with the client, the nurse instructs the client to immediately call the office if the client experiences what? A. Slight morning discharge from the eye B. Any appearance of redness of the eye C. A "scratchy" feeling in the eye D. A new floater in vision

D. A new floater in vision - Cataract surgery increases the risk of retinal detachment and the client must be instructed to notify the surgeon of new floaters in vision, flashing lights, decrease in vision, pain, or increase in redness. Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days after surgery.

A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother? A. Irrigate the ear canal with warm water to flush out the insect. B. Use an aural suction cup to pull out the insect. C. Insert a cotton-tipped applicator (e.g., Q-tip) to trap the insect and slowly pull the applicator backward. D. Instill a few drops of warmed mineral oil to cover the insect.

D. Instill a few drops of warmed mineral oil to cover the insect. - Removing a foreign body from the external auditory canal can be quite challenging. The three standard methods for removing foreign bodies are the same as those for removing cerumen: irrigation, suction, and instrumentation. Foreign vegetable bodies and insects tend to swell; thus, irrigation is contraindicated. Usually, an insect can be dislodged by instilling mineral oil, which will kill the insect and allow it to be removed.

A client with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education? A. Risk factors for postoperative cytomegalovirus (CMV) B. Compensating for vision loss for the next several weeks C. Nonpharmacologic pain management strategies D. Signs and symptoms of increased intraocular pressure

D. Signs and symptoms of increased intraocular pressure - Clients must be educated about the signs and symptoms of complications, particularly of increasing IOP and postoperative infection. CMV is not a typical complication and the patient should not expect vision loss. Vitreoretinal procedures are not associated with high levels of pain.

A client is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this client's care? A. Antioxidant supplements, vitamin C and E, beta-carotene, and selenium B. Eyeglasses or magnifying lenses C. Corticosteroid eye drops D. Surgical intervention

D. Surgical intervention - Surgery is the treatment option of choice when the client's functional and visual status is compromised. No nonsurgical (medications, eye drops, eyeglasses) treatment cures cataracts or prevents age-related cataracts. Studies recently have found no benefit from antioxidant supplements, vitamins C and E, beta-carotene, or selenium. Corticosteroid eye drops are prescribed for use after cataract surgery; however, they increase the risk for cataracts if used long-term or in high doses. Eyeglasses and magnification may improve vision in the client with early stages of cataracts, but have limitations for the client with impaired functioning.