Deck 22: Disorders of Hemostasis

Question 1

A care aide at a long-term care facility has informed a resident physician that a 80-year-old woman's eyes appear to be inflamed and that her eyelids are caked with sticky secretions. The woman has been subsequently diagnosed with posterior blepharitis. Which of the following treatments is the physician likely to initiate?

A) Surgical repair of the woman's blocked meibomian glands
B) Warm compresses to be applied regularly to her eyes in addition to oral antibiotics
C) Regularly scheduled cleansing of the woman's eyes with normal saline
D) Intravenous steroids coupled with topical antibiotic ointment

Answer 1

Warm compresses to be applied regularly to her eyes in addition to oral antibiotics

Question 2

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?

A) "The insides of her eyelids have become infected. This often produces severe discomfort."
B) "The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away."
C) "An antibiotic ointment will likely resolve her infection, but pain control will be necessary in the mean time."
D) "It's important to aggressively treat this in children, since damage to her sight can result if it's not treated."

Answer 2

"The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away."

Question 3

A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition was a corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom?

A) Burning
B) Itching
C) Photophobia
D) Severe pain

Answer 3

Severe pain

Question 4

A 30-year-old woman has sought care because of her recurrent photophobia, tearing, and eye irritation. During assessment, her care provider asks about any history of cold sores or genital herpes. What is the rationale for the care provider's line of questioning?

A) Herpes simplex virus (HSV) conjunctivitis indicated a need for antiviral rather than antibacterial treatment.
B) HSV infection of the cornea is a common cause of corneal ulceration and blindness.
C) Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia.
D) A history of HSV with eye irritation is suggestive of glaucoma.

Question 5

Which of the following preoperative teaching points related to corneal transplantation is most justified?

A) "You should know that there is a significant risk that your body will reject the transplant."
B) "The cornea is highly vascular, and therefore you will be at risk for hemorrhage."
C) "Your new cornea would come from someone who has recently died."
D) "You run a risk of developing a major inflammatory response post-op and will need frequent follow-up appointments."

Question 6

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.

A) Oculomotor nuclei
B) Retinal ganglionic cells
C) Preganglionic neurons
D) Pretectal nuclei

Question 7

During a physical exam, the nurse practitioner notes that the patient's optic disk is very pale with a larger size/depth of the optic cup. At this point, they are thinking the patient may have

A) glaucoma.
B) diabetes retinopathy.
C) macular degeneration.
D) retinal tear.

Question 8

A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The client tells the triage nurse that he received eye drops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect?

A) Infectious conjunctivitis
B) Keratitis
C) Corneal trauma
D) Angle-closure glaucoma.

Question 9

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?

A) A 17-year-old high school student who has a red, itchy eye
B) A 55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision
C) A 45-year-old school teacher complaining of a red eye that is draining yellow secretions
D) An infant with red eyes who is irritable and refusing to eat

Question 10

If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This patient would be diagnosed as having

A) hyperopia.
B) myopia.
C) cycloplegia.
D) presbyopia.

Question 11

Which of the following individuals would be considered at high risk for developing cataracts? Select all that apply.

A) An 88-year-old female with osteoporosis and congestive heart failure
B) A 51-year-old female whose rheumatoid arthritis is controlled with oral corticosteroids
C) A 50-year-old male who takes nebulized bronchodilators four times daily for the management of his emphysema
D) A 39-year-old woman with a history of open-angle glaucoma and poorly controlled diabetes
E) A 29-year-old artist who spends long hours in sunlight painting landscapes

Question 12

A 37-year-old male has survived a logging accident in which the severing of his femoral artery and consequent blood loss resulted in cardiogenic shock. On recovery, one of the deficits that he finds most frustrating is a significant loss of visual acuity. Which is the most likely rationale for his vision damage?

A) Decreased cerebral perfusion results in progressive damage to the optic nerve.
B) Circulatory collapse causes rapid death of retinal neurons.
C) Lack of oxygen results in a distortion of the fovea.
D) The visual cortex is susceptible to hypoxic necrosis.

Question 13

Which of the following patients would be considered high risk for developing papilledema? Select all that apply.

A) A 2-year-old patient who has a shunt placed following delivery where he was diagnosed with hydrocephalus
B) A 55-year-old male with substernal chest pain radiating down both arms and experiencing nausea
C) A 43-year-old male with diabetes, renal insufficiency, and BP 200/107
D) A 25-year-old motorcyclist who was in an accident and has a potential subdural hematoma
E) An 18-year-old female complaining of severe cramps with her menstrual bleeding

Question 14

A 31-year-old female has been recently diagnosed with type 2 diabetes mellitus and is attending a diabetes education class. Which of the following statements by the woman demonstrates an accurate understanding of her health problem?

A) "I'll have to control my blood sugars, my blood pressure, and my cholesterol in order to make sure I don't develop sight problems."
B) "I'm grieving the fact that I won't be able to get pregnant without causing permanent damage to my vision."
C) "It's surprising that sugar in my blood can accumulate on the lens of my eye and cause a loss of sight."
D) "I want to avoid going through the treatments for sight restoration that I would need if my diabetes causes damage to my vision."

Question 15

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 her teenager go to the emergency department immediately.

A) Glaucoma
B) Strabismus
C) Retinal detachment
D) Macular degeneration

Question 16

A public health nurse is teaching a health promotion class to a group of older adults at a seniors' center. A woman attending states that, "My husband has got dry macular degeneration, and I don't know what we're going to do when he goes blind from it." How can the nurse best respond to the woman's statement?

A) "Vitamins C and E as well as zinc and beta carotene may have some value in slowing the progression of his disease."
B) "You should talk to your doctor about the surgical options that might help preserve his sight."
C) "If your husband can lower his blood pressure and bad cholesterol, it can possibly slow the progression of his disease."
D) "Cataract surgery is showing promise as a way of replacing the part of the eye associated with macular degeneration."

Question 17

A patient has sought medical attention because of a loss of different half-fields in the two eyes. Knowing the potential causes of this complaint, the nurse anticipates that the physician will order tests looking for

A) metal fragments in the eyes.
B) hemorrhages in the capillaries of both eyes.
C) an enlarging pituitary tumor.
D) subarachnoid hemorrhage.

Question 18

As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response?

A) Cranial nerve I
B) Cranial nerve III
C) Cranial nerve VI
D) Cranial nerve IV

Question 19

A 4-month-old infant and his mother are at an appointment with a pediatrician to follow up his nonaccommodative strabismus and to determine a treatment plan. Which of the following treatments is most likely to prevent future loss of vision?

A) Prescribing glasses once the infant is 6 months of age
B) Use of beta-adrenergic blockers and latanoprost eye drops
C) Regularly scheduled eye exams and monitoring of self-correction of his eyes
D) Surgical correction of the musculature

Question 20

A 3-year-old girl has been diagnosed with amblyopia. Which of the following pathophysiological processes is most likely to underlie her health problem?

A) The child may have a congenital deficit of rods and/or cones.
B) The girl may have chronic bacterial conjunctivitis.
C) She may have been born with infantile cataracts.
D) The child may have a neural pathway disorder.