Question 1

The nurse notes that nursing assistive personnel (NAP) perform all the following actions when caring for a patient with Ménière's disease who is experiencing an acute attack. Which action by NAP indicates that the nurse should intervene immediately?

Accepted Answer

Watching television may exacerbate the symptoms of an acute attack of Ménière's disease. The other actions are appropriate.

Question 2

A patient is scheduled for a right cataract extraction and intraocular lens implantation at an ambulatory surgical center in 2 weeks. During the preoperative assessment of the patient in the physician's office, it is most important for the nurse to assess

Accepted Answer

Because it can take several weeks before the maximum improvement in vision occurs in the right eye, patient safety and independence are determined by the vision in the left eye. Cataract surgery is done using local anesthetics rather than general anesthetics. A white pupil in the operative eye would not be unusual for a patient scheduled for cataract removal and lens implantation. The length of time that the patient has had the cataract will not impact on the perioperative care.

Question 3

A patient who had cataract extraction and intraocular lens implantation the previous day calls the eye clinic and gives the nurse all of the following information. Which information is the priority to communicate to the health care provider?

Accepted Answer

Postoperative cataract surgery patients usually experience little or no pain, so pain at a 5 on a 10-point pain level may indicate complications such as hemorrhage, infection, or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching but does not indicate that complications of the surgery may be occurring.

Question 4

Which assessment finding in a patient who was struck in the right eye with a baseball is a priority for the nurse to communicate to the health care provider in the emergency department?

Accepted Answer

The patient's sensation that a curtain is coming across the field of vision suggests retinal detachment and the need for rapid action to prevent blindness. The other findings would be expected with the patient's history of being hit in the eye with a ball.

Question 5

Which information about a patient who had a stapedotomy yesterday is most important for the nurse to communicate to the health care provider?

Accepted Answer

An elevated temperature may indicate a postoperative infection. Although the nurse would report all the data, a temporary decrease in hearing, bloody drainage on the dressing, and a feeling of congestion because of the accumulation of blood and drainage in the ear are common after this surgery.

Question 6

When the nurse is admitting a 78-year-old patient, the patient repeatedly asks the nurse to "speak up so that I can hear you." Which action should the nurse take?

Accepted Answer

Patient understanding of the nurse's speech will be enhanced by speaking at a normal tone, but more slowly. Increasing the volume, overenunciating, and exaggerating facial expressions will not improve the patient's ability to comprehend the nurse.

Question 7

The priority nursing diagnosis for a patient with Ménière's disease who is experiencing an acute attack is

Accepted Answer

All the nursing diagnoses are appropriate, but because sudden attacks of vertigo can lead to "drop attacks," the major focus of nursing care is to prevent injuries associated with dizziness.

Question 8

A patient with hearing loss asks the nurse about the use of a cochlear implant. Which information will the nurse include when replying to the patient?

Accepted Answer

Extensive rehabilitation is required after cochlear implants in order for patients to receive the maximum benefit. Hearing aids, rather than cochlear implants, are used initially for presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be helpful for conductive loss. They are appropriate for some patients with congenital deafness.

Question 9

These medications are prescribed by the health care provider for a patient who has just been admitted to a hospital with acute angle-closure glaucoma. Which medication should the nurse give first?

Accepted Answer

The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly with IV administration of a hyperosmolar diuretic such as mannitol. The other medications also are appropriate for a patient with glaucoma but would not be the first medication administered.

Question 10

Which information will the nurse include when teaching a patient with keratitis caused by herpes simplex type 1?

Accepted Answer

Oral acyclovir may be ordered for herpes simplex infections. Corticosteroid ointments are usually contraindicated because they prolong the course of the infection. Although Betadine gel may be applied to the skin around the eyes for herpes zoster (varicella) infections, it is not used for herpes simplex infections. NSAIDs can be used to treat the pain associated with keratitis.

Question 11

A patient with a head injury after a motor vehicle accident arrives in the emergency department ( ED ) complaining of shortness of breath and severe eye pain. Which action will the nurse take first?

Accepted Answer

The priority action for a patient after a head injury is to assess and maintain airway and breathing. Because the patient is complaining of shortness of breath, it is essential that the nurse assess the oxygen saturation. The other actions also are appropriate but are not the first action the nurse will take.

Question 12

An older adult patient with presbycusis is fitted with binaural hearing aids. Which information will the nurse include when teaching the patient how to use the hearing aids?

Accepted Answer

Initially the patient should use the hearing aids in a quiet environment like the home, experimenting with increasing and decreasing the volume as needed. There is no need to gradually increase the time of wear. The patient should experiment with the level of volume to find what works well in various situations. Both hearing aids should be used.

Question 13

The home health nurse observes a patient taking these actions when self-administering eardrops. Which patient action indicates a need for more teaching?

Accepted Answer

Administration of cold eardrops can cause dizziness because of stimulation of the semicircular canals. The other patient actions are appropriate.

Question 14

Which of these nursing activities is appropriate for the RN working in the eye clinic to delegate to experienced nursing assistive personnel (NAP)?

Accepted Answer

Application of cold and warm packs is included in NAP education and the ability to accomplish this safely would be expected for a nursing assistant working in an eye clinic. Medication administration, patient teaching, and assessment are high-level skills appropriate for the education and legal practice level of the RN.

Question 15

Which teaching will the nurse implement for a patient who has just been diagnosed with viral conjunctivitis?

Accepted Answer

Hand washing is the major means to prevent the spread of conjunctivitis. Antiviral drops and eye irrigation will not be helpful in shortening the disease process. Contact lenses should not be used when patients have conjunctivitis because they can further irritate the conjunctiva.

Question 16

Which action should the RN who is working in the eye and ear clinic delegate to an LPN/LVN?

Accepted Answer

Using standardized screening tests such as a Snellen chart to test visual acuity is included in LPN education and scope of practice. Evaluation, assessment, and patient education are higher level skills that require RN education and scope of practice.

Question 17

The nurse at the outpatient surgery unit obtains all of this information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information has the most immediate implications for the patient's care?

Accepted Answer

Mydriatic medications used for pupil dilation are sympathetic nervous system stimulants and may increase heart rate and blood pressure. Using punctal occlusion when administering the mydriatic and monitoring of blood pressure are indicated for this patient. Patients are expected to be NPO for 6 to 8 hours before the surgical procedure. Blurred vision is an expected finding with cataracts. Cataract extraction and intraocular lens implantation are done using local anesthesia.

Question 18

The charge nurse observes a newly hired nurse performing all of the following interventions for a patient who has just arrived in the postanesthesia care unit after having right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene?

Accepted Answer

Because coughing will increase intraocular pressure, patients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a patient after having this surgery.

Question 19

The camp nurse is caring for a patient who is complaining of bilateral eye pain after a campfire log exploded, sending sparks into the patient's eyes. Which of these actions will the nurse take first?

Accepted Answer

Emergency treatment of a burn or foreign-body injury to the eyes includes protecting the eyes from further injury by covering them with dry sterile dressings and protective shields. Flushing of the eyes immediately is indicated only for chemical exposure. Except in the case of chemical exposure, the nurse should not begin treatment until the patient has been assessed by a health care provider and orders are available.

Question 20

When admitting a patient for surgery, the nurse learns that the patient has functional blindness and that the spouse has cared for the patient for many years. During the initial assessment of the patient, it is most important for the nurse to

Accepted Answer

Making eye contact with a partially sighted patient allows the patient to hear the nurse more easily and allows the nurse to assess the patient's facial expressions. The patient (rather than the spouse) should be asked about any need for assistance. The information about the cause of the vision loss and assessment of the patient's visual acuity are not priorities during the initial assessment.

Quiz 22: Nursing Management: Visual and Auditory Problems