Deck 52: Nursing Care of Patients With Sensory Disorders: Vision and Hearing

Question 1

The nurse is assisting with the auditory assessment phase of the physical examination for a high school swimming team. The nurse identifies a student who has pain and itching of the ear. The nurse would anticipate treatment for which of these disorders?

A)Chronic mastoiditis
B)External otitis
C)Furunculosis
D)Otitis media

Answer 1

External otitis

Question 2

The nurse is caring for a patient who has otitis media that develops into a chronic condition. The nurse should be observant for which of these complications?

A)Tonsillitis
B)Cerebral edema
C)Sore throat
D)Hearing loss

Answer 2

Hearing loss

Question 3

The nurse is caring for a patient who has been prescribed pilocarpine 1% eye drops every 6 hours. The nurse understands that which of these is the expected outcome for this medication?

A)Prevention of dryness of the cornea and conjunctiva
B)Reduction of inflammation of the iris and choroids
C)Dilation of the pupil by paralyzing the ciliary muscle
D)Promotion of drainage of aqueous humor from the anterior chamber of the eye

Answer 3

Promotion of drainage of aqueous humor from the anterior chamber of the eye

Question 4

The home health nurse visits a 74-year-old patient who lives alone and finds signs of possible visual impairment. Which of the following actions should the nurse recommend?

A)Make adjustments in lifestyle.
B)Avoid travel.
C)Schedule an eye examination.
D)Accept visual impairment as part of aging.

Question 5

The nurse is caring for a patient with acute angle glaucoma and a fractured femur who is scheduled for surgery. The nurse reviews the preoperative medications, which are morphine 10 mg intramuscularly (IM), and atropine 0.4 mg IM. Which of these actions would be appropriate for the nurse to take?

A)Collect data on patient's pain.
B)Contact the physician.
C)Hold the morphine.
D)Give medications as ordered.

Question 6

The nurse is caring for a patient after a left stapedectomy. When the patient is returned from surgery, which of the following positions should the nurse chose?

A)Left ear upward
B)Right ear upward
C)Flat
D)Prone

Question 7

The nurse is reinforcing teaching for a patient with open-angle glaucoma. Which of the following statements is most important to include in the patient teaching?

A)Compliance with drug therapy is essential to prevent loss of vision.
B)Damage to the eye caused by glaucoma is reversible in early stages.
C)Regardless of treatment, peripheral vision will be eventually lost.
D)Eye pain is experienced until the optic nerve atrophies, causing blindness.

Question 8

The nurse is teaching a patient with glaucoma how to instill eyedrops. The nurse would instruct the patient to take which of the following actions?

A)Look straight ahead while pulling down the lower eyelid.
B)Look up while pulling lower lid outward.
C)Squeeze the eyelids shut for 2 minutes after instillation.
D)If the eye waters, wipe from the outer canthus to the inner canthus.

Question 9

The nurse is collecting data for a patient who has Ménière's disease. Which of these findings should the nurse expect?

A)Nystagmus, nausea, and edema
B)Blurred vision, vomiting, and arthralgia
C)Syncope, headache, and diplopia
D)Hearing loss, vertigo, and tinnitus

Question 10

The nurse is collecting data for a patient who has a bulging eardrum. The nurse recognizes that this indicates which of the following?

A)Otitis media
B)Hematoma in the middle ear
C)External ear infection
D)Normal tympanic membrane

Question 11

The nurse is caring for a patient who has an acute attack of Ménière's disease. What action should the nurse take first?

A)Administer prescribed diuretics.
B)Ensure that the patient is on fluid restriction.
C)Help the patient into bed with side rails up.
D)Administer an antianxiety medication.

Question 12

The nurse is contributing to the plan of care for a patient who had a myringoplasty. The postoperative plan of care should include what nursing intervention?

A)Restricting fluids
B)Encouraging visitors to speak loudly
C)Avoiding excessive movement
D)Coughing each hour

Question 13

The nurse is collecting data for a patient with a report of vision loss. Which of these symptoms does the nurse understand is most indicative of cataract formation?

A)Loss of visual acuity
B)Loss of central vision
C)Floating filaments in vision
D)Visual fatigue

Question 14

The nurse is caring for a patient who has macular degeneration. The patient's caregiver becomes increasingly frustrated with the patient due to food spills on the patient's clothing. Which of these explanations would help the caregiver understand what the patient is experiencing?

A)"The patient's vision is blurred."
B)"The central vision is gone and only peripheral vision remains."
C)"There is total blindness in one eye occurring."
D)"There are black dots in the field of vision that cause confusion."

Question 15

The nurse is assisting with the discharge of a patient from a clinic after evaluation of a perforated eardrum. The patient is advised not to shower. Which of these, if stated by a patient, indicates to the nurse correct understanding of the teaching?

A)Showering would disturb equilibrium.
B)Water should not enter the ear.
C)Motion of the ear would cause pain.
D)The patient should move as little as possible.

Question 16

The nurse is caring for a patient who has been diagnosed with myopia and asks what it is. How should the nurse respond?

A)"It is farsightedness."
B)"It is blindness."
C)"It is nearsightedness."
D)"It is cataract development."

Question 17

The nurse is collecting data for a patient with an inner ear disorder. Which of these findings is most concerning to the nurse?

A)Nausea
B)Headache
C)Otalgia
D)Vertigo

Question 18

The nurse is caring for a patient who had a stapedectomy. What is the priority nursing action to maintain safety?

A)Have patient cough and deep breathe.
B)Put the side rails up.
C)Check for drainage.
D)Test hearing capability.

Question 19

A patient asks the nurse, "What causes cataracts in older people?" Which of these statements should form the basis for the nurse's response?

A)"Cataracts usually result from chronic systemic diseases."
B)"Cataracts may form as a result of exposure to ultraviolet light over time."
C)"Cataracts are believed to result from eye injuries sustained early in life."
D)"Cataracts usually result from the prolonged use of toxic substances."

Question 20

An 85-year-old individual is seen at a clinic after a relative notices that the patient sits about 2 feet away from the television and is not interested in going out anymore. Which of these findings supports visual impairment?

A)The patient watches television.
B)The patient does not go out anymore.
C)The patient has not moved to a new home in 45 years.
D)The patient visits with a relative occasionally.

Question 21

The nurse finds a patient with Ménière's disease crying and saying, "I don't understand why this is happening to me." Which of these outcomes is most appropriate for the nurse to recommend for the patient's plan of care?

A)Maintain fluid volume.
B)Prevent injury.
C)Prevent ear infection.
D)Decrease anxiety.

Question 22

The nurse is reinforcing teaching for a patient after a stapedectomy. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"I will avoid airplane travel for 6 months."
B)"I will keep the ear moist by packing it with cotton balls."
C)"I will gently blow my nose with both sides open."
D)"I will cough or sneeze with my mouth open."

Question 23

The nurse is to perform an ear irrigation to remove cerumen on a patient. Which of the following does the nurse understand would contraindicate this procedure?

A)Previous external ear infection
B)Previous hearing loss
C)Previous perforated eardrum
D)Chronic, severe earache

Question 24

A patient with diabetic retinopathy is being discharged home. Which patient statement indicates understanding of the discharge plan to maintain vision?

A)"I should reduce my insulin dosage."
B)"I should avoid being in the sun."
C)"I will need to schedule routine eye examinations every 3 years."
D)"I should keep my diabetes under control."

Question 25

The nurse is teaching a patient about conjunctivitis. Which of these, if stated by a patient, indicates to the nurse correct understanding of the most important means to prevent spread of conjunctivitis?

A)"Patch the eyes."
B)"Wash hands."
C)"Irrigate the eyes."
D)"Keep the eyes moist."

Question 26

The nurse is reinforcing teaching for a patient with Ménière's disease. Which of these discharge orders would the nurse question?

A)Increase daily sodium intake to 4 g.
B)During an attack, lie down and keep head still.
C)Ask for assistance when ambulating.
D)Return if symptoms worsen.Completion
Complete each statement.

Question 27

The nurse is reinforcing teaching for a patient who has just been diagnosed with Ménière's disease. Which of these, if stated by a patient, indicates to the nurse correct understanding of how to manage the vertigo?

A)"Increase sodium intake."
B)"Increase fluid intake."
C)"Avoid sudden movement."
D)"Listen to soft music."

Question 28

The nurse is having difficulty communicating with a hearing-impaired patient. Which of these nursing actions is most important?

A)Speaking softly
B)Facing the patient when speaking
C)Avoiding verbal communication
D)Speaking rapidly

Question 29

The nurse is reinforcing teaching for symptoms to report for a patient with primary open-angle glaucoma (POAG). Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"Hypotension and bradycardia."
B)"Fever and reddened conjunctiva."
C)"Headache and seeing halos around lights."
D)"Loss of central vision and dizziness."

Question 30

After surgery for a detached retina, a patient is experiencing nausea and is prescribed prochlorperazine (Compazine), 10 mg IM prn every 6 hours. Compazine is available as 5 mg/mL. The nurse should administer ________________mL in each dose.

Question 31

The nurse is reinforcing teaching for a patient being treated for myopia. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)Corrective concave lenses
B)Cataract surgery
C)Mydriatic ophthalmic drops
D)Corrective convex lenses

Question 32

The nurse is caring for a patient who is to have cataract surgery. The patient says, "Are you sure this surgery is safe?" Which of the following nursing actions is most appropriate?

A)Ask the surgeon to talk to the patient.
B)Give the patient a sedative for relaxation.
C)Encourage visitors to distract the patient.
D)Reassure the patient that everything will be all right.