Deck 24: Nursing Management: Visual and Auditory Problems

Question 1

In reviewing a 50-year-old man's medical record,the nurse notes that his last eye examination revealed an IOP of 28 mm Hg.Which of the following questions is it most appropriate for the nurse to ask the patient?

A) "How long have you had to wear glasses?"
B) "Do you see light flashes or floaters in your vision?"
C) "Have you noticed blind spots in your field of vision?"
D) "Do you use eye drops prescribed by an ophthalmologist?"

Answer 1

"Do you use eye drops prescribed by an ophthalmologist?"

Question 2

A 68-year-old man with an extensive left retinal detachment is scheduled for a scleral buckling with cryopexy and pneumatic retinopexy.Preoperatively,the nurse prepares the patient for postoperative expectations by explaining which of the following?

A) He will need to wear dark or tinted glasses to protect his eyes from ultraviolet light.
B) He will have to wear bilateral eye patches to reduce movement of the operative eye.
C) He will not have a return of lost vision,but the surgery will prevent further loss of vision in his left eye.
D) He will have to maintain a prescribed head position to maintain contact of the bubble with the retinal break.

Answer 2

He will have to maintain a prescribed head position to maintain contact of the bubble with the retinal break.

Question 3

A 74-year-old woman has worn corrective lenses most of her life to correct myopia,and for the last several years,she has had bifocals to correct presbyopia.What does the nurse recognize that the patient's lenses are used to achieve?

A) Improvement in near vision
B) Improvement in distance vision
C) Strengthening of the eye muscles
D) Improvement in both near and distance vision

Answer 3

Improvement in both near and distance vision

Question 4

A counsellor at a camp for children with diabetes was tending a campfire when a log exploded,sending sparks into his eyes.Initially,as the camp nurse,what should the nurse do?

A) Apply ice packs to the eyes.
B) Flush the eyes with cool,sterile,normal saline for 10 minutes.
C) Cover the eyes with dry,sterile patches and protective eye shields.
D) Apply an antiseptic ophthalmic ointment from the first aid kit to the eyes.

Question 5

A patient who was struck in the right eye with a handball while playing without the use of protective eyewear has pain and swelling around the orbit and loss of central vision.On assessment of the patient,the nurse suspects the presence of a retinal detachment on the patient's report of which of the following data?

A) Severe eye pain
B) Abnormal colour perception
C) Glare and halos around lights
D) Light flashes in the affected eye

Question 6

Which of the following would the nurse teach a patient who asks how to prevent the development of cataracts?

A) Wear sunglasses when in the sun.
B) There are no proven preventative measures.
C) An appropriate intake of vitamins B and D is important.
D) Wear shaded glasses when using a computer.

Question 7

A patient is seen at a clinic for repeated hordeolum of her eyes during the last 6 months.To help prevent further infection,what should the nurse advise the patient to do?

A) Discard all open or used eye cosmetics.
B) Avoid wearing contact lenses as much as possible.
C) Use an antiseborrheic shampoo on the scalp and eyebrows.
D) Be evaluated for the presence of sexually transmitted infections.

Question 8

A patient is diagnosed with adult inclusion conjunctivitis (AIC)caused by the Chlamydia trachomatis organism.In teaching the patient about his disorder,what should the nurse explain?

A) This disorder may progress to trachoma,a blindness-producing keratoconjunctivitis.
B) The infection is usually self-limiting,but antiviral eye drops help shorten the course of the infection.
C) The conjunctivitis can be easily treated with antibiotics and should not recur if good hand-eye hygiene is maintained.
D) The disorder is highly associated with genital chlamydia,and he should be evaluated for sexually transmitted Chlamydia.

Question 9

A young woman asks the nurse at a local health fair for information about LASIK as a method of refractive correction.The young woman has very thick,concave lenses in her glasses.What is the best response to the young woman?

A) "This procedure probably would not be appropriate for you since you appear to be hyperopic rather than myopic."
B) "The LASIK procedure is a highly successful surgery for treating refractive errors of vision with virtually no risks or complications."
C) "Various types of surgery effectively treat refractive errors,and you should consult an ophthalmologist about what is best for you."
D) "Surgical correction of refractive errors is a highly controversial procedure among ophthalmic specialists,and it cannot be recommended at this time."

Question 10

A patient is prepared for discharge following outpatient cataract surgery.To evaluate whether the patient understands the postoperative regimen and procedures,what should the nurse ask the patient to do?

A) Rate his pain on a scale of 0 to 10.
B) Explain the purpose of the prescribed medication.
C) Describe how well he can see with the operative eye.
D) Indicate who will be caring for him at home for the first 24 hours.

Question 11

A 78-year-old woman has age-related macular degeneration and has undergone laser photocoagulation without significant improvement in her vision.The ophthalmologist has told her that further treatment is not warranted.What is an appropriate outcome for the nurse to plan with the patient?

A) The patient plans for institutional care when blindness becomes total.
B) The patient uses optical and nonoptical methods for vision enhancement.
C) The patient comes to accept the visual impairment and eventual blindness.
D) The patient verbalizes the need to seek a second opinion regarding her condition.

Question 12

What type of strabismus does the patient have when he describes his symptom as his right eye looking in toward his nose?

A) Esotropia
B) Exotropia
C) Hypotropia
D) Hypertropia

Question 13

The nurse answers the call light of a newly admitted patient.The patient tells the nurse she is blind and asks the nurse to assist her to the bathroom.To assist the patient,how should the nurse proceed?

A) Take the patient by the arm,and lead her slowly to the bathroom.
B) Walk slightly ahead of the patient,and allow the patient to hold your elbow.
C) Lead the patient to the bathroom by the hand,describing the location and providing verbal cues.
D) Give the patient exact descriptive directions to the bathroom so that she can walk there independently.

Question 14

During a routine health examination at the clinic,the patient tells the nurse that he is legally blind.In planning care for the patient,what does the nurse recognize?

A) The patient probably has some light perception but no usable vision.
B) No vision enhancement techniques would be appropriate for the patient because he has a total lack of vision.
C) Further assessment is needed to determine how the patient's visual impairment affects his normal functioning.
D) The patient would be expected to have some usable vision,which enables him to function at an acceptable level.

Question 15

In teaching a patient with POAG about the disorder,what should the nurse explain?

A) The retinal nerve is damaged by an abnormal increase in the production of aqueous humor.
B) Aqueous humor produced in the eye cannot drain from the eye,causing pressure damage to the optic nerve.
C) Lens enlargement that occurs normally with aging pushes the iris forward,covering the outflow channels of the eye.
D) The flow of aqueous humor into the anterior chamber is decreased by the lens of the eye blocking the pupillary opening.

Question 16

A patient with herpes simplex type I keratitis of the left eye is very concerned about his diagnosis and is afraid his right eye will become involved.What should the nurse advise the patient to do,to prevent spread of the infection?

A) Apply an occlusive dressing to the affected eye.
B) Avoid touching the eye,and wash the hands frequently and thoroughly.
C) Use the eye drops prescribed for the left eye in the right eye as well for a prophylactic measure.
D) Use disposable tissues to wash the drainage from the affected eye frequently,discarding the tissues in a covered container.

Question 17

A 48-year-old woman is found to have early presbyopia on examination by her ophthalmologist.The patient asks the nurse whether she is losing her sight like her mother,who has age-related macular degeneration.What is the nurse's best response to the patient?

A) "Both of these disorders are age related and may cause eventual loss of vision."
B) "These two disorders are not related,and you have no risk factors for age-related macular degeneration."
C) "Presbyopia is an age-related loss of elasticity of the lens and is not the same as age-related macular degeneration."
D) "Presbyopia is the early stage of age-related macular degeneration,but you have many years before your vision will be seriously impaired."

Question 18

During postoperative teaching for a patient with a cataract extraction and intraocular lens implantation,what instructions should the nurse give the patient?

A) Normal activities can be resumed on return home.
B) In several weeks,aphakic glasses will be prescribed to enhance her vision.
C) The physician should be notified if increasing pain in the operative eye occurs.
D) Normal vision should be present when the eye patch is removed postoperatively.

Question 19

A 72-year-old man is admitted to the hospital for elective surgery.As the nurse prepares to perform an initial assessment of the patient,the patient's wife tells the nurse that her husband is functionally blind and that she has cared for him for years.During the initial assessment of the patient,what is it important for the nurse to do?

A) Ask the patient's wife about the cause of her husband's loss of vision.
B) Make eye contact with the patient,and ask him what assistance he needs.
C) Obtain as much information as possible from the wife about the patient's special needs.
D) Perform an evaluation of the patient's visual acuity,and schedule an ophthalmic examination.

Question 20

Primary open-angle glaucoma (POAG)is diagnosed in a middle-aged woman during a routine examination by her ophthalmologist.During the initial assessment of the patient,what would the nurse expect the patient history to include?

A) Blurred vision
B) No symptoms of pain or pressure
C) Seeing coloured halos around lights
D) Eye pain accompanied by nausea and vomiting

Question 21

A patient is hospitalized with acute angle-closure glaucoma.What immediate collaborative care would the nurse anticipate?

A) Administration of analgesics
B) Administration of cycloplegics
C) Administration of cholinergic agents
D) Preparation for a surgical iridectomy

Question 22

A patient with Ménière's disease is totally incapacitated by vertigo and is lying rigidly in bed,grasping the siderails,and staring at the television.What is an appropriate nursing intervention to decrease the patient's vertigo?

A) Encouraging fluids to 3000 mL/day
B) Changing the patient's position every 2 hours
C) Keeping the head of the bed elevated 30 degrees
D) Turning off the television set and darkening the room

Question 23

The physician places an ear wick in the external ear canal and prescribes antibiotic otic drops for a patient with external otitis.Before the patient leaves the clinic,the nurse reviews the management of the disorder and determines that the patient needs additional instruction when the patient makes which of the following statements?

A) "I may use aspirin for the pain."
B) "I should clean my ear canal daily with a cotton-tipped applicator."
C) "I may use warm compresses to the outside of my ear for comfort."
D) "I should apply the eardrops to the cotton wick placed in my ear canal."

Question 24

Which following central vision acuity finding would indicate legal blindness?

A) 20/50
B) 20/100
C) 20/150
D) 20/200

Question 25

A patient is admitted to the surgical unit in preparation for vein stripping and ligation for varicose veins.During the admission history,the patient tells the nurse that she has narrow-angle glaucoma and will need to continue her eye drops while hospitalized.For this patient,what preoperative order should the nurse question?

A) Atropine (Isopto Atropine)0.4 mg intramuscularly (IM)on call to the operating room (OR)
B) Morphine sulphate 10 mg IM on call to the OR
C) Betaxolol (Betoptic)1 drop in each eye on the morning of surgery
D) Diazepam (Valium)5 mg orally on the morning of surgery with sips of water

Question 26

Timolol (Timoptic)ophthalmic drops are prescribed for a patient with open-angle glaucoma.After using the drops for several days,the patient tells the nurse that the eye drops cause her vision to become blurry for a period of time.What is the best response to the patient's complaint?

A) "These are normal side effects of the medication,which should become less noticeable with time."
B) "If you occlude the puncta after you administer the drops,it will help relieve these side effects."
C) "These symptoms are related to the glaucoma and may indicate a need for increased dosage of eye drops."
D) "The drops are uncomfortable,but it is very important for you to continue using them as prescribed to retain your vision."

Question 27

What would the nurse document as an appropriate nursing diagnosis for a patient with Ménière's disease who has an acute attack of vertigo,nausea and vomiting,and ringing in the ears?

A) Risk for injury related to dizziness
B) Impaired verbal communication related to hearing loss
C) Risk for altered health maintenance related to inability to care for self
D) Disturbed auditory sensory perception related to increased middle-ear pressure

Question 28

When teaching a patient about the administration of eye drops,the nurse instructs the patient to close his eye and apply gentle pressure with his fingers to the inside corner of the eye for which length of time?

A) 20 to 30 seconds
B) 1 to 2 minutes
C) 2 to 3 minutes
D) 4 to 5 minutes

Question 29

A patient with refractory congestive heart failure has been receiving large doses of intravenous furosemide (Lasix)and oral spironolactone (Aldactone)for 5 days.One morning,the patient tells the nurse he has ringing in his ears and does not seem to hear very well.What is the most appropriate nursing action?

A) Arrange for the patient to have his hearing tested with audiometry.
B) Withhold the morning dose of furosemide,and notify the physician.
C) Tell the patient that these symptoms are temporary and will subside when his condition improves.
D) Add the nursing diagnosis of disturbed auditory sensory perception related to ototoxicity to the patient's care plan.

Question 30

What is a major role of the nurse who works in a women's health clinic in promoting the preservation of hearing?

A) Monitoring the noise level at the clinic
B) Discouraging excessive television watching
C) Promoting rubella immunizations for women
D) Including otoscopic examinations for all patients who attend the clinic

Question 31

Otoscopic examination reveals a central perforation of the eardrum with purulent drainage into the ear canal in a patient with chronic otitis media.A computed tomography scan confirms the presence of a cholesteatoma in the middle ear,and the patient is scheduled for a tympanoplasty.Preoperatively,the nurse teaches the patient that which of the following postoperative orders should be expected?

A) Avoidance of nose blowing
B) The need for prolonged bed rest
C) Frequent turning,coughing,and deep breathing
D) Continuous irrigation of the ear canal with antibiotic solutions

Question 32

A 28-year-old woman with otosclerosis elects to have a stapedectomy for treatment of her hearing loss.Two days after the surgery,she tells the nurse she does not hear as well as she did immediately after the surgery.Which of the following is the best response to the patient?

A) "You may have a sensorineural hearing loss that is not related to the otosclerosis."
B) "The cotton ball dressing in your ear canal most likely is impairing your hearing in that ear."
C) "Postoperative accumulation of fluid and blood in your middle ear will temporarily decrease your hearing."
D) "I will let the physician know about this because you could have a fistula or other complication of the surgery."

Question 33

Which of the following is an infection of the sebaceous glands in the eyelid margin?

A) Chalazion
B) Hordeolum
C) Blepharitis
D) Keratitis

Question 34

Which of the following is a manifestation of cerumen impaction?

A) Temporal headache
B) Difficulty breathing
C) Amplified low-pitch sounds
D) Cardiac depression

Question 35

A patient with acute otitis media of the left ear,which has been unresponsive to antibiotics,undergoes a myringotomy with placement of a ventilating tube,performed in an ambulatory surgical centre.Before she leaves the centre after the procedure,what is it most important for the nurse to instruct the patient to do?

A) Avoid coughing or sneezing.
B) Avoid getting water in her ear.
C) Use aspirin or acetaminophen for pain.
D) Restrict fluid intake for 24 hours to prevent nausea.