Question 1

Which statement by a patient with bacterial conjunctivitis indicates a need for further teaching?

Accepted Answer

Contact lenses should not be used when patients have conjunctivitis because they can further irritate the conjunctiva. Hand washing is the major means to prevent the spread of conjunctivitis. Infection may be spread by sharing towels or other contact. It is common for bacterial conjunctivitis to spread through a family or other group in close contact.

Question 2

Which nursing activity is appropriate for the registered nurse (RN)working in the eye clinic to delegate to experienced unlicensed assistive personnel (UAP)?

Accepted Answer

Application of cold and warm packs is included in UAP education and the ability to accomplish this safely would be expected for UAP 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 3

Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma?

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 are also appropriate for a patient with glaucoma but would not be the first medication administered.

Question 4

Which statement by the patient to the home health nurse indicates a need for more teaching about self-administering eardrops?

Accepted Answer

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

Question 5

A patient with a head injury after a motorcycle crash 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 are also appropriate but are not the first action the nurse will take.

Question 6

Which finding in an emergency department patient who reports being struck in the right eye with a fist is a priority for the nurse to communicate to the health care provider?

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.

Question 7

Which action could the registered nurse (RN)who is working in the eye and ear clinic delegate to a licensed practical/vocational nurse (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 teaching are higher level skills that require RN education and scope of practice.

Question 8

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

Accepted Answer

Watching television may exacerbate the symptoms of an acute attack of Ménière's disease. The other actions are appropriate because the patient will be at high fall risk and may suffer from nausea during the acute attack.

Question 9

Which information will the nurse include for a patient contemplating a cochlear implant?

Accepted Answer

Extensive rehabilitation is required after cochlear implants 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 10

The nurse learns that a newly admitted 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.

Question 11

The priority nursing diagnosis for a patient experiencing an acute attack with Meniere's disease 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 12

During the preoperative assessment of a patient scheduled for a right cataract extraction and intraocular lens implantation,it is 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. 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 affect the perioperative care. Cataract surgery is done using local anesthetics rather than general anesthetics.

Question 13

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

Accepted Answer

Oral acyclovir may be ordered for herpes simplex infections. Corticosteroid ointments are usually contraindicated because they prolong the course of the infection. Herpes simplex type 1 is viral,not parasitic or fungal. Natamycin may be used for Acanthamoeba keratitis caused by a parasite. NSAIDs can be used to treat the pain associated with keratitis.

Question 14

The occupational health nurse is caring for an employee who is complaining of bilateral eye pain after a cleaning solution splashed into the employee's eyes. Which action will the nurse take?

Accepted Answer

In the case of chemical exposure,the nurse should begin treatment by flushing the eyes until the patient has been assessed by a health care provider and orders are available. No other interventions should delay flushing the eyes.

Question 15

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. 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 level 5 on a 10-point pain scale may indicate complications such as hemorrhage,infection,or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching or follow-up does not indicate that complications of the surgery may be occurring.

Question 16

The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone 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 17

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 18

The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is important to report to the health care provider at this time?

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. Blurred vision is an expected finding with cataracts. Patients are expected to be NPO before the surgical procedure. Cataract extraction and intraocular lens implantation are done using local anesthesia.

Question 19

An older patient who is being admitted to the hospital 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.

Question 20

A 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 such as 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.

Quiz 21: Visual and Auditory Problems