Question 1

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

Accepted Answer

Handwashing 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 patient have conjunctivitis because they can further irritate the conjunctiva.

Question 2

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 3

When watching a patient self-administer eardrops, the home heath nurse observes all the following actions by the patient. Which patient action indicates a need for more teaching?

Accepted Answer

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

Question 4

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. 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 5

A patient who has heart failure and has been receiving large doses of IV furosemide (Lasix) tells the nurse, "I cannot hear very well. My ears are ringing." The most appropriate action by the nurse is to

Accepted Answer

Because ototoxicity associated with use of furosemide can lead to deafness and tinnitus, the most appropriate action at this time is to hold the furosemide until checking with the health care provider. Although the patient may need audiometry and the nursing diagnosis is accurate, these are not the most appropriate actions to take. The hearing deficit and tinnitus are not caused by the heart failure.

Question 6

A 78-year-old patient is hospitalized with a fractured femur. During the nursing assessment, the patient repeatedly asks the nurse to "speak up so that I can hear you." The best action by the nurse is to

Accepted Answer

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

Question 7

A patient with Ménière's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan?

Accepted Answer

A darkened, quiet room will decrease the symptoms of the acute attack of Ménière's disease. Fluids are administered intravenously during an acute attack. The patient should be positioned for comfort.

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 initially used 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

The nurse is assessing a patient who has recently been treated with amoxicillin (Amoxil) for acute otitis media of the right ear. Which assessment data obtained by the nurse is of most concern?

Accepted Answer

A feeling of fullness, "popping" of the ear, and decreased hearing are symptoms of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment. The fever indicates that the infection may not be resolved and the patient might need further antibiotic therapy.

Question 10

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 11

A patient with chronic otitis media is scheduled for a tympanoplasty. Preoperatively the nurse teaches the patient that postoperative expectations include

Accepted Answer

Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.

Question 12

Which of these actions by the nurse working at the college health clinic is important in decreasing the risk for hearing damage to patients at the clinic?

Accepted Answer

The nurse should discuss the impact of amplified music on hearing with young adults and discourage listening to very amplified music, especially for prolonged periods. Exposure to the noise level at the clinic is not likely to cause any hearing loss. Only women of childbearing age who have not been previously vaccinated or exposed to rubella will require immunization. Otoscopic examinations are not necessary for all patients.

Question 13

A patient with otosclerosis has a stapedectomy for treatment of hearing loss. Two days after the surgery, the patient tells the nurse, "I do not hear as well now as I did right after the surgery." Which response by the nurse is most appropriate?

Accepted Answer

Patients frequently have improved hearing immediately after surgery, which decreases postoperatively because of the accumulation of blood and drainage in the ear. The hearing will improve again as healing occurs. There is no indication of a sensorineural hearing loss. The incision for stapedectomy is in front of the ear and the dressing would not affect hearing. The decrease in hearing is not a sign of fistula or other postoperative complication.

Question 14

The health care provider places an ear wick in the external ear canal and prescribes antibiotic otic drops for a patient with external otitis. After the nurse does patient teaching about the disorder, which patient statement indicates that more instruction is needed?

Accepted Answer

The ear canal should be cleaned with a finger and washcloth. Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other patient statements indicate that the teaching has been successful.

Question 15

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 16

A patient being admitted to the hospital for a laparoscopic procedure tells the nurse about a history of glaucoma and the need to continue using prescribed eyedrops while hospitalized. For this patient, the nurse should question the preoperative order of

Accepted Answer

Atropine is a parasympathetic blocker and will relax the iris, causing blockage of aqueous humor outflow and an increase in intraocular pressure. The other medications are appropriate for this patient.

Question 17

A patient is hospitalized with acute angle-closure glaucoma. All the following orders are received. Which will the nurse implement 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 are also appropriate for a patient with glaucoma but would not be the first medication administered.

Question 18

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 eyedrops cause eye burning and visual blurriness for a time. The best response by the nurse to the patient's complaint is,

Accepted Answer

Patients should be instructed that eye discomfort and visual blurring are expected side effects of the ophthalmic drops but that the drops must be used to prevent further visual-field loss. The temporary burning and visual blurriness might not lessen with ongoing use, are not relieved by avoiding systemic absorption, and are not symptoms of glaucoma.

Question 19

A patient who is hospitalized with bacterial endophthalmitis resulting from a penetrating eye injury is noticeably restless, frequently asking whether the eye is healing and whether removal of the eye is necessary. Based on the patient's behavior, the nurse identifies a nursing diagnosis of

Accepted Answer

The patient's behavior indicates anxiety about the future possible loss of vision. The data do not indicate that the patient currently cannot see or that self-esteem is a current concern for the patient.

Question 20

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 are also appropriate but are not the first action the nurse will take.

Quiz 22: Nursing Management: Visual and Auditory Problems