NUR 216 E2

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TomWruble
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245769
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NUR 216 E2
Updated:
2013-11-21 18:49:23
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assessment and care of eye/vision and ears/hearing (plus stuff that should have been on the previous exam, but instead included material from the first quiz - whoha!)
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  1. Odor Of Orangutan Terrified Tarzan After Forty Voracious Gorillas Viciously Attacked Him
    • I Olfactory - smell
    • II Optic - vision
    • III Oculomotor - EOM
    • IV Trochlear - down and laterally
    • V Trigeminal - Sensation of cornea, skin of face and nasal mucosa
    • VI Abducens - laterally
    • VII Facial - facial expression, taste, anterior two-thirds of tongue
    • VIII Vestibulocochlear - hearing & balance
    • IX Glossopharyngeal - swallowing ability, tongue movement, taste
    • X Vagus - sensation of pharynx and larynx, swallowing, vocal cord movement
    • XI Accessory - head & shrugging shoulders
    • XII Hypoglossal - protrusion of tongue, moves tongue up and down and side to side
  2. Olfactory
    I

    Smell
  3. I
    Olfactory

    Smell
  4. Optic
    II

    Vision and visual field
  5. II
    Optic

    Vision and visual field
  6. Oculomotor
    III

    Extraocular eye movement (EOM)
  7. III
    Oculomotor

    Extraocular eye movement (EOM)
  8. Trochlear
    IV

    EOM, movement of the eyeball downward and laterally
  9. IV
    Trochlear

    EOM, movement of the eyeball downward and laterally
  10. Trigeminal
    V

    Sensation of cornea, skin of face and nasal mucosa
  11. V
    Trigeminal

    Sensation of cornea, skin of face and nasal mucosa
  12. Abducens
    VI

    EOM, moves eyeball laterally
  13. VI
    Abducens

    EOM, moves eyeball laterally
  14. Facial
    VII

    Facial expression, taste, anterior two-thirds of tongue
  15. VII
    Facial

    Facial expression, taste, anterior two-thirds of tongue
  16. Vestibulocochlear
    VIII

    Equilibrium, Hearing
  17. VIII
    Vestibulocochlear

    Equilibrium, Hearing
  18. Glossopharyngeal
    IX

    Swallowing ability, tongue movement, taste
  19. IX
    Glossopharyngeal

    Swallowing ability, tongue movement, taste
  20. Vagus
    X

    Sensation of pharynx and larynx, swallowing, vocal cord movement
  21. X
    Vagus

    Sensation of pharynx and larynx, swallowing, vocal cord movement
  22. Accessory
    XI

    Head movement, shrugging of shoulders
  23. XI
    Accessory

    Head movement, shrugging of shoulders
  24. Hypoglossal
    XII

    Protrusion of tongue, moves tongue up and down and side to side
  25. XII
    Hypoglossal

    Protrusion of tongue, moves tongue up and down and side to side
  26. Mnemonic for remembering which cranial nerves are S=sensory, M=motor, or B=both.
    • Some
    • Say
    • Marry
    • Money
    • But
    • My
    • Brother
    • Says
    • Bad
    • Business
    • Marry
    • Money
  27. The client has returned to the unit after a thymectomy and is extubated. The client begins to report chest pain. What will the nurse do next?

    A. Calls the Rapid Response Team for immediate intubation
    B. Increases the intravenous (IV) rate
    C. Informs the surgeon immediately
    D. Gives sublingual nitroglycerin (Nitrostat, Nitrolingual, others)
    C. Informs the surgeon immediately

    The cause of chest pain is noncardiac in nature and is possibly related to a hemothorax or a pneumothorax because of the sternal split surgical approach.
    (this multiple choice question has been scrambled)
  28. AAA has parasympatholytic effects and is the antidote for edrophonium chloride (Tensilon), the pharmacological drug for DX of BBB.
    • A) Atropine
    • B) MG
  29. The nurse is assessing a client admitted with myasthenia gravis. Which of these focused assessment findings are likely to be present in clients with this disease? (Select all that apply.)

    A. Ascending paralysis
    B. Ptosis
    C. Dysphagia
    D. Distal muscle weakness
    E. Hypertension
    F. Dysarthria
    ANS: B, C, E, F

    Rationale: The client with myasthenia gravis will probably present with these symptoms:


    • B. Ptosis - droopy eye lids
    • C. Dysphagia - difficulty in chewing and swallowing
    • E. Hypertension - possible if patient is in myasthenic crisis
    • F. Dysarthria - difficult or defective speech due to impairment of the tongue
  30. A 50-year-old man is admitted to your unit from a physician's office. He reports increasing muscle weakness and pain. He now has paresthesia that has progressed to his trunk. A diagnosis of Guillain-Barré is made. The physician has prescribed immunoglobulin therapy. What is the most effective way to manage the pain related to paresthesia?

    A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
    B) Non-opioid analgesics
    C) Muscle relaxants
    D) Opiates
    D) Opiates

    The typical pain experienced is often not relieved by medication other than opiates.
    (this multiple choice question has been scrambled)
  31. A 50-year-old man is admitted to your unit from a physician's office. He reports increasing muscle weakness and pain. He now has paresthesia that has progressed to his trunk. A diagnosis of Guillain-Barré is made. The physician has prescribed immunoglobulin therapy. Which medication may be prescribed to prevent a common complication of immobility?

    A) Aspirin (ASA)
    B) Acetaminophen (Tylenol)
    C) Methylprednisolone (Solu-Medrol)
    D) Enoxaparin (Lovenox)
    D) Enoxaparin (Lovenox)

    Because pulmonary emboli and deep vein thrombosis are common complications of immobility, the health care provider may prescribe prophylactic anticoagulant therapy such as Lovenox.
    (this multiple choice question has been scrambled)
  32. A 45-year-old female is admitted to your unit for diagnostic testing to rule out myasthenia gravis. She tolerated the testing procedure well and has started taking a cholinesterase inhibitor pyridostigmine (Mestinon). She wants to know how this medication works. What is your best response?

    A) "It directly stimulates the muscles to contract and thus improves muscle strength."
    B) "It decreases the amount of acetylcholine at the muscle receptors and thus improves muscle strength."
    C) "It blocks acetylcholine at the muscle receptors and improves muscle strength."
    D) "It increases the response of the muscles to nerve impulses and improves muscle strength."
    D) "It increases the response of the muscles to nerve impulses and improves muscle strength."

    Cholinesterase inhibitor drugs are the first-line management of MG. These drugs are also referred to as anticholinesterase drugs or antimyasthenics. They enhance neuromuscular impulse transmission by preventing the decrease of ACh by the enzyme ChE, thus increasing the response of the muscles to nerve impulses and improving muscle strength. The ChE drug of choice is pyridostigmine (Mestinon, Regonol). Expect day-to-day variations in dosage depending on the patient's fluctuating symptoms.
    (this multiple choice question has been scrambled)
  33. A 50-year-old man is admitted to your unit from a physician's office. He reports increasing muscle weakness and pain. He now has paresthesia that has progressed to his trunk. A diagnosis of Guillain-Barré is made. The physician has prescribed immunoglobulin therapy. What are the possible side effects from immunoglobulin g (IVIg) therapy? Select all that apply.

    A) Fever
    B) Headache
    C) Anaphylaxis
    D) Acute renal failure
    All

    Side effects can range from minor annoyances to major complications.
  34. A 45-year-old female is admitted to your unit for diagnostic testing to rule out myasthenia gravis. She has been experiencing all the typical symptoms but has not had a definitive diagnosis. What adverse effect(s) should you monitor for in this patient? Select all that apply.

    A) Ventricular fibrillation
    B) Cardiac arrest
    C) Migraine headache
    D) Seizures
    A & B

    The Tensilon test poses a danger of ventricular fibrillation and cardiac arrest, but these reactions rarely occur.

    The antidote is atropine sulfate
  35. You are caring for a patient with Guillain-Barré syndrome who is receiving immunoglobulin (IVIg). Which patient finding warrants immediate evaluation?

    A) Headache with stiff neck
    B) Temperature of 99° F
    C) Chills and fatigue
    D) Generalized malaise
    A) Headache with stiff neck

    This may be a sign of aseptic meningitis, a possible serious complication of IVIg therapy. Low-grade fever, chills, and myalgia are minor side effects of IVIg therapy and do not indicate that the therapy should be stopped.
    (this multiple choice question has been scrambled)
  36. The client has Guillain-Barré syndrome. Which interdisciplinary health care team members should collaborate to help prevent pressure ulcers related to immobility in this client? (Select all that apply.)

    A. Family
    B. Nurse
    C. Nutritionist
    D. Occupational therapist (OT)
    E. Patient
    All

    Malnutrition places clients at risk for pressure ulcers, especially when the client is immobile.
  37. The client's spouse expresses concern that the client, who has Guillain-Barré syndrome, is becoming very depressed and will not leave the house. What is the nurse's best response?

    A) ''This behavior is normal.''
    B) ''Try inviting several people over so the client won't have to go out.''
    C) ''You can contact the Guillain-Barré Foundation International for resources.''
    D) ''Let the client alone. The client will get used to it.''
    C) ''You can contact the Guillain-Barré Foundation International for resources.''

    The Guillain-Barré Foundation International (www.gbsi.com) provides resources and information for clients and their families. The client and family should be referred to self-help and support groups for clients with chronic illness, if indicated.

    Invite one close friend over is appropriate, but more than that might overwhelm the client.
    (this multiple choice question has been scrambled)
  38. The client with myasthenia gravis is receiving cholinesterase inhibitor drugs to improve muscle strength. The nurse is educating the family about this therapy. Which statement by a family member indicates a correct understanding of the nurse's instruction?

    A) ''I should increase the dose if there is a sudden increase in weakness.''
    B) ''I should call 911 if there is a sudden increase in weakness.''
    C) ''The medication should be taken with a large meal.''
    D) ''The medication should be taken on an empty stomach.''
    B) ''I should call 911 if there is a sudden increase in weakness.''

    A potential adverse effect of cholinesterase inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the client is experiencing crisis. The family member should call 911 for emergency assistance.

    The dose of cholinesterase inhibitors should never be increased without provider supervision

    Cholinesterase inhibitors should be taken with a small amount of food to help alleviate GI side effects, and the client should eat their main meal 45 to 60 minutes after taking cholinesterase inhibitors to avoid aspiration.
    (this multiple choice question has been scrambled)
  39. The client arrives to the emergency department with new onset ptosis, diplopia, and dysphagia. The nurse anticipates the client will be tested for which neurologic disease?

    A) Bell's palsy
    B) Myasthenia gravis
    C) Guillain-Barré syndrome
    D) Trigeminal neuralgia
    B) Myasthenia gravis

    The symptoms of Bell's palsy include facial paralysis. The face appears masklike and sags.
    (this multiple choice question has been scrambled)
  40. Symptoms for GBS typically begin ...
    in the legs and spread to the arms and upper body
  41. The symptoms of Bell's palsy include ...
    facial paralysis. The face appears masklike and sags.
  42. Sudden onset of ptosis, diplopia, and dysphagia are classic symptoms of AAA. Laboratory studies and BBB will most likely be done to confirm diagnosis.
    • A) MG
    • B) a Tensilon test
  43. Which statement illustrates the commonality between Guillain-Barré syndrome and myasthenia gravis?

    A) Both diseases are caused by demyelination of neurons.
    B) Both diseases exhibit exacerbations and remissions of their signs and symptoms.
    C) Both diseases affect respiratory status and muscle function of the client.
    D) Both diseases are autoimmune diseases with ocular symptoms.
    C) Both diseases affect respiratory status and muscle function of the client.
    (this multiple choice question has been scrambled)
  44. Of GBS and MG, XXX is an autoimmune disease with ocular symptoms.
    MG
  45. Of GBS and MG, XXX is characterized by exacerbations and remissions whereas GBS has three acute stages.
    MG
  46. Of GBS and MG, XXX causes demyelination of the peripheral neurons.
    GBS
  47. The client is admitted with an exacerbation of Guillain-Barré syndrome, presenting with facial weakness, dysphagia, and difficulty speaking. On admission, the client is having mild dyspnea. Which intervention does the nurse perform first?

    A) Suctions the client
    B) Instructs the client on how to cough effectively
    C) Raises the head of the bed to 45 degrees
    D) Calls the Rapid Response Team to intubate
    C) Raises the head of the bed to 45 degrees

    The head of the client's bed should be raised to 45 degrees because it allows increased lung expansion, which improves the client's ability to breathe.
    (this multiple choice question has been scrambled)
  48. The client is being evaluated for signs associated with myasthenia crisis or cholinergic crisis. Which symptoms lead the nurse to suspect that the client is experiencing a cholinergic crisis?

    A) Restlessness, increased salivation and tearing, dyspnea
    B) Bowel and bladder incontinence, pallor, cyanosis
    C) Increased pulse, anoxia, decreased urine output
    D) Abdominal cramps, blurred vision, facial muscle twitching
    D) Abdominal cramps, blurred vision, facial muscle twitching
    (this multiple choice question has been scrambled)
  49. Bowel and bladder incontinence, pallor, and cyanosis are all symptoms indicating a ...
    myasthenic crisis
  50. Increased pulse, anoxia, and decreased urine output are all symptoms indicating a ...
    myasthenic crisis
  51. Restlessness, increased salivation and tearing, and dyspnea are symptoms indicating ...
    a mixed myasthenic-cholinergic crisis
  52. Use of over-the-counter drugs [is - is not] contraindicated for clients with restless legs syndrome.
    is not
  53. Bell's palsy is caused by ...
    the herpes simplex virus
  54. T/F: Bell's palsy and trigeminal neuralgia both can cause choking, coughing, or eructation
    True
  55. Bell's palsy and trigeminal neuralgia both are disorders of:

    A) the autonomic nervous system.
    B) the cranial nerves.
    B) the cranial nerves.
  56. T/F: Bell's palsy and trigeminal neuralgia both disorders display facial twitching.
    False

    Facial twitching can be a sign of trigeminal neuralgia, whereas Bell's palsy causes a unilateral facial paralysis.
  57. Trigeminal neuralgia is ...
    thought to be caused by excessive firing of irritated nerve fibers in the trigeminal nerve.
  58. A client with myasthenia gravis has been prescribed to take pyridostigmine (Mestinon). What health teaching will the nurse include related to this drug? Select all that apply.

    A. “Watch for signs and symptoms of myasthenic crisis.”
    B. “Take the drug about an hour before eating a meal.”
    C. “Take the same dose of medication every day.”
    D. “Take the drug with food to prevent nausea.”
    E. “Do not take sedatives or sleeping pills while on this drug.”
    A, B, C, E

    Rationale: The client and family should watch for an exacerbation of myasthenic symptoms caused by underdosing of anticholinesterase drugs. The client should eat meals 45 minutes to 1 hour after taking pyridostigmine to avoid aspiration; this is especially important if the client has bulbar involvement. The client should be told that he or she should take the same dose of medication daily and on time to maintain blood levels and improve muscle strength; changing doses daily will interfere with interpretation of blood levels and adjustment of the doses. The client should not take drugs containing magnesium, morphine (or its derivatives curare, quinine, quinidine, procainamide), or hypnotics or sedatives because they may increase weakness. The client should not take pyridostigmine with food.
  59. The client arrives to the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the client will be tested for which neurologic disease?

    A. Trigeminal neuralgia
    B. Guillain-Barré syndrome
    C. Myasthenia gravis (MG)
    D. Bell's palsy
    C. Myasthenia gravis (MG)
    (this multiple choice question has been scrambled)
  60. T/F: Symptoms of MG include facial paralysis. The face appears masklike and sags.
    False

    Symptoms of Bell's palsy include facial paralysis. The face appears masklike and sags.
  61. T/F: Sudden-onset ptosis, diplopia, and dysphagia are classic symptoms of MG
    True
  62. T/F: Of GBS and MG, only GBS is an autoimmune disease with ocular symptoms.
    False

    Only MG is an autoimmune disease with ocular symptoms.
  63. T/F - myasthenic crisis: Abdominal cramps, blurred vision, and facial muscle twitching are signs of an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs.
    False

    cholinergic crisis
  64. T/F: Bowel and bladder incontinence, pallor, and cyanosis are symptoms indicating a myasthenic crisis.
    True
  65. myasthenic crisis symptoms:
    • bowel and bladder incontinence
    • pallor
    • cyanosis
    • increased pulse
    • anoxia
    • decreased urine output
  66. mixed myasthenic-cholinergic crisis symptoms
    • restlessness
    • increased salivation and tearing
    • dyspnea
  67. Presbyopia is a condition where, with age (around AAA), the eye exhibits a BBB.
    • A) 40
    • B) progressively diminished ability to focus on near objects
  68. Decongestants and antihistamines may tend to AAA and may cause BBB.
    • A) dry the eye
    • B) increased IOP
  69. About AAA% of people have a noticeable difference between the size of their pupils. This is called BBB.
    • A) 5
    • B) anisocoria
  70. Pupil reaction to light of 1 second or less is termed AAA, while longer than 1 second is termed BBB. No reaction is termed CCC or DDD.
    • A) brisk
    • B) sluggish
    • C) fixed
    • D) nonreactive
  71. AAA is an involuntary rapid twitching of the eye and is a BBB finding for the CCC gaze. It may also be caused by DDD or EEE.
    • A) Nystagmus
    • B) normal
    • C) far lateral
    • D) abnormal nerve function
    • E) prolonged reduced vision
  72. Color vision is most often tested with a AAA chart
    Ishihara
  73. AAA is used to measure IOP and a normal reading would be BBB, although CCC% of patients with healthy eyes have slightly higher pressure.
    • A) Tonometry
    • B) 10-21 mm Hg
    • C) 5
  74. AAA eye drops cause pupil dilation and should be instilled BBB before tests such as fluorescein angiography.
    • A) Mydriatic
    • B) 1 hour
  75. AAA is an inflammation of the eyelid edges, occurs most often in the older adult and those with dry-eye syndrome. BBB (greasy, itchy scaling) of the eyebrows and eyelids is often present.
    • A) Blepharitis
    • B) Seborrhea
  76. An AAA is the turning inward of the eyelid causing the lashes to rub against the eye. AAA can be caused by BBB or by scarring and deformity of the eyelid as a result of trauma. AAA occurs often among older adults because of age-related loss of tissue support.
    • A) entropion
    • B) eyelid muscle spasms
  77. The patient is an 86-year-old man who lives alone at home and is scheduled to have fluorescein angiography tomorrow. He still drives and performs all of his own housekeeping responsibilities. In addition, he drives his neighbor, who is blind, to a sheltered workshop every day. The patient calls today with some concerns about whether he will be able to drive himself to and from the procedure, pain during the procedure, and whether he will be able to play poker with his friends later tomorrow night after the test.

    1. Should he drive himself to and from the procedure? Why or why not?
    He should not drive himself to and from the procedure. He will be given drugs that widely dilate his pupils, making him extremely sensitive to light.
  78. The patient is an 86-year-old man who lives alone at home and is scheduled to have fluorescein angiography tomorrow. He still drives and performs all of his own housekeeping responsibilities. In addition, he drives his neighbor, who is blind, to a sheltered workshop every day. The patient calls today with some concerns about whether he will be able to drive himself to and from the procedure, pain during the procedure, and whether he will be able to play poker with his friends later tomorrow night after the test.

    2. What should you tell him regarding the preparation and actual fluorescein angiography procedures?
    Explain that his pupils will be dilated and that a dye will be injected IV. After a few minutes, a camera will record the blood flow through his eye. Except for the IV access, the procedure is painless. Warn that the dye may cause the skin to appear yellow for several hours after the test. The stain is eliminated through the urine, which also changes color.
  79. The patient is an 86-year-old man who lives alone at home and is scheduled to have fluorescein angiography tomorrow. He still drives and performs all of his own housekeeping responsibilities. In addition, he drives his neighbor, who is blind, to a sheltered workshop every day. The patient calls today with some concerns about whether he will be able to drive himself to and from the procedure, pain during the procedure, and whether he will be able to play poker with his friends later tomorrow night after the test.

    3. What should you teach him about altering his usual activities during the first 24 hours after the procedure?
    He can engage in most of his usual activities after the procedure; however, until pupil dilation returns to normal, exposure of the eyes to sunlight and other bright lights will cause eye pain. Therefore tell him to wear dark glasses and avoid direct sunlight. He should not golf today but can play cards. Also, encourage him to drink fluids to help eliminate the dye. Remind him that any yellow or green staining of the skin will disappear in a few hours.
  80. Gradual vision loss could be caused by AAA or BBB and CCC[does/does not] require immediate care by an ophthalmologist.
    • A) uncontrolled hypertension
    • B) diabetes
    • C) does not
  81. Which systemic disorders may affect the eye and vision and require yearly eye examinations by an ophthalmologist? (Select all that apply.)

    A. Anemia
    B. Diabetes mellitus
    C. Hepatitis
    D. Hypertension
    E. Multiple sclerosis
    B, D, E
  82. The nurse is teaching the client who is scheduled for an ultrasonography of the eye. Which statement by the client indicates a need for further instruction?

    A. ''I won't hear the high-frequency sound waves.''
    B. ''This test will help determine if my retina is detached.''
    C. ''I'll have to wear a bandage over my eye after the test.''
    D. ''I will be awake during this test.''
    C. ''I'll have to wear a bandage over my eye after the test.''

    No special follow-up care is needed. However, remind the client not to rub or touch the eye until the effects of the anesthetic drops have worn off.
    (this multiple choice question has been scrambled)
  83. Ultrasonography aids in the diagnosis of
    • trauma,
    • intraorbital tumors,
    • proptosis,
    • choroidal or retinal detachments.

    Exophthalmos, also called proptosis, is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor).
  84. Clients with a family history of which eye disorder may have problems with increased intraocular pressure (IOP), requiring additional assessment?

    A. Cataracts
    B. Diabetic retinopathy
    C. Glaucoma
    D. Anisocoria
    C. Glaucoma

    Diabetic retinopathy is microvascular damage caused by uncontrolled diabetes, not increased IOP.

    Cataracts are a result of increased IOP, not a cause. Increased IOP clouds the lens of the eye, potentially causing cataracts to develop.
    (this multiple choice question has been scrambled)
  85. The six cardinal positions of gaze assess cranial nerve(s) ...
    • III Oculomotor - extraocular eye movement
    • IV Trochlear - movement of the eyeball downward and laterally
    • VI Abducens - moves eyeball laterally
  86. The confrontation test assesses the client's ...
    visual field. It is a crude test that takes the place of a machine test, but you cover right to their left (same field) and both notice object entering that field at same time.
  87. Keratoconjunctivitis Sicca is AAA and can be caused by BBB, CCC, and DDD.
    • A) dry-eye syndrome
    • B) change in tear composition
    • C) lacrimal gland malfunction
    • D) changes in tear distribution
  88. Reduced tear production often leads to AAA of the eye structures, because tears BBB.
    • A) bacterial infection
    • B) inhibit bacterial growth
  89. Patients with extropian often have ...
    constant tears and a sagging lower eyelid.
  90. An internal hordeolum is caused by an AAA of the eyelid sebaceous glands and occurs with pain, whereas an inflammation of these glands results in BBB which is CCC.
    • A) infection
    • B) chalazion
    • C) painless
  91. Decreased tear production can also occur with the use of some drugs, such as AAA, BBB and CCC.
    • A) antihistamines
    • B0 beta-adrenergic blocking agents
    • C) anticholinergic drugs.
  92. Diseases associated with decreased tear production include ...
    • rheumatoid arthritis
    • leukemia
    • sarcoidosis
    • multiple sclerosis
  93. Injury to the AAA nerve inhibits tears.
    A) facial (cranial nerve VII)
  94. A hordeolum is caused by an infection of the eyelid sebaceous glands(AAA) or (BBB) where the lashes meet the eyelid. The most common causative organisms are CCC, DDD and EEE,
    • A) internal
    • B) external
    • C) Staphylococcus aureus
    • D) Staphylococcus epidermidis
    • E) Streptococcus
  95. Conjunctivitis is an inflammation or infection of the conjunctiva. Inflammation occurs from exposure to AAA or BBB and is not contagious.
    • A) allergens
    • B) irritants
  96. Trachoma is a chronic, bilateral scarring form of conjunctivitis caused by ...
    Chlamydia trachomatis.
  97. Trachoma is treated with ...
    a 4-week course of oral or topical tetracycline (Achromycin, Apo-Tetra) or erythromycin (Apo-Erythro-EC, E-Mycin, E.E.S.) is given. Azithromycin(Zithromax) can be used once per week for 1 to 3 weeks.
  98. T/F: The cornea can defend itself from infections that have the potential to permanently impair vision.
    False: The cornea does not have a separate blood supply (antibodies).
  99. corneal transplant is called a
    keratoplasty
  100. Corneal donors must be free of infectious disease or cancer at the time of death. If a deceased patient is a potential eye donor, follow these steps:
    • Raise the head of the bed 30 degrees.
    • Instill antibiotic eyedrops, such as Neosporin or tobramycin.
    • Close the eyes, and apply a small ice pack to the closed eyes.
    • Contact the family and physician to discuss eye donation.
  101. In open-angle (primary) glaucoma, the tonometry reading is between
    22 and 32 mm Hg
  102. In angle-closure glaucoma, the tonometry reading may be ...
    30 mm Hg or higher.
  103. When a high IOP is found this test AAA, determines whether open-angle or closed-angle glaucoma is present. It uses a special lens that eliminates the corneal curve, is painless, and allows visualization of the angle where the iris meets the cornea.
    Gonioscopy
  104. AAA is commonly used for those people with ocular hypertension or who are at risk for glaucoma from other problems. T
    Optic nerve imaging
  105. The AAA muscle is a ring of striated smooth muscle in the eye's middle layer (vascular layer) that controls accommodation for viewing objects at varying distances and regulates the flow of aqueous humour into Schlemm's canal. It changes the shape of the lens within the eye, not the size of the pupil which is carried out by the BBB muscle.
    • A) ciliary
    • B) sphincter pupillae
  106. The five most common classes of drugs to manage glaucoma are the ...
    • prostaglandinsagonists
    • adrenergic agonists
    • beta-adrenergic blockers
    • cholinergic agonists
    • carbonic anhydrase inhibitors
  107. The patient is an 82-year-old widower who lives in a retirement village. He has had cataracts for about 10 years, with the right one advancing faster than the left, and wants the surgery because his vision is too poor to pass the driving test. (The retirement community’s minibus brought him to the clinic.) He takes his meals in the dining facility and has weekly housekeeping/laundry service. He plays golf daily, using a golf cart, and plays cards every evening. He is scheduled for surgery next week and is in the clinic today for preoperative teaching. In addition to cataracts, he has osteoarthritis of both knees and is on hormonal therapy for prostate cancer. His drugs include aspirin 650 mg twice daily, losartan (Cozaar) 50 mg daily for moderate hypertension, and a multiple vitamin.

    Should any of his drugs be changed before surgery? Which one(s) and why?
    The aspirin should be stopped at least 10 days before the surgery because it disrupts platelet aggregation and can lead to excessive bleeding at any surgical site.
  108. The patient is an 82-year-old widower who lives in a retirement village. He has had cataracts for about 10 years, with the right one advancing faster than the left, and wants the surgery because his vision is too poor to pass the driving test. (The retirement community’s minibus brought him to the clinic.) He takes his meals in the dining facility and has weekly housekeeping/laundry service. He plays golf daily, using a golf cart, and plays cards every evening. He is scheduled for surgery next week and is in the clinic today for preoperative teaching. In addition to cataracts, he has osteoarthritis of both knees and is on hormonal therapy for prostate cancer. His drugs include aspirin 650 mg twice daily, losartan (Cozaar) 50 mg daily for moderate hypertension, and a multiple vitamin.

    What are the priority areas of assessment for this patient? Provide a rationale for your choices.
    Assess his understanding and likelihood of adhering to the postoperative eyedrop drug therapy. This drug therapy is critical for preventing complications after cataract surgery, and a series of eyedrops may be needed as often as 4 times a day for 2 to 4 weeks. Assess his ability to correctly instill eyedrops and to be able to distinguish one type of drug from another.
  109. The patient is an 82-year-old widower who lives in a retirement village. He has had cataracts for about 10 years, with the right one advancing faster than the left, and wants the surgery because his vision is too poor to pass the driving test. (The retirement community’s minibus brought him to the clinic.) He takes his meals in the dining facility and has weekly housekeeping/laundry service. He plays golf daily, using a golf cart, and plays cards every evening. He is scheduled for surgery next week and is in the clinic today for preoperative teaching. In addition to cataracts, he has osteoarthritis of both knees and is on hormonal therapy for prostate cancer. His drugs include aspirin 650 mg twice daily, losartan (Cozaar) 50 mg daily for moderate hypertension, and a multiple vitamin.

    What community resources should you check for this patient?
    Determine whether the retirement village has nursing services that can oversee his eyedrop therapy and can assess the appearance of the eye. If the village does not have these services, work with the patient to determine whether a friend can perform these activities or whether a home care nurse will be needed on a short-term basis.
  110. The patient is a 72-year-old man with colorectal cancer having surgery today for placement of an implanted venous access device for chemotherapy. You remember him from his last ambulatory surgery. He lists all the prescribed drugs he is currently taking but does not mention the eyedrops he was using 6 months ago for his glaucoma. When you ask him about this omission he tells you that he stopped taking the eyedrops a few months ago and is now “curing his glaucoma” by drinking 6 cups of green tea and taking 5000 mg of vitamin C each day. He asks you not to tell his oncologist because “he isn’t into alternative medicine.”

    What assessment should you perform or ask related to the glaucoma?
    Ask him when the last time his intraocular pressure was measured. Check his visual acuity and visual fields. Document these findings, and compare them with previous assessments (if those are available in his medical record). If you are skilled at IOP measurement, check his IOP. If you are not, have an advanced practice nurse or another health care provider measure it.
  111. The patient is a 72-year-old man with colorectal cancer having surgery today for placement of an implanted venous access device for chemotherapy. You remember him from his last ambulatory surgery. He lists all the prescribed drugs he is currently taking but does not mention the eyedrops he was using 6 months ago for his glaucoma. When you ask him about this omission he tells you that he stopped taking the eyedrops a few months ago and is now “curing his glaucoma” by drinking 6 cups of green tea and taking 5000 mg of vitamin C each day. He asks you not to tell his oncologist because “he isn’t into alternative medicine.”

    What should you tell him about his choice of glaucoma therapy?
    Tell him that most substances taken orally, including vitamins and other health food products, have only minor effects on intraocular pressure. These may work with the prescribed eyedrops to prevent further loss of vision. Remind him that vision loss from glaucoma is permanent and that the only prevention is keeping IOP within the normal range.
  112. The patient is a 72-year-old man with colorectal cancer having surgery today for placement of an implanted venous access device for chemotherapy. You remember him from his last ambulatory surgery. He lists all the prescribed drugs he is currently taking but does not mention the eyedrops he was using 6 months ago for his glaucoma. When you ask him about this omission he tells you that he stopped taking the eyedrops a few months ago and is now “curing his glaucoma” by drinking 6 cups of green tea and taking 5000 mg of vitamin C each day. He asks you not to tell his oncologist because “he isn’t into alternative medicine.”

    How should you respond to the patient’s request to not tell his oncologist about the change in glaucoma treatment? Provide a rationale for your response.
    Tell him that his oncologist needs to know about any vitamin supplements or other drugs to determine whether there could be a possible interaction with his chemotherapy. Remind him that his ophthalmologist should continue to be involved in his eye care, even during his cancer treatment.
  113. The client who has just had cataract removal and lens replacement in his right eye asks whether he can play cards this evening and go golfing tomorrow. What is the nurse’s best response?

    A. “Golfing is fine, but you need to refrain from playing cards for 1 week.”
    B. “You should neither play cards nor play golf for at least two weeks.”
    C. “Neither activity is restricted.”
    D. “Playing cards is fine, but you need to refrain from golfing for about 2 weeks.”
    D. “Playing cards is fine, but you need to refrain from golfing for about 2 weeks.”

    The client needs to avoid activities that increase intraocular pressure (IOP) for the first 2 weeks after cataract removal. Playing golf involves bending over to work with the ball and lifting the bag of golf clubs, both of which would increase IOP. In addition, swinging the golf club promotes eye motion and could dislodge the lens.
    (this multiple choice question has been scrambled)
  114. Situation: Your patient is a 68-year-old woman who has just undergone cataract surgery. She has never been hospitalized and expresses concern about how to use her medication and what she should expect from her medication. She is prescribed tobramycin with dexamethasone (TobraDex). Which of these indicate the appropriate way to instill ophthalmic ointment? Select all that apply.

    A. Wash your hands.
    B. Wear gloves.
    C. Pull the patient’s lower lid downward to create a pocket.
    D. Gently touch the tip of the tube to the conjunctiva and squeeze a small amount of ointment.
    A, B and C
  115. Situation: Your patient is a 68-year-old woman who has just undergone cataract surgery. She has never been hospitalized and expresses concern about how to use her medication and what she should expect from her medication. She is to be discharged with TobraDex eyedrops. What should you include in your instructions? Select all that apply.

    A. Rub the eye gently after instillation of medication.
    B. Use nasal punctual occlusion.
    C. Separate the instillation of each drug by at least 5 minutes.
    D. Administer medications by eye instillation route, not the oral route.
    B, C and D
  116. Situation: Your patient is a 68-year-old woman who has just undergone cataract surgery. She has never been hospitalized and expresses concern about how to use her medication and what she should expect from her medication. She tells you she thinks she will have difficulty instilling eyedrops. Which of these should you include with your discharge instructions? Select all that apply.

    A. She will be able to learn with practice.
    B. Adaptive equipment can be purchased to help position the bottle of eyedrops.
    C. Refrigerate the eyedrops.
    D. There are no activity restrictions.
    A, B and C
  117. Situation: Your patient is a 45-year-old with glaucoma. She has been started on bimatoprost (Lumigan) to decrease the intraocular eye pressure. What patient teaching should you give this patient concerning this medication and glaucoma treatment? Select all that apply.

    A. Check the cornea for abrasions or other signs of trauma.
    B. Over time, the eye color will darken and eyelashes will elongate.
    C. Adherence to the prescribed dose is critical to maintain the drug’s effectiveness.
    D. Use the drops in the nonaffected eye to ensure that eye colors remain the same.
    A, B and C
  118. Situation: Your patient is a 45-year-old with glaucoma. She has been started on bimatoprost (Lumigan) to decrease the intraocular eye pressure. She has taken the drug for several days, but the intraocular pressure has increased. What oral or IV medication(s) may be given to decrease the pressure to an acceptable level? Select all that apply.

    A. Oral Osmoglyn
    B. IV mannitol
    C. Oral furosemide
    D. IV thiazide diuretics
    A and B

    Systemic osmotic drugs may be given for angle-closure glaucoma as part of emergency treatment to rapidly reduce IOP. These agents include oral glycerin (Osmoglyn) and IV mannitol (Osmitrol).
  119. Situation: Your patient is a 45-year-old with glaucoma. She has been started on bimatoprost (Lumigan) to decrease the intraocular eye pressure. She has presented to the ED after a camping trip with a corneal abrasion and was started on an ophthalmic ointment. What instructions does this patient need to know to instill the ointment properly? Select all that apply.

    A. Wash your hands.
    B. Do not touch the eye or lid with the tip of the tube.
    C. Start at the nose side of the eye and move toward the outer edge.
    D. If both eyes needing treatment and only one is infected, it is okay to use the same tube for both eyes.
    A, B and C
  120. A hospitalized patient who is a potential corneal donor has just expired. Which nursing action can you delegate to the nursing assistant?

    A. Instill Neosporin eyedrops to each eye.
    B. Elevate the head 30 degrees, and apply ice packs.
    C. Contact the local tissue bank regarding this patient.
    D. Have the family sign for permission to donate.
    B. Elevate the head 30 degrees, and apply ice packs.
    (this multiple choice question has been scrambled)
  121. The nurse has interviewed these patients in the emergency department triage area. Which one warrants immediate medical evaluation?

    A. The 30-year-old with nausea after a scleral buckling procedure yesterday
    B. The 24-year-old who has a foreign body sensation in the right eye after gardening
    C. The 35-year-old who has sudden-onset eye pain and decreased vision
    D. The 18-year-old with periorbital ecchymosis acquired during an altercation
    C. The 35-year-old who has sudden-onset eye pain and decreased vision

    The patient's clinical manifestations are consistent with a corneal laceration - a medical emergency because the eye contents may prolapse through the laceration. The other patients also need assessment but are not as high a priority as the patient with possible corneal laceration.
    (this multiple choice question has been scrambled)
  122. You are caring for a patient with bacterial conjunctivitis. Which of these actions should you take first?

    A. Administer the prescribed antibiotic ointment.
    B. Collect the requested culture of the drainage.
    C. Wipe the drainage gently from the affected eye.
    D. Teach the patient about correct eye care.
    B. Collect the requested culture of the drainage.
    (this multiple choice question has been scrambled)
  123. After having a lens implant, a patient calls the ophthalmology clinic the next day and tells the nurse about all of these symptoms. Which one requires the most immediate action by the nurse?

    A. The eye feels painful.
    B. The eye itches and is bloodshot.
    C. The eyelid is swollen.
    D. The eye has white drainage.
    A. The eye feels painful.

    Pain soon after lens implant surgery may indicate an increase in intraocular pressure and needs to be assessed immediately. The other patient symptoms are common after this surgery.
    (this multiple choice question has been scrambled)
  124. Which client is most in need of immediate examination by an ophthalmologist?

    A. 40-year-old with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights
    B. 58-year old with glasses who reports an inability to see colors well and feeling like his or her glasses are always smudged
    C. 76-year-old with seborrhea of the eyebrows and eyelids who reports burning and itching of the eyes
    D. 39-year-old with contacts who reports an inability to tolerate bright lights and has visible purulent drainage on eyelids and eyelashes
    A. 40-year-old with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights

    This client is exhibiting signs and symptoms of increased intraocular pressure. This is a priority because the optic nerve can be damaged, which can cause possible blindness. Acute angle closure glaucoma can occur in those 40 years old and older.
    (this multiple choice question has been scrambled)
  125. The nurse is teaching the mother of a teenage client with conjunctivitis how to administer eye ointment. Which statement by the mother indicates a correct understanding of the nurse's instruction?

    A. ''I will place the ointment in the lower lid.''
    B. ''My child should look down at the floor during installation.''
    C. ''I will press gently on the inner canthus for 1 minute.''
    D. ''My child should rub the eye gently after instillation to increase absorption.''
    A. ''I will place the ointment in the lower lid.''

    Pressing on the inner canthus is a technique reserved for the instillation of glaucoma drops.
    (this multiple choice question has been scrambled)
  126. The nurse is performing preoperative teaching for the older adult client who will be having a cataract removed.

    T/F: You will need to wear a patch on your eye for several weeks after the surgery.
    False

    The eye is left unpatched and the client is sent home 1 hour after surgery.
  127. The client who recently lost vision in one eye says, ''I feel as if I am mourning the 'death' of my eye.'' What is the nurse's best response?

    A. ''You must adapt to one eye.''
    B. ''That is a very normal response.''
    C. ''At least you still have the eye in place.''
    D. ''Do you think you are depressed?''
    B. ''That is a very normal response.''

    Clients benefit from the honest support that the nurse can provide. They need to hear that it is normal to mourn, cry, and feel the loss of the eye. The client may feel hopeless and angry but, with time, anger usually gives way to acceptance.

    ''Do you think you are depressed?' - 'Incorrect: This is an example of a nontherapeutic communication technique called interpreting.
    (this multiple choice question has been scrambled)
  128. The client with new-onset diminished vision is being discharged and is concerned about living independently. Which technique best facilitates independent self-care for the client?

    A. Keeping the floor free of clutter
    B. Suggesting a seeing eye animal companion
    C. Teaching Braille
    D. Building on the remaining vision
    D. Building on the remaining vision

    Using large print books, talking clocks, and telephones with large, raised block numbers are examples of building on the client's remaining vision.

    Keeping the floor free of clutter - Incorrect: Keeping the floor free of clutter is important, but is too specific. There is a better answer.
    (this multiple choice question has been scrambled)
  129. Which symptom indicates the need for reassessment in the client with glaucoma?

    A. Gradual vision changes
    B. Burning in the eye
    C. Increased sensitivity to light
    D. Inability to differentiate colors
    A. Gradual vision changes

    Gradual vision changes are an indication of IOP.

    Burning in the eye Incorrect: A burning sensation in the eye usually indicates inflammation and/or infection.

    Inability to differentiate colors - Incorrect: An inability to differentiate colors is an early sign of cataracts.

    Increased sensitivity to light - Incorrect: An increased sensitivity to light might be a sign of a corneal abrasion.
    (this multiple choice question has been scrambled)
  130. The symptoms of AAA include facial paralysis. The face appears masklike and sags. It is caused by BBB.
    • A) Bell's palsy
    • B) herpes simplex virus
  131. An inability to differentiate colors is an early sign of ...
    cataracts
  132. An increased sensitivity to light might be a sign of ...
    a corneal abrasion
  133. Gradual vision changes are an indication of ...
    IOP
  134. What is the action of miotics in the client with glaucoma?

    A. Vasoconstricts the blood vessels in the eye
    B. Decreases the inflammatory process
    C. Increases the production of vitreous humor
    D. Enhances aqueous outflow
    D. Enhances aqueous outflow

    Steroid eyedrops, not miotics, decrease the inflammatory process.
    (this multiple choice question has been scrambled)
  135. AAA fills the space between the lens and the retina, is stagnant, and is not replenished like the BBB.
    • A) Vitreous humor
    • B) aqueous humor
  136. After the nurse has examined a patient's ear using an otoscope, which finding is most important to report to the physician?

    A. Pain occurs when pulling the pinna up and back.
    B. Visible scarring is observed on the eardrum.
    C. Light brown cerumen is present in the ear canal.
    D. The light reflex is triangular in shape.
    A. Pain occurs when pulling the pinna up and back.

    Pain when manipulating the pinna is an unexpected finding that should be investigated further, since it may indicate acute problems such as otitis media. A and C are normal findings, and B may be the result of an old middle ear infection or trauma.
    (this multiple choice question has been scrambled)
  137. A patient who was referred to the hearing clinic tells the nurse, "I am here because I have dizziness." Which test will the nurse anticipate will be done first?

    A. Dix-Hallpike test
    B. Computed tomography
    C. Magnetic resonance imaging
    D. Electronystagmography
    A. Dix-Hallpike test

    The Dix-Hallpike test assesses vertigo and does not require any special patient preparation. The other tests may also help in diagnosing causes of vertigo but require more patient preparation such as fasting before the exam.
    (this multiple choice question has been scrambled)
  138. The patient should AAA before BBB to avoid nausea.
    • A) fast for several hours
    • B) caloric testing
  139. The client must AAA before electronystagmography and avoid caffeine-containing beverages for BBB before the test.
    • A) fast for several hours
    • B) 24 to 48 hours
  140. The older adult client comes in for a routine visit. During the assessment, he irritably exclaims, ''Speak up and quit mumbling!'' How does the nurse respond?

    A. Apologizes and speak louder and clearer
    B. Offers the client a stethoscope to use
    C. Suggests that the client move to a soundproof examination room to improve his hearing
    D. Asks if the client has a hearing loss
    A. Apologizes and speak louder and clearer

    Speak more clearly first and then determine if further assessment is needed.

    Do not assume that the client has hearing loss. This suggestion may make the client more irritable, especially if the client is in denial.
    (this multiple choice question has been scrambled)
  141. Which clients have a high risk of developing hearing problems? (Select all that apply.)

    A. Airline mechanic
    B. Client with Down syndrome
    C. Drummer in a rock band
    D. Teenager listening to music using ear buds
    E. Telephone operator
    All

    Most people with Down syndrome develop hearing loss as adults.

    Clients who regularly use devices inserted into the ear, such as headsets, place them at high risk for hearing problems.
  142. Electronystagmography is a test that is sensitive for detecting ...
    central and peripheral disease of the vestibular system in the ear
  143. The older adult client reports ear pain. Otoscopic examination by the nurse practitioner (NP) reveals a dull and retracted membrane. What does the NP do next?

    A. Prescribes antibiotics for probable otitis media
    B. Irrigates the ear
    C. Tests hearing acuity
    D. Continues further assessment
    C. Tests hearing acuity
    (this multiple choice question has been scrambled)
  144. The nurse is assessing the client with recent changes in hearing. After taking a medication history, which drugs does the nurse identify as possible causes of the client's hearing change? (Select all that apply.)

    A. Acetaminophen
    B. Beta blockers
    C. Erythromycin
    D. Ibuprofen
    E. Insulin
    F. Lasix
    C, D and F

    • Many:
    • antibiotics
    • diruretics
    • NSAIDs
    • Chemos

    • Carbamazepine
    • Quinine
    • Quinidine
  145. A 23-year-old woman is being treated for chronic otitis media in the right ear. She rates her pain as 8 on a scale of 1 to 10. She also has decreased hearing in the affected ear and a sensation of fullness. Although she is prescribed an oral antibiotic, she tells you that she does not want to get the prescription filled and asks if she can be treated with eardrops.

    What are potential problems associated with untreated otitis media?
    If otitis progresses or remains untreated, permanent conductive hearing loss may occur. If the eardrum perforates, infective material may cause an external otitis, which can thicken and scar the middle ear if left untreated. Necrosis of the ossicles destroys middle-ear structures.
  146. A 23-year-old woman is being treated for chronic otitis media in the right ear. She rates her pain as 8 on a scale of 1 to 10. She also has decreased hearing in the affected ear and a sensation of fullness. Although she is prescribed an oral antibiotic, she tells you that she does not want to get the prescription filled and asks if she can be treated with eardrops.

    How can pain associated with otitis media be controlled?
    Pain rated as “8” on a scale of 1 to 10 may require opioid analgesics for relief. Other nonpharmacologic measures can be used to further reduce pain. Suggest bedrest, because bedrest limits head movements that intensify the pain. Heat may be applied with a heating pad adjusted to a low setting. Application of cold may also relieve the pain. Check with the health care provider about antihistamines and decongestants. These are prescribed to decrease mucus production and to decrease fluid in the middle ear. The body can then reabsorb the fluid, reducing pressure and pain.
  147. A 23-year-old woman is being treated for chronic otitis media in the right ear. She rates her pain as 8 on a scale of 1 to 10. She also has decreased hearing in the affected ear and a sensation of fullness. Although she is prescribed an oral antibiotic, she tells you that she does not want to get the prescription filled and asks if she can be treated with eardrops.

    How would you answer the patient’s question regarding treatment with eardrops?
    Topical antibiotics are not used to treat otitis media because they do not reach the site of infection. It is important for the patient to take medication as prescribed because chronic otitis media can cause middle-ear injury. In addition to treating the infective organism, systemic antibiotic therapy decreases pain by reducing inflammation.
  148. Which is the priority nursing diagnosis for a client with Ménière’s disease during an attack?

    A. Risk for Deficient Fluid Volume
    B. Risk for Injury
    C. Powerlessness
    D. Fear
    B. Risk for Injury

    The vertigo is severe with the sensation of whirling and complete loss of balance and sense position that can cause the patient to fall (even from a sitting position). The vertigo is so intense that even while lying down, the patient often holds the bed or ground to prevent the whirling sensation. The vertigo can last 3 to 4 hours, and the patient may remain dizzy for an additional 12 hours after the vertigo is gone. While vertigo and dizziness remain, the patient is at risk for injury from falls.
    (this multiple choice question has been scrambled)
  149. The 53-year-old patient is visiting the ENT clinic today. She has had progressive hearing loss since her late 20s. Her ability to hear is better with her right ear, and she has been using bilateral hearing aids for the past 5 years. After being evaluated, it is determined that she has otosclerosis. She discusses options with her physician and the decision is made for her to have a stapedectomy of the left ear.

    Why is the procedure done on the left ear rather than the right ear?
    Even though the success rate of this procedure is high, there is always a risk of failure that might lead to total deafness on the affected side. Therefore, because her hearing is better in the right ear, the procedure will be done on the ear that is most affected in case of complications.
  150. otosclerosis
    abnormal growth of bone near the middle ear. It can result in hearing loss. It is more common in women.
  151. stapedectomy
    a surgical procedure of the middle ear performed to improve hearing. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes.
  152. Situation: Your patient is a 74-year-old man with a history of diabetes and hypertension. He had an upper respiratory infection and is now complaining of pain in his left ear and decreased ability to hear. Otitis media is diagnosed. What medication might be prescribed if he complained of disequilibrium?

    A. Meclizine hydrochloride (Antivert)
    B. Droperidol (Inapsine)
    C. Hydroxyzine (Atarax)
    D. Diphenhydramine (Benadryl)
    A. Meclizine hydrochloride (Antivert)

    Many ear disorders disturb equilibrium. Antivertiginous drugs can help correct dizziness.
    (this multiple choice question has been scrambled)
  153. Situation: Your patient is a 74-year-old man with a history of diabetes and hypertension. He had an upper respiratory infection and is now complaining of pain in his left ear and decreased ability to hear. Otitis media is diagnosed. He has been shown how to instill his eardrops. He is being discharged on an antihistamine and a decongestant. He wants to know why he will need to take these. What is your best response?

    A. To decrease vertigo while decreasing fluid in the middle ear
    B. To decrease mucus production and fluid in the middle ear
    C. To ensure that he will stay awake while taking antibiotics, which will make him sleepy
    D. To increase ability to expel mucus produced during treatment
    B. To decrease mucus production and fluid in the middle ear

    Antihistamines and decongestants are prescribed to decrease mucus production and to decrease fluid in the middle ear. The body can then reabsorb the fluid, reducing pressure and pain.
    (this multiple choice question has been scrambled)
  154. Older patients are especially susceptible to ototoxicity because of ...
    reduced kidney function
  155. Situation: Your patient is a 74-year-old man with a history of diabetes and hypertension. He had an upper respiratory infection and is now complaining of pain in his left ear and decreased ability to hear. Otitis media is diagnosed. He will need eardrops. What should your education about instillation of eardrops include? Select all that apply.

    A. Check label to ensure correct dosage and time.
    B. Place the bottle in warm water for 5 minutes.
    C. Tilt head in opposite direction of affected ear.
    D. Insert cotton ball as packing.
    All
  156. Situation: Your patient is a 40-year-old female with Ménière's disease. She experiences vertigo, nausea, and vomiting on a regular basis. She is surprised at the number of medications she is taking. What medication(s) would you expect to see used in this patient? Select all that apply.

    A. Nicotinic acid
    B. Dimenhydrinate (Dramamine)
    C. Chlorpromazine hydrochloride (Novo-Chlorpromazine)
    D. Diazepam (Valium)
    All

    Drug therapy aims to control the vertigo and vomiting and restore normal balance. Nicotinic acid has been found to be useful because of its vasodilator effect. Antihistamines such as diphenhydramine hydrochloride (Benadryl, Allerdryl) and dimenhydrinate (Dramamine, Gravol) help reduce the severity of or stop an acute attack. Antiemetics such as chlorpromazine hydrochloride (Thorazine, Novo-Chlorpromazine), droperidol (Inapsine), and trimethobenzamide hydrochloride (Arrestin, Tigan) help control the nausea and vomiting. Diazepam (Valium, Apo-Diazepam) calms the patient; controls vertigo, nausea, and vomiting; and allows the patient to rest quietly during an attack.
  157. Four home health patients are scheduled for home visits today. Which patient is best for the home health nurse manager to assign to an LPN/LVN?

    A. A patient who has right-sided facial drooping after having a stapedectomy
    B. A patient who has a fever 3 days after having removal of an acoustic neuroma
    C. A patient with vertigo who needs a scopolamine patch (Trans-Derm Scop) applied
    D. A patient with Ménière's disease who has a request for dietary teaching
    C. A patient with vertigo who needs a scopolamine patch (Trans-Derm Scop) applied

    Medication administration is within the scope of practice for LPNs/LVNs. The other patients will need teaching or assessments that are appropriate for the RN level of practice.
    (this multiple choice question has been scrambled)
  158. mastoiditis
    result of an infection that extends to the air cells of the skull behind the ear. Specifically, it is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cell system inside the mastoid process. The mastoid process is the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces. Mastoiditis is usually caused by untreated acute otitis media (middle ear infection) and used to be a leading cause of child mortality. With the development of antibiotics, however, mastoiditis has become quite rare in developed countries where surgical treatment is now much less frequent and more conservative, unlike former times.[2] Untreated, the infection can spread to surrounding structures, including the brain, causing serious complications.
  159. Ménière's disease
    disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo, low-pitched tinnitus, and hearing loss. The hearing loss is fluctuating rather than permanent, meaning that it comes and goes, alternating between ears for some time, then becomes permanent with no return to normal function.
  160. acoustic neuroma
    is a growth or tumor of nerve tissue. Neuromas tend to be benign (i.e. not cancerous)
  161. The nurse is performing an otoscopic examination of the client's ear and sees a greenish white drainage. What does the nurse do next?

    A. Disposes of the otoscope tip and washes his or her hands before examining the other ear
    B. Reports the finding to the physician immediately
    C. Sends a specimen for culture
    D. Suctions out the drainage
    A. Disposes of the otoscope tip and washes his or her hands before examining the other ear

    The health care provider will be notified after the ear examination is complete. After an otoscopic examination, the nurse must perform an auditory assessment.

    A specimen is obtained only if the nurse is examining the external meatus region, but this is not the first step. The nurse must assess the second ear and compare.
    (this multiple choice question has been scrambled)
  162. Medications for vertigo may cause AAA. The client should not drive or operate machinery while taking these drugs.
    A) drowsiness
  163. Which technique is the correct way to instill eardrops?

    A. Maintaining the head in the same position for 2 minutes after instillation
    B. Placing the medication bottle in a bowl of warm water before instillation
    C. Rinsing the ear canal with hydrogen peroxide before instillation
    D. Checking to see if the eardrum is intact before instillation
    B. Placing the medication bottle in a bowl of warm water before instillation

    Place the bottle of eardrops (with the top on tightly) in a bowl of warm water for 5 minutes. This warms the medication and makes instillation more comfortable for the client.

    The head should be gently moved back and forth five times after installation to ensure proper distribution.
    (this multiple choice question has been scrambled)
  164. The nurse is teaching the client who will soon be fitted for a hearing aid about the proper care and use. Which statement by the client indicates that teaching was effective?

    A. ''I should wear my hearing aid only to work at first.''
    B. ''Listening to the radio and television will help me get used to new sounds.''
    C. ''I should just get a smaller hearing aid because I don't have much money.''
    D. ''Background noises will be difficult for me to hear.''
    B. ''Listening to the radio and television will help me get used to new sounds.''

    With hearing aids, background noises are amplified. The client must learn to concentrate and filter out background noises.

    The client should start using the hearing aid slowly, at first wearing it only at home and only during part of the day.

    The cost of smaller hearing aids is more than for larger ones.

    Listening to television and the radio and reading aloud can help the client get used to new sounds.
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  165. The nurse is teaching the client about audiometric testing. Which statement by the nurse effectively communicates information about the procedure to the client?

    A. ''Here is a picture of how the test is done. See how your bad ear will be tested first? You will be alone in the soundproof booth, so you will need to watch for lights flashing on and off as your cues.''
    B. ''You will be in a soundproof booth and the sounds will be piped in. When you first hear the loudest sound, put your hand down. When you stop hearing the sound, put your hand up to stop.''
    C. ''I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond.''
    D. ''Here is a video of the procedure. Please watch and feel free to ask me any questions.''
    C. ''I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond.''

    Pictures help the client with impaired hearing, but the good ear is tested first. The client wears earphones and listens for sounds, not flashing lights.

    Earphones are placed on the client. The client will raise her or his hand up when hearing the first sound and lower the hand when the sound first disappears.
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  166. The AAA can inform the client about support groups in the area, along with interventions to help improve hearing.
    Hearing Loss Association of America
  167. The AAA assists clients in coping with tinnitus when other therapy is unsuccessful.
    American Tinnitus Association
  168. Ear mold hearing aids can amplify sounds to AAA the tinnitus during the day.
    drown out
  169. The older adult client reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media?

    A. Pain on movement of tragus
    B. Vertigo
    C. Ringing in the ears
    D. Dry flaky cerumen
    B. Vertigo

    With otitis media, as the pressure on the middle ear pushes against the inner ear, the client may have dizziness or vertigo.

    Unlike the pinna, pain on movement of tragus (flap anterior to canal) is indicative of external otitis.
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  170. The older adult client reports nausea during the removal of impacted cerumen from the ear canal. What does the nurse do next?

    A. Stops irrigation immediately
    B. Administers an antiemetic
    C. Calls the physician
    D. Uses less water to irrigate
    A. Stops irrigation immediately

    The client's nausea may be a sign of vertigo. If nausea, vomiting, or dizziness develops in the client, stop the irrigation immediately.

    Antiemetics should not be immediately administered in this case. The client's nausea may be a symptom of vertigo and further assessment is required first.
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  171. Which type of drug therapy does the nurse anticipate giving to the client with M'ni're's disease to decrease endolymph volume?

    A. Antipyretics
    B. Diuretics
    C. Antihistamines
    D. Nicotinic acid
    B. Diuretics

    Antihistamines help reduce the severity of or stop an acute attack, but they do not decrease endolymph volume.

    Mild diuretics are prescribed to decrease endolymph volume.
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  172. The client is in the immediate postoperative period after tympanoplasty. How does the nurse position the client?

    A. On the affected side
    B. With the head elevated 60 degrees
    C. Supine, with eyes toward the ceiling
    D. With the affected ear facing up
    D. With the affected ear facing up

    Keep the client flat, with the head turned to the side and the operative ear facing up, for at least 12 hours after surgery.

    Raising the head places undue pressure on the surgical site.
    (this multiple choice question has been scrambled)
  173. The nurse is reviewing postoperative instructions with the client undergoing stapedectomy. Which statement by the client indicates a need for further teaching?

    A. ''I will have to take antibiotics after the surgery.''
    B. ''I may have problems with vertigo after the surgery.''
    C. ''I should not drink from a straw for several weeks.''
    D. ''I will be able to hear as soon as my dressing is removed.''
    D. ''I will be able to hear as soon as my dressing is removed.''

    Hearing is initially worse after a stapedectomy. Inform the client that improvement in hearing may not occur until 6 weeks after surgery. At first, the ear packing interferes with hearing. Swelling in the ear after surgery reduces hearing, but this is temporary.

    Vertigo, nausea, and vomiting are common after surgery because of the nearness of the surgical site to inner ear structures.

    Clients should not drink through a straw for 2 to 3 weeks after surgery.
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  174. Rinne Test for unilateral hearing loss
    The Rinne test is performed by placing a high frequency (512 Hz) vibrating tuning fork against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Once they signal they can't hear it, quickly position the still vibrating tuning fork 1–2 cm from the auditory canal, and again ask the patient to tell you if they are able to hear the tuning fork.

    Normal Hearing: Air conduction should be greater than bone conduction and so the patient should be able to hear the tuning fork next to the pinna after they can no longer hear it when held against the mastoid.

    Abnormal Hearing:If they are not able to hear the tuning fork after mastoid test, it means that their bone conduction is greater than their air conduction. This indicates there is something inhibiting the passage of sound waves from the ear canal, through the middle ear apparatus and into the cochlea (i.e., there is a conductive hearing loss).

    In sensorineural hearing loss the ability to sense the tuning fork by both bone and air conduction is equally diminished. Sensorineurally hearing loss patients usually can hear better on the mastoid process than air process, but indicate the sound has stopped much earlier than conductive loss patients.

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