Deck 22: Nursing Management: Visual and Auditory Problems

Question 1

A patient who was struck in the right eye with a handball has swelling around the orbit and states, "It's like a curtain blocking part of my eye." When assessing the patient, the nurse suspects the presence of a retinal detachment upon the patient's report of

A) severe right eye pain.
B) abnormal color perception.
C) glare and halos around lights.
D) light flashes in the right eye.

Answer 1

light flashes in the right eye.

Question 2

To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse will evaluate the patient for improvement in

A) blurred vision.
B) eye pain.
C) visual field.
D) depth perception.

Answer 2

visual field.

Question 3

An unconscious patient is admitted to the emergency department with multiple injuries following a motorcycle accident. While assessing the pupillary reflexes, the nurse notes the presence of contact lenses. Which action should the nurse take next?

A) Remove the contact lenses from the eyes.
B) Call the doctor to evaluate the patient's eyes.
C) Determine what lens type is present in the eyes.
D) Apply artificial tears to lubricate the eyes.

Answer 3

Remove the contact lenses from the eyes.

Question 4

A blind patient asks the nurse for assistance in walking to the bathroom. To assist the patient, the nurse should

A) take the patient by the arm and lead the patient slowly to the bathroom.
B) walk slightly ahead of the patient and allow the patient to hold the nurse's elbow.
C) have the patient place a hand on the nurse's shoulder and guide the patient.
D) stay beside the patient and describe any obstacles on the path to the bathroom.

Question 5

A patient who had cataract extraction and intraocular lens implantation the previous day calls the eye clinic and gives the nurse all of the following information. Which information will be of most concern to the nurse?

A) The patient has eye pain rated at a 5 (on a 0-10 scale).
B) The patient complains that the vision has "not improved very much."
C) The patient has poor depth perception when wearing an eye patch.
D) The patient has questions about the ordered eyedrops.

Question 6

The charge nurse observes a nurse accomplishing all of these interventions for a patient who has just arrived in the post-anesthesia care unit after having right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene?

A) The nurse elevates the patient's head to 45 degrees.
B) The nurse applies corticosteroid drops to the right eye.
C) The nurse leaves the eye shield in place.
D) The nurse encourages the patient to cough.

Question 7

During the admission assessment, the patient's spouse tells the nurse that the 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

A) obtain more information about the cause of the patient's vision loss.
B) make eye contact with the patient and ask about any need for assistance.
C) obtain information from the spouse about the patient's special needs.
D) perform an evaluation of the patient's visual acuity using a Snellen chart.

Question 8

A patient with age-related macular degeneration has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective?

A) "I will avoid using any facial lotions during the recovery period."
B) "I will use drops to keep my pupils dilated until my appointment."
C) "I will need to use bright lights to read for at least the next week."
D) "I will wear a hat, long-sleeved shirt, and pants for the next 5 days."

Question 9

A patient is seen in the ophthalmology clinic and diagnosed with recurrent staphylococcal and seborrheic blepharitis. The nurse will plan to teach the patient about

A) the use of warm compresses to soften the crusts.
B) surgical removal of the lesion.
C) saline irrigation of the eyes.
D) using baby shampoo to clean the lids.

Question 10

A patient with an extensive left retinal detachment is scheduled for a scleral buckling with cryopexy and pneumatic retinopexy. Which information will be included in the discharge teaching plan?

A) The need to wear dark or tinted glasses to protect the eyes from ultraviolet light
B) The use of bilateral eye patches to reduce movement of the operative eye
C) The procedure for sterile dressing changes when the eye dressing is saturated
D) The purpose of maintaining the head in a prescribed position for several weeks

Question 11

A 74-year-old patient has bifocals prescribed to correct myopia and presbyopia. To evaluate the effectiveness of the lenses, the nurse working in the eye clinic will check the patient for

A) cloudiness in the eye lenses.
B) intraocular pressure changes.
C) strength of the eye muscles.
D) both near and distant vision.

Question 12

A patient has bilateral senile cataracts and is scheduled for a right cataract extraction and intraocular lens implantation at an ambulatory surgical center. During the preoperative assessment of the patient, it is most important for the nurse to assess

A) the visual acuity of the patient's left eye.
B) for a history of reactions to general anesthetic agents.
C) for a white pupil in the patient's right eye.
D) pupillary response to preoperative antibiotic eyedrops.

Question 13

A patient is seen at a clinic for repeated hordeolum of the eyes during the last 6 months. To help prevent further infection, the nurse advises the patient to

A) discard all open or used cosmetics.
B) avoid contact lens use for the present.
C) wash the scalp and eyebrows with an antiseborrheic shampoo.
D) be evaluated for the presence of sexually transmitted diseases (STDs).

Question 14

A new patient with 20/200 vision (with the use of corrective lenses) is being cared for by the nurse in the eye clinic. The nurse will plan to teach the patient about

A) how to access audio books.
B) where Braille instruction is available.
C) how to use a cane safely.
D) where to obtain specialized magnifiers.

Question 15

A patient is diagnosed with adult inclusion conjunctivitis (AIC) caused by the Chlamydia trachomatis organism. Which of these actions will be included in the plan of care?

A) Educating about the use of antiviral eyedrops to treat the infection
B) Applying topical corticosteroids to prevent further inflammation
C) Discussing the need for sexually transmitted disease testing
D) Assist with applying for community visual rehabilitation services

Question 16

A patient is prepared for discharge following outpatient cataract surgery. To evaluate whether the patient understands the postoperative regimen and procedures, the nurse asks the patient

A) to use the 0 to 10 pain scale to rate eye pain.
B) to demonstrate administration of eyedrops.
C) how good the vision is in the operative eye.
D) why staying on bed rest for 24 hours is needed.

Question 17

In reviewing a 50-year-old patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess

A) color perception.
B) visual acuity.
C) peripheral vision.
D) pupil reaction.

Question 18

Which of these nursing activities is appropriate for the RN working in the eye clinic to delegate to an experienced nursing assistant?

A) Administration of antiviral drops to a patient with a corneal ulcer
B) Instruction about handwashing for a patient with herpes keratitis
C) Application of a warm compress to a patient's hordeolum
D) Assessment of a patient with possible bacterial conjunctivitis

Question 19

The nurse is caring for a patient with herpes simplex type I keratitis of the left eye who has eyedrops prescribed for use in the affected eye. The nurse explains that to prevent spread of the infection, the patient should

A) apply an occlusive dressing to the affected eye.
B) avoid touching the eyes and wash the hands frequently.
C) use the prescribed eyedrops in the right eye as well as the left eye as a prophylactic measure.
D) apply corticosteroid ophthalmic ointment to the right eye to decrease the risk for inflammation.

Question 20

The camp nurse is caring for a patient who is complaining of bilateral eye pain after a campfire log exploded, sending sparks into the patient's eyes. Which of these actions will the nurse take first?

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

Question 21

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

A) Demonstrate appropriate handwashing technique.
B) Explain the purpose of antiviral eye drops.
C) Show how to perform eye irrigation safely.
D) Instruct about how to insert soft contact lenses.

Question 22

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

A) Application of corticosteroid ophthalmic ointment to the eyes.
B) Importance of taking all of the ordered oral acyclovir (Zovirax).
C) Application of povidone-iodine (Betadine) gel around the eye.
D) Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

Question 23

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?

A) The patient gets the eardrops out of the refrigerator just before administering the drops.
B) The patient lies down before and for 2 minutes after administering the drops.
C) The patient holds the tip of the dropper 1 cm above the ear while administering the drops.
D) The patient leaves the ear wick in place while administering the drops.

Question 24

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?

A) The patient has not eaten anything for 8 hours.
B) The patient takes 3 antihypertensive medications.
C) The patient has had blurred vision for several years.
D) The patient gets nauseated with general anesthesia.

Question 25

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

A) arrange for the patient to have a hearing test using audiometry.
B) withhold the ordered dose of furosemide and notify the health care provider.
C) tell the patient that these symptoms are temporary and will subside when the heart failure improves.
D) add the nursing diagnosis of disturbed auditory perception related to ototoxicity to the patient's care plan.

Question 26

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

A) increase the volume of the nurse's voice.
B) speak normally but more slowly.
C) over enunciate while speaking.
D) use more facial expressions when talking.

Question 27

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

A) Encourage oral fluids to 3000 ml daily.
B) Change the patient's position every 2 hours.
C) Keep the head of the bed elevated 30 degrees.
D) Keep the patient's room darkened.

Question 28

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?

A) Cochlear implants are not useful for patients with congenital deafness.
B) Cochlear implants are most helpful as an early intervention for presbycusis.
C) Cochlear implants improve hearing in patients with conductive hearing loss.
D) Cochlear implants require training in order to receive the full benefit.

Question 29

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?

A) The patient complains of "popping" in the ear.
B) The patient has a temperature of 100.6° F.
C) The patient frequently asks the nurse to repeat information.
D) The patient states that the right ear has a feeling of fullness.

Question 30

The priority nursing diagnosis for a patient with Ménière's disease who is experiencing an acute attack is

A) risk for falls related to dizziness.
B) impaired verbal communication related to tinnitus.
C) self-care deficit: bathing and hygiene related to vertigo.
D) imbalanced nutrition: less than body requirements related to nausea.

Question 31

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

A) avoidance of coughing or blowing the nose.
B) the need for prolonged bed rest.
C) keeping the head elevated.
D) continuous antibiotic irrigation of the ear canal.

Question 32

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?

A) Monitoring the noise level at the clinic
B) Discussing the importance of limiting exposure time to very amplified music
C) Administration of rubella immunizations to all students at the clinic
D) Including otoscopic examinations for all patients

Question 33

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?

A) "You may have a different kind of hearing loss that is not related to the otosclerosis."
B) "The dressing over your incision most likely is decreasing your hearing in that ear."
C) "Postoperative accumulation of fluid and blood in your middle ear will temporarily decrease your hearing."
D) "I will let the health care provider know about this because you could have a fistula or other complication of the surgery."

Question 34

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?

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

Question 35

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?

A) Experiment with volume and hearing ability in a quiet environment initially.
B) Wear the hearing aids for about an hour a day at first, gradually increasing the time of use.
C) Keep the volume low on the hearing aids for the first week while adjusting to them.
D) Add the second hearing aid after making the initial adjustment to the first hearing aid.

Question 36

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

A) atropine sulfate 0.4 mg administered intramuscularly on call to the operating room (OR).
B) morphine sulfate 10 mg intramuscularly on call to the OR.
C) betaxolol (Betoptic) 1 drop to each eye.
D) diazepam (Valium) 5 mg taken orally with sip of water.

Question 37

A patient is hospitalized with acute angle-closure glaucoma. All the following orders are received. Which will the nurse implement first?

A) Morphine sulfate 4 mg administered intravenously
B) Mannitol (Osmitrol) 100 mg administered intravenously
C) Acetazolamide (Diamox) 250 mg administered orally
D) Betaxolol (Betoptic) 1 drop in each eye

Question 38

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,

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

Question 39

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

A) grieving related to current loss of functional vision.
B) anxiety related to the possibility of permanent vision loss.
C) self-esteem disturbance related to loss of visual function.
D) risk for injury and falls related to inability to see environment.

Question 40

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?

A) Check the patient's oxygen saturation.
B) Administer the ordered analgesic.
C) Elevate the head to 45 degrees.
D) Examine the eye for evidence of trauma.

Question 41

The nurse obtains all these data when assessing a patient who has left-sided labyrinthitis. Which information should be reported immediately to the health care provider?

A) The patient states, "My ears are really ringing."
B) The patient has jerking eye movements.
C) The patient complains about a stiff neck.
D) The patient's hearing is decreased on the left.

Question 42

The nurse notes a nursing assistant (NA) accomplishing all the following actions when caring for a patient with Ménière's disease who is experiencing an acute attack. Which action by the NA indicates that the nurse should intervene immediately?

A) The NA raises the side rails on the bed.
B) The NA turns on the patient's television.
C) The NA places an emesis basin at the bedside.
D) The NA turns the patient to the right side.