Deck 42: Sensory System

Question 1

The nurse is caring for an infant with brown eyes and recalls that which portion of the vascular tunic is responsible for the color of the eye?

A)cornea
B)iris
C)retina
D)sclera

Answer 1

iris

Question 2

The nurse is aware that the proper name of the "blind spot," which lacks photoreceptors and does not detect light focused on it,is:

A)fovea
B)macula lutea
C)optic disk
D)retina

Answer 2

optic disk

Question 3

The client is seeing a specialist who evaluates hearing and determines the extent and types of hearing loss.The nurse explains the client will be seeing:

A)an audiologist
B)a hearing-aid specialist
C)an ophthalmologist
D)an otolaryngologist

Answer 3

an audiologist

Question 4

When caring for a client with a vision and hearing loss,the nurse understands that this client is experiencing which alteration?

A)sensory deficit
B)sensory deprivation
C)sensory overload
D)disorientation

Question 5

The client is seeing a specialist who provides medical evaluation of hearing disorders and medical and surgical interventions.The nurse explains the client will see:

A)an audiologist
B)a hearing-aid specialist
C)an ophthalmologist
D)an otolaryngologist

Question 6

When a client is first given a hearing aid,the nurse should make sure the client and the family understand that hearing aids:

A)increase the volume of sound and speech,but not necessarily the clarity
B)improve the quality of sounds heard,but not their volume
C)stimulate the client's auditory centers
D)can determine the amount of amplification actually required by the client

Question 7

Which receptors within the nervous tunic allow color vision?

A)cones
B)fovea
C)macula lutea
D)rods

Question 8

When assessing clients for sensory,perceptual,and cognitive alterations,the nurse must also evaluate their:

A)genetic history
B)ability to concentrate
C)level of consciousness
D)family support systems

Question 9

Which structure is located within the middle ear?

A)vestibule
B)semicircular canals
C)stapes
D)oval window

Question 10

What is the name of the outer coat of the eyeball composed posteriorly of the sclera and anteriorly of the transparent cornea?

A)fibrous tunic
B)nervous tunic
C)orbital tunic
D)vascular tunic

Question 11

What are the two main functions of the inner ear?

A)amplification and sound transmission
B)hearing and equilibrium
C)pressure equalization and hearing
D)sound transmission and pressure equalization

Question 12

Which type of hearing loss indicates an inability of the sound waves to reach the inner ear?

A)common
B)conductive
C)mixed
D)sensorineural

Question 13

A possible goal for a client with a hearing impairment would be,"The client will participate in conversations and other social situations." Which nursing intervention is MOST appropriate to attain this goal?

A)consulting social services as needed
B)identifying hospital and community resources for people who are hearing impaired
C)speaking slowly and distinctly,giving the client time to respond
D)using written materials whenever possible to communicate information

Question 14

When the nurse is assessing the client's ability to receive and process stimuli through sensory organs,this is evaluating the client's:

A)sensation
B)perception
C)cognition
D)awareness

Question 15

Components of cognition include the cerebral functions of memory,judgment,perception,affect,and:

A)behavior
B)language
C)hearing
D)vision

Question 16

The nurse notes that which type of receptor increases in density toward the periphery of the retina and allows vision in dim light?

A)cones
B)fovea
C)macula lutea
D)rods

Question 17

The innermost "tunic" of the eye is also called the:

A)sclera
B)retina
C)orbit
D)iris

Question 18

Functions of the middle ear include:

A)creation of cerumen
B)equilibrium
C)pressure equalization
D)closure of the oval window

Question 19

Which factor can contribute to a client developing sensory overload?

A)analgesics
B)family visitations
C)use of hearing aids
D)invasive procedures

Question 20

In which type of hearing loss is the inner ear or cochlear portion of the eighth cranial nerve abnormal or diseased?

A)common
B)conductive
C)mixed
D)sensorineural

Question 21

The nurse anticipates treatment for cataracts to be:

A)administration of medications that enhance pupillary constriction
B)cryotherapy
C)iridectomy
D)surgical removal of the lens

Question 22

A client with cataracts has a nursing diagnosis of Risk for injury related to difficulty in processing visual images and altered depth perception.The MOST appropriate goal for this diagnosis is that the client will:

A)accept wearing glasses or contact lenses
B)avoid activities associated with increased potential for injury
C)demonstrate improved ability to process visual stimuli and communicate visual limitations
D)discuss the impact of vision loss on lifestyle

Question 23

The client asks the nurse "What is the most common cause of cataracts?" The BEST response by the nurse would be:

A)"Cataracts occur as a result of aging."
B)"Cataracts occur as a result of congenital defects."
C)"Cataracts occur as a result of systemic diseases characterized by metabolic problems."
D)"Cataracts occur as a result of uveitis."

Question 24

The client has a disorder that causes the lens or its capsule to lose its transparency or become opaque.The nurse is aware that the client has which of the following conditions?

A)cataract
B)chalazion
C)glaucoma
D)keratitis

Question 25

What is the preferred surgical technique for improving hearing loss due to otosclerosis?

A)meatoplasty
B)otothesis
C)stapedectomy
D)tympanoplasty

Question 26

For a client with Ménière's disease whose nursing diagnosis is Risk for injury related to vertigo,which intervention is essential?

A)Administer medications for vertigo when the symptoms begin.
B)Avoid glaring,bright lights.
C)Have a family member stay with the client at all times.
D)Teach the client to ambulate slowly when moving around the room or the hallway.

Question 27

The nurse should instruct the client who has glaucoma to take which action?

A)Wear loose-fitting clothing.
B)Use eye medications as ordered.
C)Wear dark glasses at all times.
D)Formulate an exercise plan.

Question 28

The main objective of the medical management of glaucoma is to:

A)correct visual abnormalities
B)prevent postsurgical infection
C)reduce intraocular pressure
D)relieve pain

Question 29

The nurse explains to the client that the condition in which inflammation occurs in the middle ear and can cause temporary conductive hearing loss is:

A)acoustic neuroma
B)Ménière's disease
C)otitis media
D)otosclerosis

Question 30

Which statement about open-angle glaucoma is TRUE?

A)The gradual rise in intraocular pressure causes rapid loss of vision.
B)It is usually unilateral.
C)The condition is seldom painful.
D)It is the most prevalent form of glaucoma.

Question 31

What are the primary clinical manifestations of otosclerosis?

A)dizziness,possible facial weakness,tinnitus,and hearing loss
B)ear pain,fever,and redness of the auricle and ear canal
C)subtle changes in hearing and low-pitched tinnitus
D)vertigo,tinnitus,and unilateral fluctuating hearing loss

Question 32

Which condition frequently results from chronic or recurrent bacterial otitis media extending into the bone and structures surrounding the middle ear?

A)acoustic neuroma
B)mastoiditis
C)Ménière's disease
D)otosclerosis

Question 33

The nurse should include in client teaching that the MOST common type of conductive hearing loss is:

A)acoustic neuroma
B)Ménière's disease
C)otitis media
D)otosclerosis

Question 34

A client with otitis media has a nursing diagnosis of Acute pain related to inflammation in the middle ear.The nursing intervention would include:

A)administrating warm saline flushes to the affected ear
B)applying an ice pack to the affected ear every 2 hours
C)administrating analgesics and antibiotics as ordered
D)telling the client that the symptoms will subside in 3 to 4 days

Question 35

The client has a disorder that is characterized by the classic triad of tinnitus,vertigo,and unilateral fluctuating hearing loss.The nurse is aware that the client has which type of problem?

A)acoustic neuroma
B)Ménière's disease
C)otitis media
D)otosclerosis

Question 36

A slow-growing and usually benign tumor of the vestibular portion of the inner ear is known as:

A)acoustic neuroma
B)Ménière's disease
C)otitis media
D)otosclerosis

Question 37

What is the MOST common treatment for acoustic neuroma?

A)pharmacological treatment with antihistamines
B)placement of a polyethylene tube in the eardrum
C)stapedectomy by laser
D)surgical excision of the tumor

Question 38

A client tells the nurse about experiencing sudden flashes of light,blurred vision,and floating spots.The nurse should recommend that the client seek evaluation by a health care provider for which condition?

A)cataracts
B)glaucoma
C)keratitis
D)retinal detachment

Question 39

The client is diagnosed with a disorder that is characterized by an abnormally high pressure of fluid within the eyeball.The nurse is aware that this condition is:

A)cataracts
B)chalazion
C)glaucoma
D)keratitis

Question 40

The client is seeing a specialist who is a medical doctor specializing in the diagnosis and medical and surgical treatment of diseases of the eye,visual disorders,and eye injuries.The nurse explains that the client will be seeing an:

A)oculist
B)ophthalmologist
C)optometrist
D)otolaryngologist

Question 41

In which refractive disorder is the eyeball elongated,causing normal near vision but poor distant vision?

A)astigmatism
B)hyperopia
C)myopia
D)strabismus

Question 42

The client is experiencing a pustular inflammation of the eyelash follicle or sebaceous gland on the lid margin that is commonly caused by staphylococcal organisms.The nurse explains to the client that this is:

A)a chalazion
B)conjunctivitis
C)keratitis
D)a sty

Question 43

When caring for a client who has altered tactile sensation,the nurse's MOST important role is to:

A)perform passive range-of-motion exercises for the client every 2 to 4 hours to avoid atrophy
B)provide clear,concise explanations of treatments while avoiding information overload
C)provide sensory stimulation by using auditory,visual,and gustatory stimuli to help compensate for tactile loss
D)reduce or prevent impairment of skin integrity

Question 44

How are refractory disorders MOST commonly corrected?

A)corrective lenses
B)ocular muscle training
C)laser photocoagulation
D)radial keratotomy

Question 45

Which intervention is essential when caring for a client who has conjunctivitis of bacterial origin?

A)Wear gloves when assisting the client with personal care.
B)Discard linens after use by the client.
C)Perform proper hand hygiene by the nurse and client.
D)Remove all possible allergens (such as flowers)from the client care area.

Question 46

The client has inflammation of the conjunctiva resulting from invasion by bacterial,viral,or rickettsial organisms,and is causing pain and redness.The nurse explains that this problem is:

A)uveitis
B)conjunctivitis
C)keratitis
D)iriditis

Question 47

The loss of central vision interferes with the client's ability to:

A)walk
B)perform activities of daily living (ADLs )
C)read and write
D)recognize colors

Question 48

When caring for a client,the nurse notes inflammation of the cornea associated with irritation or allergies.Which of the following would the nurse suspect is associated with irritation or allergies?

A)chalazion
B)glaucoma
C)keratitis
D)conjunctivitis

Question 49

A person is considered legally blind when central visual acuity is:

A)between 20/70 and 20/200 in the better eye without corrective lenses
B)20/200 or less in either eye without corrective lenses
C)20/200 or less in the better eye with corrective lenses
D)absent

Question 50

The client has deterioration of part of the retina causing loss of central vision but not affecting peripheral vision.The nurse recognizes this client is experiencing:

A)astigmatism
B)glaucoma
C)macular degeneration
D)strabismus

Question 51

The client is diagnosed with retinal detachment.Which of the following would NOT allow the surgeon to be able to visualize the retinal tear? (Select all that apply. )

A)scleral buckling
B)retinal scarring
C)jaundice
D)vitreous cloudiness
E)absence of vitreous

Question 52

Which treatment may be used for surgical correction of a retinal detachment?

A)cryotherapy
B)electrodiathermy
C)laser photocoagulation
D)scleral buckling

Question 53

The client is experiencing sensory deprivation.The nurse would expect to find which of the following noted in the client's record? (Select all that apply. )

A)confusion
B)hallucinations
C)hyperactive reflexes
D)restlessness
E)drowsiness

Question 54

In which refractive disorder do the refractive surfaces of the eye have unequal curvatures that create visual distortion?

A)astigmatism
B)hyperopia
C)myopia
D)strabismus

Question 55

In which refractive disorder is the refractive system weak or the eyeball flattened,causing vision beyond 20 feet to be normal but poor at close range?

A)astigmatism
B)hyperopia
C)myopia
D)strabismus

Question 56

The client is experiencing a cyst of the meibomian glands.The nurse is aware that the client is experiencing a:

A)chalazion
B)benign ocular tumor
C)ciliary body
D)sty

Question 57

When a person has experienced a chemical exposure or burn to the conjunctiva or cornea,which action should be taken immediately?

A)Apply an eye patch to the affected eye.
B)Administer fluorescein drops to the affected eye.
C)Perform lavage on the eye with tap water.
D)Neutralize the chemical.