Deck 22: Nursing Management: Visual and Auditory Problems

Question 1

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

Answer 1

using baby shampoo to clean the lids.

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

Answer 2

visual field.

Question 3

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

Answer 3

The patient has a temperature of 100.6° F.

Question 4

Which action should the nurse take when assisting a totally blind patient to walk to the bathroom?

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

Question 5

To evaluate the effectiveness of the prescribed bifocals for a patient with myopia and presbyopia, the nurse in the eye clinic will check the patient for

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

Question 6

Which topic will the nurse plan to include when teaching the patient with herpes simplex keratitis of the left eye about management of the infection?

A) How to apply an occlusive dressing to the affected eye
B) Need for frequent hand washing and avoiding touching the eyes
C) Application of antibiotic drops to the left eye several times daily
D) Use of corticosteroid ophthalmic ointment to decrease inflammation

Question 7

A patient with external otitis has an ear wick placed and a new prescription for antibiotic otic drops. After the nurse provides patient teaching, which patient statement indicates that more instruction is needed?

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

Question 8

To decrease the risk for future hearing loss, which action should the nurse working with college students at the on-campus health clinic implement?

A) Arrange to include otoscopic examinations for all patients.
B) Administer rubella immunizations to all students at the clinic.
C) Discuss the importance of limiting exposure to very amplified music.
D) Teach patients to regularly irrigate the ear to decrease cerumen impaction.

Question 9

A patient with a left retinal detachment has a pneumatic retinopexy procedure. Which information will be included in the discharge teaching plan?

A) The use of bilateral eye patches to reduce movement of the operative eye
B) The need to wear dark or tinted glasses to protect the eyes from bright light
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 10

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

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

Question 11

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 need to use bright lights to read for at least the next week."
B) "I will use drops to keep my pupils dilated until my appointment."
C) "I will not use facial lotions near my eyes during the recovery period."
D) "I will keep covered with long-sleeved shirts and pants for the next 5 days."

Question 12

A patient who is being admitted to the hospital for abdominal pain and nausea tells the nurse about a history of glaucoma. Which of these prescribed medications should the nurse question?

A) morphine sulfate 4 mg IV
B) diazepam ( Valium ) 5 mg IV
C) betaxolol ( Betoptic ) 0.25% eyedrops
D) scopolamine patch ( Transderm Scop ) 1.5 mg

Question 13

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

Question 14

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

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

Question 15

A patient who has bacterial endophthalmitis in the left eye is restless, frequently asking whether the eye is healing and whether removal of the eye will be necessary. Based on the assessment data, which nursing diagnosis is appropriate?

A) Grieving related to current loss of functional vision
B) Anxiety related to the possibility of permanent vision loss
C) Situational low self-esteem related to loss of visual function
D) Risk for falls related to inability to see environmental hazards

Question 16

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

Question 17

A patient with glaucoma who has been using timolol ( Timoptic ) drops for several days tells the nurse that the eyedrops cause eye burning and visual blurriness for a short time after administration. The best response to the patient's statement 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) "The drops are uncomfortable, but it is very important for you to use them as prescribed to retain your vision."
D) "These symptoms are caused by glaucoma and may indicate a need for an increased dosage of the eyedrops."

Question 18

Which topic will the nurse include in patient teaching after a patient has had outpatient cataract surgery and lens implantation?

A) Use of oral opioids for pain control
B) Administration of antibiotic eyedrops
C) Importance of coughing and deep breathing exercises
D) Need for bed rest for the first 24 hours after the surgery

Question 19

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

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

Question 20

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) apply cold compresses at the first sign of recurrence.
B) discard all open or used cosmetics used near the eyes.
C) wash the scalp and eyebrows with an antiseborrheic shampoo.
D) be evaluated for the presence of sexually transmitted diseases (STDs).

Question 21

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

A) NAP raise the side rails on the bed.
B) NAP turn on the patient's television.
C) NAP turn the patient to the right side.
D) NAP place an emesis basin at the bedside.

Question 22

A patient is scheduled for a right cataract extraction and intraocular lens implantation at an ambulatory surgical center in 2 weeks. During the preoperative assessment of the patient in the physician's office, it is most important for the nurse to assess

A) the visual acuity of the patient's left eye.
B) for a white pupil in the patient's right eye.
C) how long that the patient has had the cataract.
D) for a history of reactions to general anesthetics.

Question 23

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 is the priority to communicate to the health care provider?

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

Question 24

Which assessment finding in a patient who was struck in the right eye with a baseball is a priority for the nurse to communicate to the health care provider in the emergency department?

A) The patient complains of a right-sided headache.
B) The sclerae on the right eye have broken blood vessels.
C) The area around the right eye is bruised and tender to the touch.
D) The patient complains of "a curtain" blocking part of the visual field.

Question 25

Which information about a patient who had a stapedotomy yesterday is most important for the nurse to communicate to the health care provider?

A) The patient complains of "congestion" in the ear.
B) The patient's oral temperature is 100.6° F ( 38.1° C ).
C) The patient says "My hearing is worse now than it was right after surgery."
D) There is a small amount of dried bloody drainage on the patient's dressing.

Question 26

When the nurse is admitting a 78-year-old patient, the patient repeatedly asks the nurse to "speak up so that I can hear you." Which action should the nurse take?

A) Overenunciate while speaking.
B) Speak normally but more slowly.
C) Increase the volume when speaking.
D) Use more facial expressions when talking.

Question 27

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 dressing) related to vertigo.
D) imbalanced nutrition: less than body requirements related to nausea.

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

Question 29

These medications are prescribed by the health care provider for a patient who has just been admitted to a hospital with acute angle-closure glaucoma. Which medication should the nurse give first?

A) morphine sulfate 4 mg intravenously
B) betaxolol ( Betoptic ) 1 drop in each eye
C) acetazolamide ( Diamox ) 250 mg orally
D) mannitol ( Osmitrol ) 100 mg intravenously

Question 30

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) Application of povidone-iodine (Betadine) gel around the eye.
C) Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs).
D) Importance of taking all of the ordered oral acyclovir (Zovirax).

Question 31

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

Question 32

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) Keep the volume low on the hearing aids for the first week while adjusting to them.
C) Add the second hearing aid after making the initial adjustment to the first hearing aid.
D) Wear the hearing aids for about an hour a day at first, gradually increasing the time of use.

Question 33

The home health nurse observes a patient taking these actions when self-administering eardrops. Which patient action indicates a need for more teaching?

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

Question 34

Which of these nursing activities is appropriate for the RN working in the eye clinic to delegate to experienced nursing assistive personnel (NAP)?

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

Question 35

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

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

Question 36

Which action should the RN who is working in the eye and ear clinic delegate to an LPN/LVN?

A) Use a Snellen chart to check a patient's visual acuity.
B) Evaluate a patient's ability to insert soft contact lenses.
C) Teach a patient with otosclerosis about use of sodium fluoride and vitamin D.
D) Assess the external auditory canal for signs of irritation caused by a hearing aid.

Question 37

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 three antihypertensive medications.
C) The patient gets nauseated with general anesthesia.
D) The patient has had blurred vision for several years.

Question 38

The charge nurse observes a newly hired nurse performing all of the following interventions for a patient who has just arrived in the postanesthesia care unit after having right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene?

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

Question 39

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 40

When admitting a patient for surgery, the nurse learns 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) obtain information from the spouse about the patient's special needs.
C) make eye contact with the patient and ask about any need for assistance.
D) perform an evaluation of the patient's visual acuity using a Snellen chart.