Med Surg- Exam 4 - Chapter 22

Question 1

1. Myopia is present in 25% of Americans. Which characteristics are associated with myopia (select all that apply)
   a. Excessive light refraction
   b. Abnormally short eyeball
   c. Unequal corneal curvature
   d. Corrected with concave lens
   e. Image focused in front of retina

Answer 1

a. Excessive light refraction
d. Corrected with concave lens
e. Image focused in front of retina

Question 2

2. The patient is diagnosed with presbyopia. When he asks the nurse what that is, what is the best explanation the nurse can give to the patient?
   a. Abnormally long eyeballs
   b. Absence of crystalline lens
   c. Correctable with cylinder lens
   d. Loss of accommodation associated with age

Answer 2

d. Loss of accommodation associated with age

Question 3

3. To determine if an unconscious patient has contact lenses in place, what should be done by the nurse?
   a. Use a penlight to shine a light obliquely over the eyeball
   b. Apply drops of fluorescein dye to the eye to stain the lenses yellow
   c. Touch the cornea lightly with a dry cotton ball to see if the patient reacts
   d. Tense the lateral canthus to cause a lens to be ejected if it is present in the eye

Answer 3

a. Use a penlight to shine a light obliquely over the eyeball

Question 4

4. What surgical choices are available for correction of a refractive error (select all that apply)
   a. LASIK
   b. Contact lenses
   c. Corrective lenses
   d. Photorefractive keratectomy (PRK)
   e. Surgical implantation of intraocular lens

Answer 4

a. LASIK
d. Photorefractive keratectomy (PRK)
e. Surgical implantation of intraocular lens

Question 5

5. A patient tells the nurse on admission to the health care facility that he recently has been classified as legally blind. What does the nurse understand about the patient’s vision?
   a. Has lost usable vision but has some light perception
   b. Will need time for grieving and adjusting to living with total blindness
   c. Will be dependent on others to ensure a safe environment for functioning
   d. May be able to perform many tasks and activities with vision enhancement techniques

Answer 5

d. May be able to perform many tasks and activities with vision enhancement techniques

Question 6

6. Identify five nursing measures that should be implemented to increase a visually impaired patient’s safety and comfort.

Answer 6

a. Address the patient, not others with the patient, in normal conversational tones
b. Face the patient and make eye contact
c. Introduce self when approaching the patient and let the patient know when you are leaving
d. Orient to sounds, activities, and physical surroundings
e. Use a sighted-guide technique to ambulate and orient patient
* *Do not move objects positioned by the patient without the knowledge and consent of the patient; ask the patient what help is needed and how to provide it.

Question 7

7. A patient is admitted to the emergency department with a wood splinter imbedded in the right eye. Which intervention by the nurse is most appropriate?
   a. Irrigate the eye with a large amount of sterile saline
   b. Carefully remove the splinter with a pair of sterile forceps
   c. Cover the eye with a dry sterile patch and a protective shield
   d. Apply light pressure on the closed eye to prevent bleeding or loss of aqueous humor

Answer 7

c. Cover the eye with a dry sterile patch and a protective shield

Question 8

8. What best describes pinkeye
   a. Blindness
   b. Acute bacterial conjunctivitis
   c. Epidemic keratoconjunctivitis
   d. Chronic inflammation of sebaceous glands

Answer 8

b. Acute bacterial conjunctivitis

Question 9

9. What describes inflammation of the cornea
   a. Keratitis
   b. Blepharitis
   c. Hordeolum
   d. Conjunctivitis

Answer 9

a. Keratitis

Question 10

10. What should the nurse teach all patients with conjunctival infections to use?
    a. Artificial tears to moisten and soothe the eyes
    b. Dark glasses to prevent the discomfort of photophobia
    c. Warm moist compresses to the eyes to promote drainage and healing
    d. Frequent and thorough hand washing to avoid spreading the infection

Answer 10

d. Frequent and thorough hand washing to avoid spreading the infection

Question 11

11. Endophthalmitis can be a complication of intraocular surgery or penetrating ocular injury. What manifestations are expected when the nurse assesses a patient with this disorder (select all that apply)
    a. Ocular pain
    b. Photophobia
    c. Eyelid edema
    d. Reddened sclera
    e. Bleeding conjunctiva
    f. Decreased visual acuity

Answer 11

a. Ocular pain
b. Photophobia
f. Decreased visual acuity

Question 12

12. A patient with early cataracts tells the nurse that he is afraid cataract surgery may cause permanent visual damage. What should the nurse teach the patient?
    a. The cataracts will only worsen with time and should be removed as early as possible to prevent blindness
    b. Cataract surgery is very safe and with the implantation of an intraocular lens, the need for glasses will be eliminated
    c. Progression of the cataracts can be prevented by avoidance of ultraviolet (UV) light and good dietary management
    d. Vision enhancement techniques may improve vision until surgery becomes an acceptable option to maintain desired activities

Answer 12

d. Vision enhancement techniques may improve vision until surgery becomes an acceptable option to maintain desired activities

Question 13

13. A 60-year old patient is being prepared for outpatient cataract surgery. When obtaining admission data from the patient, what would the nurse expect to find in the patient’s history?
    a. A painless, sudden, sever loss of vision
    b. Blurred vision, colored halos around lights, and eye pain
    c. A gradual loss of vision with abnormal color perception and glare
    d. Light flashes, floaters, and a “cobweb” in the field of vision with loss of central or peripheral vision

Answer 13

c. A gradual loss of vision with abnormal color perception and glare

Question 14

14. A patient with bilateral cataracts is scheduled for an extracapsular cataract extraction with an intraocular lens implantation of one eye. What should be done by the nurse preoperatively?
    a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance
    b. Inform the patient that the operative eye will need to be patched for 3-4 days postoperatively
    c. Assure the patient that vision in the operative eye will be improved to near normal on the first postoperative day
    d. Teach the patient routine coughing and deep-breathing techniques to use postoperatively to prevent respiratory complications

Answer 14

a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance

Question 15

15. For the patient with a retinal break, what extraocular techniques may be used with sclera buckling to seal the break by creating an inflammatory reaction that causes a chorioretinal adhesion or scar (select all that apply)
    a. Cryopexy
    b. Vitrectomy
    c. Pneumatic retinopexy
    d. Laser photocoagulation
    e. Penetrating keratoplasty

Answer 15

a. Cryopexy

d. Laser photocoagulation

Question 16

16. Following a pneumatic retinopexy, what does the nurse need to know about the postoperative care for the patient?
    a. Specific positioning and activity restrictions are likely to be required for several days
    b. The patient is frequently hospitalized for 7 to 10 days on bed rest until healing is complete
    c. Patients experience little or no pain, and development of pain indicates hemorrhage or infection
    d. Reattachment of the retina commonly fails, and patients can be expected to grieve for loss of vision

Answer 16

a. Specific positioning and activity restrictions are likely to be required for several days

Question 17

17. What nursing action is most important for the patient with age-related macular degeneration (AMD)?
    a. Teach the patient how to use topical eyedrops for treatment of AMD
    b. Emphasize the use of vision enhancement techniques to improve what vision is present
    c. Encourage the patient to undergo laser treatment to slow the deposit of extracellular debris
    d. Explain that nothing can be done to save the patient’s vision because there is no treatment for AMD

Answer 17

b. Emphasize the use of vision enhancement techniques to improve what vision is present

Question 18

18. A patient with wet AMD is treated with photodynamic therapy. What does the nurse instruct the patient to do after the procedure?
    a. Maintain the head in an upright position for 24 hours
    b. Avoid blowing the nose or causing jerking movements of the head
    c. Completely cover all the skin to avoid a thermal burn from sunlight
    d. Expect to experience blind spots where the laser has caused retinal damage

Answer 18

c. Completely cover all the skin to avoid a thermal burn from sunlight

Question 19

19. What is an important health promotion nursing intervention related to glaucoma
    a. Teaching individuals at risk for glaucoma about early signs and symptoms of the disease
    b. Preparing patients with glaucoma for lifestyle changes necessary to adapt to eventual blindness
    c. Promoting regular measurements of intraocular pressure for early detection and treatment of glaucoma
    d. Informing patients that glaucoma is curable if eye medications are administered before visual impairment has occurred

Answer 19

c. Promoting regular measurements of intraocular pressure for early detection and treatment of glaucoma

Question 20

20. Which characteristics of glaucoma are associated with only primary open-angle glaucoma (POAG) select all that apply
    a. Gradual loss of peripheral vision
    b. Treated with iridotomy or iridectomy
    c. Causes loss of central vision with corneal edema
    d. May be caused by increased production of aqueous humor
    e. Treated with cholinergic agents such as pilocarpine (Pilocar)
    f. Resistance to aqueous outflow through trabecular meshwork

Answer 20

a. Gradual loss of peripheral vision
d. May be caused by increased production of aqueous humor
f. Resistance to aqueous outflow through trabecular meshwork

Question 21

21. Which characteristics of glaucoma are associated with only primary open-angle glaucoma (POAG) select all that apply
    a. Caused by lens blocking papillary opening
    b. Treated with trabeculoplasty or trabeculectomy
    c. Causes loss of central vision with corneal edema
    d. Treated with b-adrenergic blockers such as betaxolol (Betoptic)
    e. Causes sudden, severe eye pain associated with nausea and vomiting
    f. Treated with hyperosmotic oral and IV fluids to lower intraocular pressure

Answer 21

a. Caused by lens blocking papillary opening
c. Causes loss of central vision with corneal edema
e. Causes sudden, severe eye pain associated with nausea and vomiting
f. Treated with hyperosmotic oral and IV fluids to lower intraocular pressure

Question 22

22. The health care provider has prescribed optic drops of betaxolol (Betoptic), dipivefrin (Propine), and carbachol (Isopto Carbachol) in addition to oral acetazolamide (Diamox) for treatment of a patient with chronic open-angle glaucoma. What is the rationale for the use of each of these drugs in the treatment of glaucoma?

Answer 22

Drug Rationale for use

Betaxolol-An andrenergic blocking agent that decreases aqueous humor production

Dipivefrin-An andrenergic agonist that decreases the production of aqueous humor and enhances outflow facility

Carbachol-A cholinergic agent that stimulates iris sphincter contraction, leading to miosis and opening of the trabecular network, increasing aqueous outflow

Acetazolamide-A carbonic anhydrase inhibitor that decreases aqueous humor production

Question 23

23. What is one of the nurse’s role in preservation of hearing?
    a. Advise patients to keep the ears clear of wax with cotton-tipped applicators
    b. Monitor patients at risk for drug-induced ototoxicity for tinnitus and vertigo
    c. Promote the use of ear protection in work and recreational activity with noise levels above 120dB
    d. Advocate for MMR (measles, mumps, and rubella) immunization is susceptible women as soon as pregnancy is confirmed

Answer 23

b. Monitor patients at risk for drug-induced ototoxicity for tinnitus and vertigo

Question 24

24. Number the following high-noise environments from 1 for the highest risk for ear injury to 6 for the lowest risk for ear injury
    a. Noisy restaurant for 12 hours (5)
    b. Heavy factory noise for 8 hours (4)
    c. Using a chainsaw continuously for 2 hours (3)
    d. Working in a quiet home office for 8 hours (6)
    e. Guiding jet planes to and from airport gates (1)
    f. Sitting in front of amplifiers at a rock concert (2)

Answer 24

Guiding jet planes to and from airport gates (1)
Sitting in front of amplifiers at a rock concert (2)
Using a chainsaw continuously for 2 hours (3)
Heavy factory noise for 8 hours (4)
Noisy restaurant for 12 hours (5)
Working in a quiet home office for 8 hours (6)

Question 25

25. A 74-year old man has moderate presbycusis and heart disease. He takes one aspirin a day as an antiplatelet agent and uses quinidine, furosemide (Lasix), and enalapril (Vasotec) for his heart condition. What risk factors are present for ototoxicity in this situation?

Answer 25

a. Advanced age; use of three potentially ototoxic drugs (aspirin, quinidine, and furosemide)

Question 26

26. Which nursing action should be included in the management of the patient with external otitis?
    a. Irrigate the ear canal with body temperature saline several hours after instilling lubricating eardrops
    b. Insert an ear wick into the external canal before each application of eardrops to disperse the medication
    c. Teach the patient to prevent further infections by instilling antibiotic drops into the ear canal before swimming
    d. Administer eardrops without touching the dropper to the auricle and position the ear upward for 2 minutes afterward

Answer 26

d. Administer eardrops without touching the dropper to the auricle and position the ear upward for 2 minutes afterward

Question 27

27. What characteristics describe the care of a patient with chronic otitis media (select all that apply)
    a. It is most commonly treated with antibiotics
    b. It is an infection in the inner ear that may lead to headaches
    c. Impairment of the Eustachian tube is most commonly associated with effusion
    d. Formation of an acoustic neuroma may destroy the structures of the middle ear or invade the dura of the brain
    e. The patient who has had a myringotomy with placement of tympanostomy tube should be instructed to avoid getting water in the ear

Answer 27

c. Impairment of the Eustachian tube is most commonly associated with effusion
e. The patient who has had a myringotomy with placement of tympanostomy tube should be instructed to avoid getting water in the ear

Question 28

28. While caring for a patient with otosclerosis, which finding would the nurse expect in the patient’s history and physical?
    a. A strong family history of the disease
    b. Symptoms of sensorineural hearing loss
    c. A positive Rinne test and lateralization to the good or better ear on Weber testing
    d. An immediate and consistent improvement in hearing at the time of surgical treatment

Answer 28

a. A strong family history of the disease

Question 29

29. The nurse identifies a nursing diagnosis of risk for injury for a patient following a stapedectomy based on what knowledge about this surgery?
    a. Nystagmus may result from perilymph disturbances caused by surgery
    b. Stimulation of the labyrinth during surgery may cause vertigo and loss of balance
    c. Blowing the nose or coughing may precipitate dislodgement of the tympanic graft
    d. Postoperative tinnitus may decrease the patient’s awareness of environmental hazards

Answer 29

b. Stimulation of the labyrinth during surgery may cause vertigo and loss of balance

Question 30

30. What makes up the triad of symptoms that occur with inner ear problems (select all that apply)
    a. Vertigo
    b. Nausea
    c. Tinnitus
    d. Sensorineural hearing loss
    e. Inflammation of the ear canal

Answer 30

a. Vertigo
c. Tinnitus
d. Sensorineural hearing loss

Question 31

31. An appropriate nursing intervention for the patient during an acute attack of Meniere disease includes providing
    a. Frequent repositioning
    b. A quiet, darkened room
    c. A television for diversion
    d. Padded side rails on the bed

Answer 31

b. A quiet, darkened room

Question 32

32. What knowledge guides the nurse providing care for a patient with an acoustic neuroma?
    a. Widespread metastasis usually occurs before symptoms of the tumor are noticed
    b. Facial nerve function will be sacrificed during surgical treatment to preserve hearing
    c. Early diagnosis and treatment of the tumor can preserve hearing and vestibular function
    d. Treatment is usually delayed until hearing loss is significant because a neuroma is a benign tumor

Answer 32

c. Early diagnosis and treatment of the tumor can preserve hearing and vestibular function

Question 33

33. What characteristics of hearing loss are associated with conductive loss (select all that apply)?
    a. Presbysusis
    b. Speaks softly
    c. Related to otitis media
    d. Result of ototoxic drugs
    e. Hears best in noisy environment
    f. May be caused by impacted cerumen

Answer 33

b. Speaks softly
c. Related to otitis media
e. Hears best in noisy environment
f. May be caused by impacted cerumen

Question 34

34. What characteristic of hearing loss are associated with sensorineural loss (select all that apply)?
    a. Hearing aid is helpful
    b. Related to otitis media
    c. Caused by noise trauma
    d. Linked with otosclerosis
    e. Associated with Meniere disease

Answer 34

a. Hearing aid is helpful
c. Caused by noise trauma
e. Associated with Meniere disease

Question 35

35. When teaching a patient to use a hearing aid, where does the nurse encourage the patient to initially use the aid?
    a. Outdoors, where sounds are distinct
    b. At social functions, where simultaneous conversations take place
    c. In a quiet, controlled environment to experiment with tone and volume
    d. In public areas such as malls or stores, where others will not notice its use

Answer 35

c. In a quiet, controlled environment to experiment with tone and volume