MSS Ch 14 Eye and Ear Disorders Practice Questions

Question 1

The client is diagnosed with glaucoma. Which symptom should the nurse expect the client to report?

1. Loss of peripheral vision.
2. Floating spots in the vision.
3. A yellow haze around everything.
4. A curtain coming across vision.

Answer 1

1. In glaucoma, the client is often unaware he or she has the disease until the client experiences blurred vision, halos around lights, difficulty focusing, or loss of peripheral vision. Glaucoma is often called the “silent thief.”
2. Floating spots in the vision is a symptom of retinal detachment.
3. A yellow haze around everything is a complaint of clients experiencing digoxin toxicity.
4. The complaint of a curtain coming across vision is a symptom of retinal detachment.

Question 2

The client is scheduled for right-eye cataract removal surgery in five (5) days. Which preoperative instruction should be discussed with the client?

1. Administer dilating drops to both eyes for 72 hours prior to surgery.
2. Prior to surgery do not lift or push any objects heavier than 15 pounds.
3. Make arrangements for being in the hospital for at least three (3) days.
4. Avoid taking any type of medication which may cause bleeding, such as aspirin.

Answer 2

1. Dilating drops are administered every 10 minutes for four (4) doses one (1) hour prior to surgery, not for three (3) days prior to surgery.
2. Lifting and pushing objects should be avoided after surgery, not prior to surgery.
3. All types of cataract removal surgery are usually done in day surgery.
4. To reduce retrobulbar hemorrhage, any anticoagulation therapy is withheld, including aspirin, nonsteroidal anti- inflammatory drugs (NSAIDs), and warfarin (Coumadin).

Question 3

The client is postoperative retinal detachment surgery, and gas tamponade was used to flatten the retina. Which intervention should the nurse implement first?

1. Teach the signs of increased intraocular pressure.
2. Position the client as prescribed by the surgeon.
3. Assess the eye for signs/symptoms of complications.
4. Explain the importance of follow-up visits.

Answer 3

1. This should be done, but it is not the first intervention the nurse should implement.
2. The client will have to be specifically posi- tioned to make the gas bubble float into the best position; some clients must lie face down or on their side for days, but it is not the first intervention.
3. The nurse’s priority must be assessment of complications, which include increased intraocular pressure, endophthalmitis, development of another retinal detachment, or loss of turgor in the eye.
4. Follow-up visits are important, but this is not the first intervention the nurse should implement.

Question 4

The 65-year-old client is diagnosed with macular degeneration. Which statement by the client indicates the client needs more discharge teaching?

1. “I should use magnification devices as much as possible.”
2. “I will look at my Amsler grid at least twice a week.”
3. “I need to use low-watt light bulbs in my house.”
4. “I am going to contact a low-vision center to evaluate my home.”

Answer 4

1. Magnifying devices used with activities such as threading a needle will help the client’s vision; therefore, this statement does not indicate the client needs more teaching.
2. An Amsler grid is a tool to assess macular degeneration, often providing the earliest sign of a worsening condition. If the lines of the grid become distorted or faded, the client should call the ophthalmologist.
3. Macular degeneration is the most common cause of visual loss in people older than age 60 years. Any intervention which helps increase vision should be included in the teaching, such as bright lighting, not decreased lighting.
4. Low-vision centers will send representatives to the client’s home or work to make rec- ommendations about improving lighting, thereby improving the client’s vision and safety.

Question 5

The nurse who is at a local park sees a young man on the ground who has fallen and has a stick lodged in his eye. Which intervention should the nurse implement at the scene?

1. Carefully remove the stick from the eye.
2. Stabilize the stick as best as possible.
3. Flush the eye with water if available.
4. Place the young man in a high-Fowler’s position.

Answer 5

1. A foreign object should never be removed at the scene of the accident because this may cause more damage.
2. The foreign object should be stabilized to prevent further movement which could cause more damage to the eye.
3. Flushing with water may cause further movement of the foreign object and should be avoided.
4. The person should be kept flat and not in a sitting position because it may dislodge or cause movement of the foreign object.

Question 6

The employee health nurse is teaching a class on “Preventing Eye Injury.” Which information should be discussed in the class?

1. Read instructions thoroughly before using tools and working with chemicals.
2. Wear some type of glasses when working around flying fragments.
3. Always wear a protective helmet with eye shield around dust particles.
4. Pay close attention to the surroundings so eye injuries will be prevented.

Answer 6

1. Instructions provide precautions and steps to take if eye injuries occur secondary to the use of tools or chemicals.
2. The employee must wear safety glasses, not just any type of glasses and especially not regular prescription glasses.
3. A protective helmet is used to help prevent sports eye injuries, not work-related injuries.
4. Eye injuries will not be prevented by paying close attention to the surroundings. They are prevented by wearing protective glasses or eye shields.

Question 7

The 65-year-old male client who is complaining of blurred vision reports he thinks his glasses need to be cleaned all the time, and he denies any type of eye pain. Which eye disorder should the nurse suspect the client has?

1. Corneal dystrophy.
2. Conjunctivitis.
3. Diabetic retinopathy.
4. Cataracts.

Answer 7

1. Corneal dystrophy is an inherited eye disor- der occurring at about age 20 and results in decreased vision and the development of blisters; it is usually associated with primary open-angle glaucoma.
2. Conjunctivitis is an inflammation of the conjunctiva, which results in a scratching or burning sensation, itching, and photophobia.
3. Diabetic retinopathy results from deteriora- tion of the small blood vessels nourished by the retina; it leads to blindness.
4. A cataract is a lens opacity or cloudiness, resulting in the signs/symptoms discussed in the stem of the question.

Question 8

The nurse is administering eyedrops to the client. Which guidelines should the nurse adhere to when instilling the drops into the eye? Select all that apply.

1. Do not touch the tip of the medication container to the eye.
2. Apply gently pressure on the outer canthus of the eye.
3. Apply sterile gloves prior to instilling eyedrops.
4. Hold the lower lid down and instill drops into the conjunctiva. 5. Gently pat the skin to absorb excess eyedrops on the cheek.

Answer 8

1. Touching the tip of the container to the eye may cause eye injury or an eye infection.
2. Gentle pressure should be applied on the inner canthus, not outer canthus, near the bridge of the nose for one (1) or two (2) minutes after instilling eyedrops.
3. The nurse should wash hands prior to and after instilling medications; this is not a sterile procedure.
4. Medication should not be placed directly on the eye but in the lower part of the eyelid.
5. Eyedrops are meant to go in the eye, not on the skin, so the nurse should use a clean tissue to remove excess medication.

Question 9

The client has had an enucleation of the left eye. Which intervention should the nurse implement?

1. Discuss the need for special eyeglasses.
2. Refer the client for an ocular prosthesis.
3. Help the client obtain a seeing-eye dog.
4. Teach the client how to instill eyedrops.

Answer 9

1. Special eyeglasses are not needed for an enucleation.
2. An enucleation is the removal of the entire eye and part of the optic nerve. An ocular prosthesis will help maintain the shape of the eye socket after the enucleation.
3. The client had the left eye removed but is not blind because he or she still has the right eye.
4. The eyeball was totally removed and a pressure dressing was applied; therefore, there will be no need to instill eyedrops.

Question 10

The client diagnosed with glaucoma is prescribed a miotic cholinergic medication. Which data indicate the medication has been effective?

1. No redness or irritation of the eyes.
2. A decrease in intraocular pressure.
3. The pupil reacts briskly to light.
4. The client denies any type of floaters.

Answer 10

1. Steroid medication is administered to decrease inflammation.
2. Both systemic and topical medications are used to decrease the intraocular pressure in the eye, which causes glaucoma.
3. Glaucoma does not affect the pupillary reaction.
4. Floaters are a complaint of clients with retinal detachment.

Question 11

The client is scheduled for laser-assisted in situ keratomileusis (LASIK) surgery for severe myopia. Which instruction should the nurse discuss prior to the client’s discharge from day surgery?

1. Wear bilateral eye patches for three (3) days.
2. Wear corrective lenses until the follow-up visit.
3. Do not read any material for at least one (1) week.
4. Teach the client how to instill corticosteroid ophthalmic drops.

Answer 11

1. The client does not have to wear eye patches after this surgery.
2. The purpose of this surgery is to ensure the client does not have to wear any type of corrective lens.
3. The client can read immediately after this surgery.
4. LASIK surgery is an effective, safe, predictable surgery performed in day surgery; there is minimal postoperative care. Instilling topical corticosteroid drops helps decrease inflammation and edema of the eye.

Question 12

The client comes to the emergency department after splashing chemicals into the eyes. Which intervention should the nurse implement first?

1. Have the client move the eyes in all directions.
2. Administer a broad-spectrum antibiotic.
3. Irrigate the eyes with normal saline solution.
4. Determine when the client had a tetanus shot.

Answer 12

1. Movement of the eye should be avoided until the client has received general anesthesia; therefore, this is not the first intervention.
2. Parenteral broad-spectrum antibiotics are initiated but not until the eyes are treated first.
3. Before any further evaluation or treatment, the eyes must be thoroughly flushed with sterile normal saline solution.
4. Tetanus prophylaxis is recommended for full-thickness ocular wounds.

Question 13

Which statement indicates to the nurse the client is experiencing some hearing loss?

1. “I clean my ears every day after I take a shower.”
2. “I keep turning up the sound on my television.”
3. “My ears hurt, especially when I yawn.”
4. “I get dizzy when I get up from the chair.”

Answer 13

1. Cleaning the ears daily does not indicate the client has a hearing loss.
2. The need to turn up the volume on the television is an early sign of hearing impairment.
3. Pain in the ears is not a clinical manifesta- tion of hearing loss/impairment.
4. This statement may indicate a balance problem secondary to an ear disorder, but it does not indicate a hearing loss.

Question 14

Which risk factors should the nurse discuss with the client concerning reasons for hearing loss? Select all that apply.

1. Perforation of the tympanic membrane.
2. Chronic exposure to loud noises.
3. Recurrent ear infections.
4. Use of nephrotoxic medications.
5. Multiple piercings in the auricle.

Answer 14

1. The tympanic membrane is the eardrum, and if it is punctured it may lead to hearing loss.

2. Loud persistent noise, such as heavy machinery, engines, and artillery, over time may cause noise-induced hearing loss.

3. Multiple ear infections scar the tympanic membrane, which can lead to hearing loss.

4. Nephrotoxic means harmful to the kid- neys; ototoxic is harmful to the ears.
5. Multiple pierced earrings do not lead to hearing loss. The auricle (skin attached to the head) is composed mainly of cartilage, except for the fat and subcutaneous tissue in the earlobe.

Question 15

The nurse is caring for a client diagnosed with acute otitis media. Which signs/symptoms support this medical diagnosis?

1. Unilateral pain in the ear.
2. Green, foul-smelling drainage.
3. Sensation of congestion in the ear.
4. Reports of hearing loss.

Answer 15

1. Otalgia (ear pain) is experienced by clients with otitis media.
2. A green, foul-smelling drainage supports the diagnosis of external otitis, not of acute otitis media.
3. A sensation of congestion in the ear supports serous otitis media.
4. Hearing loss supports a diagnosis of chronic otitis media or serous otitis media.

Question 16

The client diagnosed with chronic otitis media is scheduled for a mastoidectomy. Which discharge teaching should the nurse discuss with the client?

1. Instruct the client to blow the nose with the mouth closed.
2. Explain the client will never be able to hear from the ear.
3. Instill ophthalmic drops in both ears and then insert a cotton ball.
4. Do not allow water to enter the ear for six (6) weeks.

Answer 16

1. The client should blow the nose with the mouth open to prevent pressure in the eustachian tube.
2. There may be temporary deafness as a result of postoperative edema, but the hearing will return as the edema subsides.
3. Ophthalmic drops are used in the eyes, not the ears. Otic drops are used for the ears.
4. Water should be prevented from enter- ing the external auditory canal because it may irritate the surgical incision and is a medium for bacterial growth.

Question 17

The client is diagnosed with Ménière’s disease. Which statement indicates the client understands the medical management for this disease?

1. “After intravenous antibiotic therapy, I will be cured.”
2. “I will have to use a hearing aid for the rest of my life.”
3. “I must adhere to a low-sodium diet, 2,000 mg/day.”
4. “I should sleep with the head of my bed elevated.”

Answer 17

1. Antibiotics will not cure this disease. Surgery is the only cure for Ménière’s disease, which may result in permanent deafness as a result of the labyrinth being removed in the surgery.
2. Ménière’s disease does not lead to deafness unless surgery is performed removing the labyrinth in attempts to eliminate the attacks of vertigo.
3. Sodium regulates the balance of fluid within the body; therefore, a low- sodium diet is prescribed to help control the symptoms of Ménière’s disease.
4. Sleeping with the head of the bed elevated will not affect Ménière’s disease.

Question 18

The client is complaining of ringing in the ears. Which data are most appropriate for the nurse to document in the client’s chart?

1. Complaints of vertigo.
2. Complaints of otorrhea.
3. Complaints of tinnitus.
4. Complaints of presbycusis.

Answer 18

1. Vertigo is an illusion of movement in which the client complains of dizziness.
2. Otorrhea is drainage of the ear.
3. Tinnitus is “ringing of the ears.” It is a subjective perception of sound with internal origins.
4. Presbycusis is progressive hearing loss associated with aging.

Question 19

Which statement best describes the scientific rationale for the nurse holding the otoscope with the hand in a pencil-hold position when examining the client’s ear?

1. It is usually the most comfortable position to hold the otoscope.
2. This allows the best visualization of the tympanic membrane.
3. This prevents inserting the otoscope too far into the external ear.
4. It ensures the nurse will not cause pain when examining the ear.

Answer 19

1. This is not the rationale for holding the otoscope in this manner.
2. Holding the otoscope in this manner does not help visualize the membrane any better than holding the otoscope in other ways.
3. Inserting the speculum of the otoscope into the external ear can cause ear trauma if not done correctly.
4. If the ear is inflamed, it may be impossi- ble to prevent hurting the client on examination.

Question 20

The nurse is preparing to administer otic drops into an adult client’s right ear. Which intervention should the nurse implement?

1. Grasp the earlobe and pull back and out when putting drops in the ear.
2. Insert the eardrops without touching the outside of the ear.
3. Instruct the client to close the mouth and blow prior to instilling drops.
4. Pull the auricle down and back prior to instilling drops.

Answer 20

1. This is not the correct way to administer eardrops.
2. The nurse must straighten the ear canal; therefore, the outside of the ear must be moved.
3. This will increase pressure in the ear and should not be done prior to administering eardrops.
4. This will straighten the ear canal so the eardrops will enter the ear canal and drain toward the tympanic membrane (eardrum).

Question 21

Which ototoxic medication should the nurse administer cautiously?

1. An oral calcium channel blocker.
2. An intravenous aminoglycoside antibiotic.
3. An intravenous glucocorticoid.
4. An oral loop diuretic.

Answer 21

1. Calcium channel blockers are not going to affect the client’s hearing.
2. Aminoglycoside antibiotics are oto-toxic. Overdosage of these medications can cause the client to go deaf, which is why peak and trough serum levels are drawn while the client is taking a medication of this type. These antibi- otics are also very nephrotoxic.
3. Steroids cause many adverse effects, but damage to the ear is not one of them.
4. Administering an intravenous push loop diuretic too fast can cause auditory nerve damage, but an oral loop diuretic does not.a

Question 22

Which teaching instruction should the nurse discuss with students who are on the high school swim team when discussing how to prevent external otitis?

1. Do not wear tight-fitting swim caps.
2. Avoid using silicone ear plugs while swimming.
3. Use a drying agent in the ear after swimming.
4. Insert a bulb syringe into each ear to remove excess water.

Answer 22

1. Tight-fitting swim caps or wetsuit hoods should be worn because they prevent wa- ter from entering the ear canal.
2. Silicone ear plugs should be worn because they keep water from entering the ear canal without reducing hearing significantly.
3. A 2% acetic acid solution or 2% boric acid in ethyl alcohol is effective in drying the canal and restoring its normal acidic environment.
4. A bulb syringe with a Teflon catheter can be used to remove impacted debris from the ear, but it is not used to remove excess water.

Question 23

The client comes to the clinic and is diagnosed with otitis media. Which intervention should the clinic nurse include in the discharge teaching?

1. Instruct the client not to take any over-the-counter pain medication.
2. Encourage the client to apply cold packs to the affected ear.
3. Tell the client to call the HCP if an abrupt relief of ear pain occurs.
4. Wear a protective ear plug in the affected ear.

Answer 23

1. Mild analgesics such as aspirin or aceta- minophen every four (4) hours as needed to relieve pain and fever are recom- mended; aspirin may help decrease inflammation of the ear.
2. Heat applied to the affected ear is recom- mended because heat dilates blood vessels, promoting the reabsorption of fluid and reducing edema.
3. Pain subsiding abruptly may indicate spontaneous perforation of the tympanic membrane within the middle ear and should be reported to the HCP.
4. Ear plugs should not be used in clients with otitis media, but cotton balls could be used to keep otic antibiotics in the ear canal.

Question 24

The client is scheduled for ear surgery. Which statement indicates the client needs more preoperative teaching concerning the surgery?

1. “If I have to sneeze or blow my nose, I will do it with my mouth open.”
2. “I may get dizzy after the surgery, so I must be careful when walking.”
3. “I will probably have some hearing loss after surgery, but hearing will return.”
4. “I can shampoo my hair the day after surgery as long as I am careful.”

Answer 24

1. Leaving the mouth open when coughing or sneezing will minimize the pressure changes in the middle ear.
2. Surgery on the ear may disrupt the client’s equilibrium, increasing the risk for falling.
3. Hearing loss secondary to postoperative edema is common after surgery, but the hearing will return after the edema subsides.
4. Shampooing, showering, and immersing the head in water are avoided to prevent contamination of the ear canal; therefore, this comment indicates the client does not understand the preoperative teaching.