Question 1

The nurse is assessing a client who has recently been treated with amoxicillin for acute otitis media of the right ear. Which of the following assessment data obtained by the nurse is of most concern?
A)The client has a temperature of 38.1°C (100.6°F).
B)The client complains of "popping" in the ear.
C)The client frequently asks the nurse to repeat information.
D)The client states that the right ear has a feeling of fullness.

Accepted Answer

The fever indicates that the infection may not be resolved and the client might need further antibiotic therapy. A feeling of fullness, "popping" of the ear, and decreased hearing are symptoms of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment.

Question 2

A client with glaucoma who has been using timolol drops for several days tells the nurse that the eye drops cause eye burning and visual blurriness for a short time after administration. Which of the following responses by the nurse is most appropriate?
A)"These are normal adverse 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 adverse 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 eye drops."

Accepted Answer

Clients should be instructed that eye discomfort and visual blurring are expected adverse effects of the ophthalmic drops but that the drops must be used to prevent further
visual-field loss. The temporary burning and visual blurriness might not lessen with ongoing use, are not relieved by avoiding systemic absorption, and are not symptoms of glaucoma.

Question 3

Aclient is seen in the ophthalmology clinic and diagnosed with recurrent staphylococcal and seborrheic blepharitis. Which of the following topics should the nurse include in the teaching plan?
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

Accepted Answer

Baby shampoo is used to soften and remove crusts associated with blepharitis. The other interventions are not used in treating this disorder.

Question 4

Aclient has been seen at a clinic for repeated hordeolum of the eyes during the last 6 months. Which of the following actions should the nurse recommend to the client to help prevent further infection?
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 anti-seborrheic shampoo.
D)Seek evaluation for the presence of sexually transmitted infections (STIs).

Accepted Answer

Hordeolum (stye) is commonly caused by Staphylococcus aureus, which may be present in cosmetics that the client is using. Warm compresses are recommended to treat hordeolum. Anti-seborrheic shampoos are recommended for seborrheic blepharitis. Clients with adult inclusion conjunctivitis, which is caused by Chlamydia trachomatis, should be referred for STD testing.

Question 5

The nurse is caring for a client with a left retinal detachment who had a pneumatic retinopexy procedure. Which of the following information should 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

Accepted Answer

Following pneumatic retinopexy, the client will need to position the head so the air bubble remains in contact with the retinal tear. The dark lenses and bilateral eye patches are not required after this procedure. Saturation of any eye dressings would not be expected following this procedure.

Question 6

Which of the following topics will the nurse include in client teaching following outpatient cataract surgery and lens implantation?
A)Use of oral opioids for pain control
B)Administration of antibiotic eye drops
C)Importance of coughing and deep-breathing exercises
D)Need for bed rest for the first 24 hours after the surgery

Accepted Answer

Antibiotic and corticosteroid eye drops are commonly prescribed after cataract surgery, and the client should be able to administer them using safe technique. Pain is not expected after cataract surgery and opioids will not be needed. Coughing and deep-breathing exercises are not needed since a general anaesthetic agent is not used. There is no bed rest restriction after cataract surgery.

Question 7

The nurse is admitting a client to the hospital with severe COPD and a history of glaucoma. Which of the following prescribed medications should the nurse question?
A)Morphine sulphate 4 mg IV
B)Diazepam 5 mg IV
C)Betaxolol 0.25% eye drops
D)Levobunolol 0.5% eye drops

Accepted Answer

Levobunolol is a noncardioselective ?2-blocker and is contraindicated for use in clients with asthma or severe COPD. The other medications are appropriate for this client.

Question 8

The nurse is assessing a client in the outpatient eye clinic who has myopia and presbyopia. Which of the following assessments should the nurse implement to evaluate the effectiveness of the prescribed bifocals?
A)Strength of the eye muscles
B)Both near and distant vision
C)Cloudiness in the eye lenses
D)Intraocular pressure changes

Accepted Answer

The lenses are prescribed to correct the client's near and distant vision. The nurse also may assess for cloudiness of the lenses, increased intraocular pressure, and eye movement, but these data will not evaluate whether the client's bifocals are effective.

Question 9

The nurse is assessing a client with primary open-angle glaucoma (POAG) to evaluate if the treatment has been effective. Which of the following parameters should the nurse assess to determine if there has been improvement?
A)Eye pain
B)Visual field
C)Blurred vision
D)Depth perception

Accepted Answer

POAG develops slowly and without symptoms except for a gradual loss of visual field. Acute closed-angle glaucoma may present with excruciating pain, coloured halos, and blurred vision. Problems with depth perception are not associated with POAG.

Question 10

The nurse is reviewing a client's medical record and notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. Which of the following parameters should the nurse assess?
A)Visual acuity
B)Pupil reaction
C)Colour perception
D)Peripheral vision

Accepted Answer

The client's increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the client has worsening glaucoma. Colour perception and pupil reaction to light are not affected by glaucoma.

Question 11

The nurse is caring for a client 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 of the following nursingdiagnoses is appropriate?
A)Hopelessness related to stressors (current loss of functional vision)
B)Anxiety related to threat to current status (uncertainty of outcome of treatment)
C)Situational low self-esteem related to decrease in control over environment (loss of visual function)
D)Risk for falls as evidenced by impaired vision

Accepted Answer

The client's restlessness and questioning of the nurse indicate anxiety about the uncertainty of the outcome of treatment, including the future possible loss of vision. Because the client can see with the right eye, functional vision is relatively intact and the client is not at a high risk for falls. There is no indication of impaired self-esteem at this time.

Question 12

The nurse is preparing a client with chronic otitis media for a tympanoplasty. Which of the following information should the nurse include in preoperative teaching related to postoperative expectations?
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

Accepted Answer

Coughing or blowing the nose increases pressure in the Eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.

Question 13

Which of the following actions should the nurse take when assisting a totally blind client to walk to the bathroom?
A)Take the client by the arm and lead the client slowly to the bathroom.
B)Have the client place a hand on the nurse's shoulder and guide the client.
C)Stay beside the client and describe any obstacles on the path to the bathroom.
D)Walk slightly ahead of the client and allow the client to hold the nurse's elbow.

Accepted Answer

When using the sighted-guide technique, the nurse walks slightly in front and to the side of the client and has the client hold the nurse's elbow. The other techniques are not as safe in assisting a blind client.

Question 14

A client with external otitis has an ear wick placed and a new prescription for antibiotic otic drops. After the nurse provides client teaching, which of the following client statements indicates that more instruction is needed?
A)"I may use aspirin or acetaminophen 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."

Accepted Answer

Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other client statements indicate that the teaching has been successful.

Question 15

To decrease the risk for future hearing loss, which of the following actions should the nurse working with college students at the on-campus health clinic implement?
A)Arrange to include otoscopic examinations for all clients.
B)Administer rubella immunizations to all students at the clinic.
C)Discuss the importance of limiting exposure to very high amplified music.
D)Teach clients to regularly irrigate the ear to decrease cerumen impaction.

Accepted Answer

The nurse should discuss the impact of amplified music on hearing with young adults and discourage listening to very high amplified music (greater than 50% of maximum volume), especially for prolonged periods. Cerumen may need to be regularly removed for older clients, but this is not a routine need for younger adults. Only women of childbearing age who have not been previously vaccinated or exposed to rubella will require immunization. Otoscopic examinations are not necessary for all clients.

Question 16

The nurse is admitting a client with Ménière's disease who has vertigo, nausea, and vomiting. Which of the following nursing interventions should be included in the care plan?
A)Keep the client's room darkened.
B)Encourage oral fluids to 3 000 mL daily.
C)Change the client's position every 2 hours.
D)Keep the head of the bed elevated 30 degrees.

Accepted Answer

A darkened, quiet room will decrease the symptoms of the acute attack of Ménière's disease. Since the client will be nauseated during an acute attack, fluids are administered intravenously. Position changes will cause vertigo and nausea. The head of the bed can be positioned for client comfort.

Question 17

The nurse is caring for a client in the eye clinic who has 20/200 vision with the use of corrective lenses. Which of the following information should the nurse include when providing client teaching?
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

Accepted Answer

Various types of magnifiers can enhance the remaining vision enough to allow the performance of many tasks and activities of daily living (ADLs). Audio books, Braille instruction, and canes usually are reserved for clients with no functional vision.

Question 18

Which of the following topics should the nurse plan to include when teaching the client 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 handwashing 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

Accepted Answer

The best way to avoid the spread of infection from one eye to another is to avoid rubbing or touching the eyes and to use careful handwashing when touching the eyes is unavoidable. Occlusive dressings are not used for herpes keratitis. Herpes simplex is a virus and antibiotic drops will not be prescribed. Topical corticosteroids typically are not ordered because they can contribute to a longer course of infection and more complications.

Question 19

The nurse is caring for a client with age-related macular degeneration who has just had photodynamic therapy. Which of the following statements by the client 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."

Accepted Answer

The photosensitizing drug used for photodynamic therapy is activated by exposure to bright light and can cause burns in areas exposed to light for 5 days after the treatment. There are no restrictions on use of facial lotions, medications to keep the pupils dilated would not be appropriate, and bright lights would increase the risk for damage caused by the treatment.

Question 20

The nurse is caring for a client with adult inclusion conjunctivitis (AIC) caused by Chlamydia trachomatis. Which of these actions should be included in the plan of care?
A)Discussing the need for sexually transmitted infection 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 eye drops to treat the infection

Accepted Answer

Clients with AIC have a high risk for concurrent genital Chlamydia infection and should be referred for STI testing. AIC is treated with antibiotics; antiviral and corticosteroid medications are not appropriate therapies. Although some types of Chlamydia infection do cause blindness, AIC does not lead to blindness, so referral for visual rehabilitation is not appropriate.

Quiz 24: Nursing Management Visual and Auditory Problems

The nurse is assessing a client who has recently been treated with amoxicillin for acute otitis media of the right ear. Which of the following assessment data obtained by the nurse is of most concern?

A client with glaucoma who has been using timolol drops for several days tells the nurse that the eye drops cause eye burning and visual blurriness for a short time after administration. Which of the following responses by the nurse is most appropriate?

Aclient is seen in the ophthalmology clinic and diagnosed with recurrent staphylococcal and seborrheic blepharitis. Which of the following topics should the nurse include in the teaching plan?

Aclient has been seen at a clinic for repeated hordeolum of the eyes during the last 6 months. Which of the following actions should the nurse recommend to the client to help prevent further infection?

The nurse is caring for a client with a left retinal detachment who had a pneumatic retinopexy procedure. Which of the following information should be included in the discharge teaching plan?

Which of the following topics will the nurse include in client teaching following outpatient cataract surgery and lens implantation?

The nurse is admitting a client to the hospital with severe COPD and a history of glaucoma. Which of the following prescribed medications should the nurse question?

The nurse is assessing a client in the outpatient eye clinic who has myopia and presbyopia. Which of the following assessments should the nurse implement to evaluate the effectiveness of the prescribed bifocals?

The nurse is assessing a client with primary open-angle glaucoma (POAG) to evaluate if the treatment has been effective. Which of the following parameters should the nurse assess to determine if there has been improvement?

The nurse is reviewing a client's medical record and notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. Which of the following parameters should the nurse assess?

The nurse is caring for a client 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 of the following nursingdiagnoses is appropriate?

The nurse is preparing a client with chronic otitis media for a tympanoplasty. Which of the following information should the nurse include in preoperative teaching related to postoperative expectations?

Which of the following actions should the nurse take when assisting a totally blind client to walk to the bathroom?

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

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

The nurse is admitting a client with Ménière's disease who has vertigo, nausea, and vomiting. Which of the following nursing interventions should be included in the care plan?

The nurse is caring for a client in the eye clinic who has 20/200 vision with the use of corrective lenses. Which of the following information should the nurse include when providing client teaching?

Which of the following topics should the nurse plan to include when teaching the client with herpes simplex keratitis of the left eye about management of the infection?

The nurse is caring for a client with age-related macular degeneration who has just had photodynamic therapy. Which of the following statements by the client indicates that the discharge teaching has been effective?

The nurse is caring for a client with adult inclusion conjunctivitis (AIC) caused by Chlamydia trachomatis. Which of these actions should be included in the plan of care?