MJ Tanael

Practice Questionnaires

PRELIM: NCM 116: MEDSURG (LEC)

1. The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart. Which of the following
identifies the accurate procedure for this visual acuity test?
A. Both eyes are assessed together, followed by the assessment of the right and then the left eye.
B. The right eye is tested followed by the left eye, and then both eyes are tested.
C. The client is asked to stand at a distance of 40ft. from the chart and is asked to read the largest line on
the chart
D. The client is asked to stand at a distance of 40ft from the chart and to read the line that can be read
200 ft away by an individual with unimpaired vision.

Correct Answer: B. The right eye is tested followed by the left eye, and then both eyes are tested.

Visual acuity is assessed in one eye at a time, and then in both eyes together with the client comfortably standing or
sitting. The right eye is tested with the left eye covered; then the left eye is tested with the right eye covered. Both
eyes then are tested together. Visual acuity is measured with or without corrective lenses and the client stands at a
distance of 20ft. from the chart. A visual acuity test is only one part of a comprehensive ophthalmologic examination.
The goal of the visual acuity test is to determine clarity or sharpness of vision.

Option A: Cover the patient’s eye with their hand or an occluder card. Some testers prefer to test the eyes in the
same order on all patients. An alternative is to test the eye with worse vision first to reduce remembered letters. The
second eye can also read the letters backward to reduce remembered letters.
Option C: Position the patient in a well-lit area so that they are a standard distance from the chart. The testing
distance is typically 20 feet (6 m), but this may vary. In smaller spaces, mirrors can be used to achieve the required
distance. Additionally, a near Snellen chart may be used at 14 inches in some cases, which would require reading
glasses if applicable.
Option D: Move the patient closer to the chart if they are unable to read to the top line, the new distance from the
chart becomes the numerator in a fraction reporting system. For example, if able to read the top line at 10 feet, the
patient’s vision would be represented as 10/200.

2. The clinic nurse notes that following several eye examinations, the physician has documented a diagnosis of
legal blindness in the client’s chart. The nurse reviews the results of the Snellen’s chart test expecting to note
which of the following?
A. 20/20 vision
B. 20/40 vision
C. 20/60 vision
D. 20/200 vision

Correct Answer: D. 20/200 vision

Legal blindness is defined as 20/200 or less with corrected vision (glasses or contact lenses) or visual acuity of less
than 20 degrees of the visual field in the better eye. The WHO describes individuals with low vision as having a best-
corrected vision of 20/60 or worse, and blind as best corrected vision worse than 20/400, whereas legal blindness is
identified as 20/200 in the United States.

Option A: Although 20/20 visual acuity has been referred to as “perfect vision,” it is important to remember that this
is only one aspect of vision and does not include other elements such as depth perception, peripheral vision, and
colorblindness.
Option B: In the United States, visual acuity screening will typically begin as early as age 3. There is a critical line that
the child should be able to complete on a visual acuity chart by age group. The critical line for children between the
ages of three to four is 20/50, four to five is 20/40, and five or older is 20/30.
Option C: An individual with 20/60 vision would be able to distinguish the same optotype at 20 ft that another
individual with normal (20/20) vision distinguishes at 60 ft. In the logMAR, visual acuity is reported as a single number
where 0.0 is standard vision. Visual acuity decreases as the number increases and improves as the number decreases.

3. The client’s vision is tested with a Snellen chart. The results of the tests are documented as 20/60. The nurse
interprets this as:
A. The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet.
B. The client is legally blind.
C. The client’s vision is normal.
D. The client can read only at a distance of 20 feet what a client with normal vision can read
at 60 feet.

Correct Answer: D. The client can read only at a distance of 20 feet what a client with normal vision can
read at 60 feet.

Vision that is 20/20 is normal, that is, the client is able to read from 20 feet what a person with normal vision can read
from 20 feet. A client with a visual acuity of 20/60 only can read at a distance of 20 feet of what a person with normal
vision can read at 60 feet. The results of visual acuity are classically reported using 20/20 (6/6 when using meters) for
standard vision. The numerator describes the distance from the chart, typically 20 ft (6 m). The denominator describes
the distance that an individual with normal vision (20/20 vision) can read the same line on the chart.
Option A: An individual with 20/60 vision would be able to distinguish the same optotype at 20 ft that another
individual with normal (20/20) vision distinguishes at 60 ft. In the logMAR, visual acuity is reported as a single number
where 0.0 is standard vision.
Option B: The WHO describes individuals with low vision as having a best-corrected vision of 20/60 or worse, and
blind as best corrected vision worse than 20/400, whereas legal blindness is identified as 20/200 in the United States.
Option C: Although 20/20 visual acuity has been referred to as “perfect vision,” it is important to remember that this
is only one aspect of vision and does not include other elements such as depth perception, peripheral vision, and
colorblindness.

4. Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test
results as documented in the client’s chart and understands that normal intraocular pressure is:

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A. 2-7 mmHg
B. 10-21 mmHg
C. 22-30 mmHg
D. 31-35 mmHg

Correct Answer: B. 10-21 mmHg

Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or flattens
the corneal apex. Pressures between 10 and 21 mmHg are considered within the normal range. Tonometry is a
common procedure employed by ophthalmologists to measure intraocular pressure (IOP) using a calibrated
instrument. Instruments measuring intraocular pressure assume the eye is a closed globe with uniform pressure
distributed throughout the anterior chamber and vitreous cavity.

Option A: 2-7 mmHg is low intraocular pressure. Tonometry is used to measure intraocular pressure in open-angle
glaucoma, acute closed-angle glaucoma, in the setting of ocular trauma without globe rupture, and before and after
ophthalmic surgical procedures.
Option C: 22-30 mmHg indicates an increased intraocular pressure. Measurement of intraocular pressure is important
in the screening and monitoring of glaucoma, a progressive optic neuropathy that can be slowed with intraocular
pressure reduction. Intraocular pressure is the only modifiable risk factor for glaucoma progression at this time
Option D: 31-35 mmHg is high intraocular pressure. Tonometry is also used to evaluate for acutely elevated
intraocular pressure as seen in acute-angle closure glaucoma and following ocular trauma. Acute angle-closure
glaucoma is an ophthalmic emergency requiring immediate intervention to lower IOP and avoid vision loss.

5. The nurse is developing a plan of care for the client scheduled for cataract surgery. The nurse documents
which more appropriate nursing diagnosis in the plan of care?
A. Self-care deficit
B. Imbalanced nutrition
C. Disturbed sensory perception
D. Anxiety
Correct Answer: C. Disturbed sensory perception

The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Disturbed sensory perception
(visual) related to lens extraction and replacement. Although the other options identify nursing diagnoses that may be
appropriate, they are not related specifically to cataract surgery. If surgery is planned, instruct the patient and/or
family regarding the procedure, post-procedure care, and the need for follow-up with the physician.

Option A: Instruct about complications and emergency signs and symptoms (flashing lights with loss of vision, seeing
a “veil” falling over visual field, loss of vision in a specific portion of the visual field, etc.) of which to notify the
physician.
Option B: Ensure the room environment is safe with adequate lighting and furniture moved toward the walls. Remove
all rugs, and objects that could be potentially hazardous. Provides a safe environment to reduce the potential for
injury.
Option D: Instruct patient and/or family regarding safe lighting. The patient should wear sunglasses to reduce glare.
Advise the family to use contrasting bright colors in household furnishings. These techniques help enhance visual
discrimination and reduce the potential for injury.

6. The nurse is performing an assessment on a client with a suspected diagnosis of cataract. The chief clinical
manifestation that the nurse would expect to note in the early stages of cataract formation is:
A. Eye pain
B. Floating spots
C. Blurred vision
D. Diplopia
Correct Answer: C. Blurred vision

A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include
slightly blurred vision and a decrease in color perception. A cataract is a clouding or opacification of the normally clear
lens of the eye or its capsule (surrounding transparent membrane) that obscures the passage of light through the lens
to the retina of the eye. This blinding disease can affect infants, adults, and older people, but it predominates the
latter group.

Option A: There is no eye pain in the cataract. In the acute angle-closure type, patients typically present with severe
sudden ocular pain, redness, blurry vision/decreased visual acuity, headache, nausea or vomiting, and may complain
of seeing halos of light.
Option B: Patients with a rhegmatogenous retinal detachment may present with a history of a large number of new-
onset floaters. They may also have significant photopsia (flashes of light) in their vision. The patient often presents
with slowly progressive or fixed visual field loss, typically starting in the periphery and then moving centrally.
Option D: Diplopia or polyopia, mostly uniocular but can be binocular, and this is due to multiple refractions through
clear areas between the opacities. The disease process progresses gradually without affecting daily activities early on,
but with time, especially after the fourth or fifth decade, the cataract will eventually mature, making the lens
completely opaque to light interfering with routine activities.

7. In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the
physician’s orders, expecting which type of eye drops to be instilled?
A. An osmotic diuretic
B. A miotic agent
C. A mydriatic medication
D. A thiazide diuretic
Correct Answer: C. A mydriatic medication

A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in
the cataract client. These medications act by dilating the pupils. They also constrict blood vessels. Tropicamide is a
safe drug used for pupillary dilation prior to a comprehensive eye exam or ocular procedure. Dilation is also necessary
for specific intraocular procedures such as cataract surgery to reduce intraoperative complications and for better
exposure of the cataract during surgery.

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Practice Questionnaires

Option A: An osmotic diuretic may be used to decrease intraocular pressure. Osmotic diuretics cause a direct
increase in luminal hyperosmolarity in the renal tubules without affecting electrolyte balance, whereas aquaretics are
substances that act directly by only affecting the excretion of water.
Option B: A miotic medication constricts the pupil. These medications reduce eye pressure by increasing the drainage
of intraocular fluid through the trabecular meshwork. Cholinergics can be used alone or combined with other glaucoma
medications.
Option D: A thiazide diuretic is not likely to be prescribed for a client with a cataract. Thiazides are the best first
choice for hypertension, as concluded in a recent Cochrane review, and chlorthalidone is the best first-line agent
among all the anti-hypertensive compared according to the 2017 American college of cardiology (ACC) hypertension
guidelines.

8. During the early postoperative period, the client who had a cataract extraction complains of nausea and
severe eye pain over the operative site. The initial nursing action is to:
A. Call the physician.
B. Administer the ordered main medication and antiemetic.
C. Reassure the client that this is normal.
D. Turn the client on his or her operative side.

Correct Answer: A. Call the physician.

Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be reported to
the physician immediately. Some of the more common complications include transient elevated intraocular pressure,
corneal edema, toxic anterior segment syndrome, and endophthalmitis. Even in glaucomatous eyes, after one year, all
patients will have IOP control, with some even having a decreased need for medication. The other options are
inappropriate.

Option B: Typically, patients are prescribed topical antibiotics, corticosteroids, or non-steroidal anti-inflammatory
drops for 1 to 4 weeks postoperatively. Patients are counseled to follow up the day after surgery, at 1 week, 1 month,
and then 3 months postoperatively.
Option C: Even though cataract surgery greatly improves vision and quality of life, patients may continue to have
subjective visual complaints. Commonly, they will include seeing shadows, halos, glare, starburst patterns around
lights, and hazy vision.
Option D: Turning the client on his operative side will increase the intraocular pressure. Instruct the patient to watch
out for the development of complications, such as sharp pain in the eye uncontrolled by analgesics, or clouding in the
anterior chamber. This may indicate infection and should be reported immediately.

9. The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides
instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of
the instructions?
A. “I will take Aspirin if I have any discomfort.”
B. “I will sleep on the side that I was operated on.”
C. “I will wear my eye shield at night and my glasses during the day.”
D. “I will not lift anything if it weighs more than 10 pounds.”
Correct Answer: C. “I will wear my eye shield at night and my glasses during the day.”

The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is instructed not to rub
the eye. Glasses may be worn during the day. Following cataract surgery, if the client was operated under topical
anesthesia, the surgeon will directly prescribe post-operative dark glasses. If the client has undergone surgery under
local anesthesia, he will have an eye pad and plastic shield over the eye. The eye pad is usually removed 2 hours after
the surgery at the hospital.
Option A: Aspirin or medications containing aspirin are not to be administered or taken by the client and the client is
instructed to take acetaminophen as needed for pain. Use the eye drops as prescribed. They are usually for preventing
infection and controlling eye pressure. Note that some eye drops need to be kept in the refrigerator. Mild pain is
expected. Over-the-counter painkillers such as Paracetamol can be used to relieve the pain, provided the person has
no allergy to the medicine.
Option B: The client is instructed not to sleep on the side of the body on which the operation occurred. Sleeping in
any position is acceptable, but the person should avoid direct pressure on the operated eye. A protective eye shield
should be worn during sleep or nap for at least the first week after surgery. This helps to prevent accidental injury to
his eye during sleep.
Option D: The client is not to lift more than 5 pounds. There is no need to totally restrict physical activities. Bending is
avoided one day after surgery. The client may do simple exercises like walking and yoga but strenuous exercises,
aerobics, or headstands must be avoided. As far as possible, vigorous coughing and sneezing should be avoided
because this can cause an increase in eye pressure. Notify a doctor if the person coughs frequently.

10. The client with glaucoma asks the nurse if complete vision will return. The most appropriate response is:
A. “Although some vision has been lost and cannot be restored, a further loss may be prevented by
adhering to the treatment plan.”
B. “Your vision will return as soon as the medications begin to work.”
C. “Your vision will never return to normal.”
D. “Your vision loss is temporary and will return in about 3-4 weeks.”

Correct Answer: A. “Although some vision has been lost and cannot be restored, a further loss may be
prevented by adhering to the treatment plan.”

Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been lost and
cannot be restored, a further loss may be prevented by adhering to the treatment plan. Glaucoma management is
tailored to the specific type and severity. However, there is no treatment at this time that can reverse any of the vision
loss that has occurred, it can only help to prevent further damage and vision loss.

Option B: Angle-closure is an emergency and must be treated as such. This is because pressures can be high enough
to cause glaucomatous optic nerve damage, ischemic nerve damage, or retinal vascular occlusion. Patients can take
medication to reduce eye pressure as quickly as possible but usually require a laser procedure called laser peripheral
iridotomy.

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Option C: This does not provide reassurance to the client. Glaucoma is a chronic and serious disease that can result in
permanent vision loss if not taken care of properly. To reduce the morbidity of the disorder, the condition is best
managed by an interprofessional team that is dedicated to the management of patients with vision problems. The key
to treatment is patient education.
Option D: Currently, glaucoma cannot be prevented or cured, but progression can be controlled to help prevent
further vision loss either through medication, glaucoma laser treatment, or incisional glaucoma surgeries.

11. The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would
the nurse include in the plan of care?
A. Decrease fluid intake to control the intraocular pressure.
B. Avoid overuse of the eyes.
C. Decrease the amount of salt in the diet.
D. Eye medications will need to be administered lifelong.

Correct Answer: D. Eye medications will need to be administered lifelong.

The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client
needs to be instructed that medications will need to be taken for the rest of his or her life. Stress the importance of
meticulous compliance with prescribed drug therapy to prevent an increase in IOP, resulting in disk changes and loss
of vision.

Option A: Discuss dietary considerations (adequate fluid, bulk, or fiber intake). Measures to maintain consistency of
stool to avoid constipation and straining during defecation. Stress the importance of routine checkups. It is important
to monitor the progression and maintenance of disease to allow for early intervention and prevent further loss of
vision.
Option B: Encourage the patient to make necessary changes in lifestyle. A tranquil lifestyle decreases the emotional
response to stress, preventing ocular changes that push the iris forward, which may precipitate an acute attack.
Option C: Review the importance of maintaining a drug schedule like eye drops. Discuss medications that should be
avoided such as mydriatic drops (atropine, propantheline bromide), overuse of topical steroids, and additive effects of
[beta]-blocking when systemic [beta]-blocking agents are used.

12. The nurse is performing an admission assessment on a client with a diagnosis of a detached retina. Which of
the following is associated with this eye disorder?
A. Pain in the affected eye.
B. Total loss of vision.
C. A sense of a curtain falling across the field of vision.
D. A yellow discoloration of the sclera.

Correct Answer: C. A sense of a curtain falling across the field of vision

A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is
falling across the field of vision. They may also have significant photopsia (flashes of light) in their vision. The patient
often presents with slowly progressive or fixed visual field loss, typically starting in the periphery and then moving
centrally.

Option A: No pain is associated with detachment of the retina. Other essential aspects of the history include the
timing of the onset of the symptoms, if the patient has the same visual loss symptoms in the fellow eye, whether
central visual acuity is affected, prior surgery, or previous trauma.
Option B: Total loss of vision is not a characteristic of this disorder. A retinal detachment is an ophthalmic emergency
and even more so if visual acuity is still normal. Essential aspects of the physical exam include getting the patient’s
best-corrected visual acuity of each eye, checking the pupillary reaction of each eye, and ensuring that there is no
relative afferent pupillary defect and confrontational visual field testing.
Option D: If the entire sclera turns yellow, it is often a sign of jaundice. Jaundice is caused by a buildup of old red
blood cells, called bilirubin. These cells are normally filtered out by the liver and turned into bile. That bile is stored in
the gallbladder and eventually excreted by the body. But when the liver, gallbladder, or pancreas are not working
properly, jaundice can develop.

13. The nurse is caring for a client with a diagnosis of a detached retina. Which assessment sign would indicate
that bleeding has occurred as a result of the retinal detachment?
A. Complaints of a burst of black spots or floaters.
B. A sudden sharp pain in the eye.
C. Total loss of vision.
D. A reddened conjunctiva.

Correct Answer: A. Complaints of a burst of black spots or floaters.

Complaints of a sudden burst of black spots or floaters indicate that bleeding has occurred as a result of the
detachment. When the retina becomes detached, bleeding from nearby blood vessels can cloud the inside of the eye
so that you may not see clearly or at all. Central vision becomes severely affected if the macula becomes detached.
The macula is the part of the retina responsible for sharp, detailed vision.

Option B: Sharp or sudden pain in the eye is usually due to debris in or around the eye. It’s commonly described as
an aching, stabbing, or burning feeling within the eye itself. Sharp pain can also be caused by more serious conditions
such as uveitis or glaucoma.
Option C: Light must travel through several transparent structures before it can be sensed by the retina. First, light
passes through the cornea (the clear layer in front of the iris and pupil), then the lens, and then the vitreous humor
(the jellylike substance that fills the eyeball). Anything that blocks light from passing through these structures, for
example, a corneal ulcer or bleeding into vitreous humor, or disrupts the transmission of nerve impulses from the back
of the eye to the brain can cause loss of vision.
Option D: An infection of the conjunctiva irritates the blood vessels causing them to swell up. It is this inflammation
that makes the whites of the eyes appear reddish or even a bit pink. Viruses cause up to 80 percent of all cases of
conjunctivitis. Pink eye is prevalent among school children and is very contagious.

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14. The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which
intervention is initiated immediately?
A. Notify the physician.
B. Irrigate the eye with cold water.
C. Apply ice to the affected eye.
D. Accompany the client to the emergency room.

Correct Answer: C. Apply ice to the affected eye.

Treatment for contusion begins at the time of injury. Ice is applied immediately. The client then should be seen by a
physician and receive a thorough eye examination to rule out the presence of other eye injuries. This injury is usually
benign, but the patient should be assessed for more serious injury, such as a hyphema or basilar skull fracture.
Symptoms usually include ecchymosis of the lids, which can make it very difficult to visualize the globe.

Option A: If the globe appears intact, rule out orbital fracture and hyphema. If no obvious associated problems are
identified, therapeutic interventions such as ice, head elevation, and reassurance are initiated. Resolution of
uncomplicated periorbital ecchymosis usually occurs within 2 to 3 weeks.
Option B: Do not instill eye drops before evaluation of ocular injury. Severe pain associated with ocular trauma can be
minimized without medication by patching both eyes. When the patient cannot blink, protect the cornea from drying
with ophthalmic ointment or artificial tears.
Option D: General principles pertaining to ocular examination are essentially the same for the patient with an eye
injury; however, the patient’s ABCs should be evaluated and stabilized before interventions for the ocular problem.
Ocular injury often occurs in conjunction with head and facial trauma; therefore these patients should be carefully
evaluated for an associated eye injury.

15. The client arrives in the emergency room with a penetrating eye injury from wood chips while cutting wood.
The nurse assesses the eye and notes a piece of wood protruding from the eye. What is the initial nursing
action?
A. Remove the piece of wood using a sterile eye clamp.
B. Apply an eye patch.
C. Perform visual acuity tests.
D. Irrigate the eye with sterile saline.

Correct Answer: C. Perform visual acuity tests.

If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. The only option
that will prevent further disruption is to assess visual acuity. Up to 40% of penetrating eye injuries are complicated by
the presence of an intraocular foreign body (IOFB). It may be toxic (iron, copper, vegetable matter) or inert (glass or
plastic). Vision loss may result from the mechanical injury or from post-traumatic complications such as
endophthalmitis, retinal detachment, metal toxicity and sympathetic ophthalmia.

Option A: This object must never be removed except by the ophthalmologist because it may be holding ocular
structures in place. Do not attempt to pull out any foreign material that may be sticking out of the eye. Avoid any
pressure on the globe; for example, do not press on the sclera.
Option B: The application of an eye patch may disrupt the foreign body and cause further tearing of the sclera.
Protect the eye from further damage by using an eye shield. Administer systemic analgesics. Administer prophylactic
broad-spectrum systemic antibiotics.
Option D: Irrigation of the eye may disrupt the foreign body and cause further tearing of the sclera. Prompt diagnosis,
referral, removal of the IOFB, and surgical repair will help to preserve the visual acuity and the globe anatomy. Record
the baseline best-corrected visual acuity in each eye and conduct a complete examination of both eyes and adnexae.
Use Desmarres retractor to avoid undue pressure on the globe during an examination.

16. The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid.
The initial nursing action is to:
A. Begin visual acuity testing.
B. Irrigate the eye with sterile normal saline.
C. Swab the eye with antibiotic ointment.
D. Cover the eye with a pressure patch.

Correct Answer: B. Irrigate the eye with sterile normal saline.

Emergency care following a chemical burn to the eye includes irrigating the eye immediately with sterile normal saline
or ocular irrigating solution. In the emergency department, the irrigation should be maintained for at least 10 minutes.
Following this emergency treatment, visual acuity is assessed. Chemical burns of the eye are one of the most common
eye injuries. The extent of the ocular surface damage is influenced by the type, temperature, volume, and pH of the
corrosive substance and duration of exposure.
Option A: Eye irrigation must be instituted immediately at the scene of exposure and continued in the emergency
department to reduce visual impairment. Traditionally lactated Ringer’s and normal saline have been used as irrigation
fluids, although one systematic review demonstrates similar outcomes with other irrigation fluids.
Option C: The Morgan Lens is a device that can be utilized to allow the provider to perform “hands free” eye
irrigation. Complications of chemical burns are more common with alkali burns as these substances destroy the
corneal epithelium and allow this corrosive base substance to penetrate deeper into the cornea.
Option D: Do not rub the eye or place a bandage over the eye. The person should keep the eye open as wide as
possible. Wash the person’s hands thoroughly to make sure no chemical is still on them.

17. The nurse is caring for a client following enucleation. The nurse notes the presence of bright red blood
drainage on the dressing. Which nursing action is appropriate?
A. Notify the physician.
B. Continue to monitor the drainage.
C. Document the finding.
D. Mark the drainage on the dressing and monitor for any increase in bleeding.

Correct Answer: A. Notify the physician.

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If the nurse notes the presence of bright red drainage on the dressing, it must be reported to the physician because
this indicated hemorrhage. Enucleation is the removal of the eye from the orbit and involves the separation of all
tissue connections between the globe and the orbit. The main indications for enucleation are trauma, painful eye, a
blind eye, which is unsightly, intraocular malignancy, and as part of eye donation.

Option B: Postoperative orbital hemorrhage after enucleation is rare with the use of compression bandages, and the
precautions discussed earlier. If severe hemorrhage occurs, surgical exploration may be necessary, and separate
incisions can decrease wound dehiscence and fat atrophy.
Option C: This is not a normal finding. Edema of the orbit after enucleation is common and usually settles down with
time. Orbital infection is a rare complication but can lead to wound dehiscence, implant exposure, and extrusion.
Symptoms can be increased chemosis and persistent pain in the socket.
Option D: The pressure patch can remain in place up to a week to reduce postoperative edema, although it is
generally removed in 24 hours because of the inevitable oozing and soaking of the dressing that occurs. It will need to
be removed to allow the application of topical antibiotics and corticosteroid ointment onto the conformer.

18. When using a Snellen alphabet chart, the nurse records the client’s vision as 20/40. Which of the following
statements best describes 20/40 vision?
A. The client has alterations in near vision and is legally blind.
B. The client can see at 20 feet what the person with normal vision can see at 40 feet.
C. The client can see at 40 feet what the person with normal vision sees at 20 feet.
D. The client has a 20% decrease in acuity in one eye, and a 40% decrease in the other eye.

Correct Answer: B. The client can see at 20 feet what the person with normal vision can see at 40 feet.

The numerator refers to the client’s vision while comparing the normal vision in the denominator. The results of visual
acuity are classically reported using 20/20 (6/6 when using meters) for standard vision. The numerator describes the
distance from the chart, typically 20 ft (6 m). The denominator describes the distance that an individual with normal
vision (20/20 vision) can read the same line on the chart.

Option A: The WHO describes individuals with low vision as having a best-corrected vision of 20/60 or worse, and
blind as best corrected vision worse than 20/400, whereas legal blindness is identified as 20/200 in the United States.
These formal definitions can have ramifications when it comes to accommodations and abilities to operate a motor
vehicle.
Option C: Visual acuity decreases as the number increases and improves as the number decreases. Although 20/20
visual acuity has been referred to as “perfect vision,” it is important to remember that this is only one aspect of vision
and does not include other elements such as depth perception, peripheral vision, and colorblindness.
Option D: Visual acuity testing is essential as many of these factors can be benefited from early intervention. It is
crucial to determine an individual’s best-corrected visual acuity. The goal of the visual acuity test is to determine
clarity or sharpness of vision. Visual acuity testing examines a patient’s ability to distinguish different optotypes
(recognizable letters or symbols) at a standard distance.

19. Which of the following instruments is used to record intraocular pressure?

A. Goniometer
B. Ophthalmoscope
C. Slit lamp
D. Tonometer

Correct Answer: D. Tonometer

A tonometer is a device used in glaucoma screening to record intraocular pressure. Instruments measuring intraocular
pressure assume the eye is a closed globe with uniform pressure distributed throughout the anterior chamber and
vitreous cavity. The normal range of intraocular pressure is 10 to 21 millimeters of mercury.
Option A: A goniometer measures joint movement and angles. A goniometer is a device that measures an angle or
permits the rotation of an object to a definite position. In orthopedics, the former applies more. The art and science of
measuring the joint ranges in each plane of the joint are called goniometry.
Option B: An ophthalmoscope examines the interior of the eye, especially the retina. The ophthalmoscope illuminates
the retina through the normal iris defect that is the pupil. Light rays forming the image of the retina re-emerge through
the pupil. The viewing aperture (window) of the ophthalmoscope contains a lens that modifies light rays to assist the
user.
Option C: A slit-lamp evaluates structures in the anterior chamber in the eye. A slit lamp is a microscope with a bright
light used during an eye exam. It gives the ophthalmologist a closer look at the different structures at the front of the
eye and inside the eye. It’s a key tool in determining the health of the eyes and detecting eye disease.

20. After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic examination, which of
the following instructions would be given to the client?
A. “Be careful because the blink reflex is paralyzed.”
B. “Avoid wearing your regular glasses when driving.”
C. “Be aware that the pupils may be unusually small.”
D. “Wear dark glasses in bright light because the pupils are dilated.”

Correct Answer: D. “Wear dark glasses in bright light because the pupils are dilated.”

Atropine, an anticholinergic drug, has mydriatic effects causing pupil dilation. This allows more light onto the retina
and may cause photophobia and blurred vision. Atropine causes the muscles in the eye to become relaxed. This
widens (dilates) the pupil so that it will not respond to light.

Option A: Atropine doesn’t paralyze the blink reflex. Atropine ophthalmic (for the eye) is used to dilate the pupils
when there is an inflammatory condition or in post surgery situations in which this effect may be helpful.
Option B: Driving may be contraindicated to blurred vision. Atropine ophthalmic may make the eyes more sensitive to
light. Wear sunglasses to protect the eyes whenever outdoors or in bright light. Do not use atropine eye drops while
wearing contact lenses. The medicine may contain a preservative that can discolor soft contact lenses. Wait at least 15
minutes after using the eye drops before putting in contact lenses.
Option C: Atropine doesn’t cause miosis (pupil constriction). Atropine ophthalmic is also used in people with a
condition called amblyopia (sometimes called “lazy eye”). Atropine ophthalmic can be placed into the stronger eye to

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temporarily blur the vision in that eye. This helps strengthen the weaker eye because the brain will force that eye to
work harder to focus.

21. Which of the following procedures or assessments must the nurse perform when preparing a client for eye
surgery?
A. Clipping the client’s eyelashes.
B. Verifying the affected eye has been patched 24 hours before surgery.
C. Verifying the client has been NPO since midnight, or at least 8 hours before surgery.
D. Obtaining informed consent with the client’s signature and placing the forms on the chart.

Correct Answer: C. Verifying the client has been NPO since midnight, or at least 8 hours before surgery.

Maintaining NPO status for at least 8 hours before surgical procedures prevents vomiting and aspiration. Historically,
general anesthesia and retrobulbar blocks were used for intracapsular cataract surgery. However, with the advent of
phacoemulsification and small incision surgeries, clinicians have since moved to local and topical anesthesia.

Option A: There is no need to clip the eyelashes unless specifically ordered by the physician. The ophthalmologic
evaluation includes a thorough ophthalmic history, with a focus on visual acuity as well as comorbidities, and slit-lamp
examination. Several measurements of the eye are then taken, including the anterior chamber depth, to determine
intraocular lens refraction.
Option B: There is no need to patch an eye before most surgeries unless specifically ordered by the physician. While
thorough medical history should be taken before surgery, routine systemic preoperative tests do not need to be
ordered. Some institutions may require clearance from the primary care physician when patients have underlying
systemic diseases.
Option D: The physician is responsible for obtaining informed consent; the nurse validates that the consent is
obtained. With newer and well-developed techniques, cataract surgery is one of the most successful clinical
managements in medicine with direct improvements in visual acuity as well as large improvements in activities of
daily living and decreased mortality.

22. Cataract surgery results in aphakia. Which of the following statements best describes this term?
A. Absence of the crystalline lens.
B. A “keyhole” pupil.
C. Loss of accommodation.
D. Retinal detachment.

Correct Answer: A. Absence of the crystalline lens

Aphakia means without a lens. Aphakia is a condition that involves not having an eye lens. The lens of the eye is a
clear, flexible structure that allows the eye to focus. This condition is most common in adults with cataracts, but it can
also affect infants and children.

Option B: A keyhole pupil results from iridectomy. Coloboma of the iris is a hole or defect of the iris of the eye. Most
colobomas are present since birth (congenital). A cat-eye is a type of coloboma. Any defect in the iris that allows light
to enter the eye, other than through the pupil, is called a coloboma.
Option C: Loss of accommodation is a normal response to aging. Loss of accommodation is a normal process of aging,
called presbyopia. However, premature or acute accommodation loss in a child or young adult necessitates systemic
evaluation and laboratory work-up to determine the etiology.
Option D: A retinal detachment is usually associated with retinal holes created by vitreous traction. Retinal
detachments constitute a serious ocular condition and can lead to permanent vision loss. When the retina, the
neurosensory layer, detaches from the back of the eye, it loses its oxygen and nutrient supply leading to the death of
the tissue.

23. When developing a teaching session on glaucoma for the community, which of the following statements would
the nurse stress?
A. Glaucoma is easily corrected with eyeglasses.
B. White and Asian individuals are at the highest risk for glaucoma.
C. Yearly screening for people ages 20-40 years is recommended.
D. Glaucoma can be painless and vision may be lost before the person is aware of a problem.

Correct Answer: D. Glaucoma can be painless and vision may be lost before the person is aware of a
problem.

Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of peripheral vision. The
patient with POAG is often asymptomatic until the optic nerve damage is severe unless signs of early glaucoma are
recognized on a routine eye exam. Open-angle glaucoma typically manifests as slow, painless damage to the optic
nerve that is thought to be due to the drainage system in the eye becoming ineffective.

Option A: A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Open-
angle glaucoma is generally managed initially with medications to lower eye pressure. Medication classes include
prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, an alpha-2 agonist, miotic agents, and more
recently rho-kinase inhibitors and nitric-oxide donating medications.
Option B: Blacks have a threefold greater chance of developing with an increased chance of blindness than other
groups. The African population has the highest prevalence of open-angle type. The likelihood of blindness from open-
angle glaucoma is up to 15-times greater in those of African-decent compared to other population groups.
Option C: Individuals older than 40 should be screened. While there are congenital, infantile, development
glaucomas, and a juvenile variant of POAG, the four previously mentioned glaucoma types typically occur in people
over the age of 40. The cause is generally correlated with increased intraocular pressure, though it has not been
proven to have a direct cause-and-effect relationship.

24. For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following
medications?
A. Acetazolamide (Diamox)
B. Atropine
C. Furosemide (Lasix)

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D. Urokinase (Abbokinase)

Correct Answer: A. Acetazolamide (Diamox)

Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of
aqueous humor. Acetazolamide is a classic treatment option for glaucoma as it causes a reduction in aqueous humor.
As well, it is useful for the treatment of altitude sickness, because of its underlying mechanism of action.

Option B: Atropine dilates the pupil and decreases the outflow of aqueous humor, causing a further increase in IOP.
Ophthalmic atropine is used before eye examinations to dilate (open) the pupil, the black part of the eye through
which you see. It is also used to relieve pain caused by swelling and inflammation of the eye.
Option C: Lasix is a loop diuretic. Furosemide inhibits tubular reabsorption of sodium and chloride in the proximal and
distal tubules and the thick ascending loop of Henle by inhibiting the sodium-chloride cotransport system resulting in
excessive excretion of water along with sodium, chloride, magnesium, and calcium.
Option D: Urokinase is a thrombolytic agent; they aren’t used for the treatment of glaucoma. Thrombolytics or
fibrinolytics are a group of medications used in the management and treatment of dissolving intravascular clots. They
are in the plasminogen activator class of drugs.

25. Which of the following symptoms would occur in a client with a detached retina?
A. Flashing lights and floaters
B. Homonymous hemianopia
C. Loss of central vision
D. Ptosis

Correct Answer: A. Flashing lights and floaters

Signs and symptoms of retinal detachment include abrupt flashing lights, floaters, loss of peripheral vision, or a
sudden shadow or curtain in the vision. Occasionally visual loss is gradual. Patients with a rhegmatogenous retinal
detachment may present with a history of a large number of new-onset floaters. They may also have significant
photopsia (flashes of light) in their vision. The patient often presents with slowly progressive or fixed visual field loss,
typically starting in the periphery and then moving centrally.

Option B: Homonymous hemianopsia involves loss of visual field zones, and patients often present with bilateral field
loss, though sometimes they complain of monocular loss or dyslexia. In addition, unilateral lesions in these following
anatomical locations do not alter acuity.

Option C: Many patients with glaucoma, especially early in the disease, are not aware they have this condition until it
is discovered on a routine eye exam. On comprehensive eye examination, optic nerves may have a focally notched
neuroretinal rim or diffuse cup enlargement, a decrease in peripheral vision detected on visual field testing, and
(although not required for diagnosis) an increased intraocular pressure reading on tonometry.

Option D: Ptosis is known as the drooping of the upper eyelid, and the patient usually presents with the complaint of
a defect in vision and cosmesis. It can be congenital or acquired, or it can be neurogenic, myogenic, aponeurotic,
mechanical, or traumatic in origin.

26. A male client has just had a cataract operation without a lens implant. In discharge teaching, the nurse will
instruct the client’s wife to:
A. Feed him soft foods for several days to prevent facial movement.
B. Keep the eye dressing on for one week.
C. Have her husband remain in bed for 3 days.
D. Allow him to walk upstairs only with assistance.

Correct Answer: D. Allow him to walk upstairs only with assistance.

Without a lens, the eye cannot accommodate. It is difficult to judge distance and climb stairs when the eyes cannot
accommodate. Therefore, the client should walk up and down stairs only with assistance. Ensure the room
environment is safe with adequate lighting and furniture moved toward the walls. Remove all rugs, and objects that
could be potentially hazardous.

Option A: Instruct patient and/or family regarding safe lighting. The patient should wear sunglasses to reduce glare.
Advise the family to use contrasting bright colors in household furnishings. These techniques help enhance visual
discrimination and reduce the potential for injury.
Option B: Instruct patient to wear a plastic or metal shield over the eye with perforations; a shield or glasses should
be worn for protection during the day to protect the eye from accidental injury.
Option C: Instruct patient to watch out for the development of complications, such as sharp pain in the eye
uncontrolled by analgesics, or clouding in the anterior chamber. This may indicate infection and should be reported
immediately.

27. The nurse is performing a voice test to assess hearing. Which of the following describes the accurate
procedure for performing this test?
A. Stand 4 feet away from the client to ensure that the client can hear at this distance.
B. Whisper a statement and ask the client to repeat it.
C. Whisper a statement with the examiners back facing the client.
D. Whisper a statement while the client blocks both ears.

Correct Answer: B. Whisper a statement and ask the client to repeat it.

The examiner stands 1-2 feet away from the client and asks the client to block one external ear canal. The nurse
whispers a statement and asks the client to repeat it. Each ear is tested separately. Before the examination, one must
first ask the patient if they are in any pain. The patient should also be asked whether they have any ear-related
symptoms (specifically discharge, pain, hearing loss) – and which they think is their better hearing ear.
Option A: The patient should be sat on a chair suited to their habitus and comfort. The chair should ideally be in the
center of the room, as part of the examination requires the examiner to stand behind the patient.

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Option C: Explain to the patient that they will be required to repeat words or phrases they hear back to the examiner.
To eliminate the possibility of lip-reading, stand behind the patient, and say a test word to be repeated back. The
examiner then stands to the side of the test ear (conventionally the better hearing ear) and gently presses on the
tragus of the non-test ear to mask it.
Option D: The examiner then speaks several test words at arm’s length and then half arm’s length. At each distance,
the test words are spoken at three volumes: whispered, conversational, and loud.

28. During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber
test. The nurse analyzes this result as:
A. A normal finding.
B. A conductive hearing loss in the right ear.
C. A sensorineural or conductive loss.
D. The presence of nystagmus.

Correct Answer: C. A sensorineural or conductive loss.

In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the client’s head, at the
midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard equally in both ears by
bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. The inner
ear is more sensitive to sound via air conduction than bone conduction (in other words, air conduction is better than
bone conduction).

Option A: Weber test does not demonstrate lateralization: in a normal subject, the sound should be heard in the
middle and equally on both sides. In the primary care setting, it is useful to use the Weber test along with the Rinne
test to help the clinician differentiate between conductive hearing loss and sensorineural hearing loss. This will guide
the clinician to the need for further examination, investigation, and management.
Option B: If the client has a conductive hearing loss in one ear, the sound is heard in that ear. In the presence of a
purely unilateral conductive hearing loss, there is a relative improvement in the ability to hear a bone-conducted
sound. In the presence of sensorineural hearing loss, the sound will be perceived louder in the unaffected ear, which
has the better cochlear.
Option D: Nystagmus is a rhythmic, involuntary, rapid, oscillatory movement of the eyes. The Weber test is a useful,
quick, and simple screening test for evaluating hearing loss. The test can detect unilateral conductive and
sensorineural hearing loss. The outer and middle ear mediate conductive hearing. The inner ear mediates
sensorineural hearing.

29. The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate
communication?
A. Speak frequently.
B. Speak loudly.
C. Speak directly into the impaired ear.
D. Speak in a normal tone.

Correct Answer: D. Speak in a normal tone.

Speaking in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk
directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said,
the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate
communication, but the nurse should avoid talking directly into the impaired ear.

Option A: When speaking with a patient who has a hearing impairment it’s important to face him directly and make
sure you have his attention. Identifying hospitalized patients who have a hearing impairment to others (for example,
with a bracelet, a bed tag, or a flag on the chart) and posting communication strategies (with the patient’s consent)
may ease frustration and minimize miscommunication.
Option B: When speaking with a patient who has a hearing impairment it’s important to speak at a normal volume
while clearly enunciating (but without using exaggerated lip movements). Remind patients to listen actively. However,
many people with hearing impairment find it tiring to keep paying attention, so provide adequate time. Training in
word recognition has also been shown to result in some improvements in older adults with hearing impairment.
Option C: When speaking with a patient who has a hearing impairment it’s important not to cover the mouth with a
hand. When a patient has a hearing impairment, a combination of adaptive techniques, environmental modifications,
and assistive devices (including hearing aids) is necessary to ensure effective communication.

30. The nurse has conducted discharge teaching for a client who had a fenestration procedure for the treatment of
otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective?
A. “I should drink liquids through a straw for the next 2-3 weeks.”
B. “It’s ok to take a shower and wash my hair.”
C. “I will take stool softeners as prescribed by my doctor.”
D. “I can resume my tennis lessons starting next week.”

Correct Answer: C. “I will take stool softeners as prescribed by my doctor.”

Following ear surgery, the client needs to avoid straining while having a bowel movement. The fenestration operation
for improving the hearing in otosclerosis rests on a very simple principle: the creation of a new window into the
labyrinth to take the place of the oval window which has become occluded by the otosclerotic bone proliferation.

Option A: The client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and coughing
excessively. The first postoperative visit is usually scheduled after 2 weeks, which allows time for the tympanomeatal
flap to heal in place. The canal may be débrided at this time.
Option B: The client needs to avoid getting his or her hair wet, washing hair, showering for 1 week. The patient should
be counseled as to the surgeon’s specific postoperative instructions, including avoidance of nose blowing, sneezing,
and allowance of water into the ear canal.
Option D: The client should avoid rapidly moving the head, bouncing, and bending over for 3 weeks. Cotton balls are
placed in the meatus 2-3 times per day to collect discharge from the canal over the first several days after the
surgery. Postoperative audiometrics are typically performed 3-6 weeks after surgery.

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31. A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an
insect. Which intervention would the nurse anticipate to be prescribed initially?
A. Irrigation of the ear.
B. Instillation of diluted alcohol.
C. Instillation of antibiotic ear drops.
D. Instillation of corticosteroids ear drops.

Correct Answer: B. Instillation of diluted alcohol.

Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or
diluted alcohol is instilled into the ear to suffocate the insect, which then is removed by using forceps. For patients
with significant discomfort (typically from a live insect), apply a topical anesthetic or give local anesthesia as a
regional auricular block.

Option A: When the foreign object is vegetable matter, irrigation is not used because this material expands with
hydration and the impaction becomes worse. Irrigation should not be attempted if the object is soft or a seed or other
vegetable matter that may swell when water is added.
Option C: If there is any injury to the canal or tympanic membrane, have the patient keep the ear dry until they are
reassessed (ear precautions are needed for 1 week in the case of a perforated tympanic membrane); consider
prescribing ciprofloxacin/corticosteroid suspension drops for 3 to 5 days.
Option D: After the foreign body is removed, inspect the external canal. For most foreign bodies, no medications are
needed. However, if infection or abrasion is evident, fill the ear canal 5 times/day for 5-7 days with a combination
antibiotic and steroid otic suspension.

32. The nurse has noted that the physician has a diagnosis of presbycusis on the client’s chart. The nurse plans
care knowing the condition is:
A. A sensorineural hearing loss that occurs with aging.
B. A conductive hearing loss that occurs with aging.
C. Tinnitus that occurs with aging.
D. Nystagmus that occurs with aging.

Correct Answer: A. A sensorineural hearing loss that occurs with aging.

Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by
nerve degeneration in the inner ear or auditory nerve. In literal terms, presbycusis means ‘old hearing’ or ‘elder
hearing ‘. It is the most common cause of hearing loss worldwide and is estimated to affect approximately two-thirds
of Americans aged 70 or older.
Option B: It is primarily due to age-related changes in hair cells, the stria vascularis, and afferent spiral ganglion
neurons. Presbycusis is a type of sensorineural hearing loss with the involvement of the inner ear and/or neurologic
pathways that form connections to the auditory cortex.
Option C: A common initial presentation is difficulty discriminating speech in specific situations, such as a room with
significant background noise. Some patients complain of tinnitus, or ringing in the ears, however, this is not specific to
presbycusis.
Option D: The hallmark of presbycusis is the impaired ability to understand high-frequency components of speech
(voiceless consonants, such as p, k, f, s, and ch). There is no cure; however, hearing aids that amplify sounds can be
used to mitigate symptoms.

33. A client with Meniere’s disease is experiencing severe vertigo. Which instruction would the nurse give to the
client to assist in controlling vertigo?
A. Increase fluid intake to 3000 ml a day.
B. Avoid sudden head movements.
C. Lie still and watch the television.
D. Increase sodium in the diet.

Correct Answer: B. Avoid sudden head movements.

The nurse instructs the client to make slow head movements to prevent the worsening of vertigo. Meniere disease is
an inner ear disorder characterized by tinnitus, vertigo, and hearing loss. This is thought to occur due to the
accumulation of endolymphatic fluid in the cochlea and the vestibular organ.

Option A: Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid
sometimes are prescribed. Studies of the temporal bone revealed endolymphatic accumulation in the cochlea and the
vestibular organ in patients with Meniere disease. Current research links endolymphatic hydrops to a hearing loss of
>40dB.
Option C: Lying still and watching television will not control vertigo. If Meniere disease is suspected, the patient
should be questioned about the character of vertigo, hearing loss, and earlier episodes. A full otologic history is part of
the clinical investigation.
Option D: A sodium restriction diet may be recommended. Low-level evidence suggests that restricting sodium intake
may help to prevent Meniere’s attacks. If Meniere disease is suspected, one should perform a full otologic
examination, facial nerve testing, and assessment of nystagmus with Frenzel goggles, Rinne, and Weber tests.

34. The nurse is reviewing the physician’s orders for a client with Meniere’s disease. Which diet will most likely be
prescribed?
A. Low-cholesterol diet
B. Low-sodium diet
C. Low-carbohydrate diet
D. Low-fat diet

Correct Answer: B. Low-sodium diet.

Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are
prescribed. Foods with high sugar or salt content cause water retention, which can worsen symptoms of Meniere’s
disease. Sugar prompts an insulin response from the body, and insulin retains sodium. Sodium causes the body to
retain water.

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Option A: It is unnecessary to place the client on a low cholesterol diet. Water retention makes Meniere’s disease
worse, but this doesn’t mean the client should stop drinking fluids. It’s more important that he avoids fluids that
contain large amounts of sugar and salt, such as soda or concentrated juices, which makes one retain water.
Option C: Carbohydrates should not be decreased from the client’s diet. People with Meniere’s disease should aim for
less than 2,300 mg of sodium each day, according to the Mayo Clinic. Intake should be spread evenly throughout the
day. Much more than that will cause water retention.
Option D: Caffeine, not fat, should be avoided because it’s a stimulant and can make tinnitus louder. Caffeine and
alcohol also interfere with the body’s ability to regulate fluid levels, which can make the inner ear worse, causing
headaches, pressure, and vertigo.

35. A client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client
complaint associated with a disorder in this part of the ear?
A. Hearing loss
B. Pruritus
C. Tinnitus
D. Burning of the ear

Correct Answer: C. Tinnitus.

Tinnitus is the most common complaint of clients with otological disorders, especially disorders involving the inner ear.
Symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in
the ear, which can interfere with the client’s thinking process and attention span.

Option A: Hearing loss can be conductive, sensorineural, or mixed. Conductive hearing loss takes place with
disruption of the transmission of the sound waves to the cochlea. The most common causes include abnormal
formation of the auricle or helix, cerumen impaction, ear canal foreign bodies, otitis externa, dysfunction or fixation of
the ossicular chain, and middle ear effusion.
Option B: Pruritus, more commonly described as itchiness, refers to an uncomfortable sensation of the skin that
typically triggers an urge to scratch. Pruritus can be transient or can persist for a longer amount of time, which often
indicates a more significant underlying cause. If itching persists past six weeks, it is known as chronic pruritus. Pruritus
can either be localized to one part of the body or more generalized to several areas.
Option D: Red ear (RE) episodes are characterized by unilateral or bilateral attacks of paroxysmal burning sensations
and reddening of the external ear. The duration of these episodes ranges from a few seconds to several hours. The
attacks occur with a frequency ranging from several a day to a few per year.

36. A nurse would question an order to irrigate the ear canal in which of the following circumstances?
A. Ear pain
B. Hearing loss
C. Otitis externa
D. Perforated tympanic membrane

Correct Answer: D. Perforated tympanic membrane.

Irrigation of the ear canal is contraindicated with perforation of the tympanic membrane because the solution entering
the inner ear may cause dizziness, nausea, vomiting, and infection. Tympanic membrane perforation is when there is a
tear in the tympanic membrane leading to a connection between the external auditory canal and the middle ear. This
can be caused by infection, trauma, or rapid changes in pressure leading to sudden otalgia, otorrhea, tinnitus, and
vertigo.

Option A: Otalgia is ear pain and breaks down into two categories of primary otalgia and secondary otalgia. Primary
otalgia is pain coming directly from the ear where secondary otalgia is referred to pain from somewhere outside the
ear. Infections cause most primary otalgia and are treated with antibiotics, while mechanical ones receive treatment
with decongestants, nasal steroids, or myringotomy.
Option B: Management of conductive hearing loss focuses on the treatment of the underlying disease. Conservative
methods such as removal of the foreign body, micro-suction of the cerumen, or discharge in the ear canal are
necessary if the ear canal is blocked. Conservative treatment of sensorineural hearing involves the use of assistive
listening devices and amplification. Hearing aids are devices designed to improve audition up to 40 to 60 dB with good
results.
Option C: The mainstay of uncomplicated otitis externa treatment usually involves topical antibiotic drops and pain
control. Pain can be intense and severe; therefore, it should be managed appropriately. Acetaminophen or
nonsteroidal anti-inflammatory drugs have been proven to be adequate for mild to moderate pain.

37. Which of the following interventions is essential when instilling Cortisporin suspension, 2 gtt right ear?
A. Verifying the proper client and route.
B. Warming the solution to prevent dizziness.
C. Holding an emesis basin under the client’s ear.
D. Positioning the client in the Semi-fowler's position.

Correct Answer: A. Verifying the proper client and route.

When giving medications, a nurse follows the five R’s of medication administration. The right patient: check that you
have the correct patient using two patient identifiers (e.g., name and date of birth). The right route: check that the
route is appropriate for the patient’s current condition.

Option B: The drops may be warmed to prevent pain or dizziness, but this action is not essential. Internal ear
structures are particularly sensitive to temperature extremes. Therefore, ear (otic) medications should always be
administered at room temperature. Always use sterile ear drops in case the eardrum is ruptured.
Option C: An emesis basin would be used for irrigation of the ear. Apply gentle pressure to the tragus several times.
Pressure helps move medication toward the tympanic membrane. If ordered, a cotton ball may be placed loosely in the
ear canal. Cotton balls help prevent the medication from escaping from the ear.
Option D: Put the client in the lateral position to prevent the drops from draining out for 5 minutes, not Semi-fowler’s
position. Position patient with affected ear uppermost, on the unaffected side, if lying down, or tilt head to the side if
sitting up. Proper positioning helps to stop the medication from escaping. Do not tilt the head if the patient has a
cervical spine injury.

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38. When teaching the client about Meniere’s disease, which of the following instructions would a nurse give about
vertigo?
A. Report dizziness at once.
B. Drive in daylight hours only.
C. Get up slowly, turning the entire body.
D. Change your position using the log roll method.

Correct Answer: C. Get up slowly, turning the entire body.

Turning the entire body, not the head, will prevent vertigo. During vertigo attacks, instruct the client to lie down and
not to move so as not to accumulate injuries or pain. Place the client in bed and raise the side rails for safety.
Administer medications as ordered for vertigo. Vertigo is not a life-threatening condition but the client may be at
greatest risk for injury.

Option A: Dizziness is expected but can be prevented. Always encourage the patient to move slowly and teach them
how long to wait between movements. Remember, sudden movements can trigger dizziness. Antivertiginous
medications, particularly meclizine, are prescribed widely for all ages of people who are dizzy.
Option B: The client shouldn’t drive as he may reflexively turn the wheel to correct vertigo. Plans should be made for
alternate transportation if the patient is dizzy, and an emergency plan can be made to stop the car in a safe place if
dizziness ensues while driving.
Option D: Turning the client in bed slowly and smoothly will be helpful; logrolling isn’t needed. Don’t rush the patient,
allow him/her to move at their own pace: rushing the patient will make him/her more prone to falling.

39. The part of the ear that contains the receptors for hearing is the:
A. Utricle
B. Cochlea
C. Middle ear
D. Tympanic cavity

Correct Answer: B. Cochlea.

The dendrites of the cochlear nerve terminate on the hair cells of the organ of Corti in the cochlea. The cochlea is the
organ of hearing. It takes its name from the Greek language that means the shell of a snail and is the part from where
the cochlear part of the VIII cranial nerve forms, thus constituting the vestibulocochlear nerve.

Option A: The utricle is a small membranous sac (part of the membranous labyrinth) and paired with the saccule lies
within the vestibule of the inner ear. It has an important role in orientation and static balance, particularly in horizontal
tilt.
Option C: The middle ear is an air-filled space. It divides into an upper and a lower chamber, the epitympanic
chamber (attic) and the tympanic chamber (atrium), respectively. It is like a room because it has a rectangular-like
shape.
Option D: The tympanic cavity is an air-filled compartment surrounded by bone that is separated from the external
ear by a thin tympanic membrane (tympanum) and is in direct communication with the pharynx via the auditory tube
(also known as the eustachian or pharyngotympanic tube).

40. The ear bones that transmit vibrations to the oval window of the cochlea are found in the:
A. Inner ear
B. Outer ear
C. Middle ear
D. Eustachian tube

Correct Answer: C. Middle ear.

The bones in the middle ear transmit and amplify air pressure waves from the tympanic membrane to the oval window
of the cochlea, which is the inner ear. The tympanic membrane separates the other from the middle ear. The middle
ear is an air-filled space. It divides into an upper and a lower chamber, the epitympanic chamber (attic) and the
tympanic chamber (atrium), respectively. It is like a room because it has a rectangular-like shape.

Option A: The inner ear is a space composed of the bony labyrinth and the membranous labyrinth, one inside the
other. The bony labyrinth has a cavity filled with semicircular canals that are in charge of sensing equilibrium; this
cavity is called the vestibule and is the place where the vestibular part of the VIII cranial nerve forms.
Option B: The outer ear, also called auricle, is composed of cartilage and it is the part with the most contact with the
external world. It has various anatomical demarcations like the helix, the antihelix, the tragus, and the antitragus and
these demarcations lead to a depression called acoustic meatus.
Option D: The Eustachian tube plays a role in equalization, oxygenation, and drainage of the tympanic cavity in the
middle ear. More specifically, the Eustachian tube permits equalization of pressure in the middle ear with respect to
ambient pressure.

41. A patients arrives in the outpatient clinic with a possible corneal abrasion. What diagnostic test would confirm
this diagnosis?
A. Tonometry
B. Visual field testing
C. Facial X-Ray
D. Flurescein staining

Correct answer: C. Facial X-Ray

42. A patient arrives in the emergency department with possible detached retina. What intervention should the
muse implement first?
A. Place the patient in dependent position
B. Discuss follow-up treatment with an ophthalmologist
C. Provide care in a calm manner
D. Notify the physician immediately

Correct answer: A. Place the patient in dependent position

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Practice Questionnaires

43. The nurse is teaching a patient the correct method for administering ear drops. Place the steps in order that
the patient should do them.
1. Tilt the head toward the unaffected side
2. Instill the ordered number of drops
3. Pull the pinna (auricle) upward and backward
4. Place a loose cotton ball in the ear canal for 15-20 minutes
5. Partially fill the ear dropper with medication
6. Warm the drops by holding the bottle

6,1,5,3,2,4

44. The nurse is caring for an older patient who has a severe hearing impairment. What would be an appropriate
nursing intervention?
A. Encourage the patient to learn sign language
B. Write out questions and responses
C. Reduce environment noise before speaking with the patient
D. Raise the voice to a higher pitch

Correct answer: C. Reduce environment noise before speaking with the patient

45. A patient is being taught about taking timilol (Timoptic). Which of the follow side effects should the patient
report to the health care provider?
A. Darkening of the iris
B. Stinging in the eyes
C. Bitter taste in the mouth
D. Difficulty breathing

Correct answer: D. Difficulty breathing

46. A patient in the outpatient clinic has possible acute otitis media. Which of the following manifestations should
the nurse report immediately to the health care provider?
A. Hearing loss in the affected ear
B. Tenderness behind the ear
C. Vertigo
D. Tinnitus

Correct answer: B. Tenderness behind the ear

47. When educating a patient about acute angle-closure glaucoma, what point should the nurse emphasize to the
patients about this condition?
A. Immediately report symptoms to the physician
B. Do not use medications that cause pupil constriction
C. Wear sunglasses when outdoors
D. Lie down for 30 minutes until symptoms disappear
Correct answer: A. Immediately report symptoms to the physician

48. Immediately after cataract surgery, it is important for the nurse to place the patient in what position?
A. Flat in bed
B. Turned in affected side
C. High Fowler's position
D. Semi-Fowler's position

Correct answer: D. Semi-Fowler's position

49. During the nurses initial assessment of an older woman with open-angle glaucoma, what symptoms might the
history reveal?
A. Light flashes in both eyes
B. Difficulty focusing on near objects
C. Acute severe eye pain
D. Watery drainage from both eyes
Correct answer: D. Difficulty focusing on near objects

50. When teaching the patient about Ménière disease, which of the following diet changes should the nurse
emphasize?
A. Avoid foods high in sodium
B. Increase the amount of green leafy vegetables
C. Reduce the intake of milk and milk products
D. Increase fluid intake before meals
Correct answer: A. Avoid foods high in sodium

51. The lens is a transparent, gelatinous mass of fibers encased in an elastic capsule situated behind the iris
True
52. The cornea, the eyes white portion, is contiguous with iris and is no transparent
True
53. One of the greatest challenges in the care of chronic eye disorders such as glaucoma is convincing the patient
of the need for long-term treatment and adherence to the therapeutic regimen
True

54. Postoperative positioning of the patient after eye surgery usually requires having the patient lie on his or her
back on the nonoperative side
True

55. By which routes are osmotic agents administered to reduce IOP? (Select all that apply)

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Practice Questionnaires
A. Intravenously
B. Orally
C. Topically
D. Intramuscularly
E. Subcutaneously
Correct answer: A. Intravenously

56. The nurse assesses a patient for an allergy to which factor before administering acetazolamide (Diamox)?
A. Penicillin
B. Eggs
C. Sulfonamides
D. Nuts
Correct answer: C. Sulfonamides

57. To prevent systemic effects of ophthalmic cholinergic agents, the nurse carefully blocks the inner canthus of
the eye for how many minutes?
A. 1-2
B. 3-5
C. 8-10
D. 12-14
Correct answer: A. 1-2

58. A patient with which disorder has the lowest risk for developing complications related to ophthalmic
adrenergic agents?
A. Mild hypertension
B. Type I diabetes
C. Renal failure
D. Hyperthyroidism
Correct answer: A. Mild hypertension

59. Which statement does the nurse include when teaching a patient about health promotion after eye surgery?
(Select all that apply)
A. Avoid bending at the waist
B. Avoid any straining with stool
C. Report any pain not relieved by prescribed medications
D. Use aseptic technique when instilling eye medications
E. Cough at least 10 times every hour
Correct answer: A. Avoid bending at the waist
B. Avoid straining with stool

60. Use aseptic technique when instilling eye medication. Which are actions of adrenergic agents used in
ophthalmology? (Select all that apply)
A. Increase outflow of aqueous humor
B. Vasodilation
C. Constriction is the ciliary muscle
D. Decreased formation of aqueous humor
E. Pupil dilation
Correct answer: A. Increased outflow of aqueous humor
B. Decreased formation or aqueous humor

61. A patient is ordered acetazolamide (Diamox) 500mg for injection. The medication is available as 500mg per
vial. Preparation instructions are reconstitute 500mg acetazolamide with 5 mL if sterile water for injection.
How many mL if acetazolamide does the nurse administer?
A. 1
B. 3
C. 4
D. 5
Correct answer: D. Five

62. The nurse administers 1 drop of olopatadine (Patanol) to each eye of a patient and records it in the patients
medication administration record. Which documentation most accurately represents this administration?
A. grr OU
B. 1 drop olopatadine (Patanol) OS
C. Drops X 1 olopatadine (Patanol) eyes
D. 1 drop olopatadine (Patanol) each eye
Correct answer: D. 1 drop olopatadine (Patanol) each eye

63. The nurse is preparing a discharge instruction sheet for a client who had an ear surgery two days ago. Which
of the following must be included in this plan?
A. Take antiemetics t.i.d
B. Change the inner dressing daily
C. Keep the mouth open when sneezing or coughing
D. Do not bathe until released by the doctor
Correct answer: C. Keep the month open when sneezing or coughing

64. A client with newly diagnosed glaucoma is receiving eye drops for the first time. After instilling the drops you
gently squeezing the bridge of his nose for 1 minute. He asks you why you are pinching his nose. The best
response should be:
A. If I pinch the nose, you won't move around as much
B. It keeps more of the medication in your eye
C. Pinching the nose increases the blood supply to your eyes
D. I'm sorry. I shouldn't have pinched your nose for such a long time
Correct answer: B. It keeps more medication in your eye

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Practice Questionnaires
65. You are responding to an accident to the hospital kitchen. A coworker is bleeding from her right eye. Upon
examination you see a small shard of metal penetrating from her right eye through the eyelid. Your next
action is to:
A. Irrigate the eye with normal saline
B. Remove the object, then irrigate the eye
C. Place a cup over the injured eye and tell her to keep the other eye closed
D. Take her to the emergency room
Correct answer: C. Place a cup over the injured eye and tell her to keep the other eye closed

66. The client is diagnosed with glaucoma. Which symptom should the nurse expect the client to report?
A. Loss of peripheral vision
B. Floating spots in the vision
C. A yellow haze around everything
D. A curtain coming across vision

Correct answer: A. Loss of peripheral vision

Rationale: 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".

67. The client is scheduled for right-eye cataract removal surgery in 5 days. Which prep instruction should be
discussed with the client?
A. Administer dilating drops to both eyes for 72 hours prior to surgery.
B. Prior to surgery do not lift or push any objects heavier than 15 pounds.
C. Make arrangements for being in the hospital for at least 3 days.
D. Avoid taking any type of medication which may cause bleeding, such as aspirin.
Correct answer: D. Avoid taking any type of medication which may cause bleeding, such as aspirin.

Rationale: To reduce retrobulbar hemorrhage, any anticoagulant therapy is withheld, including aspirin, NSAIDs, and
warfarin (Coumadin).

68. The client is post op retinal detachment surgery, and gas tamponade was used to flatten the retina. Which
intervention should the nurse implement first?
A. Teach the signs of increased intraocular pressure.
B. Position the client as prescribed by the surgeon.
C. Assess the eye for signs or symptoms of complications
D. Explain the importance of follow-ups visits

C. Assess the eye for signs or symptoms of complications

Rationale: 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.

69. The 65 yr old client is diagnosed with macular degeneration. Which statement by the client indicates the client
needs more discharge teaching?
A. "I should use magnification devices as much as possible".
B. "I will look at my Amsler grid at least twice a week".
C. "I need to use low-watt light bulbs in my house".
D. I am going to contact a low-vision center to evaluate my home".

C. "I need to use low-watt light bulbs in my house"

Rationale: 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 lightning, not decreased
lightning.

70. 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?
A. Carefully remove the stick from the eye.
B. Stabilize the stick as best as possible.
C. Flush the eye with water if available.
D. Place the young man in a high-Fowler's position

B. Stabilize the stick as best as possible.

Rationale: The foreign object should be stabilized to prevent further movement which could cause more damage to the
eye

71. The employee health nurse is teaching a class on "Preventing Eye Injury". Which info. should be discussed in
the class?
A. Read instructions thoroughly before using tools and working with chemicals.
B. Wear some type of glasses when working around flying fragments.
C. Always wear a protective helmet with eye shield around dust particles
D. Pay close attention to the surrounding so eye injuries will be prevented.

a. Read instructions thoroughly before using tools and working with chemicals.

Rationale: Instructions provide precautions and steps to take if eye injuries occur secondary to the use of tools or
chemicals.

72. 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?

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Practice Questionnaires
A. Corneal dystrophy
B. Conjunctivitis
C. Diabetic retinopathy
D. Cataracts

d. Cataracts

Rationale: A cataract is a lens opacity or cloudiness, resulting in the s/s discussed in the stem of the question

73. The nurse is administer eyedrops to the client. Which guidelines should the nurse adhere to when instilling the
drops into the eye? SATA
A. Do not touch the tip of the medication container to the eye.
B. Apply gently pressure on the outer cants of the eye.
C. Apply sterile gloves prior to instilling eyedrops
D. Hold the lower lid down and instill drops into the conjunctiva
E. Gently pat the skin to absorb excess eyedrops on the cheek

a. Do not touch the tip of the medication container to the eye.

Rationale: Touching the tip of the container to the eye may cause eye injury or an eye infection

d. Hold the lower lid down and instill drops into the conjunctiva
Rationale: Medication should not be placed directly on the eye but in the lower part of the eyelid

e. Gently pat the skin to absorb excess eyedrops on the cheek

Rationale: Eyedrops are meant to go in the eye, not on the skin, so the nurse should use a clean tissue to remove
excess medication

74. The client has had an enucleation of the left eye. Which intervention should the nurse implement?
A. Discuss the need for special eyeglasses
B. Refer the client for an ocular prosthesis
C. Help the client obtain a seeing-eye dog
D. Teach the client how to instill eyedrops

b. Refer the client for an ocular prosthesis

Rationale: 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

75. The client diagnosed with glaucoma is prescribed a biotic cholinergic medication. Which data indicate the
medication has been effective?
A. No redness or irritation of the eyes
B. A decrease in intraocular pressure
C. The pupil reacts briskly to light
D. The client denies any type of floaters

b. A decrease in intraocular pressure

Rationale: Both systemic and topical medications are used to decrease the intraocular pressure in the eye, which
causes glaucoma

76. 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?

a. Wear bilateral eye patches for 3 days

b. Wear corrective lenses until the follow-up visit
c. Do not read any material for at least one week.
d. Teach the client how to instill corticosteroid ophthalmic drops.

d. Teach the client how to instill corticosteroid ophthalmic drops.

Rationale: 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

76. The client comes to the emergency department after splashing chemicals into the eye. Which intervention
should the nurse implement first?
A. Have the client move the eyes in all directions
B. Administer a broad-spectrum antibiotic
C. Irrigate the eyes with normal saline solution
D. Determine when the client had a tetanus shot.
c. Irrigate the eyes with normal saline solution

Rationale: Before any further evaluation or treatment, the eyes must be thoroughly flushed with sterile normal saline
solution

77. Which statement indicates to the nurse the client is experiencing some hearing loss?
A. "I clean my ears every day after I take a shower".
B. "I keep turning up the sound on my television".
C. "My ears hurt, especially when I yawn"
D. " I get dizzy when I get up from the chair"

b. "I keep turning up the sound on my television"

Rationale: The need to turn up the volume on the television is an early sign of hearing impairment

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Practice Questionnaires
78. Which risk factors should the nurse discuss with the client concerning reasons for hearing loss? SATA
A. Perforation of the tympanic membrane
B. Chronic exposure to loud noises
C. Recurrent ear infections
D. Use of nephrotoxic medications
E. Multiple piercings in the auricle

a. Perforation of the tympanic membrane

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

b. Chronic exposure to loud noises

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

c. Recurrent ear infections

Rationale: Multiple ear infections scar the tympanic membrane, which can lead to hearing loss

79. The nurse is caring for a client diagnosed with acute otitis media. Which s/s support this medical diagnosis?
A. Unilateral pain in the ear
B. Green, foul-smelling drainage
C. Sensation of congestion in the ear
D. Reports of hearing loss

a. Unilateral pain in the ear

Rationale: Otalgia (ear pain) is experienced by clients with otitis media

80. The client is diagnosed with Meniere's disease. Which statement indicates the client understands the medical
management for this disease?
a. "After intravenous antibiotic therapy, I will be cured".
b. "I will have to use a hearing aid for the rest of my life".
c. "I must adhere to a low-sodium diet, 2,000 mg/day".
d. "I should sleep with the head of my bed elevated".

c. "I must adhere to a low-sodium diet, 2,000 mg/day"

Rationale: Sodium regulates the balance of fluid within the body; therefore, a low-sodium diet is prescribed to help
control the symptoms of Meniere's disease

80. The client diagnosed with chronic otitis media is scheduled for a mastoidectomy. Which discharge teaching
should the nurse discuss with the client?
A. Instruct the client to blow the nose with the mouth closed
B. Explain the client will never be able to hear from the ear
C. Instill ophthalmic drops in both ears and then insert a cotton ball.
D. Do not allow water to enter the ear for 6 weeks.

d. Do not allow water to enter the ear for 6 weeks.

Rationale: Water should be prevented from entering the external auditory canal because it may irritate the surgical
incision and is a medium for bacterial growth

81. The client is complaining of ringing in the ears. Which data are most appropriate for the nurse to document in
the client's chart?
A. Complaints of vertigo
B. Complaints of otorrhea
C. Complaints of tinnitus
D. Complaints of presbycusis

c. Complaints of tinnitus

Rationale: Tinnitus is "ringing of the ears". It is a subjective perception of sounds with internal origins

82. 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?
a. It is usually the most comfortable position to hold the otoscope
b. This allows the best visualization of the tympanic membrane
c. This prevents inserting the otoscope too far into the external ear
d. It ensures the nurse will not cause pain when examining the ear

c. This prevents inserting the otoscope too far into the external ear

Rationale: Inserting the speculum of the otoscope into the external ear can cause ear trauma if not done correctly

82. The nurse is preparing to administer otic drops into an adult client's right ear. Which intervention should the
nurse implement?
A. Grasp the earlobe and pull back and out when putting drops in the ear
B. Insert the teardrops without touching the outside of the ear.
C. Instruct the client to close the mouth and blow prior to instilling drops
D. Pull the auricle down and back prior to instilling drops

d. Pull the auricle down and back prior to instilling drops

Rationale: This will straighten the ear canal so the teardrops will enter the ear canal and drain toward the tympanic
membrane (eardrum)

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Practice Questionnaires
83. Which ototoxic medication should the nurse administer cautiously?
A. An oral calcium channel blocker
B. An intravenous amino glycoside antibiotic
C. An intravenous glucocorticoid
D. An oral lood diuretic

b. An intravenous amino glycoside antibiotic

Rationale: Aminoglycoside antibiotics are ototoxic. 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
antibiotics are also very nephrotoxic

84. Which teaching instruction should the nurse discuss with students who are on the high school swim team
when discussing how to prevent external otitis?
A. Do not wear tight-fitting swim caps
B. Avoid using silicone ear plugs while swimming
C. Use a drying agent in the ear after swimming
D. Insert a bulb syringe into each ear to remove excess water

c. Use a drying agent in the ear after swimming

Rationale: A 2% acetic acid solution or 2% boric acid in ethyl alcohol is effective in drying the canal and restoring its
normal acidic environment

85. The client comes to the clinic and is diagnosed with otitis media. Which intervention should the clinic nurse
include in the discharge teaching?
A. Instruct the client not to take any over-the-counter pain medication
B. Encourage the client to apply cold packs to the affected ear
C. Tell the client to call the HCP if an abrupt relief of ear pain occurs
D. Wear a protective ear plug in the affected ear.

c. Tell the client to call the HCP if an abrupt relief of ear pain occurs

Rationale: Pain subsiding abruptly may indicate spontaneous perforation of the tympanic membrane within the middle
ear and should be reported to the HCP
The client is scheduled for ear surgery.

86. Which statement indicates the client needs more prep operative teaching concerning the surgery?

A. "If I have to sneeze or blow my nose, I will do it with my mouth open".

B. "I may get dizzy after the surgery, so I must be careful when walking".
C. "I will probably have some hearing loss after surgery, but hearing will return".
D. "I can shampoo my hair the day after surgery as long as I am careful".

D. "I can shampoo my hair the day after surgery as long as I am careful".

Rationale: 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.

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