Nokea
An older-adult patient with presbycusis is fitted with binaural hearing aids. Which of the following information should the nurse include when teaching the patient how to use the hearing aids?
- A. Experiment with volume and hearing ability in a quiet environment initially.
- B. Keep the volume low on the hearing aids for the first week while adjusting to them.
- C. Add the second hearing aid after making the initial adjustment to the first hearing aid.
- D. Wear the hearing aids for about an hour a day at first, gradually increasing the time of use.
Correct Answer: A
Rationale: Initially the patient should use the hearing aids in a quiet environment like the home, experimenting with increasing and decreasing the volume as needed. There is no need to gradually increase the time of wear. The patient should experiment with the level of volume to find what works well in various situations. Both hearing aids should be used.
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A patient who had cataract extraction and intraocular lens implantation the previous day calls the eye clinic and gives the nurse all of this information. Which of the following information is the priority to communicate to the health care provider?
- A. The patient has eye pain rated at a 5 (on a 0-10 scale).
- B. The patient has questions about the ordered eye drops.
- C. The patient has poor depth perception when wearing an eye patch.
- D. The patient complains that the vision has 'not improved very much.'
Correct Answer: A
Rationale: Postoperative cataract surgery patients usually experience little or no pain, so pain at a 5 on a 10-point pain level may indicate complications such as hemorrhage, infection, or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching but does not indicate that complications of the surgery may be occurring.
The charge nurse observes a newly hired nurse caring for a patient who has just arrived in the postanesthesia care unit after having right cataract removal and an intraocular lens implant. Which of the following interventions requires that the charge nurse intervene?
- A. The nurse leaves the eye shield in place.
- B. The nurse encourages the patient to cough.
- C. The nurse elevates the patient's head to 45 degrees.
- D. The nurse applies corticosteroid drops to the right eye.
Correct Answer: B
Rationale: Because coughing will increase intraocular pressure, patients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a patient after having this surgery.
These medications are prescribed by the health care provider for a patient who has just been admitted to hospital with acute angle-closure glaucoma. Which of the following medications should the nurse give first?
- A. Morphine sulphate 4 mg intravenously
- B. Betaxolol 1 drop in each eye
- C. Acetazolamide 250 mg orally
- D. Mannitol 100 mg intravenously
Correct Answer: D
Rationale: The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly with IV administration of a hyperosmolar diuretic such as mannitol. The other medications also are appropriate for a patient with glaucoma but would not be the first medication administered.
The nurse is caring for a patient in the eye clinic who has 20/200 vision with the use of corrective lenses. Which of the following information should the nurse include when providing patient teaching?
- A. How to use a cane safely
- B. How to access audio books
- C. Where Braille instruction is available
- D. Where to obtain specialized magnifiers
Correct Answer: D
Rationale: Various types of magnifiers can enhance the remaining vision enough to allow the performance of many tasks and activities of daily living (ADLs). Audio books, Braille instruction, and canes usually are reserved for patients with no functional vision.
The nurse is caring for a patient with adult inclusion conjunctivitis (AIC) caused by Chlamydia trachomatis. Which of these actions should be included in the plan of care?
- A. Discussing the need for sexually transmitted infection testing
- B. Applying topical corticosteroids to prevent further inflammation
- C. Assisting with applying for community visual rehabilitation services
- D. Educating about the use of antiviral eye drops to treat the infection
Correct Answer: A
Rationale: Patients with AIC have a high risk for concurrent genital Chlamydia infection and should be referred for STI testing. AIC is treated with antibiotics, antiviral and corticosteroid medications are not appropriate therapies. Although some types of Chlamydia infection do cause blindness, AIC does not lead to blindness, so referral for visual rehabilitation is not appropriate.