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?
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Solution
“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 client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her hair wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.
The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate communication?
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Solution
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.
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:
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Solution
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 in 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. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.
The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test?
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Solution
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.
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:
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Solution
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.
Which of the following symptoms would occur in a client with a detached retina?
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Solution
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.
For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications?
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Solution
Acetazolamide (Diamox)
Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren’t used for the treatment of glaucoma.
When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress?
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Solution
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. A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased chance of blindness than other groups. Individuals older than 40 should be screened.
Cataract surgery results in aphakia. Which of the following statements best describes this term?
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Solution
Absence of the crystalline lens
Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is a normal response to aging. A retinal detachment is usually associated with retinal holes created by vitreous traction.
Which of the following procedures or assessments must the nurse perform when preparing a client for eye surgery?
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Solution
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. There is no need to patch an eye before most surgeries or to clip the eyelashes unless specifically ordered by the physician. The physician is responsible for obtaining informed consent; the nurse validates that the consent is obtained.