Glaucoma, Cataract, Otitis Lippincot Questions-1

Review questions ❍ 329
◆ Show the patient how to administer eye medications and change dressings using sterile technique to
decrease the risk of infection
◆ Tell the patient to wear the eye shield at night or when napping to prevent accidental injury to the eye
◆ Discuss when the patient can return to work, resume ADLs, and drive or perform strenuous
activities
Review questions
1. The nurse is caring for a patient who underwent stapedectomy. To prevent postoperative complications,
the nurse should instruct the patient to:
A. sneeze with her mouth open.
B. frequently blow her nose.
C. clean her operated ear with a cotton-tipped applicator twice a day.
D. resume bending and straining when she’s no longer experiencing ear pain.
Correct answer: A If sneezing can’t be avoided, the patient should sneeze with her mouth open. This
will prevent changes of air pressure in the middle ear, which can dislodge the prosthesis and graft.
Option B is incorrect because blowing the nose and coughing should be avoided. Option C is incorrect
because small objects, such as cotton-tipped applicators, shouldn’t be inserted into the ear. Option D is
incorrect because straining during a bowel movement and bending should be avoided for at least 2 to
3 weeks, or as instructed by the practitioner.
2. The nurse is assessing a 32-year-old patient with otosclerosis. The nurse should be aware that the patient’s
hearing loss:
A. will resolve in 4 to 6 weeks without intervention.
B. typically affects both ears.
C. occurred suddenly.
D. is associated with ear pain.
Correct answer: B The hearing loss associated with otosclerosis is typically bilateral, although one ear
may show a greater impairment. Option A is incorrect because otosclerosis is a progressive disorder that
is not self-limiting. Option C isn’t correct because otosclerosis develops slowly over time. Because oto-
sclerosis doesn’t cause ear pain, Option D is incorrect.
3. The nurse is teaching a patient with a detached retina who underwent scleral buckling on the left eye. The
procedure included gas injection into the vitreous. Which of the following statements indicates that the patient
understands the nurse’s instructions?
A. “I should lie on my abdomen with my head turned to the right.”
B. “I’ll lie face down with my head turned to the left.”
C. “I’ll lie face up with my head turned to the right.”
D. “I should lie on my back with my head turned to the left.”
Correct answer: B In a scleral buckling, the sclera is flattened against the retina. A piece of silicone is
attached to the sclera with a band that encircles the eye to keep the retina in contact with the choroid
and sclera. Air or other gases may be injected into the vitreous to float up against the retina and promote
retinal reattachment. When a gas is used, the patient is positioned on his abdomen with the head turned
to the affected eye (in this situation, the left side) so that the gas will float up against the retina and aid in
reattachment. The positions in Options A, C, and D don’t allow the gas to float up against the retina.
330 ❍ Eye, ear, and nose disorders
4. The nurse is providing care for a patient following right cataract removal surgery. In which position should
the nurse place the patient?
A. Right-side lying
B. Prone
C. Supine
D. Trendelenburg’s
Correct answer: C Positioning the patient on his back or inoperative side prevents pressure on the
operative eye. Right side-lying (Option A) or prone position (Option B) may put external pressure on the
affected eye. Trendelenburg’s position (Option D) may increase intraocular pressure.
5. Which position would be the most appropriate for a patient who has undergone stapedectomy?
A. On the affected side
B. On the unaffected side
C. Prone
D. Sims’
Correct answer: B The patient should be positioned on his unaffected side, with the operative ear up.
He shouldn’t be placed on the affected side (Option A) or prone (Option C). Although Sims’ position
(Option D) is a side-lying position, it doesn’t take into consideration which side is best for after ear
surgery.
6. Which symptom would occur in a patient with a detached retina?

A. Flashing lights and floaters
B. Homonymous hemianopia
C. Loss of central vision
D. Ptosis
Correct answer: A Signs and symptoms of retinal detachment include abrupt flashing lights, float-
ers, loss of peripheral vision (not central vision, as in Option C), and a sudden shadow or curtain in the
vision. Occasionally, vision loss is gradual. Homonymous hemianopia (Option B) can occur in stroke and
traumatic brain injuries. Ptosis (Option D) can result from a stroke.
7. A 72-year-old patient is being discharged from same-day surgery after having a cataract removed from his
right eye. Which discharge instruction should the nurse give the patient?
A. “Sleep on the operative side.”
B. “Resume all activities as before.”
C. “Don’t rub or place pressure on the eyes.”
D. “Wear an eye shield all day and remove it at night.”
Correct answer: C Rubbing or placing pressure on the eyes increases the risk of accidental injury to
ocular structures. The nurse would caution against sleeping on the operative side—not on the operative
side (Option A)—to reduce the risk of accidental injury to ocular structures. The nurse shouldn’t tell the
patient to resume all activities (Option B); activities such as lifting objects, straining, strenuous exercise,
and sexual activity can increase IOP. An eye shield should be worn at night, not during the day (Option D);
during waking hours, the patient should wear glasses or shaded lenses to protect the eye after the eye
dressing has been removed.
Review questions ❍ 331
8. Which of the following increases a 40-year-old patient’s risk of developing cataracts?

A. A history of frequent streptococcal throat infections
B. Maternal exposure to rubella during pregnancy
C. Increased IOP
D. Prolonged use of steroidal anti-inflammatory agents
Correct answer: D Prolonged use of steroidal anti-inflammatory agents increases the risk of developing
cataracts. The other risk factors don’t contribute to the development of cataracts.
9. In caring for a patient after cataract surgery, the nurse should tell the patient to notify his physician of
which of the following conditions?
A. Blurred vision
B. Eye pain
C. Glare
D. Itching
Correct answer: B The patient shouldn’t experience pain after cataract surgery; pain may indicate
hyphema, or clouding in the anterior chamber, and infection. The patient might normally experience the
other symptoms after cataract surgery.
10. When assessing a patient with glaucoma, the nurse would expect which of the following findings?
A. Complaints of double vision
B. Complaints of halos around lights
C. An IOP of 15 mm Hg
D. A soft globe on palpation
Correct answer: B Complaints of halos around lights is a common finding in a patient with glaucoma.
Glaucoma doesn’t cause double vision (Option A) or a soft globe on palpation (Option D). In addition to
halos around lights, signs and symptoms can include loss of peripheral vision or blind spots, reddened
sclera, firm globe, decreased accommodation, and occasional eye pain; patients may also be asymptom-
atic. An IOP of 15 mm Hg (Option C) is within the normal range of 10 to 21 mm Hg.

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Review questions ❍ 329

6. Which symptom would occur in a patient with a detached retina?

8. Which of the following increases a 40-year-old patient’s risk of developing cataracts?

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