Chapter 16: Diseases Affecting Vision and Hearing My Nursing Test Banks

Chapter 16: Diseases Affecting Vision and Hearing

Test Bank

MULTIPLE CHOICE

1. Which of the following diseases affects the eyesight of an older adult by damaging the central part of the retina?

a.

Glaucoma

b.

Presbyopia

c.

Cataract

d.

Macular degeneration

ANS: D

Macular degeneration is a disease characterized by damage to the central part of the retina that leaves the outer edges of the visual field intact. Presbyopia, a gradual decline in the flexibility of the lens, makes close-up focusing more difficult and is a common age-related change but not a disease. Glaucoma, a disease marked by increased pressure within the eye that potentially leads to optic nerve damage, is the most common cause of blindness in those 65 years of age and older. A cataract is a disease marked by clouding and blurring of the lens.

PTS:1DIF:RememberREF:7-8

TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. Which of the following is used to treat the most common cause of impairment to an older persons hearing?

a.

Hearing aids

b.

Cochlear implants

c.

Ear canal irrigation

d.

Sign language

ANS: C

Irrigation is used to dissolve and remove impacted cerumen, the most common cause of impaired hearing in older adults. Hearing aids are useful for sensorineural hearing loss, but the most common cause impairing the hearing of older persons is cerumen impaction. Cochlear implants are useful for profound sensorineural deafness, but the most common cause impairing the hearing of older persons is cerumen impaction. Sign language has been used primarily by those who become deaf in childhood or at birth, but it is not considered a treatment.

PTS: 1 DIF: Understand REF: 12 TOP: Nursing Process: Planning

MSC: Physiological Integrity

3. A medical illustration shows a man with the blunt end of a tuning fork pressed to the center of his forehead. The man is being tested for which of the following?

a.

Sensorineural hearing loss

b.

Presbycusis

c.

Tinnitus

d.

Unilateral conductive hearing loss

ANS: D

Webers test, in which a vibrating tuning fork is placed on the center of the forehead, detects the differences in hearing between one ear and the other caused by poor sound conduction. During testing, the patient is asked to describe the sensation felt when the tuning fork is activated and then placed on the forehead. If the patients hearing by conduction is intact, then he or she will feel vibrations conducted through the bones of the skull from the tuning fork. Webers test with the tuning fork is used to detect conductive hearing loss.

Presbycusis affects both ears and has a sensorineural origin. The tuning fork test is used to detect conductive hearing loss in one ear. Tinnitus is a hearing sensation not caused by an actual sound. The tuning fork test is used to detect hearing loss caused by poor sound conduction.

PTS:1DIF:RememberREF:11-13

TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. Persons with normal age-related sensory changes are likely to have the most difficulty distinguishing which of the following?

a.

Spoken pairs of phrases like shes praised and fees raised

b.

Orange towel hanging on a beige wall

c.

Go and to in lowercase letters in fine print

d.

Spoken word pairs like cupful and capful

ANS: A

A person with presbycusis has trouble hearing the higher frequencies, where most of the differences between consonant sounds occur. The contrast between a vivid color such as orange and a pale color such as beige can help an older person distinguish objects. The details of the letters may be poorly focused, but their overall shape, relative to the line around them, helps distinguish them. Age-related hearing impairments affect the hearing of consonants more than vowels. A person would have more trouble distinguishing cupful and couple.

PTS:1DIF:UnderstandREF:11

TOP: Nursing Process: Assessment MSC: Physiological Integrity

5. Which of the following interventions should the nurse use when communicating with a hearing impaired older patient.

a.

Stand beside the patients chair when speaking.

b.

Always clearly identify yourself and others with you.

c.

Exaggerate your voice, depending on the cause of the hearing loss.

d.

Select colors for paint, furniture, and pictures with rich intensity.

ANS: B

Always speak promptly, and clearly identify yourself and others who are with you. State when you are leaving to ensure that the person is aware of your departure. Get down to the persons level, and face him or her when speaking. Speak normally but not from a distance; do not raise or lower your voice, and continue to use gestures if doing so is natural to your communication. Selecting colors for paint, furniture, and pictures with rich intensity is for the visually impaired, not those with a hearing impairment.

PTS: 1 DIF: Apply REF: 22 Box 16-1 TOP: Nursing Process: Planning

MSC: Physiological Integrity

6. The nurse plans the care of an older female resident of a nursing home who has experienced a sudden deterioration in visual acuity. Which intervention should the nurse complete first?

a.

Prevent behavioral and social decline.

b.

Tell her to hold onto the rails during ambulation.

c.

Examine her mood and functional status.

d.

Use problem solving involving the resident.

ANS: C

The most important intervention for the nurse to complete first is to assess the impact of the visual impairment on the residents quality of life, mood, and functional ability. The resulting assessment data will provide the basis for solving new problems caused by the loss of vision and finding compensatory mechanisms for the resident. Preventing decline can be a goal in the overall plan of care for this resident, but that cannot be determined until the assessment is complete. Telling her to hold onto rails during ambulation is a potential nursing intervention for patient teaching; however, in problem solving, a different compensatory solution can be developed, based on the assessment. Problem solving takes place after a complete assessment.

PTS:1DIF:AnalyzeREF:2-10| 22 Box 16-1

TOP: Nursing Process: Planning MSC: Physiological Integrity

7. The most detrimental illness or condition that an older adult with deafness that occurred at birth can experience is which one of the following?

a.

Aphasia

b.

Cataracts

c.

Glaucoma

d.

Osteoarthritis

ANS: B

Cataracts can have a potentially devastating impact on the life of an individual with prelingual deafness because sign language is the primary source for communication. Without the ability to read signing or lips accurately, the older adult who has a cloudy lens is unable to receive communication except by Braille. Aphasia has the potential to affect the individuals life; however, with adequate vision, some means of communication can remain viable. Glaucoma would not devastate the individuals ability to read sign language unless blindness occurred. Effective treatment should help maintain the individuals baseline visual acuity. Osteoarthritis can make signing more difficult for an individual with prelingual deafness, but it is not nearly as devastating to the ability to communicate as a cloudy lens from cataracts.

PTS:1DIF:AnalyzeREF:2-16

TOP: Nursing Process: Assessment MSC: Physiological Integrity

8. An older man who has tinnitus complains to the nurse that it is very annoying. Which should the nurse implement to alleviate the stress he is experiencing from tinnitus?

a.

Irrigate the bilateral Eustachian tubes.

b.

Assess for modifiable risk factors.

c.

Propose a hearing aid and a masker.

d.

Use white noise to override the tinnitus.

ANS: B

The nurse assesses the patient for risk factors potentially contributing to tinnitus that can be altered such as smoking cigarettes, consuming caffeine, drinking alcohol, experiencing fatigue, and taking medications that carry a high risk of causing tinnitus. Removing these potential offenders can help give the patient a sense of control, as well as provide potential relief from tinnitus. The nurse irrigates the external auditory canal for impacted cerumen to decrease the risk of tinnitus.. Although a hearing aid and a masker have the potential to alleviate tinnitus, introducing them can also serve as a potential source of additional stress, depending on the financial and functional status of the individual. Although white noise has the potential to alleviate tinnitus, it can be ineffective or serve as a potential source of additional stress.

PTS: 1 DIF: Apply REF: 12-14 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

9. An older adult complains about experiencing dry eyes daily. Which of the following should the nurse assess to help determine the cause of the patients complaint?

a.

Vitamin B deficiency

b.

Use of humidifier at home

c.

History of diabetes mellitus

d.

Prescription antihistamine use

ANS: D

Medications can cause dry eye, especially antihistamines, diuretic agents, beta-blockers, and some sleeping pills. Vitamin A deficiency is a risk factor, not Vitamin B deficiency. The use of a humidifier should help with dry eyes, not cause it. Diabetes mellitus is an endocrine disorder, and dry eyes are an exocrine disorder.

PTS:1DIF:AnalyzeREF:8-9

TOP: Nursing Process: Assessment MSC: Physiological Integrity

10. The nurse is teaching older adults about maintaining health and wellness. Which recommendation should the nurse include in the teaching to maintain optimal vision?

a.

Take 50,000 units of vitamin A daily.

b.

Wear sunglasses that block sun rays.

c.

Read in good light to avoid eye strain.

d.

Visit the ophthalmologist every 5 years.

ANS: B

The nurse helps older adults preserve their vision by recommending sunglasses that block harmful ultraviolet rays. Although vitamin A intake is encouraged to promote visual health and to relieve dry eyes, 50,000 units is a huge dose with the potential to cause liver damage; this dose is used to treat acne but only for limited periods. Reading in good light is usually easier for older adults; however, reading in poor light does not cause eye damage. An ophthalmologist should check the vision of an older adult every year.

PTS: 1 DIF: Apply REF: 10 TOP: Teaching/Learning

MSC:Health Promotion and Maintenance

MULTIPLE RESPONSE

1. The children of an older man believe he is too old to drive a car. Which assessment information about the man warrants further investigation by the nurse to determine his fitness to drive a car safely? (Select all that apply.)

a.

Increased rate of tripping on curbs

b.

Increased frequency of getting lost

c.

Multiple bruises on lower extremities

d.

Restricts reading to a well-lit sunroom

e.

Socializes with a partners bridge group

f.

Cooks gourmet meals for entertainment

ANS: A, B, C, D

Tripping on curbs can potentially indicate a vision impairment, but it can also be caused by other problems. Getting lost frequently can potentially indicate a vision impairment, but it can also be caused by other problems. Bruising from bumping into objects can potentially indicate a vision impairment, but it can also be caused by other problems. Reading in a well-lit sunroom exclusively can potentially indicate vision impairment, especially if the patient requires additional lighting for reading. Socializing with a bridge group is likely to indicate adequate visual acuity for reading the cards and keeping score. Gourmet cooking is likely to indicate adequate visual acuity to measure and prepare food.

PTS:1DIF:ApplyREF:2-10| 22 Box 16-1

TOP: Nursing Process: Planning MSC: Safe, Effective Care Environment

2. Which population groups are most at risk for developing macular degeneration? (Select all that apply.)

a.

African American

b.

Asian American

c.

Caucasian

d.

Hispanic

ANS: B, C

Individuals who are Caucasian or Asian American are most at risk for developing macular degeneration than are African Americans or Hispanics.

PTS: 1 DIF: Understand REF: 7 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

3. When preparing a patient teaching session on retinopathy, the nurse should include which intervention(s) when discussing treatments for slowing the progression of the disease? (Select all that apply.)

a.

Glucose control

b.

Blood pressure control

c.

Laser therapy

d.

Cornea transplant

ANS: A, B, C

Better control of glucose, blood pressure, and cholesterol can assist in halting the progression of retinopathy. Laser therapy is also a treatment. Cornea transplant is not an option.

PTS: 1 DIF: Understand REF: 7-8 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

4. The nurse recognized which of the following as symptoms of wet age-related macular degeneration (AMD)? (Select all that apply.)

a.

Rarely causes severe visual impairment

b.

Yellow deposits under the retina

c.

Decrease in central vision

d.

Visual distortion

ANS: C, D

Patients suffering from wet AMD experience a decrease in central vision and visual distortion. Wet AMD leads to blindness. With distortion, edges or lines become wavy. Dry AMD rarely causes severe visual impairment, and yellow deposits under retina are a classic sign.

PTS:1DIF:UnderstandREF:7-8

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

OTHER

1. On the following illustration, mark the area of the eye where glaucoma causes fluid to accumulate.

ANS:

The X marks the area of the eye where glaucoma causes fluid to accumulate. Acute angle-closure and open-angle glaucoma are caused when the balance between intraocular fluid production and drainage is disrupted, resulting in increased intraocular pressure.

PTS:1DIF:RememberREF:3-4

TOP: Nursing Process: Assessment MSC: Physiological Integrity

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