Ch4 The Eyes And Ears Test Questions & Answers

CHAPTER 4: ADVANCED HEALTH ASSESSMENT OF THE EYES AND EARS

1. The clinician is examining a patient’s extraocular muscles and cranial nerve (CN) innervation. The clinician examines the function of CN III and is looking for adduction. The clinician should perform testing on the:

a. Superior rectus muscle

b. Inferior rectus muscle

c. Medial rectus muscle

d. Lateral rectus muscle

2. The nursing student is discussing the role of lacrimation in eye care with the nursing instructor. Identify the role of lacrimation. Select all that apply.

a. Removes debris from the eye

b. Prevents bacterial infection

c. Promotes friction within the eye

d. Provides nutrients to portions of the conjunctival epithelium

e. Provides oxygen to portions of the conjunctival epithelium

3. The clinician is performing an assessment of visual acuity. The clinician is using the Rosenbaum card. Which instruction would be consistent with performing this test? (Select all that apply.)

a. Instruct the patient to hold the card 6 inches from the face.

b. Instruct the patient to read the largest line possible.

c. Instruct the patient to hold the card 14 inches from the face.

d. Instruct the patient to read the smallest line possible.

e. Instruct the patient to stand up for the test.

4. A patient complains of eye twitching. Which factors should the clinician expect may be the cause of eye twitching? (Select all that apply.)

a. Fatigue

b. Stress

c. Cranial nerve VII lesion

d. Dry eyes

e. Foreign body

5. The clinician is teaching a nursing student about visual reflexes and accommodation. Which statement made by the nursing student indicates the need for further teaching?

a. “Upon exposure to light, the pupillary light reflex can be elicited.”

b. “Accommodation is a reflex that allows the eyes to focus on far objects.”

c. “Exposure to light in one eye causes the pupil in the contralateral eye to constrict concurrently.”

d. “The accommodation reflex cannot be directly observed but can be indirectly assessed when pupillary constriction and convergence of the eyes occur simultaneously.”

6. The clinician is assessing a patient who came in after suffering a head injury. The clinician wants to rule out a basilar skull fracture. Which symptoms would be consistent with this diagnosis? (Select all that apply.)

a. Tenderness at the lacrimal gland

b. Periorbital ecchymosis

c. Conjunctival hemorrhage

d. Edematous eyelid

e. Purulent discharge from the eyes

7. The clinician is assessing for hearing loss in a patient. Which questions would be appropriate for the clinician to ask this patient? (Select all that apply.)

a. “Does anyone smoke at home?”

b. “Do sounds appear muffled, as if underwater?”

c. “Are you exposed to loud noises at work?”

d. “Do you use cotton swabs to clean inside your ears?”

e. “Is the hearing issue most notable while talking on the phone?”

• The onset of hearing loss: slow or rapid
• Perception that people are shouting
• Hearing issue most notable: at a party, listening to TV, casual conversation, or talking on the phone
• Sounds appear muffled, as if underwater
• Recent air travel
• Family history of hearing loss
• Impact on daily life
• Occupational: exposed to loud noises, such as with heavy machinery or work at an airport

Smoking at home is related to a history of ear infections, and the use of cotton swabs is related to self-care of the ears.

8. The clinician is performing an otoscopic exam on a 22-year-old patient. Which considerations must the clinician take when performing this assessment? (Select all that apply.)

a. Instruct the patient to tilt their head away from the clinician.

b. Pull the pinna down and back.

c. Grasp the otoscope “upside down” along the clinician's fingers.

d. Cautiously introduce the speculum slowly along the axis of the canal.

e. Pull the pinna up and back.

9. The clinician is teaching an advanced practice nursing student how to complete a voice test. Which action performed by the student indicates the need for further teaching? Select all that apply.

a. The student positions himself directly in front of the patient.

b. The student performs the test one ear at a time.

c. The student asks the patient to place their hand over the ear not being tested.

d. The student whispers four-syllable words for the patient to repeat.

10. A mother brings in her 10-month-old son who is experiencing another episode of otitis media. Which statement made by the patient’s mother warrants further teaching?

a. “I hold my child upright for bottle feeding.”

b. “I breastfeed my son exclusively.”

c. “I sit my son upright in his bouncy seat for me to bottle feed him.”

d. “I lay my son supine in his crib for his bedtime bottle.”

11. Which patient is most at risk for developing presbycusis?

a. A 20-year-old

b. A 30-year-old

c. A 40-year-old

d. A 50-year-old

12. The clinician is performing a physical examination on a patient complaining of ear pain. The patient presents with pain with movement over the mastoid process. The clinician wants to rule out a diagnosis of mastoiditis. Which symptoms would be consistent with this diagnosis?

a. Pain at the posterior auricular node

b. Erythema and warmth of the ear

c. Dry scaling skin over the ears

d. The presence of exudate

13. Discuss the areas a clinician should ask a pregnant woman about when taking a history of present illness.

When taking a history of present illness, a pregnant woman should be asked the following items:

• Gestation: weeks
• Postpartum status
• Current diagnosis of hypertension or diabetes
• Use of ophthalmic eye drops
• Pregnancy-induced hypertension (PIH), diplopia, scotomata, or amaurosis fugax

14. Describe how the clinician tests the cardinal fields of gaze.

15. Identify the expected visual acuity of children by age for ages 3 through 6 years.

Age            Visual Acuity

3 years            20/50 or better

4 years            20/40 or better

5 years            20/30 or better

6 years            20/20

16. Compare and contrast the Weber test and the Rinne test.

The Weber test is valuable when a person reports hearing better with one ear over the other ear. Place a vibrating tuning fork on the top of the middle of the patient’s head and ask whether the pitch sounds the same in both ears, or better in one. Findings are considered normal when the Weber test is negative.

The Rinne test compares air conduction (AC) and bone conduction (BC sound. Place the stem of the vibrating tuning fork on the patient’s mastoid process and ask him or her to alert you when the sound is no longer heard. Quickly upend the tuning fork so the vibrating end is near the external ear canal; the patient should still hear a sound. Repeat in the other ear.

17. Compare and contrast the ear canal abnormalities of a furuncle and a polyp.

A polyp arises in the ear canal from mucosal or granulomatous tissue. It is erythematous and bleeds easily. It is typically immersed in purulent, foul drainage and may be indicative of chronic auricular disease. It is benign but needs to be referred to an ear, nose, and throat specialist for removal.

18. List the questions to ask to an infant’s parents when conducting a holistic health assessment of the ear.

Some questions may include the following:

1. Do they use cotton swabs to clean the infant’s ears?

2. Is the infant bottle-fed or breastfed? If the infant receives a bottle, does the caregiver hold the infant while giving the bottle, or do they prop the bottle?

3. While feeding, do they lay the infant flat, or keep the infant upright?

4. Is there any smoking in the home?

5. Does the infant go to daycare?

19. Discuss conductive hearing loss in young adults.

20. Discuss special considerations with regard to hearing for patients with disabilities.