Test Bank For Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition Complete All Chapters 1-72 ()

A client with external otitis has an ear wick placed and a new prescription for antibiotic otic drops. After the nurse provides client teaching, which of the following client statements indicates that more instruction is needed? a. “I may use aspirin or acetaminophen for pain relief.” b. “I should apply the eardrops to the cotton wick in my ear canal.” c. “I should clean my ear canal daily with a cotton-tipped applicator.” d. “I may use warm compresses to the outside of my ear for comfort.” ANS: C Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other client statements indicate that the teaching has been successful. DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation 18. The nurse is preparing a client with chronic otitis media for a tympanoplasty. Which of the following information should the nurse include in preoperative teaching related to postoperative expectations? a. Keeping the head elevated b. The need for prolonged bed rest c. Avoidance of coughing or blowing the nose d. Continuous antibiotic irrigation of the ear canal ANS: C Coughing or blowing the nose increases pressure in the Eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 19. The nurse is assessing a client who has recently been treated with amoxicillin for acute otitis media of the right ear. Which of the following assessment data obtained by the nurse is of most concern? a. The client has a temperature of 38.1C (100.6F). b. The client complains of “popping” in the ear. c. The client frequently asks the nurse to repeat information. d. The client states that the right ear has a feeling of fullness. ANS: A The fever indicates that the infection may not be resolved and the client might need further antibiotic therapy. A feeling of fullness, “popping” of the ear, and decreased hearing are symptoms of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment. NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 20. The nurse is admitting a client with Ménière’s disease who has vertigo, nausea, and vomiting. Which of the following nursing interventions should be included in the care plan? a. Keep the client’s room darkened. b. Encourage oral fluids to 3 000 mL daily. c. Change the client’s position every 2 hours. d. Keep the head of the bed elevated 30 degrees. ANS: A A darkened, quiet room will decrease the symptoms of the acute attack of Ménière’s disease. Since the client will be nauseated during an acute attack, fluids are administered intravenously. Position changes will cause vertigo and nausea. The head of the bed can be positioned for client comfort. DIF: Cognitive Level: Application TOP: Nursing Process: Planning 21. The home health nurse observes a client taking these actions when self-administering eardrops. Which of the following client actions indicates a need for more teaching? a. The client leaves the ear wick in place while administering the drops. b. The client lies down before and for 2 minutes after administering the drops. c. The client gets the eardrops out of the refrigerator just before administering the drops. d. The client holds the tip of the dropper 1 cm above the ear while administering the drops. ANS: C Administration of cold eardrops can cause dizziness because of stimulation of the semicircular canals. The other client actions are appropriate. DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation 22. The nurse is admitting an older-adult client and the client repeatedly asks the nurse to “speak up so that I can hear you.” Which of the following actions should the nurse take? a. Overenunciate while speaking. b. Speak normally but more slowly. c. Increase the volume when speaking. d. Use more facial expressions when talking. ANS: B Client understanding of the nurse’s speech will be enhanced by speaking at a normal tone, but more slowly. Increasing the volume, overenunciating, and exaggerating facial expressions will not improve the client’s ability to comprehend the nurse. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 23. An older adult client with presbycusis is fitted with binaural hearing aids. Which of the following information should the nurse include when teaching the client 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 NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M 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. ANS: A Initially the client 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 client should experiment with the level of volume to find what works well in various situations. Both hearing aids should be used. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 24. A client with hearing loss asks the nurse about the use of a cochlear implant. Which of the following information will the nurse include when replying to the client? a. Cochlear implants require training in order to receive the full benefit. b. Cochlear implants are not useful for clients with congenital deafness. c. Cochlear implants are most helpful as an early intervention for presbycusis. d. Cochlear implants improve hearing in clients with conductive hearing loss. ANS: A Extensive rehabilitation is required after cochlear implants in order for clients to receive the maximum benefit. Hearing aids, rather than cochlear implants, are used initially for presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be helpful for conductive loss. They are appropriate for some clients with congenital deafness. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation 25. Which of the following interventions should the nurse implement for a client who has just diagnosed with viral conjunctivitis? a. Explain the purpose of antiviral eye drops. b. Show how to perform eye irrigation safely. c. Instruct about how to insert soft contact lenses. d. Demonstrate appropriate handwashing technique. ANS: D Good hand hygiene is the major means to prevent the spread of conjunctivitis. Antiviral drops and eye irrigation will not be helpful in shortening the disease process. Contact lenses should not be used when clients have conjunctivitis because they can further irritate the conjunctiva. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 26. Which of the following information should the nurse include when teaching a client with keratitis caused by herpes simplex type 1? a. Application of corticosteroid ophthalmic ointment to the eyes b. Application of povidone-iodine gel around the eye c. Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) d. Importance of taking all of the ordered oral acyclovir ANS: D NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M Oral acyclovir may be ordered for herpes simplex infections. Corticosteroid ointments are usually contraindicated because they prolong the course of the infection. Although povidone-iodine gel may be applied to the skin around the eyes for herpes zoster (varicella) infections, it is not used for herpes simplex infections. NSAIDs can be used to treat the pain associated with keratitis. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 27. The nurse is admitting a client to the outpatient surgery unit who is scheduled for cataract extraction and implantation of an intraocular lens. Which of the following information has the most immediate implications for the client’s care? a. The client has not eaten anything for 8 hours. b. The client takes three antihypertensive medications. c. The client gets nauseated with general anaesthesia. d. The client has had blurred vision for several years. ANS: B Mydriatic medications used for pupil dilation are sympathetic nervous system stimulants and may increase heart rate and blood pressure. Using punctal occlusion when administering the mydriatic to minimize systemic effects and monitoring of blood pressure are indicated for this client. Clients are expected to be NPO for 6–8 hours before the surgical procedure. Blurred vision is an expected finding with cataracts. Cataract extraction and intraocular lens implantation are done using local anaesthesia. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 28. The nurse is caring for a client with neural presbycusis. Which of the following hearing changes should the nurse expect with this type of presbycusis? a. Loss of high-pitched sounds b. Loss of speech discrimination c. Uniform loss for all frequencies d. Range of hearing loss with low frequencies ANS: B The hearing change with a neural presbycusis is a loss of speech discrimination. Loss of high-pitched sounds accompanies a sensory presbycusis. A metabolic presbycusis has a hearing change that is uniform for all frequencies, accompanied by recruitment. A cochlear presbycusis has a hearing change that is a range of hearing loss that increases from low to high frequencies. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment 29. The nurse is admitting a client for surgery who has functional blindness for several years and is cared for by the client’s spouse. Which of the following actions is most important to implement during the initial assessment? a. Obtain more information about the cause of the client’s vision loss. b. Obtain information from the spouse about the client’s special needs. c. Make eye contact with the client and ask about any need for assistance. d. Perform an evaluation of the client’s visual acuity using a Snellen chart. ANS: C NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M Making eye contact with a partially sighted client allows the client to hear the nurse more easily and allows the nurse to assess the client’s facial expressions. The client (rather than the spouse) should be asked about any need for assistance. The information about the cause of the vision loss and assessment of the client’s visual acuity are not priorities during the initial assessment. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 30. Which of the following actions is an example of an approach magnification? a. Using a telescopic lens b. Sitting closer to a television while watching it c. Using a black-tipped felt marker when writing d. Reading books with large-type print ANS: B Approach magnification is a simple but sometimes overlooked technique for enhancing the client’s residual vision. The nurse can recommend that the client sit closer to the television or hold books closer to the eyes, which the client may be reluctant to do unless encouraged. Using a telescopic lens is an optical device. Using a black-tipped marker to write is a contrast enhancement technique. Reading large-type print books may be helpful but is not an approach magnification action unless the book was brought close to the eyes, which is not indicated in the answer choice. DIF: Cognitive Level: Application TOP: Nursing Process: Planning 31. The camp nurse is caring for a client who is complaining of bilateral eye pain after a campfire log exploded, sending sparks into the client’s eyes. Which of the following actions should the nurse take first? a. Apply ice packs to the eyes. b. Flush the eyes with sterile saline. c. Cover the eyes with dry sterile patches and protective eye shields. d. Apply antiseptic ophthalmic ointment from the first aid kit to the eyes. ANS: C Emergency treatment of a burn or foreign-body injury to the eyes includes protecting the eyes from further injury by covering them with dry sterile dressings and protective shields. Flushing of the eyes immediately is indicated only for chemical exposure. Except in the case of chemical exposure, the nurse should not begin treatment until the client has been assessed by a health care provider and orders are available. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 32. The nurse is caring for a client with an acute attack of Ménière’s disease. Which of the following actions carried out by a family member that is visiting the client should the nurse intervene? a. Raises the side rails on the bed b. Turns on the client’s television c. Turns the client to the right side d. Places an emesis basin at the bedside ANS: B NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M Watching television may exacerbate the symptoms of an acute attack of Ménière’s disease. The other actions are appropriate. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 33. A client 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 client has eye pain rated at a 5 (on a 0-10 scale). b. The client has questions about the ordered eye drops. c. The client has poor depth perception when wearing an eye patch. d. The client complains that the vision has “not improved very much.” ANS: A Postoperative cataract surgery clients 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 client indicates a need for client teaching but does not indicate that complications of the surgery may be occurring. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 34. Which of the following assessment findings in a client who was struck in the right eye with a baseball is a priority for the nurse to communicate to the health care provider in the emergency department? a. The client complains of a right-sided headache. b. The sclerae on the right eye have broken blood vessels. c. The area around the right eye is bruised and tender to the touch. d. The client complains of “a curtain” blocking part of the visual field. ANS: D The client’s sensation that a curtain is coming across the field of vision suggests retinal detachment and the need for rapid action to prevent blindness. The other findings would be expected with the client’s history of being hit in the eye with a ball. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 35. The charge nurse observes a newly hired nurse caring for a client who has just arrived in the postanaesthesia 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 client to cough. c. The nurse elevates the client’s head to 45 degrees. d. The nurse applies corticosteroid drops to the right eye. ANS: B Because coughing will increase intraocular pressure, clients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a client after having this surgery. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M 36. The nurse is assessing the presence or absence of contact lenses in an unconscious client. Which of the following directions should the nurse shine a pen light? a. Parallel to the eye b. At a 90-degree angle to the eye c. Obliquely into the eye d. Toward the centre of the nasal bridge ANS: C The nurse must know whether the client has contact lenses in and assesses the eye by shining a light obliquely on the eyeball to help the nurse visualize a contact lens. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 37. The nurse is admitting a client with a head injury after a motor vehicle accident who has shortness of breath and severe eye pain. Which of the following actions should the nurse take first? a. Elevate the head to 45 degrees. b. Administer the ordered analgesic. c. Check the client’s oxygen saturation. d. Examine the eye for evidence of trauma. ANS: C The priority action for a client after a head injury is to assess and maintain airway and breathing. Because the client is complaining of shortness of breath, it is essential that the nurse assess the oxygen saturation. The other actions also are appropriate but are not the first action the nurse will take. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 38. These medications are prescribed by the health care provider for a client 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 ANS: D The most immediate concern for the client 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 client with glaucoma but would not be the first medication administered. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 39. Which of the following nursing diagnoses is priority when caring for a client who is experiencing an acute attack of Ménière’s disease? a. Risk for falls related to impaired balance b. Impaired verbal communication related to vulnerability (tinnitus) c. Bathing self-care deficit related to weakness (vertigo) d. Imbalanced nutrition: less than body requirements related to insufficient dietary NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M intake (nausea) ANS: A All the nursing diagnoses are appropriate, but because sudden acute attacks of vertigo, the major focus of nursing care is to prevent injuries associated with impaired balance. DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis 40. The nurse is caring for a client who had a stapedotomy yesterday. Which of the following findings is most important for the nurse to communicate to the health care provider? a. The client complains of “congestion” in the ear. b. The client’s oral temperature is 38.1C (100.6F). c. The client says “My hearing is worse now than it was right after surgery.” d. There is a small amount of dried bloody drainage on the client’s dressing. ANS: B An elevated temperature following any surgery may indicate a postoperative infection. Although the nurse would report all the data, a temporary decrease in hearing, bloody drainage on the dressing, and a feeling of congestion because of the accumulation of blood and drainage in the ear are common after this surgery. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 41. The nurse is caring for a client with chronic otitis media. Which of the following findings should the nurse expect to assess? a. Pinked-tinged exudate b. Pain c. Nausea d. Bulging tympanic membrane ANS: C Chronic otitis media is characterized by a purulent exudate and inflammation that can involve the ossicles, Eustachian tube, and mastoid bone. It is often painless and may be accompanied by hearing loss, nausea, and episodes of dizziness. A red, bulging tympanic membrane is assessed with acute otitis media. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment