Chapter 38: Sensory Alterations

Chapter 38: Sensory Alterations

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A 63-year-old welder who has gone to the clinic for an annual checkup. The patient shares a concern regarding difficulty hearing conversations at the coffee shop in the mornings. After looking in his ears to determine if there is a build-up of cerumen, the nurse tells the patient that the hearing loss may be associated with his occupation or it may be associated with aging. The nurse is aware that hearing loss associated with the aging process is known as which of the following?

a.	Tinnitus
b.	Ménière’s disease
c.	Presbycusis
d.	Presbyopia

 

 

ANS:   C

Hearing changes often associated with aging include decreased hearing acuity, speech intelligibility, and pitch discrimination, which is referred to as presbycusis. Low-pitched sounds are easiest to hear, but it is difficult to hear conversation over background noise. A decrease in active sebaceous glands causes the cerumen to become dry and completely obstruct the external auditory canal. Tinnitus is commonly caused by ototoxicity and patients experience the sensation of ringing in the ears. Presbyopia refers to the gradual decline in ability of the lens to accommodate or focus on close objects and reduces ability to see near objects clearly. Although the cause of Ménière’s disease is unknown the symptoms include progressive low-frequency hearing loss, vertigo, tinnitus, and a full feeling or pressure in the affected ear.

 

PTS:    1                      DIF:    Cognitive Level: Remembering (Knowledge)

REF:    1113 | 1114     OBJ:    Discuss common sensory changes that occur with aging.

TOP:    Nursing Process: Assessment            MSC:   Client Needs: Physiological Integrity

 

2. A 64-year-old house painter who is seeing his health care provider for his annual checkup. When the nurse asks the patient if they have any health concerns, the patient states, “I don’t think my vision is as good as it used to be, things look more yellow than they used to.” The nurse knows that this is a visual change in older adults caused by which of the following?

a.	Iris yellows
b.	Lens yellows
c.	Retina is hypersensitive
d.	Need for less light to see than when they were in young adulthood

 

 

ANS:   B

Visual changes often include reduced visual fields, increased glare sensitivity, impaired night vision, reduced accommodation, reduced depth perception, and reduced color discrimination. Many of these symptoms occur because the pupils in the older adult take longer to dilate and constrict secondary to weaker iris muscles. Color vision decreases because the retina is duller and the lens yellows. Eventually, older adults may require three times as much light to see things as they did when they were in young adulthood.

 

PTS:    1                      DIF:    Cognitive Level: Applying (Application)

REF:    1113                OBJ:    Discuss common sensory changes that occur with aging.

TOP:    Nursing Process: Assessment            MSC:   Client Needs: Physiological Integrity

 

3. A family member is accompanying the elderly patient to their follow-up appointment after a recent hospitalization for gastrointestinal problems. The nurse interrupts a discussion between the family member and the patient regarding rancid food in the patient’s refrigerator. The family member looks at the nurse and states, “She was trying to eat spoiled food for lunch, it spelled terrible, and she still wanted to eat it.” What is the most likely physiological reason that the patient not realizes that the food is spoiled?

a.	She has xerostomia.
b.	She has a diminished sense of smell.
c.	She has a diminished sense of taste.
d.	She has a limited vision.

 

 

ANS:   B

Olfactory changes begin around age 50 and include a loss of cells in the olfactory bulb of the brain and a decrease in the number of sensory cells in the nasal lining. Reduced sensitivity to odors is common. A small decrease in the number of taste cells occurs with aging, beginning around age 60. Reduced sour, salty, and bitter taste discrimination is common. The ability to detect sweet tastes seems to remain intact. Xerostomia is the decrease in salivary production that leads to thicker mucus and a dry mouth. This interferes with the ability to eat and leads to appetite and nutritional problems.

 

PTS:    1                      DIF:    Cognitive Level: Applying (Application)

REF:    1113 | 1114 | 1124

OBJ:    Discuss common sensory changes that occur with aging.

TOP:    Nursing Process: Assessment            MSC:   Client Needs: Physiological Integrity

 

4. The patient has a methicillin-resistant Staphylococcus aureus (MRSA) infection in an abdominal surgical wound. The patient is in a private room, is receiving vancomycin (Vancocin) for the MRSA, and pain is well controlled with a morphine sulfate patient-controlled analgesia (PCA) pump, and is receiving docusate sodium (Colace) to prevent constipation. During the nurse’s rounds, the patient begins complaining of ringing in the ears. Which is the most likely cause for the patient’s tinnitus?

a.	Surgical anesthesia
b.	Morphine sulfate
c.	Vancomycin
d.	Docusate sodium

 

 

ANS:   C

Ototoxic medications, such as analgesics, antibiotics (such as vancomycin and aminoglycosides), or diuretics, affect hearing acuity, balance, or both, with the most common symptom being tinnitus (ringing in the ears). Surgical anesthesia, morphine, and docusate sodium do not have the side effect of ototoxicity or tinnitus.

 

PTS:    1                      DIF:    Cognitive Level: Analyzing (Analysis)

REF:    1114                OBJ:    Discuss common causes and effects of sensory alterations.

TOP:    Nursing Process: Assessment            MSC:   Client Needs: Physiological Integrity