Chapter 29: Sensory Function

Chapter 29: Sensory Function

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. An older adult patient reports burning and itching eyes. On assessment, the nurse notes swelling of the eyelid margins bilaterally. What additional data are necessary to confirm the nurse’s suspicion of blepharitis?

a.	The patient reports visual disturbances such as rainbow halos.
b.	The eyelids are reddened from seborrhea.
c.	The patient is being treated with anticoagulants.
d.	Small corneal hemorrhages are present.

 

 

ANS:  B

Blepharitis is a chronic inflammation of the eyelid margins that is commonly found in older adults. It can be caused by seborrheic dermatitis or infection. The symptoms include red, swollen eyelids, matting and crusting along the base of the eyelash at the margins, small ulcerations along the lid margins, and complaints of irritation, itching, burning, tearing, and photophobia.

 

DIF:    Remembering (Knowledge)             REF:   Page 642        OBJ:   29-10

TOP:   Nursing Process: Assessment           MSC:  Physiologic Integrity

 

2. The morning of her scheduled cataract extraction and intraocular lens placement of the right eye, an older adult patient expresses concern that she will not remember her instructions for home care. Which statement is the best response to the patient’s concern?

a.	“Is your family going to be here while you’re in surgery?”
b.	“Are you anxious about the surgery?”
c.	“I’ll reinforce the important points.”
d.	“We will provide you with written instructions.”

 

 

ANS:  D

Postoperative care requires teaching the patient and family home care procedures for the period after cataract surgery and should be given orally as well in written form. The patient may or may not have family present. Asking about anxiety could be important, but yes/no questions are not therapeutic. The nurse’s idea of what are the important points may differ from the patient’s.

 

DIF:    Understanding (Comprehension)      REF:   Page 655        OBJ:   29-2

TOP:   Teaching-Learning                          MSC:  Physiologic Integrity

 

3. Your 88-year-old patient is hospitalized for a retinal detachment. He is on bed rest, and both eyes are covered with patches. Which nursing diagnosis takes priority at this time?

a.	Self-esteem disturbance related to decreased independence
b.	High risk for altered thought processes related to visual impairment
c.	High risk for injury related to altered sensory perception
d.	Impaired social interaction related to visual deficit

 

 

ANS:  C

If the eyes are patched, safety precautions, such as keeping call lights, side rails, and necessary items within reach, must be instituted. Finally, assistance must be provided with activities of daily living (ADLs) and walking as needed to promote comfort and safety. The other diagnoses may be appropriate for selected patients.

 

DIF:    Applying (Application)                    REF:   N/A                OBJ:   29-2

TOP:   Nursing Process: Implementation     MSC:  Safe Effective Care Environment

 

4. A 66-year-old patient has been diagnosed with type 2 diabetes mellitus and related vision loss. Which statement demonstrates the ability to manage her condition?

a.	“I schedule my yearly eye examination for the week of my birthday.”
b.	“When I notice haloes around lights, I’ll know I’m developing a problem with retinopathy.”
c.	“My sister had diabetic retinopathy, and the vessels in her eyes were scarred.”
d.	“I understand that the eye problems need to be diagnosed with an ophthalmoscopic exam.”

 

 

ANS:  A

Patients with diabetes should have a yearly examination by an ophthalmologist. Scheduling the exam for the week of her birthday will keep the patient from forgetting to do so. The other statements are not related to management.

 

DIF:    Evaluating (Evaluation)                   REF:   N/A                OBJ:   29-3

TOP:    Nursing Process: Evaluation      MSC:   Health Promotion