Chapter 11: Vision

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose?

a. A brightly lit, blue room with cozy throw rugs b. An orange-carpeted room with soft lighting and yellow walls c. A brightly lit, blue room with an EZ-Glide wax floor d. A fluorescent-lighted room with green walls and a glossy, tiled floor

ANS: B

Light colors such as red, orange, and yellow are more easily seen by aging eyes. Softer lighting will help reduce some of the glare and is also easier seen by aging eyes. Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem. Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare.

DIF: Cognitive Level: Applying REF: p. 138

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

2. An older adult client shares with the nurse that, “I don’t know what it is but it seems that I need more light for reading or even watching television as I get older.” The nurse explains that aging may cause this change due to the: a. slower ability of the pupil to adjust to changes in lighting. b. impact arcus senilis has on visual acuity c. flattening and thinning of the cornea. d. retinal changes that begin to occur with aging.

ANS: A

A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read. Arcus senilis does not affect vision. It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism. Astigmatism does not account for the need for increased light that this patient is reporting. The changes in the retina do not account for the need for increased light that this patient is reporting.

DIF: Cognitive Level: Applying REF: p. 131

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

3. A 77- year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse’s response is: a. the exact etiology of glaucoma is variable and often unknown. b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.

ANS: A

The etiology of glaucoma is variable and often unknown. However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs. Spasms of the orbicular muscle can cause the lower lid to turn inward. If it stays this way, it is called entropion. The changes described contribute to decreased accommodation. Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters.

DIF: Cognitive Level: Remembering REF: p. 134

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

4. An older man tells a nurse, “The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight.” The nurse formulates a response based on the knowledge that: a. the lens of the eye loses elasticity causing a loss of focus for near objects. b. the cornea of the eye becomes thicker and less curved causing an increase in astigmatism. c. the lens of the eye increases in opacity causing a decrease in light refraction. d. the cornea of the eye forms a gray ring at the edges.

ANS: A

Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye. All of the other options are normal age-related changes; however, they are not related to presbyopia.

DIF: Cognitive Level: Applying REF: p. 132, Table 11-1

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

5. An older resident in a long-term care facility reports to the nurse that she has been noticing changes in her vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with: a. cataracts. b. glaucoma. c. diabetic retinopathy. d. age-related macular degeneration.

ANS: A

Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare.

DIF: Cognitive Level: Remembering REF: p. 134

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Glaucoma b. Age related macular degeneration c. Diabetic retinopathy d. Cataracts

6. An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. He also states, “Strangely enough my peripheral vision continues to be pretty good.” The nurse suspects that the patient has which of the following?

ANS: B

Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration. The other three eye diseases do not present with these symptoms.

DIF: Cognitive Level: Applying REF: pp. 135–136

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

Multiple Response

1. A nurse is providing glaucoma education for a group of older adults in a senior center. The nurse knows that the following groups are most likely to develop glaucoma. (Select all that apply.)

a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes e. Asian Americans

ANS: A, B, C, D

African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups. Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups. Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups.

DIF: Cognitive Level: Remembering REF: p. 133

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Avoid lifting heavy objects after the surgery b. Avoid bending from the waist after the surgery c. Take stool softeners as needed d. Maintain strict control of your blood sugar and blood pressure e. Maintain a dry sterile dressing over the eye for 10 days

2. A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (Select all that apply.)

ANS: A, B, C

Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist. Fall prevention is also very important as is complying with eye drop administration. Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction. There usually is not a dressing over the operative site, and not for 10 days.

DIF: Cognitive Level: Applying REF: pp. 134–135

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Strict control of blood glucose levels is important in slowing disease progression b. Laser photocoagulation treatments can stop progression of the disease c. Control of blood pressure and cholesterol levels are important steps slowing disease progression d. Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression e. Eating a diet high in beta-carotene can stop disease progression

3. An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: “Is there anything that I can do to prevent progression of this disease and blindness?” The nurse includes which of the following into the response? (Select all that apply.)

ANS: A, B, C

Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease. Laser treatment can reduce vision loss in 50% of patients. Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression.

DIF: Cognitive Level: Applying REF: p. 136

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. The eyelids are less elastic and droopy b. The eyes are very dry c. The eyelids may not close completely d. There is a loss of eyelashes e. The lower lid may be turned outward

4. A nurse is conducting an assessment of an older patient’s eyes. The nurse expects to see which of the following normal age-related changes of the external eye? (Select all that apply.)

ANS: A, B, C, E

Normal age-related changes in the external eye include a loss of elasticity causing drooping. Eyes become drier, and the eyelids may not close completely. Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid. Loss of eyelashes is not a normal age-related change.

DIF: Cognitive Level: Remembering REF: p. 132, Table 11-1

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

Chapter 12: Hearing

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. An older client reports to a nurse, “My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well.” Based on the client’s description, the nurse suspects which of the following?

a. Presbycusis b. Otosclerosis c. Tinnitus d. A perforated eardrum

ANS: A

Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children’s voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

DIF: Cognitive Level: Analyzing REF: p. 143

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Refer the resident for an evaluation for a hearing aid b. Raise her voice when speaking to the resident c. Examine the resident’s ears for cerumen impaction d. Teach the resident to read lips

2. An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse?

ANS: C

When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one’s voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

DIF: Cognitive Level: Analyzing REF: p. 144

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

3. An older patient asks a nurse, “My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?” The nurse formulates a response based on the knowledge that: a. a cochlear implant is permanent, surgically-implanted hearing aid. b. a cochlear implant speeds up the conduction of sound to the auditory nerve. c. a cochlear implant functions as an artificial auditory nerve. d. a cochlear implant directly stimulates the auditory nerve.

ANS: D

A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.

DIF: Cognitive Level: Analyzing REF: p. 146

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. “Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure.” b. “With the right hearing aid, you can expect your hearing to be back to normal.” c. “Hearing aids are covered by Medicare Part B.” d. “Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise.”

4. A 74- year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse’s teaching plan?

ANS: D

Hearing aids do bring challenges, such as distorted speech and amplified background noise. Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal. Medicare does not cover the cost of hearing aids.

DIF: Cognitive Level: Analyzing REF: p. 145

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

Multiple Response

1. A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.)

a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises

ANS: A, B, C, E

Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.

DIF: Cognitive Level: Remembering REF: p. 145

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear

2. An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.)

ANS: A, C, D

Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications.

DIF: Cognitive Level: Remembering REF: p. 149

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. tumors of the middle ear. b. cerumen impaction. c. infections of the external and middle ear. d. age-related hearing impairment. e. excessive and loud noise.

3. An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (Select all that apply.)

ANS: D, E

A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss.

DIF: Cognitive Level: Remembering REF: p. 144

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance