.The nurse is aware that the patient has 20/40 vision. This means that the patient can see at 20 feet what the
normal eye can see at _______ feet.
a.
... [Show More] 100
b. 200
c. 300
d. 400
ANS: B
The Snellen Eye Chart tests visual acuity. A vision evaluation of 20/40 means that the patient can see at 20 feet
what the person with normal vision can see at 200 feet.
PTS: 1 DIF: Cognitive Level: Application REF: Page 1850
OBJ:7TOP:Snellen evaluation
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
2.The patient tells the nurse that he is legally blind. How would this information impact the nurse’s plan of care
for this patient?
1/21/2018 Chapter 52: Care of the Patient with a Sensory Disorder | Nursing Test Banks
https://boostgrade.info/chapter-52-care-of-the-patient-with-a-sensory-disorder/ 2/23
a. The patient would be considered totally blind.
b. This patient probably has some light perception, but no usable vision.
c. This patient has some usable vision, which enables function at an acceptable level.
d. The nurse would need to determine how this patient’s visual impairment aects normal functioning.
ANS: D
“Legal blindness” refers to individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or
visual eld sight capacity reduced by 20 degrees. Categories have been established to help determine the exact
extent of the vision loss and what assistive measures are appropriate for the individual. The nurse will need
more information as to the exact extent of the vision loss for this patient.
PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1851
OBJ:N/ATOP:Legal blindness
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
3.One of the housekeepers splashes a chemical in the eyes. What should be the rst priority?
a. Transport to a physician immediately
b. Cover the eyes with a sterile gauze
c. Irrigate with H O for 5 minutes
d. Irrigate with normal saline solution for 20 minutes
ANS: D
Burns are medically treated with a prolonged, 15- to 20-minute or longer normal saline ush immediately after
burn exposure.
PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1871
OBJ:11TOP:Chemical burn of eye
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2
1/21/2018 Chapter 52: Care of the Patient with a Sensory Disorder | Nursing Test Banks
https://boostgrade.info/chapter-52-care-of-the-patient-with-a-sensory-disorder/ 3/23
4.What does a tympanoplasty correct?
a. Conductive hearing loss
b. Sensorineural hearing loss
c. Congenital hearing loss
d. Functional hearing loss
ANS: A
Tympanoplasty can correct a conductive hearing loss.
PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1889
OBJ:17TOP:Tympanoplasty
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5.The 62-year-old home health patient who is recovering from eye surgery complains of a feeling of “grittiness”
in the eye and is having blurred vision. The eyes are reddened and have stringy mucus. What do these
complaints indicate?
a. Sjögren syndrome
b. Early cataracts
c. Macular degeneration
d. Retinal detachment
ANS: A
The Sjögren syndrome of “dry eye” frequently appears after eye surgery. There is insucient production of
tears. Excessive use of antihistamines, antidepressants, and decongestants may cause this syndrome to
appear.
PTS: 1 DIF: Cognitive Level: Application REF: Page 1858
OBJ:8TOP:Sjögren syndrome
1/21/2018 Chapter 52: Care of the Patient with a Sensory Disorder | Nursing Test Banks
https://boostgrade.info/chapter-52-care-of-the-patient-with-a-sensory-disorder/ 4/23
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
6.Four hours after a stapedectomy the patient complains that hearing has not improved at all. What knowledge
would the nurse use to shape a response?
a. A large percentage of stapedectomies are not successful
b. It will take at least 10 days for the graft to heal
c. Hearing will not return until edema subsides
d. Hearing will improve after irrigation of the ear
ANS: C
Hearing improvement will not be noted until edema subsides and the packing is removed. [Show Less]