Medical-Surgical Nursing Exam 17

1. When the nurse observes diffuse swelling involving the deeper skin layers in the patient who has experienced an allergic reaction, the nurse records the finding as

1. angioneurotic edema.
   The area of skin demonstrating angioneurotic edema may appear normal but often has a reddish hue and does not pit.
2. urticaria.
   Urticaria (hives) is characterized as edematous skin elevations that vary in size and shape, itch, and cause local discomfort.
3. contact dermatitis.
   Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance, such as poison ivy.
4. pitting edema.
   Pitting edema is the result of increased interstitial fluid and associated with disorders such as congestive heart failure.

2. Atopic allergic disorders are characterized by

1. a hereditary predisposition.
   Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens.
2. an IgA-mediated reaction.
   Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions.
3. production of a systemic reaction.
   Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens.
4. a response to physiologic allergens.
   Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens.

3. The nurse teaches the patient with allergies about anaphylaxis including which of the following statements?

1. The most common cause of anaphylaxis is penicillin.
   The most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the U.S., is penicillin.
2. Anaphylactoid (anaphylaxis-like) reactions are commonly fatal.
   Although possibly severe, anaphylactoid reactions are rarely fatal.
3. The most common food item causing anaphylaxis is chocolate.
   Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy and wheat.
4. Systemic reactions include urticaria and angioedema
   Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions occur within about 30 minutes of exposure involving cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.

4. Which of the following statements describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex?

1. Signs and symptoms are localized to the area of exposure, usually the back of the hands.
   Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure.
2. Signs and symptoms can be eliminated by changing glove brands or using powder-free gloves.
   Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves.
3. Signs and symptoms may worsen when hand lotion is applied before donning latex gloves.
   With an irritant contact dermatitis, avoid use of hand lotion before donning gloves as this may worsen symptoms as lotions may leach latex proteins from the gloves.
4. Signs and symptoms occur within minutes after exposure to latex.
   Described as a latex allergy, when clinical manifestations occur within minutes after exposure to latex, an immediate hypersensitivity (type I) allergic reaction has occurred.

5. Which of the following terms refers to fixation or immobility of a joint?

1. Ankylosis
   Ankylosis may result from disease or scarring due to trauma.
2. Hemarthrosis
   Hemarthrosis refers to bleeding into the joint.
3. Diarthrodial
   Diarthrodial refers to a joint with two freely moveable parts.
4. Arthroplasty
   Arthroplasty refers to replacement of a joint.

6. Accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage is referred to as

1. tophi.
   Tophi, when problematic, are surgically excised.
2. subchondral bone.
   Subchondral bone refers to a bony plate that supports the articular cartilage.
3. pannus.
   Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells.
4. joint effusion.
   Joint effusion refers to the escape of fluid from the blood vessels or lymphatics into the joint cavity.

7. Passive range-of-motion exercises are indicated during which stage of rheumatic disease?

1. Acute
   Passive range of motion is indicated because the patient is unable to perform exercises alone during an acute stage of rheumatic disease.
2. Subacute
   Active assistive or active range of motion is recommended during the subacute stage of rheumatic diseases.
3. Inactive
   Active range of motion and isometrics are recommended during the inactive stage of rheumatic diseases.
4. Remission
   Active range of motion and isometrics are recommended during the remission stage of rheumatic diseases.

8. Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues?

1. Scleroderma
   Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death.
2. Rheumatoid arthritis
   Rheumatoid arthritis results from an autoimmune response in the synovial tissue with damage taking place in body joints.
3. Systemic lupus erythematosus
   SLE is an immunoregulatory disturbance that results in increased autoantibody production.
4. Polymyalgia rheumatic
   In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

9. Osteoarthritis is known as a disease that

1. is the most common and frequently disabling of joint disorders.
   The functional impact of osteoarthritis on quality of life, especially for elderly patients, is often ignored.
2. affects young males.
   Reiter’s syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis.
3. requires early treatment because most of the damage appears to occur early in the course of the disease.
   Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis requires early treatment because of early damage caused by disease.
4. affects the cartilaginous joints of the spine and surrounding tissues.
   Ankylosing spondylitis causes the described problem and is usually diagnosed in the second or third decade of life.

10. Which of the following newer pharmacological therapies used for the treatment of osteoarthritis is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects?

1. Viscosupplementation
   Viscosupplementation, the intraarticular injection of hyaluronic acid, is thought to improve cartilage function and retard degradation. It may also have some anti-inflammatory effects.
2. Glucosamine
   Glucosamine and chondroitin are thought to improve tissue function and retard breakdown of cartilage.
3. Chondroitin
   Chondroitin and glucosamine are thought to improve tissue function and retard breakdown of cartilage.
4. Capsaicin                                                                                                                                              Capsaicin is a topical analgesic.

11. Which of the following statements reflect nursing interventions in the care of the patient with osteoarthritis?

1. Encourage weight loss and an increase in aerobic activity.
   Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening are important approaches to pain management.
2. Provide an analgesic after exercise.
   Patients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, prior to their exercise session.
3. Assess for the gastrointestinal complications associated with COX-2 inhibitors.
   Gastrointestinal complications, especially GI bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
4. Avoid the use of topical analgesics.
   Topical analgesics such as capsaicin and methylsalicylate may be used for pain management.

12. Fibromyalgia is a common condition that

1. involves chronic fatigue, generalized muscle aching and stiffness.
   Fibromyalgia, is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness.
2. is caused by a virus.
   The cause is unknown and no pathological characteristics have been identified that are specific for the condition
3. is treated by diet, exercise, and physical therapy.
   Treatment consists of attention to the specific symptoms reported by the patient. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general de-conditioning that occurs in these individuals
4. usually lasts for less than two weeks,
   Fibromyalgia, is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. It is very typical for patients to have endured their symptoms for a long period of time.

13. Which of the following terms refers to a condition characterized by destruction of the melanocytes in circumscribed areas of the skin?

1. Vitiligo
   Vitiligo results in the development of white patches that may be localized or widespread.
2. Hirsutism
   Hirsutism is the condition of having excessive hair growth.
3. Lichenification
   Lichenification refers to a leathery thickening of the skin.
4. Telangiectases
   Telangiectases refers to red marks on the skin caused by stretching of the superficial blood vessels.

14. Of the following types of cells, which are believed to play a significant role in cutaneous immune system reactions?

1. Langerhans’ cells
   Langerhans’ cells are common to the epidermis and are accessory cells of the afferent immune system process.
2. Merkel’s cells
   Merkel’s cells are the receptor cells in the epidermis that transmit stimuli to the axon via a chemical response.
3. Melanocytes
   Melanocytes are special cells of the epidermis that are primarily involved in producing melanin, which colors the hair and skin.
4. Phagocytes
   Phagocytes are white blood cells that engulf and destroy foreign materials.

15. When the nurse assesses the patient and observes blue-red and dark brown plaques and nodules, she recognizes that these manifestations are associated with

1. Kaposi’s sarcoma.
   Kaposi’s sarcoma is a frequent comorbidity of the patient with AIDS.
2. platelet disorders.
   With platelet disorders, the nurse observes ecchymoses (bruising) and purpura (bleeding into the skin).
3. allergic reactions.
   Urticaria (wheals or hives) is the manifestation of allergic reactions.
4. syphilis.
   A painless chancre or ulcerated lesion is a typical finding in the patient with syphilis.

16. The nurse reading the physician’s report of an elderly patient’s physical examination knows a notation that the patient demonstrates xanthelasma refers to

1. yellowish waxy deposits on upper eyelids.
   The change is a common, benign manifestation of aging skin or it can sometimes signal hyperlipidemia.
2. liver spots.
   Solar lentigo is the term that refers to liver spots.
3. dark discoloration of the skin.
   Melasma is the term that refers to dark discoloration of the skin.
4. bright red moles.
   Cherry angioma is the term that is used to describe a bright red mole.

17. The nurse notes that the patient demonstrates generalized pallor and recognizes that this finding may be indicative of

1. anemia.
   In the light-skinned individual, generalized pallor is a manifestation of anemia. In brown- and black-skinned individuals, anemia is demonstrated as a dull skin appearance.
2. albinism.
   Albinism is a condition of total absence of pigment in which the skin appears whitish pink.
3. vitiligo.
   Vitiligo is a condition characterized by the destruction of the melanocytes in circumscribed areas of skin, resulting in patchy, milky white spots.
4. local arterial insufficiency.
   Local arterial insufficiency is characterized by marked localized pallor.

18. Which of the following terms refers most precisely to a localized skin infection of a single hair follicle?

1. Furuncle
   Furuncles occur anywhere on the body, but are most prevalent in areas subjected to irritation, pressure friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks.
2. Carbuncle
   A carbuncle is a localized skin infection involving several hair follicles.
3. Chelitis.
   Chelitis refers to dry cracking at the corners of the mouth.
4. Comedone.
   Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.

19. The nurse recommends which of the following types of therapeutic baths for its antipruritic action?

1. Colloidal (Aveeno, oatmeal)
   Aveeno or oatmeal baths are recommended to decrease itching associated with a dermatologic disorder.
2. Sodium bicarbonate (baking soda)
   Baking soda baths are cooling but dangerous. The tub gets very slippery and a bath mat must be used in the tub.
3. Water
   Water baths have the same effect as wet dressings, not known to counteract itching.
4. Saline
   Saline baths have the same effects as saline dressings, not known to counteract itching.

20. Which of the following materials consists of a powder in water?

1. Suspension
   A suspension requires shaking before application, exemplified by calamine lotion.
2. Hygroscopic agent
   A hygroscopic agent is a powder that acts to absorb and retain moisture from the air and to reduce friction between surfaces.
3. Paste
   A paste is a mixture of powder and ointment.
4. Linament                                                                                                                                             A linament is a lotion with oil added to prevent crusting.

21. Which of the following skin conditions is caused by staphylococci, streptococci, or multiple bacteria?

1. Impetigo
   Impetigo is seen at all ages, but is particularly common among children living under poor hygienic conditions.
2. Scabies
   Scabies is caused by the itch mite.
3. Pediculosis capitis
   Pediculosis capitis is caused by head lice.
4. Poison ivy
   Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy.

22. The nurse teaches the patient who demonstrates herpes zoster (shingles) that

1. the infection results from reactivation of the chickenpox virus.
   It is assumed that herpes zoster represents a reactivation of latent varicella (chickenpox) virus and reflects lowered immunity.
2. once a patient has had shingles, they will not have it a second time.
   It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers.
3. a person who has had chickenpox can contract it again upon exposure to a person with shingles.
   A person who has had chickenpox is immune and, therefore, not at risk of infection after exposure to patients with herpes zoster.
4. There are no known medications that affect the course of shingles.
   There is some evidence that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.

23. Development of malignant melanoma is associated with which of the following risk factors?

1. Individuals with a history of severe sunburn
   Ultraviolet rays are strongly suspected as the etiology of malignant melanoma.
2. African-American heritage
   Fair-skinned, blue-eyed, light-haired people of Celtic or Scandinavian origin are at higher risk for development of malignant melanoma.
3. People who tan easily
   People who burn and do not tan are at risk for development of malignant melanoma.
4. Elderly individuals residing in the Northeast
   Elderly individuals who retire to the southwestern United States appear to have a higher incidence of development of malignant melanoma.

24. When caring for a patient receiving autolytic debridement therapy, the nurse

1. advises the patient about the foul odor that will occur during therapy.
   During autolytic debridement therapy a foul odor will be produced by the breakdown of cellular debris. This odor does not indicate that the wound is infected.
2. ensures that the dressing is kept dry at all times.
   During autolytic debridement therapy the wound is kept moist.
3. ensures that the wound is kept open to the air for at least six hours per day.
   During autolytic debridement therapy the wound is covered with an occlusive dressing.
4. Uses an enzymatic debriding agent such as Pancrease.
   Commercially available enzymatic debriding agents include Accuzyme, Clooagenase, Granulex, and Zymase.

25. Which of the following reflect the pathophysiology of cutaneous signs of HIV disease?

1. Immune function deterioration
   Cutaneous signs may be the first manifestations of HIV, appearing in more than 90 per cent of HIV infected patients as the immune function deteriorates. Common complaints include pruritis, folliculitis, and chronic actinic dermatitis.
2. High CD4 count
   Cutaneous signs of HIV disease correlate to low CD4 counts.
3. Genetic predisposition
   Cutaneous signs of HIV disease appear as immune function deteriorates.
4. Decrease in normal skin flora
   Cutaneous signs of HIV disease appear as immune function deteriorates.

26. Most skin conditions related to HIV disease may be helped primarily by

1. highly active antiretroviral therapy (HAART).
   The goals of all HIV-related conditions include improvement of CD4 count and lowering of viral load. Initiation of HAART (highly active antiretroviral therapy) will help improve most skin conditions related to HIV disease. Symptomatic relief will be required until the skin condition improves.
2. symptomatic therapies.
   Initiation of HAART (highly active antiretroviral therapy) will help improve most skin conditions related to HIV disease. Symptomatic relief will be required until the skin condition improves.
3. low potency topical corticosteroid therapy.
   High-potency, not low-potency, topical corticosteroid therapy may be helpful for some skin conditions.
4. improvement of the patient’s nutritional status.
   Improvement of the patient’s nutritional status is beneficial for the overall treatment of HIV disease; it is not specific for treatment of skin conditions.

27. Which of the following terms refers to a graft derived from one part of a patient’s body and used on another part of that same patient’s body?

1. Autograft
   Autografts of full-thickness and pedicle flaps are commonly used for reconstructive surgery, months or years after the initial injury.
2. Allograft
   An allograft is a graft transferred from one human (living or cadaveric) to another human.
3. Homograft
   A homograft is a graft transferred from one human (living or cadaveric) to another human.
4. Heterograft
   A heterograft is a graft obtained from an animal of a species other than that of the recipient.

28. When the emergency nurse learns that the patient suffered injury from a flash flame, the nurse anticipates which depth of burn?

1. Deep partial thickness
   A deep partial thickness burn is similar to a second-degree burn and is associated with scalds and flash flames.
2. Superficial partial thickness
   Superficial partial thickness burns are similar to first-degree burns and are associated with sunburns.
3. Full thickness
   Full thickness burns are similar to third-degree burns and are associated with direct flame, electric current, and chemical contact.
4. Superficial
   Injury from a flash flame is not associated with a burn that is limited to the epidermis.

29. Regarding emergency procedures at the burn scene, the nurse teaches which of the following guidelines?

1. Never wrap burn victims in ice.
   Such procedure may worsen the tissue damage and lead to hypothermia in patients with large burns.
2. Apply ice directly to a burn area.
   Ice must never be applied directly to a burn because it may worsen the tissue damage.
3. Never apply water to a chemical burn.
   Chemical burns resulting from contact with a corrosive material are irrigated immediately.
4. Maintain cold dressings on a burn site at all times.
   Such procedures may worsen the tissue damage and lead to hypothermia in patients with large burns.

30. The first dressing change for an autografted area is performed

1. as soon as foul odor or purulent drainage is noted, or 3-5 days after surgery.
   A foul odor or purulent infection may indicate infection and should be reported to the surgeon immediately.
2. within 12 hours after surgery.
   The first dressing change usually occurs 3-5 days after surgery.
3. within 24 hours after surgery.
   The first dressing change usually occurs 3-5 days after surgery.
4. as soon as sanguineous drainage is noted.                                                                                 Sanguineous drainage on a dressing covering an autograft is an anticipated abnormal observation postoperatively.

31. Which of the following observations in the patient who has undergone allograft for treatment of burn site must be reported to the physician immediately?

1. Crackles in the lungs
   Crackles in the lungs may indicate a fluid buildup indicative of congestive heart failure and pulmonary edema.
2. Pain at the allograft donor site
   Pain at the allograft donor site is anticipated, since the nerve endings have been stimulated.
3. Sanguineous drainage at the allograft donor site
   Sanguineous drainage at the allograft donor site is anticipated, since upper layers of tissue have been removed.
4. Decreased pain at the allograft recipient site
   Decreased pain at the recipient site is anticipated since the wound has been protected by the graft.

32. Which of the following factors are associated with increased fluid requirements in the management of patients with burn injury?

1. Inhalation injuries
   Factors associated with increased fluid requirements include inhalation injuries, delayed resuscitation, scald burn injuries, high-voltage electrical injuries, hyperglycemia, alcohol intoxification and chronic diuretic therapy.
2. Chemical burn injuries
   Chemical burn injuries are not associated with increased fluid requirements.
3. Low-voltage electrical injuries
   Low-voltage electrical injuries are not associated with increased fluid requirements.
4. Hypoglycemia
   Hypoglycemia is not associated with increased fluid requirements.

33. Antimicrobial barrier?Acticoat dressings used in the treatment of burn wounds can be left in place for five days. Antimicrobial barrier dressings can be left in place for?

1. Acticoat up to five days
   thus helping to decrease discomfort to the patient, decrease costs of dressing supplies, and decrease nursing time involved in burn dressing changes.
2. seven to ten days.
   antimicrobial barrier dressings?Acticoat can be left in place for up to five days.
3. three days.
   Acticoat antimicrobial barrier dressings can be left in place for up to five days.
4. two days.
   antimicrobial barrier dressings can be left in?Acticoat place for up to five days.

34. A new biosynthetic dressing used , is used to treat?in the treatment of burns, TransCyte

1. burns of indeterminate depth
   is used to treat burns in which the depth is?TransCyte indeterminate or between superficial and deep partial thickness in depth.
2. partial-thickness burns.
   is a temporary biosynthetic?BCG Matrix wound covering intended for use with partial-thickness burns and donor sites
3. superficial burns.
   is used to treat burns in which?TransCyte the depth is indeterminate or between superficial and deep partial thickness in depth.
4. donor sites.
   is a temporary biosynthetic wound?BCG Matrix covering intended for use with partial-thickness burns and donor sites

35. Which of the following statements reflect current research regarding the utilization of non-pharmacological measures in the management of burn pain?

1. Music therapy may provide reality orientation, distraction, and sensory stimulation.
   Researchers have found that music affects both the physiologic and psychological aspects of the pain experience. Music diverts the patient’s attention away from the painful stimulus. Music may also provide reality orientation, distraction, and sensory stimulation. It also allows for patient self-expression.
2. Music therapy diverts the patient’s attention toward painful stimulus.
   Music diverts the patient’s attention away from, not toward, the painful stimulus.
3. Humor therapy has not proven effective in the management of burn pain.
   Humor therapy has proven effective in the management of burn pain.
4. Pet therapy has proven effective in the management of burn pain.
   Pet therapy has not proven effective in the management of burn pain.

36. The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to:

1. decrease catabolism.
   The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to decrease catabolism. Nutritional support with optimized protein intake can decrease the protein losses by approximately 50%.
2. increase metabolic rate.
   A marked increase in metabolic rate is seen after a burn injury; interventions are instituted to decrease metabolic rate and catabolism.
3. increase glucose demands.
   A marked increase in glucose demands are seen after a burn injury; interventions are instituted to decrease glucose demands and catabolism.
4. increase skeletal muscle breakdown.
   Rapid skeletal muscle breakdown with amino acids serving as the energy source is seen after a burn injury; interventions are instituted to decrease catabolism.

37. Which of the following terms refers to the absence of the natural lens?

1. Aphakia
   When a cataract is extracted, and an intraocular lens implant is not used, the patient demonstrates aphakia.
2. Scotoma
   Scotoma refers to a blind or partially blind area in the visual field.
3. Keratoconus
   Keratoconus refers to a cone-shaped deformity of the cornea.
4. Hyphema
   Hyphema refers to blood in the anterior chamber of the eye.

38. Edema of the conjunctiva is termed

1. chemosis.
   Chemosis is a common manifestation of pink-eye.
2. papilledema.
   Papilledema refers to swelling of the optic disk due to increased intracranial pressure.
3. proptosis.
   Proptosis is the downward displacement of the eyeball.
4. strabismus.
   Strabismus is a condition in which there is a deviation from perfect ocular alignment.

39. When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision

1. sees an object from 20 feet away that a person with normal vision sees from 200 feet away.
   The fraction 20/20 is considered the standard of normal vision.
2. sees an object from 200 feet away that a person with normal vision sees from 20 feet away.
   Most people, positioned 20 feet from the eye chart, can see the letters designated as 20/20 from a distance of 20 feet.
3. sees an object from 20 feet away that a person with normal vision sees from 20 feet away.
   The standard of normal vision, 20/20 means that the patient can read the 20/20 line from a distance of 20 feet.
4. sees an object from 200 feet away that a person with normal vision sees from 200 feet away.
   In order to read the 20/20 line, the person of normal vision will be standing at a distance of 20 feet from the chart.

40. Which type of glaucoma presents an ocular emergency?

1. Acute angle-closure glaucoma
   Acute angle-closure glaucoma results in rapid progressive visual impairment.
2. Normal tension glaucoma
   Normal tension glaucoma is treated with topical medication.
3. Ocular hypertension
   Ocular hypertension is treated with topical medication.
4. Chronic open-angle glaucoma                                                                                                              Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added at a later time.

41. Which of the following categories of medications increases aqueous fluid outflow in the patient with glaucoma?

1. Cholinergics
   Cholinergics increase aqueous fluid outflow by contracting the ciliary muscle, causing miosis, and opening the trabecular meshwork.
2. Beta-blockers
   Beta-blockers decrease aqueous humor production.
3. Alpha-adrenergic agonists
   Alpha-adrenergic agonists decrease aqueous humor production.
4. Carbonic anhydrase inhibitors
   Carbonic anhydrase inhibitors decrease aqueous humor production.

42. Which of the following statements describe refractive surgery?

1. Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.
   Refractive surgery is an elective procedure and is considered a cosmetic procedure (to achieve clear vision without the aid of prosthetic devices). It is performed to reshape the cornea for the purpose of correction of all refractive errors.
2. Refractive surgery will alter the normal aging of the eye.
   Refractive surgery will not alter the normal aging process of the eye.
3. Refractive surgery may be performed on all patients, even if they have underlying health conditions.
   Patients with conditions that are likely to adversely affect corneal wound healing (corticosteroid use, immunosuppression, elevated IOP) are not good candidates for the procedure.
4. Refractive surgery may be performed on patients with an abnormal corneal structure as long as they have a stable refractive error.
   The corneal structure must be normal and refractive error stable.

43. The nurse knows that a postoperative vision-threatening complication of LASIK refractive surgery, diffuse lamellar keratitis (DLK) occurs

1. in the first week after surgery.
   DLK is a peculiar, non-infectious, inflammatory reaction in the lamellar interface after LASIK. It is characterized by a white granular, diffuse culture-negative lamellar keratitis occurring in the first week after surgery. Studies suggest that since no single agent appears to be solely the cause of DLK, a multifactorial etiology is likely.
2. 1 month after surgery.
   DLK occurs in the first week after surgery.
3. 2-3 months after surgery.
   DLK occurs in the first week after surgery.
4. 6 months after surgery.
   DLK occurs in the first week after surgery.

44. The nurse advises the patient undergoing photodynamic therapy (PDT) for macular degeneration to avoid exposure to direct sunlight or bright lights for

1. the first five days after the procedure.
   Photodynamic therapy includes the use of verteporfin, a light-activated dye. The dye within the blood vessels near the surface of the skin could become activated with exposure to strong light, such as sunlight or bright lights. Ordinary indoor light is not a problem. The patient should be counseled to wear protective clothing, such as long-sleeved shirts, sunglasses, and wide-brimmed hats, if the patient has to go outdoors during daylight hours in the first five days post-treatment. Inadvertent sunlight exposure can lead to severe blistering of the skin and sunburn.
2. the first 24 hours after the procedure.
   The patient should avoid exposure to direct sunlight or bright lights for the first five days post-treatment.
3. two weeks after the procedure.
   The patient should avoid exposure to direct sunlight or bright lights for the first five days post-treatment.
4. the first month after the procedure.
   The patient should avoid exposure to direct sunlight or bright lights for the first five days post-treatment.

45. Retinoblastoma is the most common eye tumor of childhood; it is hereditary in

1. 30-40% of cases.
   Retinoblastoma can be hereditary or nonhereditary. It is hereditary in 30-40% of cases. All bilateral cases are hereditary.
2. 10-20% of cases.
   Retinoblastoma is hereditary in 30-40% of cases.
3. 25-50% of cases.
   Retinoblastoma is hereditary in 30-40% of cases.
4. 50-75% of cases.
   Retinoblastoma is hereditary in 30-40% of cases.

46. Which of the following terms refers to altered sensation of orientation in space?

1. Dizziness
   Dizziness may be associated with inner ear disturbances.
2. Vertigo
   Vertigo is the illusion of movement where the individual or the surroundings are sensed as moving.
3. Tinnitus
   Tinnitus refers to a subjective perception of sound with internal origin.
4. Nystagmus
   Nystagmus refers to involuntary rhythmic eye movement.

47. Of the following terms, which describes a condition characterized by abnormal spongy bone formation around the stapes?

1. Otosclerosis
   Otosclerosis is more common in females than males and is frequently hereditary.
2. Middle ear effusion
   A middle ear effusion is denoted by fluid in the middle ear without evidence of infection.
3. Chronic otitis media
   Chronic otitis media is defined as repeated episodes of acute otitis media causing irreversible tissue damage and persistent tympanic membrane perforation.
4. Otitis externa
   Otitis externa refers to inflammation of the external auditory canal.

48. Ossiculoplasty is defined as

1. surgical reconstruction of the middle ear bones.
   Ossiculoplasty is performed to restore hearing.
2. surgical repair of the eardrum.
   Surgical repair of the eardrum is termed tympanoplasty.
3. incision into the tympanic membrane.
   Tympanotomy or myringotomy is the term used to refer to incision into the tympanic membrane.
4. incision into the eardrum.
   Tympanotomy or myringotomy is the term used to refer to incision into the tympanic membrane.

49. Which of the following terms refers to surgical repair of the tympanic membrane?

1. Tympanoplasty
   Tympanoplasty may be necessary to repair a scarred eardrum.
2. Tympanotomy
   A tympanotomy is an incision into the tympanic membrane.
3. Myringotomy
   A myringotomy is an incision into the tympanic membrane.
4. Ossiculoplasty
   An ossiculoplasty is a surgical reconstruction of the middle ear bones to restore hearing.

50. Of the following tests, which uses a tuning fork between two positions to assess hearing?

1. Rinne’s
   In the Rinne’s test, the examiner shifts the stem of a vibrating tuning fork between two positions to test air conduction of sound and bone conduction of sound.
2. Whisper
   The whisper test involves covering the untested ear and, whispering from a distance of 1 or 2 feet from the unoccluded ear, and the ability of the patient to repeat what was whispered.
3. Watch tick
   The watch tick test relies on the ability of the patient to perceive the high-pitched sound made by a watch held at the patient’s auricle.
4. Weber’s                                                                                                                                                                                          The Weber’s test uses bone conduction to test lateralization of sound.