NCLEX Eye and Ear Questions Made Simple

Glaucoma, cataracts and macular degeneration

Glaucoma results from raised intraocular pressure that damages the optic nerve. Open-angle glaucoma, the common chronic form, is insidious and painless. It destroys peripheral vision first, producing the classic tunnel vision, and the loss is permanent. This is why screening and lifelong adherence to drops are the correct teaching answers, and why any option suggesting drops can stop once vision seems stable is wrong.

Acute angle-closure glaucoma is the emergency variant. The stem describes sudden severe eye pain, blurred vision, halos around lights, a hard globe, a fixed dilated pupil, nausea and vomiting. This requires immediate intervention to lower pressure and prevent permanent blindness. Anticholinergic medications and mydriatics can precipitate it, which is why atropine-type drugs carry glaucoma cautions.

Cataracts are opacities of the lens producing painless, gradual blurring, faded colour perception, glare and halos around lights, and difficulty with night driving. Treatment is surgical lens replacement, usually as an outpatient procedure with excellent outcomes. Macular degeneration destroys central vision while peripheral vision is preserved, so the client reports difficulty reading and recognising faces and may describe straight lines appearing wavy.

The pattern of loss is the discriminator in almost every item: peripheral loss means glaucoma, central loss means macular degeneration, generalised cloudiness with glare means cataract, and sudden painless loss with floaters and a curtain across the field means retinal detachment, which is a surgical emergency.

Eye drops, post-operative rules and low-vision safety

Eye drop administration appears repeatedly. Wash hands, have the client tilt the head back and look up, pull down the lower lid to form a conjunctival sac, instil the drop into that sac without touching the eye with the dropper tip, then have the client close the eye gently and apply light pressure to the inner canthus for about a minute to reduce systemic absorption. When two different drops are ordered, wait at least five minutes between them. When both a drop and an ointment are ordered, the drop goes first.

Glaucoma medication classes matter. Beta blocker drops such as timolol lower pressure by reducing aqueous production and can cause systemic bradycardia and bronchospasm, so punctal occlusion matters and asthma is a caution. Prostaglandin analogues such as latanoprost increase outflow and darken the iris and lengthen lashes. Miotics constrict the pupil and cause dim vision, a safety issue at night. Carbonic anhydrase inhibitors are sulfonamide derivatives.

After cataract or other eye surgery the restriction list is the answer set: no bending at the waist, no lifting more than about 10 pounds, no straining at stool, no coughing or sneezing forcefully, no rubbing the eye, sleep on the unaffected side, wear the eye shield as directed, and report sudden pain, a decrease in vision, a green or yellow discharge, or flashes of light. Mild scratchiness and some redness are expected.

For clients with low vision, teach environmental safety: consistent furniture placement, adequate non-glare lighting, contrasting colours on step edges, removal of throw rugs, and when guiding a client, allow them to take your arm just above the elbow and walk half a step ahead while describing changes in terrain.

• •Instil drops into the lower conjunctival sac, never on the cornea
• •Five minutes between different drops; drops before ointments
• •Occlude the inner canthus to limit systemic absorption
• •After eye surgery avoid bending, straining and lifting
• •Report sudden pain, vision loss or purulent drainage immediately

Ear disorders, vertigo and communicating with hearing loss

Conductive hearing loss results from a mechanical problem in the outer or middle ear: impacted cerumen, otitis media with effusion, a perforated tympanic membrane or otosclerosis. It is often correctable. Sensorineural loss results from damage to the cochlea or auditory nerve from ageing, noise exposure or ototoxic drugs, and it is usually permanent. Ototoxic agents worth remembering are aminoglycosides such as gentamicin, loop diuretics given rapidly intravenously, high-dose salicylates and cisplatin.

Otitis media is predominantly a paediatric item because the child's eustachian tube is shorter, wider and more horizontal. Findings include ear pain, tugging at the ear, fever, irritability and a bulging red tympanic membrane. Teaching includes completing the full antibiotic course, holding infants upright for feeds rather than bottle-propping, and avoiding tobacco smoke exposure. After tympanostomy tube placement, keep the ears dry and report any tube that falls out.

Meniere's disease produces the triad of episodic vertigo, tinnitus and fluctuating sensorineural hearing loss, often with a sensation of aural fullness. The client is taught to move the head slowly, to sit or lie down at the first sign of vertigo, to avoid driving during episodes, and to restrict sodium along with caffeine, alcohol and nicotine. Vertigo items almost always have a safety answer: assist with ambulation, keep the bed low, and clear the path to the bathroom.

Communication technique with hearing loss is a frequently tested set of behaviours. Face the client at eye level in good light, gain attention first, speak clearly at a normal rate in a lower pitch rather than shouting, use short sentences, rephrase rather than simply repeat, reduce background noise, and verify understanding. Confirm the hearing aid is in place, switched on and has a working battery before assuming confusion.

• •Conductive loss: mechanical and often reversible
• •Sensorineural loss: cochlear or nerve damage, usually permanent
• •Ototoxic: aminoglycosides, rapid IV loop diuretics, high-dose aspirin, cisplatin
• •Meniere's: vertigo, tinnitus, hearing loss — low sodium and fall safety
• •Lower your pitch, do not shout, and face the client directly