Name: Jewel Eve Balida Competency Appraisal Date: 10/17/16

Topic 12- Special Senses: Eyes

1. Answer: B; Rationale: Cones photoreceptors responsible colored vision.

2. Answer: C; Rationale: The normal intraocular pressure is 12-21 mmHg or 10-20mmHg.
3. Answer: A; Rationale: In instilling eye drops, tilt the patients head back slightly if he is sitting or
place the head over a pillow if he is lying down. Using forefinger, pull lower lid down gently.
Instruct patient to look upward. Allow the prescribed number of drops to fall in the lower
conjunctival sac but do not allow to fall onto the cornea. Release the lower lid after the drops are
instilled. Instruct the patient to close eyes slowly, move the eye and not to squeeze or rub.
4. Answer: C; Rationale: Acetazolamide, as a carbonic anhydrase inhibitor, decreases the aqueous
humor thus treating glaucoma.
5. Answer: A; Rationale: Aphakia is the absence of the lens of the eye, due to surgical removal, a
perforating wound or ulcer, or congenital anomaly.
6. Answer: B; Rationale: Left homonymous hemi-anopsia results from right optic tract defect.
7. Answer: C; Rationale: The management of hyperopia is by a convex-shaped eye glasses.
8. Answer: C; Rationale: Astigmatism is caused by irregularity in corneal shape resulting to blurred
vision and headache.
9. Answer: A; Rationale: Snellen chart is used when testing at distances shorter than 20 feet.
10. Answer: C; Rationale: After traumatic injury, first diagnostic procedure is testing for visual acuities
of both eyes: using a Snellen chart; if this is not possible, document what the patient can see - eg,
signs in the waiting room, finger counting and light perception (if the eye cannot be opened, check
light perception through closed lids).
11. Answer: B; Rationale: The purpose of irrigating the eye with plain tap water is to prevent tissue
damage thus preventing vision loss.
Name of Disorder Cataracts Conjunctivitis Trachoma
Brief Explanation Progressive opacity or clouding An inflammation of the conjunctiva. A contagious bacterial infection of the eye in which
of the lens. Superficial inflammation or infection there is inflamed granulation on the inner surface of the
lids
- Common in areas where water is scarce.
Causes/ Precipitating Age related or caused by Allergens or irritating chemicals Chlamydia trachomatis
Factor metabolic abnormalities Redness, itching, excessive tearing
Excessive exposure to Bacteria: Staphylococcus aureus,
sunlight Chlamydia trachomatis and
Congenital Neisseria gonorrhea
Traumatic Virus
Diabetes

Common Assessment Clouded, blurred or dim Sclera and eyelid appear red Mild itching and irritation of the eyes and eyelids
Results vision Purulent discharge Discharge from the eyes containing mucus or pus
Increasing difficulty with Increased amount of tears Eyelid swelling
vision at night Itchy and burning eyes Light sensitivity (photophobia)
Sensitivity to light and glare Blurred vision Eye pain
Seeing "halos" around lights pain World Health Organization has identified five stages
Fading or yellowing of colors Increased sensitivity to light in the development of trachoma:
Double vision in a single eye Inflammation follicular. The infection is just
beginning in this stage. Five or more follicles
small bumps that contain lymphocytes, a type of
white blood cell are visible with
magnification on the inner surface of upper
eyelid (conjunctiva).
Inflammation intense. In this stage, the eye is
now highly infectious and becomes irritated,
with a thickening or swelling of the upper eyelid.
Eyelid scarring. Repeated infections lead to
scarring of the inner eyelid. The scars often
appear as white lines when examined with
magnification. The eyelid may become distorted
and may turn in (entropion).
Ingrown eyelashes (trichiasis). The scarred inner
lining of the eyelid continues to deform, causing
the lashes to turn in so that they rub on and
scratch the transparent outer surface of the eye
(cornea).
 Corneal clouding. The cornea becomes affected
by an inflammation that is most commonly seen
under the upper lid. Continual inflammation
compounded by scratching from the in-turned
lashes leads to clouding of the cornea.

Nursing Diagnosis Disturbed Sensory Perception Acute Pain related to inflammation Acute pain: eye related to swelling of the lymph nodes,
related to Cataracts of the conjunctiva photophobia and inflammation.
Medical/Surgical Surgical Management: Medical Management: Medical Management:
Management Phacoemulsication (method Bacterial- Half of bacterial Early stages- Antibiotics (tetracycline eye ointment or
of extra capsular conjunctivitis cases will clear up in oral azithromycin)
cataract surgery) one to two weeks without treatment.
Lens Taking an antibiotic may speed up Surgical Management:
replacement (intraocular lens the healing process. Doctor may Eyelid rotation surgery (bilamellar tarsal rotation)-
implants). prescribe antibiotic eye drops or incision in the scarred lid and rotates the eyelashes
ointment. away from cornea. The procedure limits the
Viral- In most cases, no treatment is progression of corneal scarring and may help
available for viral conjunctivitis. prevent further loss of vision
Doctor may prescribe an antiviral
medication if the condition is caused
by herpes simplex virus.
Allergic conjunctivitis- Drugs that
help control allergic reactions, such
as a combination of antihistamines
and mast cell stabilizers. Also drugs
that help control inflammation, such
as decongestants, steroids and anti-
inflammatory eye drops.
Nursing Management Approach patient with a Teach proper hand washing Encourage patient and family to prevent the spread
decreased field of vision on technique and instruct keep hand of the disease.
the side where visual away of eyes. Isolate patient because this disease spreads through
perception is intact. Encourage patient to avoid sharing direct contact
Teach patient to turn and look personal cloths with other. Encourage personal hygiene
in the direction in the Apply warm compression over eye Carry out antibiotic treatment as prescribed by the
defective visual field to and drop and ointment as order. physician (The antibiotic of choice for treating
compensate for the loss. Instruct patient to clean eye active trachoma is azithromycin)
Provide comfort measures discharge with tissue and dispose Observe nonverbal reactions of discomfort since
and establish a therapeutic carefully. swelling of the lymph nodes, photophobia and
relationship with the patient. inflammation may be present
 Allow patient to express his Teach the patient to install eye Perform a comprehensive pain assessment includes
fears and anxieties about his drops and ointments correctly the location, characteristics, duration, frequency,
visual loss. without touching tip of container quality
Prepare patient for cataract with eye or lashes. Determine the visual acuity, note whether one or
surgery as appropriate. Encourage patient to stay away of both eyes are involved (for corneal damage)
school for at least 7 days. Utilize good hand washing t Wash hands before
Instruct to use dark black eye glass contact with patients and between procedure with
to avoid bright light and the patient.
contamination. Observe for signs and symptoms of disorientation.
Use and care of contact lenses Orient the patient on the environment, other people
correctly. in the area. (provides increased comfort and
Avoid rubbing eyes. familiarity)

Name of Disorder Otitis Media Otosclerosis Menieres syndrome

Brief Explanation Inflammation or infection of Abnormal bone growth in the middle Recurrent vertigo accompanied by ringing in the ears
the middle ear. ear that causes hearing loss. and deafness.
Causes/ Precipitating Hemophilus influenza Family history Improper fluid drainage, cause by a blockage or
Factor Pneumococci, beta- Viral anatomic abnormality
hemolytic streptococci, Infection Abnormal immune response
staphylococci Pregnancy Allergies
Viral infections Viral infection
Genetic predisposition
Head trauma
Migraines

Common Assessment Severe ear pain Hearing loss (slow at first, but Vertigo
Results Tympanic membrane red and Hearing loss
worsens over time)
bulging Tinnitus
Mild hearing loss Ringing in the ears (tinnitus) Aural fullness (a feeling that the ear is full or
Feeling of fullness. Vertigo or dizziness plugged)
Drainage of fluid from the
ear
Fever
Nursing Diagnosis Acute Pain related to Disturbed Sensory Perception: Risk for Injury related to vertigo
inflammation of the middle Auditory
ear. related to decreased sensory
reception.
Medical/Surgical Antimicrobials/Antibiotics Fluoride supplementation Medical Management:
Management Antihistamine-decongestants Hearing Aids Anti-nausea medications
Intranasal and systemic Stapedectomy Diuretic (long-term medication)
steroids Antibiotics Hearing aid
Nonsteroidal anti- Motion sickness medications
inflammatory drugs Meniett device.
(NSAIDs) Rehabilitation
Mucolytics Gentamicin (antibiotic)
Aggressive management of Surgical Management:
allergic symptoms Endolymphatic sac procedure
Analgesics Vestibular nerve section
Labyrinthectomy

Nursing Management Assess the level of intensity Avoid water in ear for 2 months, Assess vertigo which includes history, onset,
of the client and client's loud noise, blowing nose and description of the attack, duration, frequency, and
coping mechanisms. mouth open when sneezing. the presence of symptoms related ear hearing loss,
Assess hearing ability Assess for sensory-neutral tinnitus, a feeling of fullness in the ear.
frequently. deafness. Assess the extent of disability in connection with the
Give analgesics as Avoid straining, bending, heavy activities of daily living.
indicated. lifting, and infection. Teach vestibular therapy or stress / balance in
Distract the patient by using Antibiotic full course and as accordance with the provisions.
relaxation techniques: advised Give or teach how anti-drug or vertigo and
distraction, guided Change cotton ball in the ear as vestibular sedatives and give instructions to patients
imagination, touching, etc.. needed. about the side effects.
Have the child sit up, raise Encourage the patient to lie down if feeling dizzy,
head on pillows, or lie on with fence bed is raised.
unaffected ear. Help patients locate and determine the aura (the
Apply heating pad or warm aural symptoms) that precedes the occurrence of any
hot water bottle. attack.
Teach family members to
cover mouths and noses
when sneezing or coughing
and to wash hands
 frequently. Have parents
isolate sick children.
Encourage optimal
nutrition, rest, and exercise.
Position bottle-fed infants
upright when feeding. Do
not prop bottles.
Eliminate allergens and
upper respiratory irritants
such as tobacco, smoke, and
dust.
Topic 13- Autonomic Nervous System

1. Answer: A; Rationale: Ejaculation is part of the sympathetic nervous system.

2. Answer: D; Rationale: Somatic nervous system is the part of the peripheral nervous system
associated with skeletal muscle voluntary control of body movements.
3. Answer: A; Rationale: Beta2 adrenergic receptor stimulation results to bronchodilation and
glycogenolysis which also results to hyperglycemia.
4. Answer: B; Rationale: Dobutamine primarily stimulates beta1 receptors resulting to increase
heart rate, cardiac output and renin release.
5. Answer: B; Rationale: Selective beta blockers includes metoprolol and atenolol while Non-
selective beta blockers includes propranolol, timolol, and nadolol.
6. Answer: C; Rationale: Stimulates A1,B1 & B2 receptors resulting to relaxation of bronchial muscle,
improved cardiac contractility and vasoconstrictive effect.
7. Answer: D; Rationale: Dobutamine continuous infusion titration is based on heart rate, BP, and
urine output.
8. Answer: B; Rationale: If patient is bradycardic, a low dose of 0.5 mg of atropine sulfate will be
given.
9. Answer: B; Rationale: Propanolol is a non-selective beta adrenergic antagonist.
10. Answer: A; Rationale: Constipation, dry mouth, and decreased sweating are normal
parasympathetic effects of the medication.
11. Answer: C; Rationale: Edrophonium is the drug used to diagnose myasthenia gravis.
12. Answer: B; Rationale: Tachycardia is an adverse reaction caused by cholinergic blocking drugs.
13. Answer: A; Rationale: Patients with primary and secondary Raynauds disease benefit from a
selective alpha1 adrenergic blocking agent (Prazosin). By blocking alpha 1 vasodilation occurs thus
treating raynauds disease.
14. Answer: B; Rationale: Metoprolol is a selective beta 2 antagonist thus promoting
bronchoconstriction thus can worsen asthma condition.
15. Answer: D; Rationale: Pancuronium is a nondepolarizing (competitive blockers) it blocks nicotinic
receptors by competing with acetylcholine.
16. Answer: D; Rationale: Atropine is given before anaesthesia to decrease mucus secretions, such
as saliva.
17. Answer: D; Rationale: Trihexyphenidyl blocks efferent impulses in parasympathetically
innervated structures like smooth muscles (spasmolytic activity), salivary glands, and eyes
(mydriasis).
18. Answer: A; Rationale: Aldomet is used in treating for gestational hypertension. It is a competitive
inhibitor of the enzyme DOPA decarboxylase, also known as aromatic L-amino acid decarboxylase,
which converts L-DOPA into dopamine. This inhibition results in reduced dopaminergic and
adrenergic neurotransmission in the peripheral nervous system.
19. Answer: B; Rationale: Clonidine is a centrally acting alpha2 agonist.
20. Answer: B; Rationale: Norepinephrine stimulates alpha1 and beta1 while epinephrine stimulates
alpha1, beta1 and beta2 thus reducing difficulty of breathing through bronchodilation.
Topic 13- CNS Agents

1. Answer: C; Rationale: According to the World Health Organization, epilepsy is the most
common serious brain disorder worldwide with no age, racial, social class, national nor
geographic boundaries. There are 40-50 million sufferers in the world today, 85% of whom
live in developing countries. An estimated two million new cases occur each year globally.
2. Answer: D; Rationale: Generalized seizures includes grand-mal, petit-mal, febrile, and
myoclonic seizure while complex seizure belongs to the partial seizures.
3. Answer: D; Rationale: Ethosuximide is the drug of choice for absence seizures.
4. Answer: A; Rationale: In this book p. 187, the drug used in the management of partial seizures
are phenytoin and carbamazepine. Other choices are not found on the said page.
5. Answer: B; Rationale: Prolonged phenytoin administration usually results to gingival
hyperplasia or gum overgrowth.
6. Answer: C; Rationale: Therapeutic blood level of phenytoin is 10-20 mcg/ml.
7. Answer: C; Rationale: Anticonvulsants suppress or decreases the rapid and excessive firing of
neurons during seizures.
8. Answer: C; Rationale: Phenytoin IV must not to exceed 50 mg per minute in adults.
9. Answer: B; Rationale: Phenytoin may cause urine color to be pink, red or reddish brown.
10. Answer: A; Rationale: Duloxetine, a serotonin norepinephrine reuptake inhibitor, is indicated
for depressed patients with body aches or muscle aches.
11. Answer: B; Rationale: Fluoxetine is usually administered in the morning.
12. Answer: C; Rationale: Onset of effect is felt by the patient after 2 weeks.
13. Answer: D; Rationale: Patients taking TCAs should be advised to change position slowly
because of orthostatic hypotension.
14. Answer: C; Rationale: Because TCAs has a lot of cardiovascular reactions than SSRIs.
15. Answer: D; Rationale: Eating foods rich in tyramine while on MAOI therapy will result to
hypertensive crisis thus it is contraindicated.
16. Answer: C; Rationale: Aged cheese is rich in tyramine.
17. Answer: B; Rationale: Therapeutic range of lithium is 0.6-1.2 mEq/L.
18. Answer: B; Rationale: Early signs of lithium toxicity, such as nausea, vomiting, diarrhea,
drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your
ears. Other choices are not included.
19. Answer: A; Rationale: Lithium carbonate is available in oral form only.
20. Answer: D; Rationale: Buspirone, a non-benzodiazepine anxiolytic, has less adverse effects
than benzodiazepines.
21. Answer: D; Rationale: Benzodiazepines targets GABA receptor.
22. Answer: C; Rationale: Tapering of dose and/or conversion to oral phenobarbital has been
reported for therapy greater than or equal to 5 days.
23. Answer: A; Rationale: Flumazenil (Romazicon) is a competitive benzodiazepine receptor
antagonist that can be used as an antidote for benzodiazepine overdose.
24. Answer: C; Rationale: A patient who has sleep pattern disturbance is a candidate for sedative-
hypnotic agents.
25. Answer: D; Rationale: Sedatives are drugs that decrease activity and have a calming, relaxing
effect. People use these drugs mainly to reduce anxiety. At higher doses, sedatives usually
cause sleep. Drugs used mainly to cause sleep are called hypnotics. The difference between
 sedatives and hypnotics, then, is usually the amount of the doselower doses have a calming
effect and higher doses cause sleep.
26. Answer: D; Rationale: Since the patient wants to go on picnic, constipation is the most
concerned drug adverse reaction.
27. Answer: B; Rationale: The patient has EPS thus benztropine (Cogentin) should be added in
the medication regimen.
28. Answer: A; Rationale: Extrapyramidal side effects are dystonia, akathisia,
pseudoparkinsonism and tardive dyskinesia. Other choices are not extrapyramidal side
effects.
29. Answer: B; Rationale: Clozapine may cause agranulocytosis thus CBC monitoring is very
important.
30. Answer: B; Rationale: Risperidone has a greater affinity for dopamine D2 receptors and a
similar antagonism of serotonin 5-HT2a receptors, thus, risperidone theoretically has a
favorable receptor profile for both positive and negative schizophrenia.
31. Answer: B; Rationale: Dry mouth results from blockage of muscarinic receptors and
hypotension results from alpha-1 blockage.
32. Answer: C; Rationale: Increased levels of dopamine in the limbic area of the brain cause
schizophrenia and its psychotic symptoms. To treat the disorder, antipsychotic drugs blocks
dopamine receptors thus decreasing the levels of dopamine.
33. Answer: D; Rationale: Severe dry cough, anesthesia and diarrhea are medical conditions for
opioid use while nausea and vomiting are side effects of the said drug.
34. Answer: A; Rationale: Large doses of morphine can greatly affect or depress the respiratory
center of the brain thus causing bradypnea.
35. Answer: B; Rationale: People who take opioids for a long period of time may develop
tolerance.
36. Answer: B; Rationale: The narcotic antagonist naloxone is a specific antidote against
respiratory depression which may result from over dosage or unusual sensitivity to narcotics,
including morphine.
37. Answer: A; Rationale: The patient should be advised to have regular blood pressure checks
to monitor the effectiveness of the drug.
38. Answer: D; Rationale: The result of Cox1 effects are GI protection and platelet aggregation
while Cox2 effects are increase pain, inflammation and fever.
39. Answer: C; Rationale: Celecoxib does not block Cox1 thus promoting platelet aggregation or
has a lesser anti-platelet effect.
40. Answer: C; Rationale: Acetaminophen has an excellent safety profile when administered in
proper therapeutic doses, but hepatotoxicity can occur after overdose or when misused in at-
risk populations. Therefore, it is important to monitor liver enzymes.
41. Answer: D; Rationale: The priority nursing diagnosis for patients receiving morphine is
Impaired gas exchange because it affects the respiratory center in the brain.
42. Answer: C; Rationale: Brainstem is the cough reflex and respiratory center. So if cough reflex
is stimulated the respiration are also affected.