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
Brief Explanation Progressive opacity or clouding
of the lens.
Causes/ Precipitating Age related or caused by
Factor metabolic abnormalities
Excessive exposure to
sunlight
Congenital
Traumatic
Diabetes
Common Assessment Clouded, blurred or dim
Results vision
Increasing difficulty with
vision at night
Sensitivity to light and glare
Seeing "halos" around lights
Fading or yellowing of colors
Double vision in a single eye
Conjunctivitis
An inflammation of the conjunctiva.
Superficial inflammation or infection
Allergens or irritating chemicals
Redness, itching, excessive tearing
Bacteria: Staphylococcus aureus,
Chlamydia trachomatis and
Neisseria gonorrhea
Virus
Sclera and eyelid appear red
Purulent discharge
Increased amount of tears
Itchy and burning eyes
Blurred vision
pain
Increased sensitivity to light
Trachoma
A contagious bacterial infection of the eye in which
there is inflamed granulation on the inner surface of the
lids
- Common in areas where water is scarce.
Chlamydia trachomatis
Mild itching and irritation of the eyes and eyelids
Discharge from the eyes containing mucus or pus
Eyelid swelling
Light sensitivity (photophobia)
Eye pain
World Health Organization has identified five stages
in the development of trachoma:
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).

Nursing Diagnosis Disturbed Sensory Perception
related to Cataracts
Medical/Surgical Surgical Management:
Management Phacoemulsication (method
of extra capsular
cataract surgery)
Lens
replacement (intraocular lens
implants).
Nursing Management Approach patient with a
decreased field of vision on
the side where visual
perception is intact.
Teach patient to turn and look
in the direction in the
defective visual field to
compensate for the loss.
Provide comfort measures
and establish a therapeutic
relationship with the patient.
Acute Pain related to inflammation
of the conjunctiva
Medical Management:
Bacterial- Half of bacterial
conjunctivitis cases will clear up in
one to two weeks without treatment.
Taking an antibiotic may speed up
the healing process. Doctor may
prescribe antibiotic eye drops or
ointment.
Viral- In most cases, no treatment is
available for viral conjunctivitis.
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.
Teach proper hand washing
technique and instruct keep hand
away of eyes.
Encourage patient to avoid sharing
personal cloths with other.
Apply warm compression over eye
and drop and ointment as order.
Instruct patient to clean eye
discharge with tissue and dispose
carefully.
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.
Acute pain: eye related to swelling of the lymph nodes,
photophobia and inflammation.
Medical Management:
Early stages- Antibiotics (tetracycline eye ointment or
oral azithromycin)
Surgical Management:
Eyelid rotation surgery (bilamellar tarsal rotation)-
incision in the scarred lid and rotates the eyelashes
away from cornea. The procedure limits the
progression of corneal scarring and may help
prevent further loss of vision
Encourage patient and family to prevent the spread
of the disease.
Isolate patient because this disease spreads through
direct contact
Encourage personal hygiene
Carry out antibiotic treatment as prescribed by the
physician (The antibiotic of choice for treating
active trachoma is azithromycin)
Observe nonverbal reactions of discomfort since
swelling of the lymph nodes, photophobia and
inflammation may be present
 Allow patient to express his
fears and anxieties about his
visual loss.
Prepare patient for cataract
surgery as appropriate.
Name of Disorder Otitis Media
Brief Explanation Inflammation or infection of
the middle ear.
Causes/ Precipitating Hemophilus influenza
Factor Pneumococci, beta-
hemolytic streptococci,
staphylococci
Viral infections
Common Assessment Severe ear pain
Results Tympanic membrane red and
bulging
Mild hearing loss
Feeling of fullness.
Drainage of fluid from the
ear
Fever
Teach the patient to install eye
drops and ointments correctly
without touching tip of container
with eye or lashes.
Encourage patient to stay away of
school for at least 7 days.
Instruct to use dark black eye glass
to avoid bright light and
contamination.
Use and care of contact lenses
correctly.
Avoid rubbing eyes.
Otosclerosis
Abnormal bone growth in the middle
ear that causes hearing loss.
Family history
Viral
Infection
Pregnancy
Hearing loss (slow at first, but
worsens over time)
Ringing in the ears (tinnitus)
Vertigo or dizziness
Perform a comprehensive pain assessment includes
the location, characteristics, duration, frequency,
quality
Determine the visual acuity, note whether one or
both eyes are involved (for corneal damage)
Utilize good hand washing t Wash hands before
contact with patients and between procedure with
the patient.
Observe for signs and symptoms of disorientation.
Orient the patient on the environment, other people
in the area. (provides increased comfort and
familiarity)
Menieres syndrome
Recurrent vertigo accompanied by ringing in the ears
and deafness.
Improper fluid drainage, cause by a blockage or
anatomic abnormality
Abnormal immune response
Allergies
Viral infection
Genetic predisposition
Head trauma
Migraines
Vertigo
Hearing loss
Tinnitus
Aural fullness (a feeling that the ear is full or
plugged)
Nursing Diagnosis Acute Pain related to
inflammation of the middle
ear.
Medical/Surgical Antimicrobials/Antibiotics
Management Antihistamine-decongestants
Intranasal and systemic
steroids
Nonsteroidal anti-
inflammatory drugs
(NSAIDs)
Mucolytics
Aggressive management of
allergic symptoms
Analgesics
Disturbed Sensory Perception: Risk for Injury related to vertigo
Auditory
related to decreased sensory
reception.
Fluoride supplementation Medical Management:
Hearing Aids Anti-nausea medications
Stapedectomy Diuretic (long-term medication)
Antibiotics Hearing aid
Motion sickness medications
Meniett device.
Rehabilitation
Gentamicin (antibiotic)
Surgical Management:
Endolymphatic sac procedure
Vestibular nerve section
Labyrinthectomy

Nursing Management Assess the level of intensity
of the client and client's
coping mechanisms.
Assess hearing ability
frequently.
Give analgesics as
indicated.
Distract the patient by using
relaxation techniques:
distraction, guided
imagination, touching, etc..
Have the child sit up, raise
head on pillows, or lie on
unaffected ear.
Apply heating pad or warm
hot water bottle.
Teach family members to
cover mouths and noses
when sneezing or coughing
and to wash hands
Avoid water in ear for 2 months,
loud noise, blowing nose and
mouth open when sneezing.
Assess for sensory-neutral
deafness.
Avoid straining, bending, heavy
lifting, and infection.
Antibiotic full course and as
advised
Change cotton ball in the ear as
needed.
Assess vertigo which includes history, onset,
description of the attack, duration, frequency, and
the presence of symptoms related ear hearing loss,
tinnitus, a feeling of fullness in the ear.
Assess the extent of disability in connection with the
activities of daily living.
Teach vestibular therapy or stress / balance in
accordance with the provisions.
Give or teach how anti-drug or vertigo and
vestibular sedatives and give instructions to patients
about the side effects.
Encourage the patient to lie down if feeling dizzy,
with fence bed is raised.
Help patients locate and determine the aura (the
aural symptoms) that precedes the occurrence of any
attack.
 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.