Republic of the Philippines

Batangas State University

COLLEGE OF NURSING
Gov. Pablo Borbon Campus 1, Rizal Ave., Batangas City
Tel. No.: (043) 300-2202 loc. 120
e-mail at: bsu_collegeofnursing@yahoo.com

COMPREHENSIVE EXAMINATION
CNS & ENT
2nd Semester AY 2010 - 2011

DIRECTION: Shade the letter of the best answer on the answer sheet provided. STRICTLY
NO ERASURES.

1. Ian Francis is using Snellen chart to test the eye acuity of his patient and records the client’s
vision as 20/40. Which of the following statements best describes 20/40 vision?
a. The client has an alteration in near vision and is legally blind.
b. The client can see at 20 feet of what the person with normal vision sees at 40 feet.
c. The client can see at 40 feet of what the person with normal vision sees at 20 feet.
d. The person has 20% decrease in acuity in one eye, and 40% decrease in the other
eye.

2. After Cherry Anne instills atropine drops into the eyes of a client undergoing ophthalmic
examination, which of the following instructions will she give to her patient?
a. “Wear dark glasses in bright light because you may have photosensitivity.”
b. “Avoid wearing regular glasses when driving.”
c. “Be careful because the blink reflex is paralyzed.”
d. “Be aware that pupils may be unusually small.”

3. Rosalie is giving health teaching to a patient who had undergone cataract surgery. Which of
the following statements made by the client needs additional teaching?
a. “I’ll avoid eating until the nausea subsides.”
b. “I can’t wait to pick up my granddaughter.”
c. “I’ll avoid bending over to tie my shoelace.”
d. “I’ll avoid touching the medication dropper to my eye.”

4. Citadel is assessing a client who has a possible detachment of retina. Which of the following
signs and symptoms would occur in her client?
a. Flashes lights & floaters c. Loss of central vision
b. Ptosis d. Hemianopsia
5. Mark Tristan is assessing a client with glaucoma. He will expect which of the following
findings?
a. Complaints of double vision
b. Complaints of halos around lights
c. Intraocular pressure of 15mmHg
d. Soft globe on palpation

6. Which of the following instruments measures the intraocular pressure?

 a. Goniometer c. Opthalmoscope
b. Slit lamp d. Tonometer

7. Karla Mae is giving Pilocarpine 2 gtts OU QID. She knows that she should instill the
medication to which of the following procedures?
a. Two drops on the sclera of left eye two times daily
b. Two drops over the lacrimal duct of right eye four times daily
c. Two drops of the drug toward the nasal side of each conjuctival sac four times daily
d. Two drops of the medication in both eyes four times a day

8. Arlene’s patient was diagnosed of Meniere’s disease. Which of the following nursing
diagnoses would take priority for her client?
a. Risk for injury
b. Imbalanced nutrition: More than body requirements
c. Ineffective tissue perfusion (cerebral)
d. Impaired Social interaction

9. Bryan, an 80 yr old client is admitted to the hospital with chest pain and with impaired
hearing. Which of the following methods should be use when assessing the client?
a. Shout into the better ear.
b. Lower your voice pitch while facing the client.
c. Ask a relative to go home and get the hearing aid of the patient.
d. Direct the conversation to the relatives.

10. On the male surgical ward of BRH, Emerald was tasked to change the dressing of her
patient. Which of the following interventions should she perform first when changing
dressing or giving wound care?
a. Put on a gloves
b. Wash hands
c. Slowly remove the soiled dressing
d. Observe the dressing for the amount, type and odor of the drainage

11. Jeamy would anticipate the use of convex lenses in patients with:
a. Hyperopia c. Myopia
b. Astigmatism d. Presbyopia

12. Nerve deafness would most likely result from an injury or infection that damage the:
a. Vagus nerve c. Cochlear nerve
b. Vestibular nerve d. Trigeminal nerve

13. Aiza is caring for a client with glaucoma. She should understand that the goal of therapy is:
a. Dilating the pupils
b. Controlling the intraocular pressure
c. Preventing secondary infections
d. Resting the eye muscles

14. Roxanne is preparing a teaching plan for a mother of a child diagnosed with bacterial
conjunctivitis. Which of the following, if stated by the child’s mother would indicate a need
for further education?
a. “I need to wash my hands frequently.”
b. “I need to clean the eye as prescribed.”
c. “I need to give the eye Drops as prescribed.”
d. “It is okey to share towels and washcloths.”

15. May provides discharge instructions to the mother of a child after myringotomy. Which of
the following is not included in the instructions?
a. In blowing the nose, let the child use soft tissue
b. Place earplugs with petroleum jelly in the ears during baths and showers
c. Swimming in deep water is prohibited
d. Rapid head movements or bending should be avoided.

16. Abigail is caring for a client with a diagnosis of detached retina. Which assessment sign
would indicate that bleeding has occurred as a result of the retinal detachment?
a. A sudden sharp pain on the eye
 b. Complaints of a burst of black spots or floaters
c. Total loss of vision
d. A reddened conjunctiva

17. Aileen is performing a voice test to assess hearing. Which of the following describes the
accurate procedure for performing this test?
a. Aileen stands four feet away from the client and ensures that her client can hear her
at this distance.
b. She whispers a statement with her back facing the client.
c. Aileen quietly whispers a statement and asks her client to repeat it
d. Whispers a statement while the client blocks both ears

18. A nurse notes that a physician has documented presbycusis (hearing impairment) on a
client’s chart. The nurse plans care, knowing that the condition is:
a. A sensorineural hearing loss that occurs with aging
b. A conductive hearing loss that occurs with aging
c. Tinnitus that occurs with aging
d. Nystagmus that occurs with aging

19. A 4 year old child was rushed into the hospital due to accidental penetration of fish hook into
the eye. Applicable nursing diagnosis will be the following except:
a. Pain c. Impaired tissue integrity
b. Risk for infection d. Disturbed Body image

20. Florence is conducting an assessment on bone and air conduction. After assessing for bone
conduction, she immediately placed the tuning fork in front of the patient’s pinna and asked
her patient if he still hears the sound. Her patient claimed that he doesn’t hear any sound.
Florence would interpret this finding as:
a. Positive Rinne’s test c. Negative Rinne’s test
b. Positive Romberg’s test d. Negative Romberg’s test

21. For a client having an episode of acute narrow-angle glaucoma, Kathleen expects to give
which of the following medications?
a. Acetazolamide (Diamox)
b. Furosemide (lasix)
c. Atropine
d. Urokinase (Abbokinase)

22. To properly instill the ear drops in a 28-year-old client with otitis externa, which of the
following methods would Rioverna perform?
a. Pulling the pinna up and back
b. Instill the ear drops directly into the ear
c. Pulling the pinna down and back
d. Pulling the pinna up and down

23. Nerve deafness would most likely result from an injury or infection that damage the:
a. Vagus nerve c. Cochlear nerve
b. Vestibular nerve d. Trigeminal nerve

24. The nurse would identify which ocular response as desirable for the client using Pilocarpine
eye drops?
a. Pupillary Constriction
b. Corneal Lubrication
c. Pupillary Dilation
d. Clearing of Injected sclera

25. Which is the most important postoperative nursing action for the client following a scleral
buckling procedure for detached retina?
a. Remove reading material to decrease eye strain
b. Closely assess for presence of nausea and prevent vomiting
c. Assess color of drainage from the affected ear
d. Maintain sterility for q3h saline eye irrigation

26. The nurse is caring for an elderly client with bilateral eye patches. Which nursing action
would be most beneficial in preventing problems secondary to sensory deprivation?
 a. Maintain client sedation until eye patches are removed
b. Isolate client so others will not confuse him
c. Maintain dark, quite environment conducive to rest
d. Speak to him frequently, and provide frequent touch

27. In planning the care of a client with an acute episode of Meniere’s Disease, the nurse would
outline teaching to include:
a. Adding salt to food
b. Instructing the client to irrigate the ear daily
c. Avoiding sudden motion of the head
d. Keeping cotton in affected ear

28. The primary problem with cataract is:

a. Blurring of vision c. Loss of peripheral vision
b. Presence of floaters d. Halos and light

29. The following are appropriate nursing interventions after cataract extraction except:
a. Place the client in supine position or turn towards the unoperated side
b. Advise the client to avoid bending or stooping
c. Instruct the client to limit fluid intake
d. Advise the client to protect his eye with eye patch and eye shield for a week

30. The following drugs may be administered to the client with Glaucoma except:
a. Diamox c. Pilocarpine
b. Atropine Sulfate d. Timolol Meleate

31. Farsightedness is corrected with what type of lens?

a. Concave lens c. Convex lens
b. Aphakic lens d. Bifocal lens

32. Otosclerosis is characterized by:

a. Increased endolymphatic pressure
b. Replacement of normal bones by spongy and highly vascularized bones and the
stapes becomes fixed with the oval window
c. Rupture of tympanic membrane
d. Damage of the labyrinth or acoustic nerve

33. Which of the following diagnostic tests compares air and bone conduction?
a. Rinne’s test c. Weber’s test
b. Romberg’s test d. Otoscopic exam

34. The diet of a client with Meniere’s disease should be:

a. Low-protein c. Low fats
b. Low potassium d. Low sodium

35. Tinnitus is what type of data:

a. Objective c. Subjective
b. Direct d. Indirect

36. The child is scheduled for myringotomy. What goal of this procedure will the nurse discuss
with the parents?
a. Promote drainage from the ear
b. Correct a malformation in the ear
c. Irrigate the Eustachian tube
d. Equalize pressure on the tympanic membrane

37. During rounds you observed that your patient with Meniere’s disease is eating her lunch.
Which of the following foods would be contraindicated with her patient?
a. rice, chicken soup and salted egg
b. milk, whole wheat bread and vegetable salad
c. rice and steamed fish
d. mango juice, spaghetti and bread

38. You will question an order to irrigate the ear canal in which of the following circumstances?
a. Ear pain b. Otitis externa
 c. Hearing loss d. Perforated eardrum

39. The ear bones that transmit vibrations to the oval window of the cochlea are found in the:
a. Outer ear c. Inner ear
b. Middle ear d. Tympanic membrane

40. The preferred treatment for malignant melanoma of the eye is:
a. Radiation c. Enucleation
b. Cryosurgery d. Chemotherapy

41. A labyrinthectomy can be performed to treat Meniere’s disease. This procedure results in:
a. Anosmia c. Absence of pain
b. Reduction hearing d. Irreversible deafness

42. The nurse would question which medication order for a client with acute closed-angle
glaucoma?
a. Atropine 1-2 gtts OU OD
b. Hydrochlorothiazide (Diuril) 25mg PO OD
c. Propanolol (Inderal) 20mg PO BID
d. Carbamyl Cholin (Isopto carbachol) eye drops: 1 gtts BID

43. The client had undergone labyrinthectomy on the right ear 5 hours ago. Which of the
following is incorrect when done by the nurse?
a. Turn the client to the unoperated ears
b. Anticipate the use of hearing aid
c. Speak to the client on the unoperated side
d. Lower down the bed of the client

44. A client was tested using Weber’s tuning fork test. Which of the following is an abnormal
finding?
a. Positive Weber’s test c. Negative Weber’s test
b. Lateralization d. Central lateralization

45. Which of the following is a Normal test result?

a. Positive Romberg’s test c. Lateralization
b. Negative Weber’s test d. Positive Rinne’s test

46. All of the following are ototoxic drugs except:

a. Vancomycin c. Streptomycin
b. ASA d. Furosemide

47. A client comes to the clinic for eye examination, which include eye measurement of IOP
with a tonometer. When teaching the client about the test procedure, the nurse should cover
which point?
a. The client will direct gaze forward to while the practitioner rest the tonometer on the
corneal surface
b. A topical anesthesia will be administered after the procedure
c. The client should wear dark glasses after the procedure
d. Miotic drugs are administered prior to procedure

48. A nurse is providing instructions to a client who will be self-administering eye drops. To
minimize the systemic effects that the eye drops can produce, the nurse instructs the client
to:
a. Eat prior instilling the medication
b. Swallow several times after instilling the drops
c. Blink vigorously to encourage tearing after instilling the medication
d. Occlude the nasolacrimal duct with a finger for several minutes after instilling the
drops

49. Betaxolol (Betaoptic) eye drops have been prescribed for a client with glaucoma. Which of
the following nursing actions is most appropriate related to monitoring for the side effects of
this medication?
a. Monitor temperature
b. Assess blood glucose level
c. Monitor blood pressure
 d. Assess peripheral pulses

50. You are giving an atropine sulfate eye drop to a client. When asked by the client about the
effect of the medication, which response would be the best?
a. The medication provides corneal lubrication
b. The medication makes your pupil dilated
c. It will result to pupil constriction
d. It fights infection

51. The nurse is assessing a client with a tentative diagnosis of a brain tumor. What would the
nurse anticipate the client’s primary complaint to be?
a. Decreased appetite c. Recurrent headaches
b. Frequent insomnia d. Peripheral edema

52. The nurse is caring for a client who has had a right-sided cerebrovascular accident. The
nurse includes what activities in the care of this client?
a. Passive ROM exercises to affected side, active on unaffected side
b. Place food on the affected side of the client’s mouth
c. Hot packs to the right legs to decrease the muscle spasm
d. Turn every 2 hours and maintain position on the right side for 2 hours

53. A client is scheduled for an electroencephalogram. What will the nurse explain to the client
regarding the purpose of this test?
a. Evaluates electrical currents of skeletal muscles
b. Measures ultrasonic waves in the brain
c. Determines the size and location of brain activity
d. Records brain electrical activity

54. A client who had CVA is aphasic; it has been a week since his stroke. He is beginning to
show functional improvement and demonstrate to follow verbal directions. What will
rehabilitation now include?
a. A right-leg brace c. Speech training
b. Ambulation training d. Vocational retraining

55. The nurse is caring for a client who is doing well after his craniotomy. What will be the
bowel care for this client?
a. An enema every other day to avoid the valsalva maneuver
b. High fiber diet and stool softeners to prevent constipation
c. Low residue diet to decrease stool formation and prevent constipation
d. Daily checking for impaction caused by loss of bowel innervations

56. After Grand mal seizures, what nursing action has the highest priority?
a. Loosen or remove constricting clothing and protect client from injuring
herself/himself.
b. Maintain a patent airway by turning the client’s health to the side and suctioning, if
necessary.
c. Remain with the client and administer anticonvulsant medications as ordered by the
physician.
d. Describe and record events before the onset of the seizure, and after the seizure.

57. After a temporal craniotomy, what is an important nursing intervention?

a. Take temperature orally only
b. Restraint the client as necessary
c. Suction the client every 2 hours
d. Do not position the client with head down

58. The nurse is assessing a client with multiple sclerosis. Which finding would the nurse
identify as characteristic as early signs of multiple sclerosis?
a. Diplopia c. Flaccid paralysis
b. Resting tremor d. Unilateral neglect

59. The nurse understands that hemiplegia involves:

a. Paresis of both lower extremities
b. Paralysis of one side of the body
c. Paralysis of both lower extremities
 d. Paresis of lower and upper extremities

60. A physician performs a lumbar puncture. To do this procedure, the physician must insert the
needle into the :
a. Pia mater c. Dura mater
b. Foramen ovale d. Subarachnoid space

61. A client complains severe pain 2 days after surgery. The nurse’s initial action should be to:
a. Have the client rest
b. Take the client’s vital signs
c. Administer PRN medication
d. Document the client’s complain

62. It is most important for the nurse to observe a client with diagnosis of tetanus for:
a. Muscular rigidity
b. Respiratory tract spasms
c. Restlessness and irritability
d. Spastic voluntary muscle contraction

63. After sustaining a head trauma, a client complains of hearing ringing noises. The nurse
recognizes that this assessment suggests injury of the:
a. Frontal lobe c. VI cranial nerve
b. Occipital lobe d. VIII CN

64. When the client is unconscious, the nurse should expect the person to be unable to:
a. Hear voices c. Move spontaneously
b. Control elimination d. React to verbal stimuli

65. A client with quadriplegia is in spinal shock. What should the nurse expect?
a. Absence of reflexes along with flaccid extremities
b. Positive Babinski reflex along with spastic extremities
c. Hyperreflexia along with spastic extremities
d. Spasticity along all four extremities

66. If a client experienced a stroke that damaged the hypothalamus, the nurse would anticipate
that the client has problems with:
a. Body temperature control
b. Balance and equilibrium
c. Visual acuity
d. Thinking and reasoning

67. A physician prescribes diazepam (Valium), 10 mg IV for a client experiencing status

epilepticus. Which statement about IV Diazepam is true?
a. It may be mixed with other drugs in IV infusion
b. It should be administered in small vein to prevent irritation
c. It rarely causes adverse reaction
d. It should be administered no faster 5 mg/minute in an adult

68. A newly graduate nurse from BSU is working on a surgical floor. The nurse must log roll a
client following a:
a. Laminectomy c. Hemoroidectomy
b. Thoracotomy d. Cystectomy

69. Lolo Eugene has Alzeimer’s Disease. He is being treated with malnutrition and dehydration.
Mutya, his nurse decides to place him closer to nurse’s station because of his tendency to:
a. To forget to eat
b. Not to change his position often
c. Exhibit destructive behavior
d. Wander

70. Damage to which part of the brain will result to receptive aphasia?
a. Parietal lobe c. Occipital lobe
b. Temporal lobe d. Frontal lobe
71. A client with a tentative diagnosis of brain tumor is admitted for a diagnostic workup. Brain
tumor is confirmed by following diagnostic test except:
a. CT Scan c. MRI
b. Skull X-ray d. Myelogram

72. A client had undergone tensilon test. After administration of teh medicaiton, the client’s
condition improved. Which will be the correct diagnosis for the client?
a. Multiple sclerosis c. Cholinergic crisis
b. Amyotropic lateral sclerosis d. Myasthenic crisis

73. The client is experiencing problems with balance as well as fine and gross motor function.
Which part of the brain is malfunctioning?
a. Cerebrum c. Hypothalamus
b. Midbrain d. Cerebellum

74. What is the function of CSF?

a. It acts as a shock absorber of the brain and the spinal cord
b. It acts a insulator to maintain a constant fluid temperature
c. It acts a barrier to bacteria
d. It produces cerebral neurotransmitters

75. A client is suspected of having ALS (Amyotropic Lateral Sclerosis). To help confirm this
test, the nurse prepares the client for various diagnostic tests. The nurse expects the
physician to order:
a. Electromyography c. CT Scan
b. Doppler Scanning d. Lumbar Puncture

76. A client is admitted in a health care facility after a diagnosis of brain tumor. When reviewing
the chart the nurse notes a score of 3 in the verbal response of the client. Based on
Glasgow’s Coma Scale what does this rating tells the nurse?
a. The client can speak words but cannot sustain conversations
b. Groans on evoked pain
c. The client is oriented to time, place and person
d. The client engages in conversation but has inadequate speech content

77. A client is admitted in a health care facility after a motor cycle activity. When reviewing the
chart the nurse gives the client a score of 4 in the eye opening. Based on Glasgow’s Coma
Scale what does this rating means?
a. To speech c. No opening
b. Spontaneous d. To painful stimuli

78. A client with a seizure disorder comes to the clinic for routine checkup. Knowing that the
client is taking phenytoin (Dilantin) to control seizures. The nurse should assess which
common side effect of the medication?
a. Gingival hyperplasia c. HPN
b. Drowsiness d. Nausea and vomiting

79. All of the following are signs and symptoms of bacterial meningitis except:
a. Wandering c. Positive Kernig’s sign
b. Nuchal rigidity d. Brudzinski’s sign

80. A client experiences loss of consciousness, tongue biting, and incontinence, along with tonic
and clonic phases of seizure activity. The nurse should document this type of seizure as
which type of seizure?
a. Jacksonian c. Grand Mal
b. Petit mal d. Febrile

81. A client undergoes cerebral angiography for evaluation revealed subarachnoid hemorrhage.
Afterwards the nurse checks frequently for signs and symptoms of complications associated
with this procedure. Which findings indicate spasm or occlusion of a cerebral vessel by a
clot?
a. Nausea, vomiting and profuse sweating
b. Hemiplegia, seizures, decreased LOC
c. Difficulty of breathing and swallowing
d. Tachycardia, tachypnea and hypotension
 a. Dysphagia c. Difficulty in speaking
82. To test
b. the
Dyspnea
function of cranial nerve II the nurse should: d. Anopsia
a. Elicit the gag reflex
84. A client
b. Ask
withthe
extensive
client tohead
readinjury
the Snellen
was brought
chart to the ICU after craniotomy. Because
monitoring
c. AskoftoICP
identify
is thethe
priority
nonirritating
for the client
odors the
suchphysician
as coffee,inserts
tea, soap
ICP monitoring device.
Whatd.is Check
the normal
for shoulder
value of and
ICP?neck movements
a. 0 c. 25 to 35 mmHg
83. The b.
following
> 15 are characteristic of Myasthenic crisis except: d. 40 to 50 mmHg

85. A client is disoriented and restless after sustaining a concussion during car accident is
admitted to the hospital. Which nursing diagnosis takes highest priority for this client’s care
plan?
a. Disturbed sensory perception (vision)
b. Self-care deficit
c. Impaired verbal communication
d. Risk for injury

86. Cold applications for short period of time produce:

a. Local anesthesia
b. Peripheral vasodilatation
c. Depression of vital sign
d. Decreased blood viscosity

87. The injury to the brain is likely to cause death if it involves the:
a. Pons c. Midbrain
b. Medulla d. Thalamus

88. A Client is scheduled for EEG after having a seizure. Client preparation for this test includes
which of the following instructions?
a. “Don’t eat anything 12 hours before the test.”
b. “ Do not shampoo hair 24 hours before the test”
c. “Avoid stimulants and alcohol 24-48 hours before the test”
d. “Avoid thinking personal matters 24 hours before the test.”

89. A client with tumor on the occipital lobe will most likely experience:
a. Hemiparesis c. Personality changes
b. Receptive aphasia d. Visual changes

90. After sustaining head trauma, a client complains of hearing ringing noises. The nurse
recognizes that this assessment suggests injury of the:
a. Frontal lobe c. Cranial Nerve VI
b. Occipital lobe d. Cranial Nerve VIII

91. When a client is unconscious, the nurse should expect that the person is unable to:
a. Hear voices c. Move spontaneously
b. Control elimination d. React to painful stimuli

92. When caring for a client who has sustained a head injury, the nurse should assess for:
a. Decreased carotid pulses
b. Bleeding from the oral cavity
c. Altered level of consciousness
d. Absence of deep tendon reflexes

93. The nurse can best prevent foot drop in a client for whom bed rest has been prescribed by the
use of:
a. Splints c. Cradles
b. Blocks d. Sand bags

94. A client is diagnosed as having expressive aphasia. The nurse anticipates that the client will
have difficulty with:
a. Speaking and/or writing
b. Following specific instructions
c. Understanding speech and/or writing
d. Recognizing words for familiar objects
 95. As a part of planning of long term care for a client with expressive aphasia, the nurse should:
a. Help the client accept his disability as permanent
b. Begin helping the client associate words with physical objects
c. Wait for the client to initiate communication even if it takes a long time
d. Help family members accept the fact that they cannot verbally communicate with
the client

96. All of the following are medications for Trigeminal neuralgia except:
a. Phenytoin (Dilantin)
b. Metoclopramide (Plasil)
c. Carbamazepine (Tegretol)
d. Diazepam (Valium)

97. The nurse would expect a client with tic douloureux, to exhibit:
a. Multiple petechiae
b. Unilateral muscle weakness
c. Excruciating head and facial pain
d. Uncontrollable tremors of the eyelid

98. The following are signs of Parkinson’s disease except:

a. Bradykinesia
b. Tremors in the hands and fingers at rest
c. Slow but coordinated movements
d. Difficulty in swallowing and speaking

99. Nursing care of Bell’s palsy includes:

a. Managing incontinence
b. Assisting with ambulation
c. Active facial exercises
d. Maintaining seizure precaution

100. The nurse should expect a client with an exacerbation of multiple sclerosis to experience:
a. Double vision c. Flaccid paralysis
b. Resting tremors d. Mental retardation

“Only as high as I reach can I grow, only as far as I seek can I go, only as deep as I look can I
see, only as much as I dream can I be.”

--Karen Ravn--

PREPARED BY:

ARCON S. ALVAR, RN
INSTRUCTOR