Two systems, one nursing goal: preserve function. Most of these questions are decided by a single phrase in the stem — so learn the signature findings first.
| Words in the stem | Diagnosis | Urgency |
|---|---|---|
| Curtain across the vision · flashes · new floaters | Retinal detachment | Emergency |
| Halos around lights · cloudy · faded colour · glare | Cataract | Elective surgery |
| Peripheral loss → tunnel vision · painless · gradual | Open-angle glaucoma | Lifelong treatment |
| Central loss · straight lines look wavy | Macular degeneration | Wet AMD is urgent |
| Severe eye pain · halos · nausea · fixed mid-dilated pupil | Acute angle-closure glaucoma | Emergency |
One word each: Curtain = detachment · Halos = cataract · Tunnel = glaucoma · Centre = macular.
Close the eye gently, then press the inner canthus for 30–60 seconds. That stops the drop draining down the tear duct into the bloodstream.
With a beta blocker like timolol, skipping it can cause bradycardia, hypotension and bronchospasm — dangerous in asthma, COPD or heart block.
Pressing the lower lid instead of the inner corner is the classic wrong answer.
Dilating drops blur vision and increase light sensitivity for hours — arrange a driver and sunglasses.
| Open-angle (chronic) | Angle-closure (acute) | |
|---|---|---|
| Onset | Slow, insidious | Sudden |
| Pain | None | Severe eye pain and headache |
| Vision | Peripheral loss → tunnel vision | Blurred with halos, rapid decline |
| Pupil | Normal | Fixed, mid-dilated |
| Other | Usually bilateral, often symptom-free | Red eye, nausea and vomiting |
| Urgency | Lifelong pressure control | Ocular emergency |
Open = silent. Closed = screaming. That is why glaucoma questions look contradictory — “painless peripheral loss” and “severe pain” are both correct, for different types. The stem tells you which.
Recognise: severe eye pain or headache · red eye, blurred vision, halos · nausea and vomiting · fixed mid-dilated pupil · rapid vision decline.
Act: notify the provider immediately · give ordered pressure-lowering therapy · treat pain and nausea · do not delay definitive ophthalmic care.
Delay means permanent vision loss.
Damage is irreversible; treatment only protects what is left. Glaucoma can also occur at normal pressure.
The nursing priority is lifelong follow-up even when she feels completely well.
A cataract is a cloudy lens — not a retinal disorder. Painless and gradual.
Risk: age, diabetes, smoking, steroids, UV exposure, trauma, prior eye surgery.
Outpatient; the cloudy lens is removed through a small incision and an intraocular lens is inserted.
Report vision loss, severe pain, marked redness, flashes, or new floaters — those suggest a detachment.
| Type | Signs | Care |
|---|---|---|
| Allergic | Itching, watery — not contagious | Avoid triggers, cold compresses, antihistamine drops |
| Viral | Watery, URI symptoms — highly contagious | Supportive care and strict precautions. Antibiotics do not treat viruses. |
| Bacterial | Purulent discharge, matted lids | Complete the antibiotics; discard contaminated make-up |
All types: wash hands before and after eye care · do not share towels, make-up, drops or pillowcases · stop contact lenses until cleared and replace lenses and cases.
Red flags: pain, photophobia, reduced vision, or contact-lens wear — prompt evaluation.
| Type | Where | Examples |
|---|---|---|
| Conductive | Outer or middle ear — transmission blocked | Cerumen, otitis media, otosclerosis |
| Sensorineural | Cochlea or CN VIII — hair cell or nerve damage | Ageing, noise, ototoxicity |
| Mixed | Both together |
Weber — fork at midline, ask where the sound is heard.
Rinne — compare bone conduction at the mastoid with air conduction at the canal.
Expected: air > bone.
Conductive loss lateralises to the BAD ear. Sensorineural lateralises to the GOOD ear.
Gradual, usually bilateral age-related loss. High-frequency speech sounds go first — which is exactly why shouting does not help.
Causes reversible conductive loss: fullness, hearing change, tinnitus, cough.
No cotton swabs. No ear candles.
Avoid irrigation with suspected perforation, tubes, or prior ear surgery — refer instead.
Ear pain, tugging, fever, fullness, bulging red tympanic membrane, reduced hearing.
Normal otoscopic exam: pearly grey, translucent, intact, visible malleus and cone of light. Fluid or bubbles behind the membrane is the abnormal finding — soft cerumen and a visible malleus are normal.
Tympanoplasty reconstructs the membrane; mastoidectomy removes infected mastoid air cells or cholesteatoma.
Expect hearing to be worse before it is better — oedema and packing. Monitor temperature, drainage, facial movement and vertigo; fall precautions.
Low salt (often 1,500–2,000 mg/day), no caffeine, move slowly. Avoid alcohol and nicotine too. “Increase sodium” and “increase caffeine” are always wrong answers.
New tinnitus is the early warning sign. It triggers a prompt medication review — not abrupt self-discontinuation.
Document a baseline hearing and balance assessment, review renal function and dose, and ask about tinnitus, fullness and dizziness each shift.
| If the stem says… | Think… |
|---|---|
| Curtain across the visual field | Retinal detachment — emergency |
| Halos around lights, faded colours | Cataract |
| Tunnel vision, painless, gradual | Open-angle glaucoma |
| Severe eye pain + nausea + fixed mid-dilated pupil | Acute angle closure — emergency |
| Straight lines look wavy | Macular degeneration — Amsler grid |
| Press the inner canthus 30–60 seconds | Eye drops, especially timolol |
| Pain when the tragus is moved | Otitis externa |
| Bulging red tympanic membrane, fullness | Acute otitis media |
| Vertigo + tinnitus + fluctuating hearing loss + fullness | Ménière disease |
| Weber lateralises to the bad ear | Conductive loss |
| Weber lateralises to the good ear | Sensorineural loss |
| New ringing in the ears on gentamicin | Ototoxicity — report it |
| No bending, lifting, straining; sneeze with the mouth open | After eye or middle-ear surgery |