Assessment and Management of Patients With Eye and Vision Disorders

Leslie Waterman, a 57-year-old corrections officer, is being seen at the ophthalmic group where you practice nursing. Leslie is concerned about his vision changes because recently, he has started to see distance much more clearly than nearby sights. What is the term used to describe his visual condition? a) Emmetropia b) Hyperopia c) Astigmatism d) Myopia

Hyperopia

A patient presents to the ED complaining of a chemical burn to both eyes. Which of the following is the priority nursing intervention? a) Irrigate both eyes. b) Assess the pH of the corneal surface. c) Assess visual acuity. d) Obtain the Material Safety Data Sheet (MSDS).

Irrigate both eyes

Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse? a) "It is nothing serious." b) "Simple surgery can fix this problem." c) "This is normal for anyone your age." d) "It means corrective lenses are required."

It means corrective lenses are required

The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find? a) Marked blurring of vision b) Watery ocular discharge c) Clear cornea d) Constricted pupil

Marked blurring of vision

Choice Multiple question - Select all answer choices that apply. When an impaled object is in the eye, which of the following steps should be taken to ensure that no further damage occurs? Select all that apply. a) Protect object from jarring b) Apply gentle pressure to the eye c) Apply a patch to the eye d) No attempt should be made to remove the object e) Use metal shield

No attempt should be made to remove the object Use metal shield Protect object from jarring

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder? a) Hyperopia since age 20 years b) History of respiratory disease c) Prolonged use of corticosteroids d) Age younger than 40 years

Prolonged use of corticosteroids

A client comes to the occupational health nurse complaining of eye irritation. The client works in a dusty, outdoor environment. Why should the nurse advise periodic blinking to this client? a) To clear the dust and particles from the surface of the eyes b) To minimize the impact of the wind on the eye and to trap foreign debris c) To prevent the collection of tears over the surface of the eye d) To control the amount of sunlight that enters the eye

To clear the dust and particles from the surface of the eyes

A patient's vision is assessed at 20/200. The patient asks what that means. Which of the following is the most appropriate response by the nurse? a) "You see an object from 20 feet away that a person with normal vision sees from 20 feet away." b) "You see an object from 200 feet away that a person with normal vision sees from 20 feet away." c) "You see an object from 200 feet away that a person with normal vision sees from 200 feet away." d) "You see an object from 20 feet away that a person with normal vision sees from 200 feet away."

You see an object from 20 feet away that a person with normal vision sees from 200 feet away

A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment? a. Ask the client where to store his or her self-care items. b. Keep personal care items where the nurse knows their location. c. Arrange the meal tray in a way that is easiest for the nurse to assist the client. d. Open all containers without prompting to be helpful.

a. Ask the client where to store his or her self-care items. Explanation: Ask the client's preference for where to store hygiene articles and other objects needed for self-care. Involving the client promotes his or her control over the environment. Personal care items should be kept in the same location at all times to provide the client with the ability to locate toiletries easily. At mealtime, describe where food is on the plate using the positions on the face of a clock. This measure assists the client to identify the location of food. Allow the client to open containers and offer help if needed. Having a choice facilitates independence.

A patient has been brought to the emergency room after being hit in the head with a baseball. The nurse should be alert to which of the following clinical manifestations of a detached retina? Select all that apply. a. Bright flashing lights b. Sudden onset of floaters c. Cobwebs d. Sensation of a curtain coming across vision of one eye e. Pain

a. Bright flashing lights b. Sudden onset of floaters c. Cobwebs d. Sensation of a curtain coming across vision of one eye Explanation: Patients may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do not complain of pain.

Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests? a. Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss b. Conducting various tests to determine the function and the structure of the eyes c. Determining if further action is warranted d. Advising the patient on the diet and exercise regimen to be followed

a. Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss Explanation: Although nurses may not be directly involved in caring for patients who are undergoing eye examinations and tests, it is essential that they ensure that patients receive eye care to preserve their eye function and/or prevent further visual loss. The nurse is not involved in conducting the various tests to determine the status of the eyes and in determining if further action is warranted. Patients who are to undergo eye examinations and tests are not required to modify their diet and exercise regimen.

The nurse is providing care to a client who has been admitted to the hospital for treatment of an infection. The client is visually impaired. Which of the following would be most appropriate for the nurse to do when interacting with the client? a. Face the client when speaking directly to him. b. Avoid using the terms "see" or "look." c. Talk to the client in a loud tone of voice. d. Touch the client before identifying himself or herself.

a. Face the client when speaking directly to him. Explanation: When interacting with a client with a visual impairment, the nurse should face the client and speak directly to the client using a normal tone of voice. It is not necessary to raise the voice unless the client asks the nurse to do so and it is not necessary to avoid the terms, "see" or "look" when interacting with the client. The nurse should identify himself or herself when approaching the client and before making any physical contact.

A client has received a diagnosis of hyperopia and is wondering if there is a physical condition that has caused these vision changes. In explaining hyperopia, what does the nurse indicate is the cause of this client's vision changes? a. eyeballs that are shorter than normal b. eyeballs that are longer than normal c. unequal curvatures in the cornea d. irregularly shaped corneas

a. eyeballs that are shorter than normal Explanation: Hyperopia results when the eyeball is shorter than normal, causing the light rays to focus at a theoretical point behind the retina.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important? a) Avoid washing face and eyes for first 24 hours. b) Apply protective patch to both eyes at bedtime. c) Avoid any activity that can increase intraocular pressure. d) Only sleep on back.

avoid any activity that can increase intraocular pressure

An elderly client is scheduled for cataract surgery and asks the nurse, "Will I need to wear pop-bottle lenses after surgery?" Which is the most appropriate response from the nurse? a. "Contact lenses are preferred by most clients after this surgery." b. "An implanted lens has replaced the need for corrective glasses." c. "No lens is necessary with cataract surgery." d. "They can make corrective lenses much thinner now."

b. "An implanted lens has replaced the need for corrective glasses." Explanation: Vision is usually restored after cataract surgery with an intraocular lens implant. Contact lenses can be used but can be burdensome for the elderly. Corrective glass lenses can cause a distortion of peripheral vision and only required one lens (over operative eye). To restore vision after cataract surgery, a lens is required.

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client? a. Visual field b. Amsler grid c. Slit lamp d. Ishihara polychromatic plates

b. Amsler grid Explanation: Clients with macular problems are tested with an Amsler grid. It is made up of a geometric grid of identical squares with a central fixation point. The examiner instructs the client to stare at the central fixation spot on the grid and report if they see any distortion of the squares. Clients with macular problems may say some of the squares are faded or wavy. An Ishihara polychromatic plate, visual field, or slit lamp test will not diagnose macular degeneration.

A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography? a. Hemoglobin and hematocrit b. BUN and creatinine c. Platelet count d. AST and ALT

b. BUN and creatinine Explanation: Angiography is done using fluorescein or indocyanine green as contrast agents. Fluorescein angiography is used to evaluate clinically significant macular edema, document macular capillary nonperfusion, and identify retinal and choroidal neovascularization (growth of abnormal new blood vessels) in age-related macular degeneration. It is an invasive procedure in which fluorescein dye is injected, usually into an antecubital vein. Prior to the angiography, the patient's blood urea nitrogen (BUN) and creatinine should be checked to ensure that the kidneys will excrete the contrast agent (Fischbach & Dunning, 2011).

The nures is assessing a client using an Amsler Grid. The nurse is assessing for which of the following? a. Visual field b. Macular problems c. Visual acuity d. Intraocular pressure

b. Macular problems Explanation: The Amsler grid is a test used to assess clients for macular problems. Visual acuity is tested using the Snellen chart. Intraocular pressure is measured using tonometry. Perimetry testing evaluates the field of vision.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as: a. Chronic open-angle. b. Normal tension. c. Acute angle-closure. d. Chronic angle-closure.

c. Acute angle-closure. Explanation: Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain.

It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye? a) 20/100 b) 20/50 c) 20/200 d) 20/150

20/200

A nurse is teaching a patient with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the patient to perform what action? A) Instill the medication in the conjunctival sac. B) Maintain a supine position for 10 minutes after administration. C) Keep the eyes closed for 1 to 2 minutes after administration. D) Apply the medication evenly to the sclera

A

The nurse has taken shift report on her patients and has been told that one patient has an ocular condition that has primarily affected the rods in his eyes. Considering this information, what should the nurse do while caring for the patient? A) Ensure adequate lighting in the patient's room. B) Provide a dimly lit room to aid vision by limiting contrast. C) Carefully point out color differences for the patient. D) Carefully point out fine details for the patient.

A

The nurse should recognize the greatest risk for the development of blindness in which of the following patients? A) A 58-year-old Caucasian woman with macular degeneration B) A 28-year-old Caucasian man with astigmatism C) A 58-year-old African American woman with hyperopia D) A 28-year-old African American man with myopia

A

A patient comes to the ophthalmology clinic for an eye examination. The patient tells the nurse that he often sees floaters in his vision. How should the nurse best interpret this subjective assessment finding? A) This is a normal aging process of the eye. B) Glasses will minimize this phenomenon. C) The patient may be exhibiting signs of glaucoma. D) This may be a result of weakened ciliary muscles.

A Floaters is a sign of retinal detachment, not glaucoma

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of? A) Adhere to the medication regimen B) participate in the decision-making process C) keep all follow-up appointments D) keep a record of eye pressure measurements

A) Adhere to the medication regimen

A 43-year-old woman tripped on a toy in her home, fell, and hit her head on the corner of a table. Shortly after her accident, she arrives at the ED, unable to see out of her left eye. She tells the nurse caring for her that her symptoms began with seeing spots or moving particles in her field of vision but she didn't think anything was wrong because she wasn't having any pain in her eye. Now, she is very upset that her vision will not return. What is the most likely cause of this client's symptoms? A) Retinal detachment B) Chalazion C) Eye trauma D) Angle-closure glaucoma

A) Retinal Detachment

A patient presents at the ED after receiving a chemical burn to the eye. What would be the nurse's initial intervention for this patient? A) Generously flush the affected eye with a dilute antibiotic solution. B) Generously flush the affected eye with normal saline or water. C) Apply a patch to the affected eye. D) Apply direct pressure to the affected eye.

B

During discharge teaching the nurse realizes that the patient is not able to read medication bottles accurately and has not been taking her medications consistently at home. How should the nurse intervene most appropriately in this situation? A) Ask the social worker to investigate alternative housing arrangements. B) Ask the social worker to investigate community support agencies. C) Encourage the patient to explore surgical corrections for the vision problem. D) Arrange for referral to a rehabilitation facility for vision training.

B

The nurse is providing health education to a patient newly diagnosed with glaucoma. The nurse teaches the patient that this disease has a familial tendency. The nurse should encourage the patient's immediate family members to undergo clinical examinations how often? A) At least monthly B) At least once every 2 years C) At least once every 5 years D) At least once every 10 years

B

The nurse's assessment of a patient with significant visual losses reveals that the patient cannot count fingers. How should the nurse proceed with assessment of the patient's visual acuity? A) Assess the patient's vision using a Snellen chart. B) Determine whether the patient is able to see the nurse's hand motion. C) Perform a detailed examination of the patient's external eye structures. D) Palpate the patient's periocular regions.

B

A patient is being discharged home from the ambulatory surgical center after cataract surgery. In reviewing the discharge instructions with the patient, the nurse instructs the patient to immediately call the office if the patient experiences what? A) Slight morning discharge from the eye B) Any appearance of redness of the eye C) A "scratchy" feeling in the eye D) A new floater in vision

D

A patient is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this patient's care? A) Antioxidant supplements, vitamin C and E, beta-carotene, and selenium B) Eyeglasses or magnifying lenses C) Corticosteroid eye drops D) Surgical intervention

D

The nurse is administering eye drops to a patient with glaucoma. After instilling the patient's first medication, how long should the nurse wait before instilling the patient's second medication into the same eye? A) 30 seconds B) 1 minute C) 3 minutes D) 5 minutes

D

The registered nurse taking shift report learns that an assigned patient is blind. How should the nurse best communicate with this patient? A) Provide instructions in simple, clear terms. B) Introduce herself in a firm, loud voice at the doorway of the room. C) Lightly touch the patient's arm and then introduce herself. D) State her name and role immediately after entering the patient's room.

D

The nurse asks a client to follow the movement of a pencil up, down, right, left, and both ways diagonally. The nurse is assessing which of the following? a) Pupillary reaction b) Eyelid drooping c) Eyeball oscillation movements d) Extraocular muscle function

Extraocular muscle function

A client is scheduled to have a cataract removed and an artificial lens implanted. What test would the nurse know would be useful in measuring for an intraocular lens implant in this client? a) Slit lamp b) Retinal angiography c) Visual field d) Ultrasonography

Ultrasonography

The school nurse is testing the kindergarten class with the Snellen chart. What is the nurse testing the children for? a) Near vision b) Color vision c) Hearing d) Visual acuity

Visual acuity

A 52-year-old woman comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate? a) "Most clients need to use the drops for only about a few months." b) "These drops are just the first step to make sure that your vision doesn't get worse." c) "You'll need to use the drops for the rest of your life to control the glaucoma." d) "If the drops don't work, surgery may be needed to cure your condition."

You'll need to used the drops for the rest of your life to control the glaucoma

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate? a. "You'll need to use the drops for the rest of your life to control the glaucoma." b. "These drops are just the first step to make sure that your vision doesn't get worse." c. "Most clients need to use the drops for only about a few months." d. "If the drops don't work, surgery may be needed to cure your condition."

a. "You'll need to use the drops for the rest of your life to control the glaucoma." Explanation: The client is demonstrating a lack of understanding about the condition and its treatment. The nurse needs to provide additional information to the client that the condition can be controlled but not cured. The statement about lifelong therapy would be most appropriate. Eye medications would most likely be needed for the long term, not just a few months. Surgery may be used in conjunction with medication therapy; however, neither method cures the condition. The goal of therapy is to reduce the intraocular pressure to prevent optic nerve damage. In some clients, medication may be all that is needed. In other cases, additional or combintation treatment with surgery or laser procedures may be necessary.

Which feature should a nurse observe during an ophthalmic assessment? a. Appearance of the external eye b. Internal eye function c. Visual acuity d. Intraocular pressure

a. Appearance of the external eye Explanation: During an ophthalmic assessment, the nurse should examine the appearance of the external eye and the pupil responses in the client. A qualified examiner determines internal eye function, visual acuity, and intraocular pressure.

A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate? a. Explain the therapeutic effect and expected outcome of the medication. b. Talk with the doctor about switching to a different glaucoma medication. c. Administer the medication immediately. d. Refer the patient to the emergency department.

a. Explain the therapeutic effect and expected outcome of the medication. Explanation: The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.

Which of the following would not be included as a marker of medication effectiveness in glaucoma control? a. Opacity of the lens b. Visual field c. Appearance of optic nerve head d. Lowering intraocular pressure (IOP) to target pressure

a. Opacity of the lens Explanation: Opacity of the lenses relates to cataract formation. The main markers of the efficacy of the medication in glaucoma control are lowering of the IOP to the target pressure, appearance of the optic nerve head, and the visual field.

Which of the following would be an inaccurate clinical manifestation of a retinal detachment? a. Pain b. Bright flashing lights c. Sudden onset of a greater number of floaters d. Cobwebs

a. Pain Explanation: Patient may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do no complain of pain.

Nursing students are reviewing information about the causes associated with low vision and blindness. The students demonstrate a need for additional review when they identify which of the following as a common cause in older adults? a. Presbyopia b. Macular degeneration c. Glaucoma d. Diabetic retinopathy

a. Presbyopia Explanation: Presbyopia refers to the loss of accomodative power in the lens with age. It is not a common cause of low vision and blindness. The most common causes of low vision and blindness among adults 40 years and older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts.

A client with glaucoma has been given a prescription for a mydriatic drug. What is a priority action of the nurse? a. Tell the physician. b. Nothing. c. Have the client fill the prescription. d. Have the client ask the physician for another drug.

a. Tell the physician. Explanation: Mydriatics (drugs that dilate the pupil) must never be administered to clients with glaucoma. The nurse should tell the physician right away. The client should not fill the prescription. The client should not ask the physician for another prescription.

A client comes to the clinic for a routine examination. After obtaining the ocular history, which of the following would the nurse do next? a. Test the client's visual acuity. b. Prepare the client for a slit-lamp examination. c. Perform direct ophthalmoscopy. d. Examine the external eye.

a. Test the client's visual acuity. Explanation: After obtaining the client's ocular history, the nurse would test the client's visual acuity. Then the nurse would examine the client's external eye. Direct ophthalmoscopy would follow, and then other examinations, such as a slit-lamp examination, would be done.

When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is: a. The presence of halos around lights. b. Pain associated with a purulent discharge. c. Diminished acuity. d. A significant loss of central vision.

a. The presence of halos around lights. Explanation: Most patients are unaware that they have glaucoma until they experience visual changes and vision loss. Usually the patient notices blurred vision and the presence of "halos" around lights.

Which features should a nurse observe during an ophthalmic assessment? Select all that apply. a. external eye appearance b. pupil responses c. visual acuity d. intraocular pressure

a. external eye appearance b. pupil responses Explanation: During an ophthalmic assessment, the nurse should examine the external appearance of the eye and the pupil responses. Intraocular pressure and visual acuity involve a more complex examination and would be performed by a vision specialist.

An 8th grade boy comes to the school nurse and tells the nurse that he had an eye exam the day before. He says the eye doctor told him he had astigmatism and that meant his eyeball wasn't shaped right. The boy is concerned because he says he went home and looked in the mirror and both eyes looked just alike. What is the school nurse's best response? a. "Astigmatism means that the lens of the eye is more of an oval shape than the lens in most eyes." b. "Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes." c. "Astigmatism means that the eye is shaped more like an olive than most eyes." d. "Astigmatism means that the inside of the eye is shaped differently than the inside of most eyes."

b. "Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes." Explanation: Astigmatism is visual distortion caused by an irregularly shaped cornea. Many people have both astigmatism and myopia or hyperopia. Options B, C, and D are incorrect because they are not the best answer.

After surgery for removal of cataract, a client is being discharged, and the nurse has completed discharge instruction. Which client statement indicates that the outcome of the teaching plan has been met? a. "Dots or flashing lights in my vision are to be expected for the first few days." b. "I should avoid pulling or pushing any object that weighs more than 15 lbs." c. "I need to keep the eye patch on for about a week after surgery." d. "I need to wear sunglasses for the first 3 to 4 days even when I'm inside."

b. "I should avoid pulling or pushing any object that weighs more than 15 lbs." Explanation: After cataract surgery, the client needs to avoid lifting, pulling, or pushing any object that weighs more than 15 pounds to prevent putting excessive pressure on the surgical site. Sunglasses should be worn when outdoors during the day because the eye is sensitive to light. Dots, flashing lights, a decrease in vision, pain, and increased redness need to be reported to the physician immediately. The eye patch is worn for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks.

The nurse is obtaining a history on a client stating the inability to read the newspaper and even seeing detail when looking at an image. Which assessment test would add additional data for a diagnosis? a. Assess vision on the Snellen chart. b. Assess peripheral vision. c. Assess color vision. d. Assess if the pupils are equal and reactive to light.

b. Assess peripheral vision. Explanation: The client states symptoms of the inability to discriminate letters, words, and details of an image, indicating the degeneration of the macula. If the macula is damaged, the client will only have the ability to see movement and gross objects in the peripheral fields. Assessing the peripheral vision will add essential information. The other visual tests are not as important at this time.

A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale? a. Blinking keeps substances from entering the eye. b. Blinking causes the eye drop to be expelled from the conjunctival sac. c. Blinking limits the size of the conjunctival sac for the needed amount of eye drop. d. Blinking slows absorption of the instilled eye drops.

b. Blinking causes the eye drop to be expelled from the conjunctival sac. Explanation: Blinking expels an instilled eye drop from the conjunctival sac, which interferes wtih the efficacy of the medication. Blood-ocular barriers keep foreign substances from entering the eye. The size of the conjunctival sac does change with blinking. It can hold only 50 uL.

An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: a. Farsightedness. b. Blurred distance vision. c. A shorter depth to the eyeball. d. Eyes that are shallow.

b. Blurred distance vision Explanation: People who have myopia are said to be nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. Myopic people experience blurred distance vision.

The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient? a. It does not work as rapidly as eye drops do. b. Blurred vision results after application. c. It has a lower concentration than eye drops. d. It has more side effects than eye drops.

b. Blurred vision results after application. Explanation: Ophthalmic ointments have extended retention time in the conjunctival sac and provide a higher concentration than eye drops. The major disadvantage of ointments is the blurred vision that results after application. In general, eyelids and eyelid margins are best treated with ointments.

The nurse is caring for geriatric clients who state that they are prescribed reading glasses. Some individuals state needing assistance with seeing writing far away, and others need assistance with closer vision. The nurse is correct to understand that the aging visual changes relate to which of the following? a. Changes in refraction b. Changes in accommodation c. Changes in central vision d. Changes in the visual field

b. Changes in accommodation Explanation: The changes that occur in vision during aging, which include difficulty reading and the need for reading glasses, include changes in accommodation. Accommodation occurs when the ciliary muscles contract or relax to focus an image on the retina.

The nurse is caring for four clients who have come to the clinic for eye exams. The nurse would know that which client is visually impaired? a. Client D- eyes test at 20/40 and 20/60 b. Client B - eyes test at 20/100 and 20/200 c. Client A - eyes test at 20/40 and 20/100 d. Client C - eyes test at 20/30 and 20/50

b. Client B - eyes test at 20/100 and 20/200 Explanation: The term visually impaired is used to describe a BCVA between 20/70 and 20/200 in the better eye with the use of glasses. Options A, C, and D do not meet the criteria for visual impairment.

Which of the following is the correct advice regarding food for a patient who underwent a cataract surgery? a. Eat spinach or collard greens two to four times per week. b. Eat soft, easily chewed foods. c. Increase intake of vitamins A and C. d. Eat red meat two to four times per week.

b. Eat soft, easily chewed foods. Explanation: The nurse should advise patients recovering from cataract surgery to eat soft, easily chewed foods until healing is complete to avoid tearing from excessive facial movements. Eating spinach or collard greens two to four times per week reduces the risk of macular degeneration and increasing the intake of vitamins A and C is essential for preventing cataracts; however, these have no implications on recovery from cataract surgery.

A nurse is preparing a presentation for a local senior citizen's group about changes in the eye that accompany aging. Which of the following would the nurse most likely include? Select all that apply. a. Increased orbital fat b. Loss of eyelid skin elasticity c. Development of lens opacities d. Loss of lens accommodative power e. Expansion of the vitreous body

b. Loss of eyelid skin elasticity c. Development of lens opacities d. Loss of lens accommodative power Explanation: Age-related changes in the eye include loss of accommodative power of the lens, development of opacities in the lens, decreased orbital fat, shrinkage of the vitreous body, and loss of skin elasticity.

A client has just been diagnosed with glaucoma. What teaching should the nurse include with this client? a. How long they have to wear dark glasses. b. Maintain regular bowel habits. c. What vegetables to eat. d. When they can read again.

b. Maintain regular bowel habits. Explanation: Instructions for the client with glaucoma include the following: Obtain assistance from a family member, relative, or friend if you have trouble instilling eyedrops; Avoid all drugs that contain atropine; Check with physician or pharmacist before using any nonprescription drug; preparations for cold or allergy symptoms may contain an atropine-like drug; Maintain regular bowel habits; straining at stool can raise IOP; Avoid heavy lifting and emotional upsets (especially crying) because they increase IOP.

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal? a. Ultrasonography b. Retinal Angiography c. Retinal Imaging d. Retinoscopy

b. Retinal Angiography Explanation: The nurse is most correct to instruct the client that his skin and urine may turn yellow following a retinal angiography. Sodium fluorescein is a water-soluble dye that is injected into a vein. The dye then travels to the retinal arteries and capillaries, where pictures are obtained of the vascular supply. The other options do not include a dye injection.

The nurse is teaching a parent how to instill drops in their 12-year-old son's eyes. Which action would the nurse teach is accomplished first? a. Close the eye gently. b. Tilt the head slightly backward. c. Instill the prescribed number of drops into the conjunctival pocket. d. Do not allow the tip of the container to touch the eye.

b. Tilt the head slightly backward. Explanation: To instill eye drops: Tilt the head slightly backward and toward the eye in which the medication is to be instilled; Do not allow the tip of the container to touch the eye; Instill the prescribed number of drops into the conjunctival pocket, or apply a thin ribbon of ointment directly into the conjunctival pocket, beginning at the inner corner and moving outward; Close the eye gently. Options A, C, and D are not the first action in instilling eye drops.

A client is color blind. The nurse understands that this client has a problem with: a. rods. b. cones. c. lens. d. aqueous humor.

b. cones. Explanation: Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can't discriminate color. The lens is responsible for focusing images. Aqueous humor is a clear watery fluid and isn't involved with color perception.

A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition? a. astigmatism b. hyperopia c. myopia d. emmetropia

b. hyperopia Explanation: Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close.

A client is having a routine eye examination. The procedure being performed is done by using an instrument to indent or flatten the surface of the eye. This is known as ________ and it is routinely done to test for ________. a. retinoscopy; cataracts b. tonometry; intraocular pressure c. retinoscopy; detached retina d. tonometry; macular degeneration

b. tonometry; intraocular pressure Explanation: The procedure being performed is known as tonometry and it measures intraocular pressure.

A nurse is performing an eye examination. Which question would not be included in the examination? a. Have you experienced blurred, double, or distorted vision?" b. "What medications are you taking?" c. "Are you able to raise both eyebrows?" d. "Do any family members have any eye conditions?"

c. "Are you able to raise both eyebrows?" Explanation: Asking to raise both eyebrows is a test for cranial nerve VII, the facial nerve, and would not be included in an eye assessment.

A client asks the nurse what they can do to improve her vision after having a cataract removed. What is the nurse's best response? a. "There is nothing you can do to improve your vision." b. "To improve your vision, you need to eat more beta carotene." c. "Having an intraocular lens implanted at the time of surgery is the best thing you can do." d. "To improve your vision, you need to rest more."

c. "Having an intraocular lens implanted at the time of surgery is the best thing you can do." Explanation: Insertion of an IOL at the time of cataract surgery is the most often used method for improving vision. Most commonly, IOLs are inserted behind the iris. Ultrasonography is performed before surgery to determine the size and prescription of the IOL. A monofocal (single-vision) or multifocal lens is implanted to correct presbyopia. Eating more beta carotene and resting more will not improve your vision after cataract surgery. Option A is incorrect because it is an untrue statement.

A patient has had cataract extractions and the nurse is providing discharge instructions. What should the nurse encourage the patient to do at home? a. Maintain bed rest for 1 week. b. Lie on the stomach while sleeping. c. Avoid bending the head below the waist. d. Lift weights to increase muscle strength.

c. Avoid bending the head below the waist. Explanation: The nurse should encourage the patient to avoid bending or stooping for an extended period. Keep activity light. Avoid lying on the side of the affected eye the night after surgery. Avoid lifting, pushing, or pulling objects heavier than 15 pounds.

A client who had a corneal transplant a few months ago arrives at the emergency department reporting eye discomfort. When assessing the client, which of the following would lead the nurse to suspect graft failure? a. Reduced tearing b. Pale conjunctiva c. Blurred vision d. Halos around lights

c. Blurred vision Explanation: Signs and symptoms of graft failure include eye discomfort, blurred vision, tearing, and redness of the eye. Halos around lights are associated with glaucoma.

Which is be an accurate clinical manifestation of a retinal detachment? a. Sudden onset of intense pain b. Colored halos around lights c. Bright flashing lights d. Chemosis and redness of the sclera

c. Bright flashing lights Explanation: Clients can complain of bright flashing lights as a clinical manifestation of retinal detachment. Clients with retinal detachment do not complain of pain. Colored halos around lights is specific to glaucoma. Chemosis does not usually occur with retinal detachment.

Miotic eye solutions are often ordered in the treatment of glaucoma. Which is the best nursing rationale for the use of this medication? a. Constricts intraocular vessels b. Paralyzes ciliary muscles c. Constricts pupil d. Dilates the pupil

c. Constricts pupil Explanation: A miotic agent works by constricting the pupil and pulling the iris away from the drainage channels so that the aqueous fluid can escape. These medications increase outflow and decrease intraocular pressure. Cycloplegics paralyze the ciliary muscles of the eye. Mydriatics drugs are used to dilate the pupil and are contraindicated in glaucoma.

Chemical burns of the eye are immediately treated by: a. Administering local anesthetics and antibacterial drops for 24 to 36 hours. b. Applying hot compresses at 15-minute intervals. c. Flushing the lids, conjunctiva, and cornea with tap water or normal saline. d. Cleansing the conjunctiva with a small cotton-tipped applicator.

c. Flushing the lids, conjunctiva, and cornea with tap water or normal saline. Explanation: The immediate response is to always flush the affected eyelid and eye with normal saline or tap water to dilute the effectiveness of the agent that is causing the burn.

The nurse should monitor for which manifestation in a client who has undergone LASIK? a. Excessive tearing b. Cataract formation c. Halos and glare d. Stye formation

c. Halos and glare Explanation: Symptoms of central islands and decentered ablations can occur after LASIK surgery; these include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation.

The nurse is obtaining a visual history from a client who has noted an increase in glare and changes in color perception. Which assessment would the nurse anticipate to confirm a definitive diagnosis? a. Identification of yellowish aging spot on the retina b. Identification of redness of the sclera c. Identification of opacities on the lens d. Identification of white circle around the cornea

c. Identification of opacities on the lens Explanation: The client states an increased glare and changes in color perception, which indicates a cataract. Identification of opacities on the lens confirms that diagnosis. A white circle around the cornea and a yellowish aging spot are also symptoms of aging but with different symptoms. Redness of the sclera indicates irritation.

An ophthalmologist tells a patient that he has a cataract. The nurse explains to the patient that this means there is: a. Distortion and loss of central vision. b. A tendency for the retina to tear. c. Interference with focusing of a sharp image. d. Increased corneal exposure.

c. Interference with focusing of a sharp image. Explanation: Refer to Table 48-1 in the text for the distinguishing functional changes associated with a cataract.

A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness? a. Rosenbaum b. Jaeger c. Ishihara d. Snellen

c. Ishihara Explanation: Color vision is assessed with Ishihara polychromatic plates. The client receives a series of cards on which the pattern of a number is embedded in a circle of colored dots. The numbers are in colors that color-blind persons commonly cannot see. Clients with normal vision readily identify the numbers. The Jaeger and the Rosenbaum test near vision while the Snellen tests far vision.

During a routine eye examination, a patient complains that she is unable to read road signs at a distance when driving her car. What should the patient be assessed for? a. Astigmatism b. Anisometropia c. Myopia d. Presbyopia

c. Myopia Explanation: Some people have deeper eyeballs, in which case the distant visual image focuses in front of, or short of, the retina; those with myopia Impaired Vision are said to be nearsighted and have blurred distance vision.

The nurse screens a middle-aged client's vision and notes that the client has difficulty reading print when it is placed at arm's length. The client tells the nurse that the same problem happened to his father. The nurse is aware that the health care practitioner will refer this client to an ophthalmologist for correction of what vision problem? a. Astigmatism b. Hyperopia c. Presbyopia d. Myopia

c. Presbyopia Explanation: Presbyopia is an age-related condition that results in difficulty with near vision. The individual will try to read materials by holding the arms farther and farther away from the face. Myopia is ALSO known as nearsightedness and hyperopia is known as farsightedness. Astigmatism is a visual distortion caused by an irregularly shaped cornea.

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is: a. The abrupt onset of symptoms. b. Reporting that a straight line appears crooked. c. The appearance of tiny, yellow spots in the field of vision. d. Reporting that letters in words appear broken.

c. The appearance of tiny, yellow spots in the field of vision. Explanation: Drusen are tiny yellow spots that patients who have dry AMD report.

The nurse is evaluating the client while taking the color vision test. Which response would the nurse anticipate when caring for a client with normal color vision? a. The nurse would anticipate no differentiation in between colors. b. The nurse would anticipate a cross-eyed appearance. c. The nurse would anticipate the client identifying numbers and shapes. d. The nurse would anticipate responding to the color names in the pictures.

c. The nurse would anticipate the client identifying numbers and shapes. Explanation: The nurse is correct to anticipate the client being able to identify numbers and shapes dictated by different color codes. The other options do not test for color vision or indicate an inability to differentiate colors.

A client is examined due to recent vision changes and is diagnosed with myopia. What is the cause of this client's vision change? a. shortened eyeballs b. irregularly shaped corneas c. elongated eyeballs d. unequal curvatures in the cornea

c. elongated eyeballs Explanation: Myopia occurs in people with elongated eyeballs.

Which would be an advanced stage finding in a client with wet macular degeneration? a. blurred vision when reading or doing close up work b. distortion of vision c. inability to see images by looking at them directly d. diminished perception of color

c. inability to see images by looking at them directly Explanation: When the macula becomes irreparably damaged, clients compare their vision to a target in which the bulls-eye area of the image is absent. In clients with dry macular degeneration, blurred vision is the first symptom of disease. Vision distortion is an early finding in clients with wet macular degeneration.

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client: a. allows the tip of the container to touch the eyelid while administering the medication. b. wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze. c. pulls the tissue near the cheek downward to instill medication. d. rubs the eye after administering medication.

c. pulls the tissue near the cheek downward to instill medication. Explanation: Pull the cheek downward to form a sack in the lower lid. Instill the drops into the conjunctival pocket. The lid and lashes would be wiped in a direction away from the nose to avoid contamination. The tip of the container will be contaminated if it touches eye or eyelid. Do not rub the eye because it may irritate the eye.

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer? a. "This test measures visual acuity." b. "This test measures how well your eyes move." c. "This test is to see how well your eyes are aging." d. "This test measures peripheral vision and detects gaps in the visual field."

d. "This test measures peripheral vision and detects gaps in the visual field." Explanation: A visual field examination OR perimetry test measures peripheral vision and detects gaps in the visual field. It examines the vision from the corners of ur eye

The nurse is precepting a nursing student when a new client comes to the eye clinic. The client explains that she thinks she may have a corneal abrasion. The nurse should explain what to the student nurse? a. "To detect corneal abrasions, an opthalmoscope is used." b. "To detect corneal abrasions, ultrasonography is used." c. "To detect corneal abrasions, retinal angiography is used." d. "To detect corneal abrasions, a slit lamp is used."

d. "To detect corneal abrasions, a slit lamp is used." Explanation: A slit lamp is a binocular microscope that magnifies the surface of the eye. A beam of light, narrowed to a slit, is directed at the cornea, facilitating an examination of structures and fluid in the anterior segment of the eye. This examination is used to identify disorders such as corneal abrasions, iritis, conjunctivitis, and cataracts. Options A, B, and D are not used to detect corneal abrasions.

A nurse practitioner examines a patient and documents a best corrected visual acuity (BCVA) ratio in his better eye that qualifies him for government financial assistance based on the definition of legal blindness. What is that ratio? a. 20/120 b. 20/140 c. 20/160 d. 20/200

d. 20/200 Explanation: Legal blindness is a condition of impaired vision in which a person has a BCVA that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20 degrees or less.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important? a. Apply protective patch to both eyes at bedtime. b. Only sleep on back. c. Avoid washing face and eyes for first 24 hours. d. Avoid any activity that can increase intraocular pressure.

d. Avoid any activity that can increase intraocular pressure. Explanation: For approximately 1 week, the client should avoid any activity that can cause an increase in intraocular pressure. Clients may sleep on back or unaffected side. Clients may use a clean damp cloth to remove eye discharge and wash face. An eye shield is often ordered for the first 24 hours and during the night to prevent rubbing or trauma to the operative eye.

A client diagnosed with a cataract comes into the clinic. What assessments should the nurse observe in this client? a. A swollen lacrimal caruncle b. A burning sensation and the sensation of an object in the eye c. Inability to produce sufficient tears d. Blurred or cloudy visual image

d. Blurred or cloudy visual image Explanation: When a cataract forms, the light is blocked from reaching the macula and the visual image becomes blurred or cloudy. The client does not experience any burning or the sensation of an object in the eye, an inability to produce sufficient tears, or a swollen lacrimal caruncle.

Which nursing intervention should be included during the assessment of a client with an eye disorder? a. Instruct the client to stare at the central fixation spot on an Amsler grid and report if he or she sees any distortion of the squares. b. Examine the retina with a direct ophthalmoscope. c. Use a tonometer to indent or flatten the surface of the eye. d. Check the extraocular muscles by instructing the client to keep his or her head still when following an object.

d. Check the extraocular muscles by instructing the client to keep his or her head still when following an object. Explanation: When assessing a client with an eye disorder, the nurse should check the extraocular muscles by instructing the client to keep his or her head still when following an object. A qualified examiner, not the nurse, should assess the client by examining the retina with a direct ophthalmoscope, using a tonometer, or an Amsler grid.

A client comes to the eye clinic for an examination. The client tells the nurse that his vision is like a target with the bull's eye area of the image missing. What would the nurse suspect? a. Retinal detachment b. Fractured orbit c. Conjunctivitis d. Macular degeneration

d. Macular degeneration Explanation: When the macula becomes irreparably damaged, clients compare their vision to a target in which the bull's-eye area of the image is absent. Retinal detachment, a fractured orbit, and conjunctivitis do not present with vision likened to a target with the bull's eye portion missing.

There are four major types of ophthalmic procedures to complete a glaucoma examination. If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for: a. Gonioscopy. b. Perimetry. c. Tonometry. d. Ophthalmoscopy.

d. Ophthalmoscopy. Explanation: Four major types of examinations are used in glaucoma evaluation, diagnosis, and management: tonometry to measure the IOP, ophthalmoscopy to inspect the optic nerve, gonioscopy to examine the filtration angle of the anterior chamber, and perimetry to assess the visual fields.

Which of the following is the overall aim of glaucoma treatment? a. Reattach the retina b. Optimize the patient's remaining vision c. Reverse optic nerve damage d. Prevent optic nerve damage

d. Prevent optic nerve damage Explanation: The aim of all glaucoma treatment is prevention of optic nerve damage. Although treatment cannot reverse optic nerve damage, further damage can be controlled. Reattachment of the retina is not part of glaucoma treatment.

A client comes to the clinic for an ophthalmologic screening, which will include measurement of intraocular pressure (IOP) with a tonometer. Which statement about this procedure is true? a. The client will direct the gaze forward while the physician rests the tonometer on the scleral surface. b. The client should wear dark glasses for several hours after the procedure. c. A topical anesthetic will be administered after the examination. d. The tonometer will register the force required to indent or flatten the corneal apex.

d. The tonometer will register the force required to indent or flatten the corneal apex. Explanation: The tonometer will register the force required to indent (using Schiotz's tonometer) or flatten (using an applanation tonometer) the corneal apex. This force varies with firmness of the eye, which fluctuates with IOP. Although the client does direct the gaze forward during tonometry, the tonometer rests on the surface of the cornea, not the sclera. Topical anesthetic drops are administered before, not after, the examination. The client should wear dark glasses after pupil dilation, not tonometry, to protect the eyes from light.

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment? a. To eliminate the need for medical care b. To hasten formation of scar tissue c. To serve as a stopgap measure until help arrives d. To prevent vision loss

d. To prevent vision loss Explanation: Prolonged eye irrigation after a chemical burn is the most effective way to prevent formation of permanent scar tissue and thus help prevent vision loss. After a potentially serious eye injury, the victim should always seek medical care. Eye irrigation isn't considered a stopgap measure.

A client having an eye exam asks the nurse what she can do to help prevent cataracts. What dietary recommendations should a nurse give to a client to prevent cataracts? a. Calcium with vitamin D b. Foods rich in purine c. Fat-free foods d. Vitamins A and C

d. Vitamins A and C Explanation: Studies have shown that vitamins A and C are essential for preventing cataracts. Calcium with vitamin D, foods rich in purine, and fat-free foods have no implications on prevention of cataracts.

A client with multiple sclerosis is being seen by a neuroophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a: a. slit-lamp examination b. retinal angiography c. color vision test d. perimetry test

d. perimetry test Explanation: A visual field test or perimetry test measures peripheral vision and detects gaps in the visual field.

When the client tells the nurse that his vision is 20/200 and then asks what that means, the nurse informs the client that a person with 20/200 vision a. sees an object from 200 feet away that a person with normal vision sees from 20 feet away. b. sees an object from 20 feet away just like a person with normal vision. c. sees an object from 200 feet away just like a person with normal vision. d. sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

d. sees an object from 20 feet away that a person with normal vision sees from 200 feet away (must be 20 ft away, rather than 200, to see) Explanation: The fraction 20/20 is considered the standard of normal vision. Most people can see the letters on an eye chart designated as 20/20 from a distance of 20 feet.

A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should: a) provide instructions on eye patching. b) demonstrate eyedrop instillation. c) assess the client's visual acuity. d) teach about intraocular lens cleaning.

demonstrate eyedrop instillation

Which of the following features should a nurse observe during an ophthalmic assessment? a) Internal eye function b) Visual acuity c) External eye appearance d) Intraocular pressure

external eye apperance

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the fundus and interior of the eye? A) retinoscope B) ophthalmoscope C) amsler grid D) tonometer

ophthalmoscope

The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment? a) The skin around the eyes will be more elastic. b) The depth of the eyeball will be increased, leading to myopia. c) The power of the lens to accommodate will be decreased. d) Increased fat will be around the orbit.

the power of the lens to accommodate will be decreased.