Cataracts & Age-related Macular Degeneration (AMD) Study TEST

A patient has arrived for a post-op visit to the clinic after cataract surgery in the left eye. Which statement by the patient causes concern and requires further investigation? A. "My left eye has experienced some itchiness." B. "The vision in my left eye was blurry for a few days." C. "I have been experiencing flashes of light in my left eye." D. "I had pain in my left eye after surgery and took Acetaminophen."

C. "I have been experiencing flashes of light in my left eye." Rationale: The answer is C. A possible complication after cataract surgery is retinal detachment. This could present with the patient experiencing flashes of light or seeing floaters in the vision. The nurse should report this to the surgeon who will further evaluate the patient.

Which patient finding below is associated with the development of cataracts? A. Loss of central vision B. Loss of peripheral vision C. Cloudy, hazy vision D. Black spots in vision

C. Cloudy, hazy vision Rationale: The answer is C: cloudy, hazy vision. Option A is found in macular degeneration, option B is glaucoma, and option D is diabetic retinopathy.

Prior to cataract surgery, the nurse is ordered to administer an eye medication that paralyzes the ciliary muscle of the eye which results in the loss of accommodation. Which medication group below has this type of mechanism of action? A. Rho Kinase Inhibitors B. Mydriatrics C. Cycloplegics D. Carbonic Anhydrase Inhibitors

C. Cycloplegics Rationale: The answer C: Cycloplegic. Mydriatics cause mydriasis, or pupil dilation; whereas cycloplegics cause cycloplegia, or paralysis of the muscles that are responsible for accommodation to focus on nearby objects.

In the development of cataracts, light is scattered and cannot travel properly to the retina's _____________________, and this leads to visual impairment. A. crystalline proteins B. amacrine cells C. ganglion cells D. cones and rods

D. cones and rods Rationale: The answer is D: cones and rods. In the development of cataracts, light is scattered and cannot travel properly to the retina's CONES AND RODS (photoreceptors) and this leads to visual impairment.

One way to help prevent AMD is to eat plenty of leafy green vegetables. True False

True Rationale: The cause of AMD isn't yet known, but genes and environmental factors may both play a role. Researchers say that one way to help prevent macular degeneration is to eat a healthy low-fat diet. Include plenty of fruits and vegetables, particularly leafy green vegetables such as spinach and kale. Other good health habits include getting regular exercise, not smoking, wearing sunglasses with UV protection, and getting regular eye exams.

Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of corticosteroid eye drops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 1 to 2 days after the surgery

b. Administration of corticosteroid eye drops Rationale: Antibiotic and corticosteroid eye drops are commonly prescribed after cataract surgery. The patient should be able to administer them using safe technique. Pain is not expected after cataract surgery and opioids will not be needed. Coughing and deep breathing exercises are not needed because a general anesthetic agent is not used. There is no bed rest restriction after cataract surgery.

The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? a. The patient has had blurred vision for 3 years. b. The patient has not eaten anything for 8 hours. c. The patient takes 2 antihypertensive medications. d. The patient gets nauseated with general anesthesia.

c. The patient takes 2 antihypertensive medications. Rationale: Mydriatic medications used for pupil dilation are sympathetic nervous system stimulants and may increase heart rate and blood pressure. Using punctal occlusion when administering the mydriatic and monitoring of blood pressure are indicated for this patient. Blurred vision is an expected finding with cataracts. Patients are expected to be NPO for 6 to 8 hours before the surgical procedure. Cataract extraction and intraocular lens implantation are done using local anesthesia.

Visual impairment

describes vision that cannot be fully corrected by corrective lenses, medical treatment, or surgery. It includes conditions ranging from low vision to the absence of all vision (total blindness).

Most common form of cataract surgery

phacoemulsification In this procedure, a very small incision is made in the surface of the eye in or near the cornea. A thin ultrasound probe is inserted into the eye and ultrasonic vibrations are used to dissolve the clouded lens into fragments. These pieces are then suctioned out through the same ultrasound probe. The small incisions are self-sealing and usually do not need sutures.

legal blindness

refers to central visual acuity of 20/200 or less in the better eye with correction or a peripheral visual field of 20 degrees or less.

Age-related macular degeneration (AMD)

the most common cause of irreversible central vision loss in people over age 60 in which the macula degenerates, gradually causing irreversible central vision loss

Wet age-related macular degeneration (AMD)

most severe, rapid onset of vison loss. Accounts for most cases of AMD related blindness. Proliferation of abnormal blood vessels that leak blood and fluid into macula causing central vision loss

Your patient is having a phacoemulsification for treatment of a cataract. You're providing education to the patient about the procedure. Which statement by the patient demonstrates he understood the educational material provided about this procedure? A. "The cloudy lens in my eye will be broken up with sound waves and removed. Then a new permanent lens, called an intraocular lens, will be placed in my eye." B. "A small air bubble is injected into the eye to help push the retina back into position to help the lens refract light." C. "An incision is made to remove the trabecular meshwork and this will help drain fluid out of the cloudy lens." D. "The surgeon will remove parts of the iris and lens."

A. "The cloudy lens in my eye will be broken up with sound waves and removed. Then a new permanent lens, called an intraocular lens, will be placed in my eye." Rationale: The answer is A. A phacoemulsification is the most common type of cataract surgery. It consists of the cloudy lens in the eye being broken up with sound waves and removed. Then a new permanent lens, called an intraocular lens, will be placed in the eye.

What is the most common cause of cataracts? A. Congenital B. Aging C. Trauma D. Uncontrolled blood glucose levels

B. Aging Rationale: The answer is B: aging. Most cataracts are known as senile cataracts and happen due to aging. This is because over time the eye lens starts to lose its transparency and proteins start to stick together on the lens causing the lens to become cloudy.

AMD leads to total blindness. True False

False Rationale: AMD can cause a loss of central vision. This makes a person's vision become fuzzier. Over time, they have problems reading, driving, and recognizing people's faces. Most people with AMD still have their peripheral vision.

TRUE OR FALSE: If a patient has bilateral cataracts and needs surgery, both eyes can be surgically treated at the same time. True False

False Rationale: The answer is FALSE: Only one eye is treated with cataract surgery at a time. Typically, the patient will have to wait a few weeks before having surgery in the other affected eye.

severe visual impairment

Inability to read ordinary newsprint even with correction, may or may not be legally blind.

AMD develops as one of two forms, wet or dry. True False

True Rationale: Dry AMD is the most common form. This form gets worse so slowly that a person may not notice any vision problems for years. The wet form of AMD at first causes straight lines to appear wavy. This is because blood vessels leak blood beneath the macula. This distorts vision. Wet AMD affects vision more quickly and dramatically than the dry form and is more likely to lead to loss of central vision. Central vision is also called straight-ahead vision. It allows a person to read, drive, and recognize people's faces.

Smokers are more likely to develop AMD than nonsmokers. True False

True Rationale: Family history of AMD is also a main risk factor. Other risk factors include: Gender. Women are more likely to develop AMD than men. Being overweight Being older than 50 Having high blood pressure, heart disease, or high cholesterol Race. Whites are more likely to develop AMD than African Americans.

A blurred spot in the middle of your vision is one symptom of AMD. True False

True Rationale: Other symptoms include slightly blurred vision overall, needing extra light for reading, and difficulty recognizing a face until you are very near the person. For a person with the wet form of AMD, straight lines appear wavy.

age-related macular degeneration (AMD) risk factors

age, family history, inadequate nutrition, long-term exposure to UV light, cigarette

Which assessment finding alerts the nurse to provide patient teaching about cataract development? a. History of hyperthyroidism b. Unequal pupil size and shape c. Blurred vision and light sensitivity d. Loss of peripheral vision in both eyes

c. Blurred vision and light sensitivity Rationale: Classic signs of cataracts include blurred vision and light sensitivity. Thyroid problems are a major cause of exophthalmos. Unequal pupil is indicative of anisocoria, not cataracts. Loss of peripheral vision is a sign of glaucoma.

Procedure used for very advanced cataracts

extracapsular cataract extraction This procedure is used for very advanced cataracts where the lens is too dense to dissolve into fragments. This technique requires a larger incision so that the cataract can be removed in one piece without being fragmented inside the eye. Sutures are needed to close the larger wound, and visual recovery is often slower.

Dry age-related macular degeneration (AMD)

most common type of AMD; causes deposits of yellow-colored extracellular material (drusen) within the macula of the eye, causing possible atrophy of the retina and a gradual loss of central vision

Dry age-related macular degeneration (AMD) treatment

none

Low vision impairment

vision that cannot be improved by conventional eyeglasses, contact lenses, medications, or surgery in which some good usable vision remains.

Wet age-related macular degeneration (AMD) treatment

-injections [Ranibizumab (Lucentis), bevacizumab (Avastin), aflibercept (Eylea), and pegaptanib (Macugen)] to help slow vision loss by stopping new vessels from forming - Photodynamic therapy (PDT) uses verteporfin (Visudyne) IV and a "cold" laser to excite the dye. This procedure is used to damage the abnormal blood vessels

A nurse is providing teaching for a client who has a new diagnosis of dry Age-related Macular Degeneration (AMD). Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables B. Administer eye drops C. Avoid bending at the waist D. Wear an eye patch

A. Increase intake of deep yellow and orange vegetables Rationale: Instruct the client to increase dietary intake of carotenoids and antioxidants to slow progression. A client who has primary open-angle glaucoma should administer eye drops twice a day. A client who is at risk for increased intraocular pressure, such as following cataract surgery should avoid bending at the waist. A client who has had eye surgery, such as cataract surgery, should wear an eye patch at night to protect the eye from injury.

A 68-year-old male patient is considering cataract surgery. You're collecting the patient's health and medication history. Which medication below on the patient's home medication list should the nurse notify the doctor about? A. Tamsulosin B. Levothyroxine C. Atorvastatin D. Omeprazole

A. Tamsulosin Rationale: The answer is A: Tamsulosin. Tamsulosin, also called Flomax, is used to treat an enlarged prostate and relaxes the smooth muscle. It also can affect the eye's muscle such as the iris. Remember the iris is responsible for dilation and constriction of the pupils. In order to have a successful surgery to remove the cataract, the eye must be dilated properly. However, Tamsulosin (or other alpha-blockers) can make the iris floppy. The eye doctor must be aware that the patient is taking this medication prior to surgery because the patient is at risk for intraoperative floppy iris syndrome.

A patient is 2 hours post-op from cataract surgery in the right eye. You're collecting vital signs and assessing the patient. Which finding in your patient after cataract surgery requires to you re-educate the patient? A. The patient is asleep on their right side. B. The patient is wearing the eye shield while asleep. C. The patient fell asleep watching TV. D. The patient is not wearing his glasses.

A. The patient is asleep on their right side. Rationale: The answer is A. The patient should sleep on his non-operative side (the left side NOT the right). The patient should wear an eye shield while sleeping and during naps to protect the eye. It is okay to watch TV and the patient doesn't have to be wearing his glasses unless needed at this time.

Your patient has several risk factors that increase his risk for developing cataracts. What preventive measures can you educate the patient about? Select all that apply: A. Wearing large brim hats while in the sun B. Eating a diet rich in vegetables and fruits C. Quit smoking D. Reducing alcohol consumption E. Managing blood glucose levels F. Scheduling regular eye exams

A. Wearing large brim hats while in the sun B. Eating a diet rich in vegetables and fruits C. Quit smoking D. Reducing alcohol consumption E. Managing blood glucose levels F. Scheduling regular eye exams Rationale: All the answers are correct. These are all preventive measures the patient can take to help prevent cataracts.

A patient has a cataract in the left eye and has decided to prolong having surgery as long as possible until her activities of daily living are affected. What are some measures the patient can take to help manage the cataract at this time? Select all that apply: A. Wearing sunglasses with UVA protection. B. Enlarging text or visual images with a magnifier. C. Adding more light when reading. D. Wearing anti-glare glasses.

B. Enlarging text or visual images with a magnifier. C. Adding more light when reading. D. Wearing anti-glare glasses. Rationale: The answers are B,C, D. Option A is wrong because sunglasses that provide UVA and UVB protection should be used (not just UVA).

In your patient's health history you read that the patient has a cataract in the right eye. You know that this eye disorder can be best described by which statement below? A. This eye disorder is caused by increased intraocular pressure that results in damage to the optic nerve. B. Cataracts occur in the eye when the macula of the retina become damaged and impair the central vision. C. The development of a cataract occurs when the lens of the eye loses its transparency. D. This eye disorder occurs from uncontrolled high blood glucose levels which lead to retinal damage.

C. The development of a cataract occurs when the lens of the eye loses its transparency. Rationale: The answer is C. Option A describes glaucoma, option B describes macular degeneration, and option D describes diabetic retinopathy.

The nurse is preparing to instill eye dilation drops to a patient prior to cataract surgery. The nurse confirms that the operative eye is the right eye. On assessment, the nurse notes the patient has dark brown eyes and that a cataract is present in the right eye. Which of the following nursing actions is incorrect prior to instillation of the eye drops? A. The nurse will lower the lights in the room prior to administration. B. The nurse prepares the patient for blurry vision. C. The nurse is aware that pupil dilation effects will occur quickly in this patient and should be administered at a time that correlates with the actual time of the surgery. D. The nurse places the call light within reach of the patient.

C. The nurse is aware that pupil dilation effects will occur quickly in this patient and should be administered at a time that correlates with the actual time of the surgery. Rationale: The answer is C. Option C is incorrect because patients with dark brown eyes have a lot of pigment in their eyes compared to a patient with blue or green eyes. The pigment actually binds or bounds the eye drop medication. Therefore, it takes longer for the medication to dilate the eyes and higher doses of the medication may be needed.

A patient will be having outpatient cataract surgery in 3 days. The surgeon ordered the patient to begin instilling two types of eye drop medications 3 days prior to the surgery. You have demonstrated and educated the patient on how to do this properly. Which action by the patient is incorrect and requires re-education about how to instill the eye drops? A. The patient instills the eye drops onto the conjunctival sac. B. The patient instilled the anti-inflammatory eye drops before the antibiotic eye drops. C. The patient waited 30 seconds before instilling the second eye drop medication into the eye. D. After instilling each type of eye drop medication, the patient kept the eye closed and took her index finger and placed it at the side of the bridge of the nose for 2 minutes.

C. The patient waited 30 seconds before instilling the second eye drop medication into the eye. Rationale: The answer is C. Option C is INCORRECT. The patient should wait at least 3-5 minutes in between instilling each type of eye drop medication. Options A, B, and D are correct ways to instill eye drops. It doesn't matter the sequence for how the eye drops are instilled (anti-inflammatory vs. antibiotic), and option D demonstrates the patient is performing punctual occlusion, which helps prevent the eye medication from being absorbed by the bloodstream and entering systemic circulation.

Which activity below is allowed after cataract surgery? A. Bending B. Running C. Watching TV D. Swimming

C. Watching TV Rationale: The answer is C. Patients can watch TV or read if they desire and should take breaks as needed. All the other activities should be avoided until the doctors clears the patient.

A patient is being evaluated for cataracts. The doctor uses a slit-lamp to assess the patient's eyes. As the nurse you know that this device will? A. help test the patient's visual acuity. B. test the strength of the ciliary muscles. C. enlarge the front area of the eye (cornea, iris, lens etc.). D. help for visualization of the fundus.

C. enlarge the front area of the eye (cornea, iris, lens etc.). Rationale: The answer is C. The slit-lamp is helpful with detecting cataracts because it enlarges the front area of the eye so the doctor can observe the cornea, iris, lens etc.. This is particularly useful with detecting cataracts because remember in cataract the lens has lost transparency and will appear cloudy.

People who have the greatest risk for developing AMD are 60 or older. True False

True Rationale: The risk increases with age. But AMD can occur during middle age

A patient with bilateral cataracts is scheduled for an extracapsular cataract extraction with an intraocular lens implantation of 1 eye. What should be done by the nurse preoperatively? a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance. b. Inform the patient that the operative eye will need to be patched for 3 to 4 days postoperatively. c. Assure the patient that vision in the operative eye will be improved to near normal on the first postoperative day. d. Teach the patient routine coughing and deep-breathing techniques to use postoperatively to prevent respiratory complications.

a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance. Rationale: Assessment of the visual acuity in the patient's unoperated eye enables the nurse to determine how visually compromised the patient may be while the operative eye is patched and healing and to plan for assistance until vision improves. The patch on the operative eye is usually removed within 24 hours (if used), and although vision in the eye may be good, it is not unusual for visual acuity to be reduced immediately after surgery. Activities that are thought to increase intraocular pressure, such as bending, coughing, and lifting, are frequently restricted postoperatively.

What should be included in the discharge teaching for the patient who had cataract surgery (select all that apply)? a. Eye discomfort is often relieved with mild analgesics. b. A decline in visual acuity is common for the first week. c. Stay on bed rest and limit activity for the first few days. d. Notify the provider if an increase in redness or drainage occurs. e. Following activity restrictions is essential to reduce intraocular pressure.

a. Eye discomfort is often relieved with mild analgesics. d. Notify the provider if an increase in redness or drainage occurs. e. Following activity restrictions is essential to reduce intraocular pressure. Rationale: After cataract surgery, the nurse should teach the patient and caregiver about the following topics before discharge: topical antibiotics; topical corticosteroids or other antiinflammatory agents; mild analgesia, if necessary; eye shield, if used (usually worn overnight and removed during the first postoperative visit); and activity restrictions as preferred by the patient's surgeon. Activities that increase the intraocular pressure, like bending, stooping, coughing, and lifting, may be restricted. Complications that should be reported include intense pain, infection, increased intraocular pressure, increased or purulent drainage, increased redness, and any change in visual acuity.

During the preoperative assessment of the patient scheduled for a right cataract extraction and intraocular lens implantation, it is most important for the nurse to assess a. the visual acuity of the patients left eye. b. how long the patient has had the cataract. c. for a white pupil in the patients right eye. d. for a history of reactions to general anesthetics.

a. the visual acuity of the patients left eye. Rationale: Because it can take several weeks before the maximum improvement in vision occurs in the right eye, patient safety and independence are determined by the vision in the left eye. A white pupil in the operative eye would not be unusual for a patient scheduled for cataract removal and lens implantation. The length of time that the patient has had the cataract will not affect the perioperative care. Cataract surgery is done using local anesthetics rather than general anesthetics.

Priority Decision: What nursing action is most important for the patient with age-related dry macular degeneration (AMD)? a. Teach the patient how to use topical eyedrops for treatment of AMD. b. Emphasize the use of vision enhancement techniques to improve what vision is present. c. Encourage the patient to undergo laser treatment to slow the deposit of extracellular debris. d. Explain that nothing can be done to save the patient's vision because there is no treatment for AMD.

b. Emphasize the use of vision enhancement techniques to improve what vision is present. Rationale: The patient with dry age-related macular degeneration (AMD) can benefit from low-vision aids despite increasing loss of vision, and it is important to promote a positive outlook by not giving patients the impression that "nothing can be done" for them. Approach magnification can help, and vision-enhancing devices include desktop video magnification/closed circuit units, electronic hand-held magnifiers, text-to-speech scanners, e-readers and computer tablets with magnification, brighter screens, voice recognition, and verbal response. The American Foundation for the Blind can help as well. Limited treatment options include vitreal injections of selective inhibitors of endothelial growth factor slow vision loss in wet AMD. Photodynamic therapy is indicated for neovascularization in a small percentage of patients with wet AMD, but there is no treatment for the increasing deposit of extracellular debris (drusen) in the retinal pigment epithelium. Mineral and vitamin supplements may also be ordered.

The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene? a. The nurse leaves the eye shield in place. b. The nurse encourages the patient to cough. c. The nurse elevates the patients head to 45 degrees. d. The nurse applies corticosteroid drops to the right eye.

b. The nurse encourages the patient to cough. Rationale: Because coughing will increase intraocular pressure, patients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a patient after having this surgery.

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider? a. The patient has questions about the ordered eye drops. b. The patient has eye pain rated at a 5 (on a 0 to 10 scale). c. The patient has poor depth perception when wearing an eye patch. d. The patient complains that the vision has not improved very much.

b. The patient has eye pain rated at a 5 (on a 0 to 10 scale). Rationale: Postoperative cataract surgery patients usually experience little or no pain, so pain at a level 5 on a 10-point pain scale may indicate complications such as hemorrhage, infection, or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching but does not indicate that complications of the surgery may be occurring.

A 60-year-old patient is being prepared for outpatient cataract surgery. When obtaining admission data from the patient, what would the nurse expect to find in the patient's history? a. A painless, sudden, severe loss of vision b. Blurred vision, colored halos around lights, and eye pain c. A gradual loss of vision with abnormal color perception and glare d. Light flashes, floaters, and a "cobweb" in the field of vision with loss of central or peripheral vision

c. A gradual loss of vision with abnormal color perception and glare Rationale: The lens opacity of cataracts causes a decrease in vision, abnormal color perception, and glare. Blurred vision, halos around lights, and eye pain are characteristic of glaucoma. Light flashes, floaters, and "cobwebs" or "hairnets" in the field of vision followed by a painless, sudden loss of vision are characteristic of detached retina.

A patient with wet Age-related Macular Degeneration (AMD) is treated with photodynamic therapy. What does the nurse instruct the patient to do after the procedure? a. Maintain the head in an upright position for 24 hours. b. Avoid blowing the nose or causing jerking movements of the head. c. Completely cover all the skin to avoid a thermal burn from sunlight. d. Expect to experience blind spots where the laser has caused retinal damage.

c. Completely cover all the skin to avoid a thermal burn from sunlight. Rationale: Verteporfin, the dye used with photodynamic therapy to destroy abnormal blood vessels, is a photosensitizing drug that can be activated by exposure to sunlight or other high-intensity light. Patients must cover all of their skin to avoid chemical burns when exposed to sunlight until the drug has cleared the body. Blind spots occur with wet AMD. Head movements and position are not of concern following this procedure.

A 72-year-old patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective? a. I will need to use bright lights to read for at least the next week. b. I will use drops to keep my pupils dilated until my appointment. c. I will not use facial lotions near my eyes during the recovery period. d. I will cover up with long-sleeved shirts and pants for the next 5 days.

d. I will cover up with long-sleeved shirts and pants for the next 5 days. Rationale: The photosensitizing drug used for photodynamic therapy is activated by exposure to bright light and can cause burns in areas exposed to light for 5 days after the treatment. There are no restrictions on the use of facial lotions, medications to keep the pupils dilated would not be appropriate, and bright lights would increase the risk for damage caused by the treatment.

A patient with early cataracts tells the nurse that he is afraid cataract surgery may cause permanent visual damage. What should the nurse teach the patient? a. The cataracts will only worsen with time and should be removed as early as possible to prevent blindness. b. Cataract surgery is very safe, and with the implantation of an intraocular lens, the need for glasses will be eliminated. c. Progression of the cataracts can be prevented by avoidance of ultraviolet (UV) light and good dietary management. d. Vision enhancement techniques may improve vision until surgery becomes an acceptable way to maintain desired activities.

d. Vision enhancement techniques may improve vision until surgery becomes an acceptable way to maintain desired activities. Rationale: Vision enhancement techniques may be used until the patient feels the need for cataract surgery. Although cataracts do become worse with time, surgical extraction is considered an elective procedure. Surgical extraction is generally safe, but infections can occur. The patient will still need glasses for near vision and for any residual refractive error of the implanted lens. There are no proven measures to prevent cataract development or progression.