Ch. 47 - Care of patients with eye and vision problems

Above what age is the cost of cataract surgery of the patient covered by Medicare? Record your answer using a whole number.

-65 Rationale The cost of cataract surgery is covered by Medicare for patients who are 65 years or older. p. 969

The nurse instructor is teaching nursing students about the causes of decreased visual acuity. What statement by a student indicates a need for further teaching? -"Reduced vision in a patient may affect any or all aspects of vision." -"Central vision in a patient can be impaired by the presence of glaucoma." -"The best visual acuity with corrective lenses in a legally blind patient is 20/200 or less." -"The widest diameter of the visual field in a legally blind patient is no greater than 20 degrees."

-"Central vision in a patient can be impaired by the presence of glaucoma." Rationale Central vision can be impaired by diseases involving the macula, such as macular edema or macular degeneration. Glaucoma causes loss of peripheral vision. Patients are legally blind if the widest diameter of the visual field in the affected eye is no greater than 20 degrees. Patients are also legally blind if the best visual acuity with corrective lenses is 20/200 or less. Reduced vision may affect any or all aspects of vision such as color, light, image, movement, and acuity. p.972

Which instruction should the nurse provide to a patient for whom a topical anesthetic medication is prescribed to reduce eye inflammation? -"Check the eye periodically for any signs of bleeding." -"Check the cornea periodically for any signs of ulcers." -"Do not rub the eye after administration of the medication." -"Do not wear contact lenses during administration of anesthesia."

-"Do not rub the eye after administration of the medication." Rationale When a topical anesthetic medication is prescribed for the eye, the nurse instructs the patient not to rub the eye after the medication is administered because it may cause injury to the eye and stimulate tears that will wash out the medication. The nurse should instruct a patient with a prescription for nonsteroidal anti-inflammatory drugs (NSAIDs) to check for bleeding in the eyes and to not wear contact lenses. A periodic assessment of the cornea is appropriate for a patient for whom topical steroids have been prescribed. p. 977

A patient has a bilateral corneal disorder and must instill anti-infective eyedrops every hour for the first 24 hours. Which comment by the patient indicates a need for further instruction by the nurse? -"I must apply the drops throughout the night." -"I won't be able to wear my contacts for a while." -"I have two bottles of eyedrops because I will require a lot of medication." -"I must wash my hands before and between eye applications and after putting the drops in."

-"I have two bottles of eyedrops because I will require a lot of medication." Rationale If both eyes are infected, separate bottles of drugs are needed for each eye. The patient should be taught to clearly label the bottles "right eye" and "left eye" and to not switch the drugs from eye to eye. The patient should not wear contact lenses during the entire time that these drugs are being used because the eye then has fewer protections against infection or injury. In addition, the drugs can cloud or damage contact lenses. If the drugs are to be instilled every hour for the first 24 hours, the patient will have to wake up every hour during the night to apply the drops. The patient should completely care for one eye, wash the hands, and by using the drugs for the remaining eye, care for that eye. As always, handwashing should be done before and after eye care. p. 977

The nurse is teaching the mother of a teenage patient with conjunctivitis how to administer eye ointment. Which statement by the mother indicates a correct understanding of the nurse's instruction? "I will place the ointment in the lower lid." "I will press gently on the inner canthus for 1 minute." "My child should look down at the floor during instillation." "My child should rub the eye gently after instillation to increase absorption."

-"I will place the ointment in the lower lid. Rationale After the lower lid is gently pulled down to form a small pocket, eye ointmentshould be placed in the lower lid. For instillation of eye ointment, the patient should tilt the head backward and look up at the ceiling. After closing the eye, the patient may gently wipe away any excess ointment with a tissue, but the eye should never be rubbed. Pressing on the inner canthus is a technique reserved for the instillation of glaucoma drops. p. 970

A patient is returning home after cataract surgery with a patch over the affected eye. Which statement by the patient's spouse indicates a need for further instruction on providing a safe home environment? -"I will place a nonskid mat in the bathtub." -"I will get some books on tape for entertainment." -"I will be sure to pick up all clutter and loose carpets from the floor." -"I will rearrange the furniture for better flow before my spouse gets home."

-"I will rearrange the furniture for better flow before my spouse gets home." Rationale Changes in item location should not be made without input from the patient with reduced vision. Books on tape are a good diversion for recuperating patients with reduced vision. Any objects that may present a tripping hazard should be removed at once. A nonskid mat may be used to prevent falls in the bathtub. p. 975

The nurse is teaching a patient about eyedrop use in the management of open-angle glaucoma. Which statement by the patient indicates a need for further instruction? -"It is important to not skip a dose." -"These eyedrops will not cure my glaucoma." -"I must press on the inside of my eye to prevent washout." -"I must wait 10 to 15 minutes between different eyedrop medications."

--"I must press on the inside of my eye to prevent washout." Rationale Pressing on the inside of the eye after instillation of eye medication prevents systemic absorption of the drug, not washout. This statement indicates a need for additional information. To avoid washout, the patient should wait 10 to 15 minutes between different eyedrops. It is important not to skip doses of any medication. The medication will not cure glaucoma, but it will control its progression. p. 975

A patient is scheduled to undergo corneal implant surgery due to keratoconus. What does the nurse include in the preoperative instructions? Select all that apply. -Improvement to best vision takes some time. -The risk for corneal clouding or scarring is low. -The procedure is performed under general anesthesia. -Overcorrection or undercorrection of refraction is possible. -A flexible corneal ring will be placed in the outer edges of the cornea.

-A flexible corneal ring will be placed in the outer edges of the cornea. -The risk for corneal clouding or scarring is low -Overcorrection or undercorrection of refraction is possible.

Which condition is the most common cause of cataracts in a patient? Age Toxic agents Disease linked Traumatic events

-Age Rationale With aging the lens steadily loses water, leading to loss of density, which is the most common cause of cataracts. Toxic agents, comorbid conditions, and traumatic events are not the most common causes of cataracts. Use of toxic agents such as corticosteroids and miotic agents can lead to development of cataracts. Diseases such as diabetes mellitus and hypoparathyroidism are the associated diseases that can lead to the formation of a cataract. Traumatic events like penetrating injuries to eye, intraocular foreign bodies, and exposure to radiation may also lead to cataracts. None of these, however, are considered the most common causes of cataracts. p. 968

Which is the most common type of cataract? Toxic cataracts Traumatic cataracts Associated cataracts Age-related cataracts

-Age related cataracts Rationale The most common type of cataract is age-related cataracts. Cataracts may be present at birth or develop at any time. They may be age-related or caused by trauma or exposure to toxic agents. They also occur with other diseases and eye disorders, but the most common type of cataract affects people older than 70 years of age. p. 968

What refractive error occurs when the curve of the cornea is uneven? Myopia Hyperopia Presbyopia Astigmatism

-Astigmatism Rationale When light rays do not refract equally in all directions, the image cannot adequately focus on the retina; in turn, this causes visual problems. Astigmatism occurs when the curve of the cornea is uneven. Myopia (nearsightedness) occurs when the eye over-refracts light and the bent images fall in front of, not on, the retina. Hyperopia (farsightedness) happens when refraction is not strong enough and images fall behind the retina. Presbyopia (an age-related problem) happens due to decreased lens elasticity, causing images to fall behind the retina as well. Due to this decrease in elasticity, the lens is not able to change shape to focus for close-up work. p. 981

Which clinical manifestation is an indication of graft rejection in a patient who has had a corneal transplant? Cloudy cornea Excessive tears Clear fluid discharge Excessive bleeding

-Cloudy cornea Rationale Blurred or decreased vision is a clinical manifestation of graft rejection in a patient with a corneal transplant. This will manifest as visible cloudiness of the transplanted cornea. Excessive tearing is caused by the over-activation of the lacrimal system after the surgery. Clear fluid leakage from the graft site may occur after surgery but does not indicate graft rejection. Excessive bleeding may also occur after surgery but is not an indication of graft rejection. p.978

Which eye condition may be caused by a small foreign body, eye trauma, or by using a contact lens? Trachoma Chalazion Conjunctivitis Corneal abrasion

-Corneal abrasion Rationale A corneal abrasion is a scratch on the eye's cornea. This painful condition can be caused by a small foreign body, trauma, or by using contact lens. Trachoma is a chronic conjunctivitis caused by chlamydia trachomatis. It scars the conjunctiva and is a common cause of preventable blindness worldwide. A chalazion is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. It begins with redness and tenderness of the eyelids, followed by a gradual painless swelling. Conjunctivitis, also known as "pink eye," is an inflammation of the conjunctiva. It is commonly caused by an infection or allergic reaction. p. 977

Which factor can cause toxic cataracts? Corticosteroids Radiation therapy Intraocular foreign bodies Chronic sunlight exposure

-Corticosteroids Rationale Toxic cataracts may result from exposure to corticosteroids, phenothiazine derivatives, and miotic agents. Radiation therapy and intraocular foreign bodies can cause traumatic cataracts, whereas chronic sunlight exposure can cause associated cataracts. p. 969

Which eye condition includes refraction that is too weak, causing images to be focused behind the retina? Myopia Hyperopia Retinal tear Presbyopia

-Hyperopia Rationale Hyperopia, also called hypermetropia, or farsightedness, is a condition in which refraction is too weak, causing images to be focused behind the retina. Myopia, also called nearsightedness, is the most common refractive error of the eye. A retinal tear is a jagged and irregularly shaped break in the retina. It occurs when part of the retina separates from the outer layers of the eye. Presbyopia is the result of an age-related process and is when the lens loses its elasticity and is less able to change shape to focus the eye for close work. p. 981

The nurse reviews a patient's understanding of a keratoplasty procedure. What statement made by the patient indicates a need for further education? -"I will be discharged home the next day." -"The nerves around and behind the eye will be numbed." -"This procedure involves receiving a cornea from another person." -"A penetrating keratoplasty may necessitate transplanting the entire depth of cornea."

-I will be discharged home the next day Rationale The patient who undergoes a keratoplasty is discharged to home 1 to 2 hours after the procedure. Keratoplasty or corneal transplantation involves removing and replacing diseased corneal tissue with tissue from a human donor cornea. The transplant may involve the entire depth of corneal tissue, also called penetrating keratoplasty. The nerves around and behind the eye are numbed so that the patient cannot see or move the eye. p. 978

A patient has sustained damage to cranial nerve II after a traumatic injury. Which intervention does the nurse anticipate to accommodate for this injury? -Artificial tears -Identifying food on the patient's plate using the clock method -Daily eye assessment using the six cardinal positions of gaze -Ensuring that the patient wears sunglasses when the curtains are open or when the room light is on

-Identifying food on the patient's plate using the clock method Rationale The optic nerve (cranial nerve [CN] II) controls sight. Using the clock method helps the patient with impaired vision or loss of vision locate food on his or her plate. Artificial tears are used when tear production is decreased due to the aging process. The six cardinal positions of gaze assess CN III, IV, and VI. Sunglasses are used when the pupils are artificially dilated for assessment purposes, or when medications are used that cause dilation of the pupil. p.975

What eye disease is manifested by the degeneration of the corneal tissue, resulting in an abnormal corneal shape? Cellulitis Blepharitis Keratoconus Conjunctivitis

-KEratoconus Keratoconus is the degeneration of the corneal tissue resulting in an abnormal corneal shape. Blepharitis is inflammation (swelling) of the eyelids. Cellulitis is a bacterial infection of tissue that can affect both the eyes and skin. Conjunctivitis is swelling of the conjunctiva, the thin filmy membrane that covers the inside of eyelids and the white part of your eye (sclera). p. 977

Which disorder of the eye is genetically inherited? Trachoma Keratoconus Corneal abrasion Keratoconjunctivitis sicca

-Keratoconus Rationale Keratoconus is the degeneration of corneal tissue leading to an abnormally shaped cornea; it is a genetically inherited disorder. Trachoma is a chronic conjunctivitis caused by exposure to Chlamydia trachomatis, which is present in warm, moist climates, and areas with poor sanitation. A corneal abrasion is a scratch or scrape to the cornea. Keratoconjunctivitis sicca is characterized by abnormal tear production; it is associated with the use of certain medications and diseases such as rheumatoid arthritis and leukemia. p. 977

Which term is used to describe an eye wound caused by sharp objects and projectiles? Hyphema Melanoma Laceration Contusion

-Laceration Rationale Eye wounds caused by sharp objects and projectiles are known as lacerations. This type of wound is commonly seen in the eyelids and the cornea. Melanoma is a common malignant eye tumor. Hyphema is a hemorrhage in the anterior chamber which occurs when force is applied to the eye. Eye wounds caused by traumatic contact with a blunt object are known as contusions. p. 981

Which activity performed by the patient increases intraocular pressure? Lifting heavy objects Rubbing the eye constantly Exposing the eye to sunlight Wearing soft contact lenses during drug therapy

-Lifting heavy objects Rationale Lifting heavy objects will increase intraocular pressure. Constant rubbing of the eye may lead to injury but does not increase intraocular pressure. Exposure to sunlight increases the risk of cataracts. Wearing soft contact lenses during drug therapy makes the eye more vulnerable to infections. p.971

A patient with visual limitations has been admitted to the intensive care unit (ICU). Which action is most important to implement for this patient? -Keeping the patient bedridden for safety -Addressing the patient in a loud, clear voice -Allowing the patient's seeing-eye dog in the unit -Making all health care team members aware of the patient's visual limitations

-Making all health care team members aware of the patient's visual limitations Rationale All health care team members must be made aware of the patient's visual limitations and need for assistance. Seeing-eye dogs are not usually allowed in the ICU. It is not necessary to keep the patient bedridden. The patient should be addressed in a normal tone of voice; the patient's hearing is not affected. p. 975

Which refractive error involves over-refracting of light that results in focusing the bent images in front of the retina, instead of focusing them onto the retina? Myopia Hyperopia Presbyopia Astigmatism

-Myopia Rationale Myopia is near-sightedness, in which the eye over-refracts the light which results in the bent images falling in front of the retina. Hyperopia is a refractive error in which the refraction of the eye is too weak. It results in focusing the images behind the retina. Presbyopia is an age-related refractive error in which the lens loses its elasticity. This causes difficulty for the patient in focusing the eye on objects that are close by. Astigmatism is a refractive error which causes an uneven shape of the cornea, resulting in the inability to focus the image onto the retina. p. 980

Which is a common cause of toxic cataracts? -Phenothiazine derivatives -Chronic sunlight exposure -Blunt injury to eye or head -Lens water loss and fiber compaction

-Phenothiazine derivatives Rationale Phenothiazine derivative is a common cause of toxic cataracts. Chronic sunlight exposure is a common cause of associated cataracts. Blunt injury to the eye or head is a common cause of traumatic cataracts. Lens water loss and fiber compaction are common causes of age-related cataracts. p. 969

A patient has a purulent drainage in the inner canthus of the eye. Before examining the eye, what must the nurse do first? Put on gloves. Instill antibiotic drops. Administer a Snellen test. Obtain an informed consent.

-Put on gloves Rationale Gloves should be worn in the presence of drainage and should be put on before examining the eye. Administering a Snellen test or instilling antibiotic eyedrops is not the first thing that the nurse should do before examining the patient's eye. Obtaining informed consent is not necessary for an eye examination. p. 977

Which age-related eye condition results from the lens losing its elasticity, causing an inability to change shape or focus the eye for close work? Myopia Hyperopia Presbyopia Astigmatism

-Rationale Presbyopia is the age-related problem in which the lens loses its elasticity, causing an inability to change shape or focus the eye for close work. Myopia is nearsightedness, in which the eye over-refracts the light and the bent images fall in front of, not on, the retina. Hyperopia, also called hypermetropia, is farsightedness, in which refraction is too weak, causing images to be focused behind the retina. Astigmatism is a vision condition that causes blurred vision due to the irregular shape of the cornea, the clear front cover of the eye, or sometimes the curvature of the lens inside the eye. p.981

A patient has recently had cataract surgery. About which symptom does the nurse instruct the patient to notify the health care provider? Swollen eyelid Itching of the eye Increased tearing Reduction in vision

-Reduction in vision Rationale A reduction in vision after cataract surgery indicates a problem, and the patient should notify the provider immediately. Increased tearing, itching of the eye, and a swollen eyelid all are expected after cataract surgery. p. 971

Which term defines the separation of the retina from the epithelium? Retinal tear Retinal hole Retinal detachment Macular degeneration

-Retinal detachment Rationale A retinal detachment is the separation of the retina from the epithelium. A retinal tear occurs when part of the retina separates from the outer layers of the eye. A retinal hole is a break in the retina. These holes can be caused by trauma or can occur with aging. The deterioration of the macula (the area of central vision) can be age-related or exudative, which is known as macular degeneration. p. 979

A patient is scheduled to undergo corneal implant surgery due to keratoconus. What does the nurse include in the preoperative instructions? Select all that apply. -Improvement to best vision takes some time. -The risk for corneal clouding or scarring is low. -The procedure is performed under general anesthesia. -Overcorrection or undercorrection of refraction is possible. -A flexible corneal ring will be placed in the outer edges of the cornea.se

-The risk for corneal clouding or scarring is low. -Overcorrection or undercorrection of refraction is possible. -A flexible corneal ring will be placed in the outer edges of the cornea. Rationale During a corneal implant, the shape of the cornea is corrected by placing a flexible ring in the outer edges of the cornea. As the ring is applied to the outside of the optical zone, the risk for corneal clouding or scarring is low. Overcorrection or undercorrection of refraction is possible, but removal, replacement, or adjustment of ring tightness can enhance satisfaction. The procedure is performed under local anesthesia. Improvement to best vision is immediate. pp. 977-978

Which is the deep disruption of the corneal epithelium that extends into the stromal layer? Cordectomy Corneal abrasion Contrecoup injury Corneal ulceration

Corneal ulceration Rationale Corneal ulceration is a deep disruption of the corneal epithelium that extends into the stromal layer and is caused by bacteria, protozoa, or fungi. Cordectomy is an excision of a vocal cord in surgery for laryngeal cancer. A corneal abrasion is a scrape or scratch injury of the cornea. This painful condition can be caused by a small foreign body, trauma, or by using contact lens. Contrecoup injury is a bruising of the brain tissue, with damage occurring on the side opposite the impact site. p. 977

Which factors are possible causes of corneal abrasions? Select all that apply. Foreign body Direct sunlight Contact lenses Bacteria or protozoa infection Large-volume solution containers

Foreign body Contact lense Rationale A corneal abrasion is a scrape or scratch on the cornea that interferes with the integrity of the cornea. Corneal abrasions can occur with the use of contact lenses, and foreign bodies. Chronic sunlight exposure can cause cataracts. Bacterial, protozoal, and fungal infections can lead to corneal ulcerations, which is a deeper disruption of the epithelium. The use of large volume solution containers that can easily become contaminated have led to a sharp rise in the incidence of corneal ulcers infected with Pseudomonas aeruginosa and fungi. p. 977

Which surgery entails that the diseased corneal tissue be removed and replaced with tissue from a human donor cornea? Trabeculectomy Cataract surgery Keratoplasty surgery Laser trabeculoplasty

Keratoplasty surgery Rationale In keratoplasty surgery or corneal transplant, the diseased corneal tissue is replaced with tissue from a human donor cornea. Trabeculectomy is a surgical procedure for open-angle glaucoma because it creates a new channel for fluid outflow. Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. A laser trabeculoplasty is also a surgical procedure for open-angle glaucoma. It burns the trabecular meshwork, scarring it and causing the meshwork fibers to tighten. p.978

Which drug is appropriate for a patient with glaucoma? Trifluridine Bromfenac Latanoprost Sulfisoxazole

Latanoprost Rationale Latanoprost is a prostaglandin agonist that is used to treat glaucoma. It lowers the intraocular pressure in the eyes by dilating the blood vessels in the trabecular mesh of the eye. Trifluridine is a topical antiviral agent used for eye inflammation or infection. Sulfisoxazole is an anti-infective agent. Glaucoma is not caused by bacterial infection. Bromfenac is a nonsteroidal anti-inflammatory agent used to treat eyelid disorders. p. 976

Which term defines a jagged and irregularly shaped break in the retina? Retinal tear Retinal hole Retinal detachment Macular degeneration

Retinal tear Rationale A retinal tear is a jagged and irregularly shaped break in the retina. It occurs when part of the retina separates from the outer layers of the eye. A retinal hole is a break in the retina. A retinal detachment is the separation of the retina from the epithelium. The deterioration of the macula (the area of central vision) can be age-related or exudative and is usually referred to as macular degeneration. p. 979