Chapter 21, Nursing Management: Visual and Auditory Problems: Visual problems

A nurse administered tropicamide in both eyes of a patient in the preoperative room before cataract surgery. What is the most important nursing intervention for this patient? Brighten the room with extra lights. Instruct the patient to wear dark glasses. Monitor for pulmonary effects of the drug. Reassure the patient that the surgery will be uneventful.

Instruct the patient to wear dark glasses.

A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. On which treatment option does the nurse educate the patient? Filtration surgery Photodynamic therapy Laser photocoagulation Argon laser trabeculoplasty

Laser photocoagulation

A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? Use suitable coping strategies to reduce stress Identify patient's strengths and support system Verbalize feelings related to visual impairment Transition successfully to the sudden vision loss

Verbalize feelings related to visual impairment

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. Which surgical procedure will be used to relieve traction on the retina and will the nurse educate the patient? Vitrectomy Cryotherapy Photodynamic therapy Ocular coherence tomography

Vitrectomy

The nurse has completed patient teaching for a patient who had cataract surgery on the left eye. Which statement by the patient indicates a need for further teaching? "I might feel some scratchiness in my left eye." "I should notice an improvement in my vision in a few days." "I will call my health care provider if I notice white drainage or redness in my left eye." "I will call my health care provider if I notice white drainage or redness in my left eye."

"I should notice an improvement in my vision in a few days."

Which statement by the student nurse indicates the need for further teaching regarding age-related macular degeneration (AMD)? "AMD is related to retinal aging." "Family history is a major risk factor for AMD." "People with dark-colored eyes are more at the risk for AMD." "Long-term exposure to ultraviolet light is a risk factor for AMD."

"People with dark-colored eyes are more at the risk for AMD."

A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? "Papilledema is caused by irritants and microorganisms." "Papilledema is fluid accumulation between two layers within the retina." "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

"Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema."

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

"There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve."

Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? "You may feel some palpitations after instilling these eye drops." "You may have a temporary headache after instilling these drops." "You should withhold this medication if your blood pressure becomes elevated." "You should keep your eyes closed for 15 minutes after instilling these eye drops."

"You may have a temporary headache after instilling these drops."

The nurse, who is reinforcing medication teaching before administering the scheduled dose of pilocarpine, would include which statement? "You will need someone to drive you home." "This medication should be used as needed to reduce eye pain." "Eye irritation is to be expected during the first two weeks of use." "This medication will help to raise intraocular pressure to a near normal level."

"You will need someone to drive you home."

A patient has severe myopia. Which type of correction is the patient planning to have if the patient tells the nurse, "I can't wait to be able to see after they implant a contact lens over my lens"? Photorefractive keratectomy (PRK) Phakic intraocular lenses (phakic IOLs) Refractive intraocular lens (refractive IOL) Laser-assisted in situ keratomileusis (LASIK)

Phakic intraocular lenses (phakic IOLs)

Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells? Filtration surgery Photodynamic therapy Laser photocoagulation Argon laser trabeculoplasty

Photodynamic therapy

A patient informs the nurse that he or she is using a homemade saline solution to store contact lenses but is now having irritation and soreness. The nurse assesses inflammation of the cornea. On what medication does the nurse anticipate educating the patient? Tropicamide Besifloxacin Acetazolamide Polyhexamethylene biguanide

Polyhexamethylene biguanide

Which nursing intervention is the highest priority for a patient who has undergone retinal surgery? Monitoring the blood pressure Preventing fluid volume excess Maintaining a darkened environment Positioning and activity as preferred by surgeon

Positioning and activity as preferred by surgeon

The nurse would refrain from administering a prescribed dose of pilocarpine two drops to both eyes if it was documented that the patient has which comorbidity? Secondary glaucoma Macular degeneration Benign prostatic hypertrophy Chronic obstructive pulmonary disease (COPD)

Secondary glaucoma

While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team? Place the patient in a flat supine position. Stabilize the foreign object within the injury site. Instruct the patient to bend over and take deep breaths. Continuously irrigate the eye with sterile saline solution.

Stabilize the foreign object within the injury site.

The adult child of a patient with macular degeneration asks the nurse how to avoid developing the condition. Which intervention should the nurse include in teaching? Select all that apply. Stop smoking or do not start. Avoid exposure to ultraviolet light. Wash hands before touching face or eyes. Wear eye protection while doing yard work. Eat green leafy vegetables such as spinach or kale daily.

Stop smoking or do not start. Avoid exposure to ultraviolet light. Eat green leafy vegetables such as spinach or kale daily.

Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention? Tobacco smoking cessation Yearly ophthalmic examination Eating a diet high in green leafy vegetables and lysine Strict adherence to prescribed eye drop medication schedule

Strict adherence to prescribed eye drop medication schedule

A patient is prescribed bimatoprost. What nursing intervention would ensure safe administration of the drug? Teach the patient to instill three drops three times a day. Advise the patient to wash hands with water and then instill the medicine. Suggest the patient rinse eyes immediately after instilling the medicine. Suggest the patient remove contact lenses 15 minutes before instilling the drops.

Suggest the patient remove contact lenses 15 minutes before instilling the drops.

A patient is diagnosed with epidemic keratoconjunctivitis. How should the nurse help the patient relieve the eye infection? Suggest the use of ice packs and dark glasses. Discourage the use of mild topical corticosteroids. Advise to avoid the use of topical antibiotic ointments. Advise to avoid taking any treatment because the condition is self-limiting.

Suggest the use of ice packs and dark glasses.

A patient is using dipivefrin for the treatment of glaucoma. What side effects should the nurse educate the patient to monitor? Select all that apply. Depression Tachycardia Hypertension Bronchospasm Taste alteration

Tachycardia Hypertension

A patient presents with a sty in the left eye. Which nursing actions are appropriate to manage the patient's condition? Select all that apply. Teach the patient to perform lid scrubs daily. Prepare the patient for surgical removal of the sty. Administer appropriate antibiotic ointments or drops, as prescribed. Teach the patient to gently cleanse the lid margins with baby shampoo. Instruct the patient to apply warm, moist compresses at least four times a day.

Teach the patient to perform lid scrubs daily. Administer appropriate antibiotic ointments or drops, as prescribed. Instruct the patient to apply warm, moist compresses at least four times a day.

Which visual problem will the nurse suspect in the patient who has symptoms of itching, irritation, intolerance towards light, with crusts on the lid margins and lashes? Cataract Blepharitis Retinal detachment Allergic conjunctivitis

Blepharitis

The nurse cares for a patient with a detached retina. The patient says, "Before my eye was patched, I saw a lot of spots." The nurse explains that the symptoms are caused by what? Contamination of the aqueous humor Pieces of the retina floating within the eye Blood cells released into the eye by the detached retina Spasms of the retinal blood vessels traumatized by the detached retina

Blood cells released into the eye by the detached retina

While examining the eye of a patient, the nurse finds a cone-shaped anterior cornea. Which other finding is associated with this condition? Pain Blurred vision Corneal inflammation Abnormal color perception

Blurred vision

The nurse is caring for a patient suspected of having age-related macular degeneration. What symptoms should the nurse document and report regarding this disorder? Blurred, darkened vision Itching, burning, and redness Sudden, excruciating pain in the eye Decreased vision, abnormal color perception

Blurred, darkened vision

A nurse reviews the medical record for a patient with acute glaucoma for which acetazolamide has been prescribed. The patient has a history of high-dose aspirin therapy. Considering the concomitant use of the medications, the nurse expects what change in medication prescriptions? The dose of acetazolamide will be decreased. There will be no change in prescriptions of either medication. The patient cannot take both medications due to gastric disturbances. The patient will be advised to take acetazolamide at a different time than aspirin.

The patient cannot take both medications due to gastric disturbances

A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse? To decrease pain To prevent anxiety To minimize photophobia To minimize intraocular pressure

To minimize photophobia

The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering? Oral acyclovir Trifluridine drops Topical corticosteroids Topical vidarabine ointment

Topical corticosteroids

A patient has a prescription to receive timolol two drops to both eyes every 12 hours. The nurse would withhold the dose and question the prescription if the patient had which condition? Asthma Urinary retention Cluster headaches Chronic constipation

asthma

A patient is having retinal hemorrhages, anoxic cotton-wool spots, and macular swelling in the eye. What should the nurse closely monitor that is a contributing factor to this disorder? Glucose level Blood pressure Intraocular pressure Thyroid hormone levels

bp

A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms? Itching, burning, irritation, and photophobia Tearing, redness, photophobia, and foreign body sensation Red, swollen, circumscribed, and acutely tender area in the lid margin Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

A nurse should instruct a patient who had cataract surgery to contact the surgeon if which condition develops? Glare Itching Eye pain Blurred vision

EYE PAIN

A patient sustained an eye injury, and the nurse assesses blood in the anterior chamber as well as redness of the sclera. What is a priority nursing action for this patient? Applying pressure on the eye Giving oral fluids to the patient Instructing the patient to blow the nose Elevating the head of bed to 45 degrees

Elevating the head of bed to 45 degrees

A 68-year-old patient has undergone a total hip replacement and has glaucoma. The nurse forms a nursing diagnosis of disturbed sensory perception related to increased intraocular pressure. The plan of care should focus on which main element? Restriction of driving privileges immediately Use of occupational and physical therapy for visual deficits Encouraging medication compliance to reduce the risk of vision loss Managing the pain using oral antiinflammatories and opioids as needed

Encouraging medication compliance to reduce the risk of vision loss

A patient reports ocular pain, photophobia, decreased visual acuity, headaches, corneal edema, and conjunctiva that is reddened and swollen. The nurse recognizes that the patient is most likely experiencing which type of inflammation? Scotoma Blepharitis Endophthalmitis Cytomegalovirus retinitis

Endophthalmitis

Which condition involves inflammation of the vitreous cavity? Uveitis Blepharitis Otitis media Endophthalmitis

Endophthalmitis

Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos? Strabismus Keratoconus Exposure keratitis Keratoconjunctivitis sicca

Exposure keratitis

The nurse is assessing a patient for esotropia. What sign observed by the nurse is clinically significant related to this disorder? Eye deviating in Eye deviating up Eye deviating out Eye deviating down

Eye deviating in

A patient admitted to the hospital has been taking pilocarpine eye drops at home. What is the desired effect of this medication? Select all that apply. Facilitates aqueous humor outflow Reverses damage to the optic nerve Improves the patient's vision in dim light Lessens the amount of pupillary dilation Decreases the amount of fluid within the eye

Facilitates aqueous humor outflow Lessens the amount of pupillary dilation

A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient? Instruct the patient to quit smoking. Suggest that the patient consider using supplements of vitamins and minerals. Advise the patient to eat lots of dark green, leafy vegetables containing lutein. Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect? Cataract Strabismus Keratoconus Keratoconjunctivitis sicca

Keratoconjunctivitis sicca

When performing an assessment for a patient with glaucoma, the nurse observes brown iris pigmentation. Which antiglaucoma drug does the nurse determine the patient is taking? Carteolol Dipivefrin Carbachol Latanoprost

Latanoprost

A patient reports an inability to see near objects. The nurse recalls that which physiologic condition is responsible for this disorder? Cornea having irregular curvature Light rays focusing behind the retina Incoming light rays bending unequally Light rays focusing in front of the retina

Light rays focusing behind the retina

The patient calls the clinic about a sty that the patient has had for some time on the upper eyelid. The patient says warm moist compresses have been used, but it is no better. What should the nurse tell the patient to do? "Go to the pharmacy to get some eye drops." "Come in so the ophthalmologist can remove the lesion for you." "The health care provider will need to inject it with an antibiotic." "Wash the lid margins with baby shampoo to remove the crusting."

"Come in so the ophthalmologist can remove the lesion for you."

The nurse is reviewing refractive errors of the eye. Which statement does the nurse identify as being true? Presbyopia occurs when the eyeball elongates. Astigmatism is caused by an irregular corneal curvature. Myopia is an inability to accommodate for near objects. Hyperopia is an inability to accommodate for objects at a distance.

Astigmatism is caused by an irregular corneal curvature.

The nurse is discussing glaucoma prevention with a 52-year-old African American patient. Which statement by the patient reflects a correct understanding of glaucoma prevention? "I will visit my eye doctor every one to two years." "I will wear protective sunglasses while outside." "I will take lutein and vitamin E supplements for eye health." "There is nothing that can be done to prevent vision loss from glaucoma."

"I will visit my eye doctor every one to two years."

The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching? "I'll limit my fluid intake." "I'll change positions slowly." "I'll use my eye drops until my vision clears." "I'll check the labels on my nonprescription drugs."

"I'll check the labels on my nonprescription drugs."

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? Absence of pain or pressure Blurred vision in the morning Seeing colored halos around lights Eye pain accompanied with nausea and vomiting

Absence of pain or pressure

A patient presenting with an itching, burning sensation and redness in the eye is diagnosed with allergic conjunctivitis. What interventions are most important to ease the symptoms? Select all that apply. Administer artificial tears, as prescribed. Instruct the patient to wash hands regularly. Instruct the patient to avoid the allergen if it is known. Administer topical antihistamines and corticosteroids. Instruct the patient to use individual or disposable towels.

Administer artificial tears, as prescribed. Instruct the patient to avoid the allergen if it is known. Administer topical antihistamines and corticosteroids.

Identify risk factors associated with development of cataracts. Select all that apply. Advanced age History of diabetes mellitus Exposure to ultraviolet light Eating a diet high in lutein History of eye chronic open-angle glaucoma History of prolonged therapy with systemic corticosteroids

Advanced age History of diabetes mellitus Exposure to ultraviolet light History of prolonged therapy with systemic corticosteroids

The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom? Carteolol Dipivefrin Carbachol Latanoprost

Carbachol

A patient reports, "While I was walking, I got something in my eye." What nursing intervention is most appropriate for a patient with a suspected foreign object in the eye? Beginning irrigation with sterile normal saline solution Attempting to remove the object without causing further damage to the eye Refraining from doing anything until the patient can be seen by an ophthalmologist Loosely covering the eye with a sterile patch and referring the patient to emergency care

Loosely covering the eye with a sterile patch and referring the patient to emergency care

A patient is advised to take acetazolamide for chronic glaucoma. What nursing interventions are appropriate to perform when administering acetazolamide? Select all that apply. Monitor electrolyte levels. Ask if the patient is allergic to sulfa drugs. Avoid use if the patient has a history of asthma. Caution the patient about decreased visual acuity. Avoid use if the patient is on high-dose aspirin therapy.

Monitor electrolyte levels. Ask if the patient is allergic to sulfa drugs. Avoid use if the patient is on high-dose aspirin therapy.