Glaucoma/Cataracts

Which complications can occur following cataract surgery? Select all that apply. 1. acute bacterial endophthalmitis 2. retrobulbar hemorrhage 3. rupture of the posterior capsule 4. suprachoroidal hemorrhage 5. vision loss

1,5 Acute bacterial endophthalmitis can occur in about 1 out of 1,000 cases. Organisms that are typically involved include Staphylococcus epidermidis, Staphylococcus aureus, and Pseudomonas and Proteus species. Vision loss is one result of acute bacterial infection. In addition, vision loss can be the result of malposition of the intraocular lens implant or opacification of the posterior capsule. Retrobulbar hemorrhage is a complication that may occur right before surgery and is a result of retrobulbar infiltration of anesthetic agents. Rupture of the posterior capsule and suprachoroidal hemorrhage are both complications that can result during surgery.

A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eye drops cause eye burning and visual blurriness for a short time after administration. The best response to the patients statement is a. Those symptoms may indicate a need for an increased dosage of the eye drops. b. The drops are uncomfortable, but it is important to use them to retain your vision. c. These are normal side effects of the drug, which should be less noticeable with time. d. Notify your health care provider so that different eye drops can be prescribed for you.

ANS: B Patients should be instructed that eye discomfort and visual blurring are expected side effects of the ophthalmic drops but that the drops must be used to prevent further visual-field loss. The temporary burning and visual blurriness might not lessen with ongoing use, are not relieved by avoiding systemic absorption, and are not symptoms of glaucoma.

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.

ANS: B 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.

The client with a cataract tells the nurse that she is afraid of being awake during eye surgery. Which of the following responses by the nurse would be the most appropriate? 1. "Have you ever had any reactions to local anesthetics?" 2. "What is it that disturbs you about the idea of being awake?" 3. "By using a local anesthetic, you won't have nausea and vomiting after the surgery." 4. "There's really nothing to fear about being awake. You'll be given a medication that will help you relax."

2.

The client with glaucoma is scheduled for a hip replacement. Which prescription would require clarification before the nurse carries it out? 1. Administer morphine sulfate. 2. Administer atropine sulfate. 3. Teach deep-breathing exercises. 4. Teach leg lifts and muscle-setting exercises.

2. Administer atropine sulfate.

A client who has been treated for chronic open-angle glaucoma (COAG) for 5 years asks the nurse. "How does glaucoma damage my eyesight?" The nurse's reply should be based on the knowledge that COAG: 1. Results from chronic eye inflammation 2. Causes increased intraocular pressure 3. Leads to detachment of the retina 4. Is caused by decreased blood flow to the retina.

2. In COAG, there is an obstruction to the outflow of aqueous humor, leading to increased intraocular pressure.

The nurse is observing a student nurse administer eyedrops, as shown in the figure. What should the nurse instruct the student to do? 1. Move the dropper to the inner canthus. 2. Have the client raise her eyebrows. 3. Administer the drops in the center of the lower lid. 4. Have the client squeeze both eyes after administering the drops.

3. The student has positioned the dropped and the client correctly to prevent injury to the clients eye. The student should administer the drops to the center of the lower lid.

The client has had a cataract removed. The nurse's discharge instructions should include which of the following? 1. Keep the head aligned straight 2. Utilize bright lights in the home. 3. Use an eye shield at night. 4. Change the eye patch as needed.

3. Using an eye shield at night prevents rubbing the eye. The head should be turned to the side to scan the entire visual field to compensate for impaired peripheral vision. The surgeon changes the eye patch the second postoperative day.

After cataract removal surgery, the client is instructed to report sharp pain in the operative eye because this could indicate which postoperative complication? 1. detached retina 2. prolapse of the iris 3. extracapsular erosion 4. intraocular hemorrhage

4. intraocular hemorrhage

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

ANS: B 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.

A patient with a head injury after a motorcycle crash arrives in the emergency department (ED) complaining of shortness of breath and severe eye pain. Which action will the nurse take first? a. Administer the ordered analgesic. b. Check the patients oxygen saturation. c. Examine the eye for evidence of trauma. d. Assess each of the cranial nerve functions.

ANS: B The priority action for a patient after a head injury is to assess and maintain airway and breathing. Because the patient is complaining of shortness of breath, it is essential that the nurse assess the oxygen saturation. The other actions are also appropriate but are not the first action the nurse will take.

When using a Snellen alphabet chart, the nurse records the client's vision as 20/40. Which of the following statements best describes 20/40 vision? A. The client has alterations in near vision and is legally blind. B. The client can see at 20 feet what the person with normal vision can see at 40 feet. C. The client can see at 40 feet what the person with normal vision sees at 20 feet. D. The client has a 20% decrease in acuity in one eye, and a 40% decrease in the other eye

B The numerator refers to the client's vision while comparing the normal vision in the denominator.

The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which intervention is initiated immediately? A. Notify the physician B. Irrigate the eye with cold water C. Apply ice to the affected eye D. Accompany the client to the emergency room

C Treatment for contusion begins at the time of injury. Ice is applied immediately. The client then should be seen by a physician and receive a thorough eye examination to rule out the presence of other eye injuries.

The nurse should assess clients with chronic open-angle glaucoma (COAG) for: 1. eye pain. 2. excessive lacrimation. 3. colored light flashes. 4. decreasing peripheral vision.

4. decreasing peripheral vision.

To decrease intraocular pressure following cataract surgery, the nurse should instruct the client to avoid: 1. lying supine. 2. coughing. 3. deep breathing. 4. ambulation.

2. coughing

The expected outcome of using motifs to treat glaucoma is: 1. Paralyzing ciliary muscles 2. Constriction the intraocular vessels 3. Constricting the pupil 4. Relaxing ciliary muscles

3. Miotic agent constricts the pupil and contracts ciliary musculature.

In reviewing a 55-year-old patients medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a. visual acuity. b. pupil reaction. c. color perception. d. peripheral vision.

ANS: D The patients increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma.

A nurse in the outpatient unit is preparing a client who is scheduled for a laser trabeculoplasty for the treatment of primary open-angle glaucoma. Which of the following instructions should the nurse provide to the client? a) the procedure takes about 2 hours b) activities can be resumed following the procedure immediately c) you may return to work 1 to 2 days following the procedure d) your vision loss will be restored following the procedure

C- Laser trabeculoplasty is performed in the outpatient setting and requires about 30 minutes. The client will experience little discomfort and may resume all normal activities including returning to work within 1 to 2 days. The treatment prevents further visual loss, but the lost vision cannot be restored.

The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: A. Eye pain B. Floating spots C. Blurred vision D. Diplopia

C:A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception.

The nurse instill drops of phenylephrine hydrochloride into the client's eye prior to cataract surgery. Which of the following is the expected outcome? 1. Dilation of the pupil and blood vessels. 2. Dilation of the pupil and constriction of blood vessels. 3. Constriction of the pupil and constriction of blood vessels. 4. Constriction of the pupil and dilation of blood vessels.

2 acts as mydriatic

The nurse observes the client instill eyedrops. The client says, "I just try to hit the middle of my eyeball so the drops do not run out of my eye." The nurse explains to the client that this method may cause: 1. scleral staining. 2. corneal injury. 3. excessive lacrimation. 4. systemic drug absorption.

2. corneal injury

A short time after cataract surgery, the client has nausea. The nurse should first: 1. instruct the client to take a few deep breaths until the nausea subsides. 2. explain that this is a common feeling that will pass quickly. 3. tell the client to call the nurse promptly if vomiting occurs. 4. medicate the client with an antiemetic, as prescribed.

4.

The nurse is preparing a teaching plan for a client who had a cataract extraction with intraocular implantation. Which home care measures should the nurse include in the plan? SATA 1. Avoid activities that requires bending over 2. Contact the surgeon if eye scratchiness occurs 3. Take acetaminophen for minor eye discomfort. 4. Expect episodes of sudden severe eye pain 5. Place an eye shield on the surgical eye at night 6. Contact the surgeon if a decrease in visual acuity occurs.

1,3,5,6 Saunders

For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications? A:Acetazolamide (Diamox) B:Atropine C:Furosemide (Lasix) D:Urokinase (Abbokinase)

A.Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren't used for the treatment of glaucoma.

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.

ANS: A 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.

The nurse is completing the admission database for a patient admitted with abdominal pain and notes a history of hypertension and glaucoma. Which prescribed medications should the nurse question? a. Morphine sulfate 4 mg IV b. Diazepam (Valium) 5 mg IV c. Betaxolol (Betoptic) 0.25% eyedrops d. Scopolamine patch (Transderm Scop) 1.5 mg

ANS: D Scopolamine is a parasympathetic blocker and will relax the iris, causing blockage of aqueous humor outflow and an increase in intraocular pressure. The other medications are appropriate for this patient.

The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? A. Decrease fluid intake to control the intraocular pressure B. Avoid overuse of the eyes C. Decrease the amount of salt in the diet D. Eye medications will need to be administered lifelong

D The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life.

Tonometry is performed on a client with a suspected diagnosis of glaucoma. The nurse looks at the documented test results and notes an intraocular pressure (IOP) value of 23. What should be the nurse's initial action? 1. Apply normal saline drops 2. Note the time of day the test was done 3. Contact the HCP 4. Instruct the client to sleep with the head of the bed flat

2. Fluid between 10-21 are normal. IOP is slightly higher in the morning,

A client uses timolol maleate eyedrops. The expected outcome of this (beta-adrenergic blocker) drug is to control glaucoma by: 1. constricting the pupils. 2. dilating the canals of Schlemm. 3. reducing aqueous humor formation. 4. improving the ability of the ciliary muscle to contract.

3. reducing aqueous humor formation.

One day after cataract surgery, the client is having discomfort from bright light. The nurse should advise the client to:1. dim lights in the house and stay inside for 1 week.2. attach sun shields to existing eyeglasses when in direct sunlight.3. use sunglasses that wrap around the side of the face when in bright light.4. patch the affected eye when in bright light.

3. use sunglasses that wrap around the side of the face when in bright light

Which clinical manifestation should the nurse assess when a client has acute angle-closure glaucoma? 1. gradual loss of central vision 2. acute light sensitivity 3. loss of color vision 4. sudden eye pain

4. sudden eye pain

What information should the nurse provide when preparing the client for tonometry? 1. Oral pain medication will be given before the procedure. 2. It is a painless procedure with no adverse effects. 3. Blurred or double vision may occur after the procedure. 4. Medication will be given to dilate the pupils before the procedure.

2. It is a painless procedure with no adverse effects.

What should the nurse do for a client who just had cataract surgery? 1 Instruct the client to avoid driving for several weeks. 2 Teach the client coughing and deep-breathing techniques. 3 Advise the client to refrain from vigorous brushing of the teeth and hair. 4 Encourage the client to perform eye exercises to strengthen the ocular musculature.

3 Activities such as rigorous brushing of hair and teeth cause increased intraocular pressure and may lead to hemorrhage in the anterior chamber.1 This is unnecessary; clients are usually permitted to drive before this time. 2 Coughing and deep breathing can increase intraocular pressure and should be avoided. 4 Weakening of the eye musculature is not related to cataracts.

Which patient arriving at the urgent care center will the nurse assess first? a. Patient with acute right eye pain that occurred while using home power tools b. Patient with purulent left eye discharge, pruritus, and conjunctival inflammation c. Patient who is complaining of intense discomfort after an insect crawled into the right ear d. Patient who has Mnires disease and is complaining of nausea, vomiting, and dizziness

ANS: A The history and symptoms suggest eye trauma with a possible penetrating injury. Blindness may occur unless the patient is assessed and treated rapidly. The other patients should be treated as soon as possible, but do not have clinical manifestations that indicate any acute risk for vision or hearing loss.

The client arrives in the emergency room with a penetrating eye injury from wood chips while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye, what is the initial nursing action? A. Remove the piece of wood using a sterile eye clamp B. Apply an eye patch C. Perform visual acuity tests D. Irrigate the eye with sterile saline

C If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. This object must never be removed except by the ophthalmologist because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the sclera. (The only option that will prevent further disruption is to assess visual acuity.)

Nurse Jairuz Roy is carrying out his preoperative teachings for an older client who will have cataract surgery on the right eye. The nurse concludes that the client needs further understanding about the teachings if he says: A. "I will sleep on my left side after the surgery." B. "I will wipe my nose gently if it is congested after surgery." C. "I will call my physician if I have sharp and sudden pain or a fever after surgery." D. "I will bend below my waist frequently to increase circulation after surgery."

D Immediately after the procedure, the client should avoid bending over, to prevent putting extra pressure on the eye.

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.

ANS: B 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.

To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by a. questioning the patient about blurred vision. b. noting any changes in the patients visual field. c. asking the patient to rate the pain using a 0 to 10 scale. d. assessing the patients depth perception when climbing stairs.

ANS: B POAG develops slowly and without symptoms except for a gradual loss of visual fields. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG.

A nurse provides a list of instructions to a client with glaucoma regarding measures that will prevent an increase in intraocular pressure in the eyes. Which statement by the client indicates a need for further instructions? a) I can move objects weighing 20 pounds or more by pushing the object on the floor using my feet b) I can tie my shoelaces by bending over slowly c) I need to consume a diet high in fiber and bulk d) I need to maintain an intake of six to eight glasses of water a day

B- Activities such as bending over or straining at stool will increase intraocular pressure. The client needs to be instructed to maintain a diet high in bulk and fiber and to consume a high intake of liquids, unless contraindicated, to prevent constipation and straining at stools. The client should tie shoelaces by bending the knee, raising the thigh, and bringing the foot within reach. Objects weighing 20 pounds or more can be moved by pushing the object on the floor by using the feet or a mechanical dolly.

A client is having a cataract removed and will use eyeglasses after the surgery. The nurse should develop a teaching plan that includes which of the following? Select all that apply. 1. Images will appear to be one-third larger. 2. Look through the center of the glasses. 3. The changes will be immediate. 4. Use handrails when climbing stairs. 5. Stay out of the sun for 2 weeks.

1,2,4 Images will appear to be one-third larger.• Look through the center of the glasses.• Use handrails when climbing stairs.Explanation: The use of glasses following cataract surgery does not totally restore binocular vision. Glasses will cause images to appear larger and peripheral vision will be distorted; the client should look through the center of the glasses and turn his or her head to view objects in the periphery. The client should also use caution when walking or climbing stairs until he or she has adjusted to the change in vision. Changes in vision following cataract surgery are not immediate and the nurse can instruct the client to be patient while adjusting to the changes. The client does not need to stay out of the sun, but should wear dark glasses to prevent discomfort from photophobia

The nurse is instructing the client about postoperative care following cataract removal. What position should the nurse teach the client to use? 1. Remain in a semi-Fowler's position. 2. Position the feet higher than the body. 3. Lie on the operative side. 4. Place the head in a dependent position.

1. Remain in semi-Fowler's position. (or on the non-operative side)

After returning home, a client who has had cataract surgery will need to continue to instill eyedrops in the affected eye. The client is instructed to apply slight pressure against the nose at the inner canthus of the eye after instilling the eyedrops. The expected outcome of applying pressure is that the pressure: 1. prevents the medication from entering the tear duct. 2. prevents the drug from running down the client's face. 3. allows the sensitive cornea to adjust to the medication 4. facilitates distribution of the medication over the eye surface.

1. prevents the medication from entering the tear duct (systemic effects)

A client with glaucoma is to receive 3 gtt of acetazolamide in the left eye. What should the nurse do? 1. Ask the client to close his right eye while administering the drug in the left eye. 2. Have the client look up while the nurse administers the eyedrops. 3. Have the client lift the eyebrows while the nurse positions the hand with the dropper on the client's forehead. 4. Wipe the eyes with a tissue following administration of the drops.

2. Have the client look up while the nurse administers the eyedrops.

A client has been diagnosed with an acute episode of angle-closure glaucoma. The nurse plans the client's nursing care with the understanding that acute angle-closure glaucoma: 1. frequently resolves without treatment. 2. is typically treated with sustained bed rest. 3. is a medical emergency that can rapidly lead to blindness. 4. is most commonly treated with steroid therapy.

3. is a medical emergency that can rapidly lead to blindness

A client tells the nurse about the vision being blurred and hazy throughout the entire day. The nurse should recommend that the client: 1. purchase a pair of magnifying glasses. 2. wear glasses with tinted lenses. 3. schedule an appointment with an optician. 4. schedule an appointment with an ophthalmologist.

4. schedule an appointment with an ophthalmologist. Ophthalmologist= tx eye disorders Optician= make eye glasses

The client's vision is tested with a Snellen's chart. The results of the tests are documented as 20/60. The nurse interprets this as: A. The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet. B. The client is legally blind. C. The client's vision is normal D. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet.

D. Vision that is 20/20 is normal, that is, the client is able to read from 20 feet what a person with normal vision can read from 20 feet. A client with a visual acuity of 20/60 only can read at a distance of 20 feet of what a person with normal vision can read at 60 feet.

A patient who received a corneal transplant 2 weeks ago calls the ophthalmology clinic to report that his vision has not improved with the transplant. Which action should the nurse take? a. Suggest the patient arrange a ride to the clinic immediately. b. Ask about the presence of floaters in the patients visual field. c. Remind the patient it may take months to restore vision after transplant. d. Teach the patient to continue using prescribed pupil-dilating medications.

ANS: C Vision may not be restored for up to a year after corneal transplant. Because the patient is not experiencing complications of the surgery, an emergency clinic visit is not needed. Because floaters are not associated with complications of corneal transplant, the nurse will not need to ask the patient about their presence. Corticosteroid drops, not mydriatic drops, are used after corneal transplant surgery.

During the nursing history, which assessment data would the nurse expect the client scheduled for surgical correction of chronic open-angle glaucoma to report? A. Seeing flashes of lights and floaters B. Recent motor vehicle crash while changing lanes C. Complaints of headaches, nausea, and redness of the eyes D. Increasingly frequent episodes of double vision

B Typically, the client with chronic open-angle glaucoma experiences a gradual loss in peripheral vision leading to tunnel vision. Being involved in a motor vehicle crash while changing lanes suggests the disorder. The client may experience insidious blurring, decreased accommodation, mild aching eyes and, eventually, halos around the lights as intraocular pressure increases. Flashes of light and floaters are characteristic of retinal detachment. Nausea, headache, and eye redness are seen with an episode of acute (sudden) closed-angle closure. Double vision occurs when one eye has a lens and other is aphakic.

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled?A:An osmotic diuretic B:A miotic agent C:A mydriatic medication D:A thiazide diuretic

C .A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the cataract client. These medication act by dilating the pupils. They also constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract.

Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma? a. Morphine sulfate 4 mg IV b. Mannitol (Osmitrol) 100 mg IV c. Betaxolol (Betoptic) 1 drop in each eye d. Acetazolamide (Diamox) 250 mg orally

ANS: B The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly with IV administration of a hyperosmolar diuretic such as mannitol. The other medications are also appropriate for a patient with glaucoma but would not be the first medication administered.

Which action could the registered nurse (RN) who is working in the eye and ear clinic delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Evaluate a patients ability to administer eye drops. b. Use a Snellen chart to check a patients visual acuity. c. Teach a patient with otosclerosis about use of sodium fluoride and vitamin D. d. Check the patients external ear for signs of irritation caused by a hearing aid.

ANS: B Using standardized screening tests such as a Snellen chart to test visual acuity is included in LPN education and scope of practice. Evaluation, assessment, and patient teaching are higher level skills that require RN education and scope of practice.

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.

ANS: C 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.

The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart. Which of the following identifies the accurate procedure for this visual acuity test? A:Both eyes are assessed together, followed by the assessment of the right and then the left eye. B: The right eye is tested followed by the left eye, and then both eyes are tested. C: The client is asked to stand at a distance of 40ft. from the chart and is asked to read the largest line on the chart. D: The client is asked to stand at a distance of 40ft from the chart and to read the line than can be read 200 ft away by an individual with unimpaired vision.

B. Visual acuity is assessed in one eye at a time, and then in both eyes together with the client comfortably standing or sitting. The right eye is tested with the left eye covered; then the left eye is tested with the right eye covered. Both eyes then are tested together. Visual acuity is measured with or without corrective lenses and the client stands at a distance of 20ft. from the chart.