MED SURG 2 CH. 53 EAQ

A patient who had eye surgery on the right eye is being discharged from the hospital. What statement made by the patient would suggest that patient education has been effective? 1. "I will make sure to sleep on my left side for a little while." 2. "I have been straining trying to have a bowel movement." 3. "It is okay for me to rub my eyes if I get something in them." 4. "I am excited that I will be able to go bowling this weekend."

1. "I will make sure to sleep on my left side for a little while." The patient should avoid lying on the affected side as this could cause increased intraocular pressure. The patient should avoid straining as this could cause increased intraocular pressure. The patient should avoid rubbing the eyes as this could cause injury. The patient should avoid leaning or bending forward as well as lifting objects greater than 5 pounds as this could cause increased intraocular pressure.

A patient is diagnosed with keratitis in the left eye. Which statement made by the patient would suggest that further patient education is required? Select all that apply. 1. "I will make sure to wear an eye pad." 2. "I will apply erythromycin ointment to the eye." 3. "I will apply dexamethasone ointment to the eye." 4. "The health care provider may inject erythromycin into the eye." 5. "The health care provider will treat the eye with tetracaine HCl."

1. "I will make sure to wear an eye pad." 5. "The health care provider will treat the eye with tetracaine HCl." Eye pads are not used with keratitis because they provide a dark, damp environment for microorganisms to grow. Tetracaine HCl, a topical anesthetic, is not recommended because the patient might accidentally cause additional injury to the anesthetized cornea. Erythromycin, either ointment or injection, and dexamethasone are used in the treatment of keratitis.

A patient who had keratoplasty of the left eye 1 week ago comes in for a follow-up appointment complaining of redness, swelling, increased light sensitivity, and pain. Which patient statement indicates the need for further education on postoperative care? 1. "These are normal signs and symptoms related to keratoplasty." 2. "Corticosteroid drops usually help prevent the risk of rejection." 3. "These are signs and symptoms of a rejection of the corneal graft." 4. "I must immediately notify the health care provider of these signs and symptoms."

1. "These are normal signs and symptoms related to keratoplasty." These signs and symptoms are not normal; they are signs and symptoms of rejection of the corneal graft. The health care provider must be notified immediately in the event of graft rejection. Corticosteroid drops are used to help prevent the risk of rejection.

A patient who has open-angle glaucoma is taking pilocarpine and begins to experience bronchospasm, hypotension, bradycardia, and a headache. The nurse suspects that the patient is experiencing a toxicity reaction. Which priority nursing intervention should be implemented? 1. Administer atropine 2. Administer carbachol 3. Administer acetylcholine 4. Administer physostigmine

1. Administer atropine Administering atropine is the antidote for pilocarpine. Carbachol, acetylcholine, and physostigmine are all cholinergics like pilocarpine and may exacerbate the symptoms.

Select all that apply concerning the admission of a visually impaired person to a health care facility. 1. Alert staff that the patient has a visual impairment. 2. To avoid embarrassment, do not bring a patient's visual impairment to the staff's attention. 3. When you enter the room, announce your presence and introduce yourself. 4. Speak before touching the patient, to avoid startling the patient. 5. Let the patient know when you are leaving the room. 6. Let the patient know where the call bell is, but let the patient have the independence to figure out how to use the call bell.

1. Alert staff that the patient has a visual impairment. 3. When you enter the room, announce your presence and introduce yourself. 4. Speak before touching the patient, to avoid startling the patient. 5. Let the patient know when you are leaving the room. When a visually impaired person is admitted to a health care facility, alert staff that the patient has a visual impairment. When the nurse enters the room, announce your presence and introduce yourself. Speak before touching the patient, to avoid startling the patient, and let the patient know when you are leaving the room. It is inappropriate, and potentially harmful to NOT explain to the patient how to use the call bell.

What purpose is served by moving your assisting arm to your back when moving with a visually impaired person? 1. Alerting the visually impaired person that we are walking through a narrow area 2. Alerting the visually impaired person to stop walking and to wait for directions from the assistant 3. Alerting the visually impaired person that it is unsafe to proceed and to wait for directions from the assistant 4. Alerting the visually impaired person that there will be a different sighted person along in a minute to assist and to wait in place

1. Alerting the visually impaired person that we are walking through a narrow area To assist a visually impaired person in an open area, the visually impaired person holds on to the nurse's open arm, walking side by side. Moving the arm to the back signals that you are going through a narrow area and can no longer walk side by side, but that assistance is still available.

Betaxolol or metipranolol are often the first drug class to be used to treat glaucoma. To which drug category do these medications belong? 1. Beta blockers 2. Optic blockers 3. Alpha blockers 4. Calcium channel blockers

1. Beta blockers Beta-adrenergic blocker agents often are the first drug used in the treatment of glaucoma. Betoptic and metipranolol are two examples of beta blockers. Calcium channel blockers do not assist in lowering the optic pressure found in glaucoma. There are no categories of medication known as optic blockers or alpha blockers.

A patient comes in for an annual eye exam. Upon examination, it is noted that the patient has good peripheral vision, sees better in dim light, and that the lens is cloudy in the center. These symptoms are most closely associated with which disease? 1. Central cataracts 2. Peripheral cataracts 3. Open-angle glaucoma 4. Angle-closure glaucoma

1. Central cataracts Patients with central cataracts have fairly good peripheral vision, see better in dim light, and have a cloudy center of the lens. Patients with peripheral cataracts can usually see straight ahead but not to the side. Open-angle glaucoma and angle-closure glaucoma do not cause a cloudy center in the lens.

In addition to bacteria, viruses, or fungi, what is a possible source of keratitis? 1. Chemical contact 2. Eye strain 3. Overuse 4. Incorrect lens (eyeglass) prescription

1. Chemical contact Keratitis is an inflammation or infection, of one or both, of the cornea. Sources of infection include bacteria, viruses, and fungi. In addition, chemical or mechanical injuries that cause inflammation may be followed by infection. Direct contact is required for the onset of keratitis, which would exclude eye strain, overuse, or eyeglass prescription.

A patient comes to the clinic complaining of visual disturbances. Which medications would the nurse suspect are most likely related to the disturbances? Select all that apply. 1. Digitalis 2. Cimetidine 3. Indomethacin 4. Esomeprazole 5. Sulfisoxazole

1. Digitalis 3. Indomethacin 5. Sulfisoxazole Digitalis, indomethacin, and sulfisoxazole are especially likely to be related to visual disturbances. Cimetidine and esomeprazole are likely to be related to gastrointestinal disturbances.

Some of the medications used to treat glaucoma may cause which side effects? 1. Headache, blurred vision 2. Halos, decreased night vision 3. Increased ocular, optic nerve pressure 4. Tired eyes, frequency of lens prescription change

1. Headache, blurred vision Headache, brow ache, blurred vision, and ocular irritation may be some of the side effects caused by medication prescribed for glaucoma. Halos, decreased night vision, tired eyes, frequent lens prescription changes and increased ocular and optic nerve pressure are all symptoms of untreated glaucoma.

A patient with liver dysfunction is seen in the clinic. What does the nurse expect to note during the examination of the eye? 1. Icterus 2. Macula 3. Scotomata 4. Arcus senilis

1. Icterus Icterus is the term for the sclera with a yellow color that is associated with liver dysfunction. Macula is the term for an area of the retina that has the sharpest vision. Scotomata is the term for blind spots. Arcus senilis is the term for a grayish ring around the outer margin of the iris seen in older patients.

A patient comes into the emergency department with gray, round, raised areas (follicles) seen on the conjunctiva. Redness and watery drainage are also noted. The nurse suspects that the infection is caused by HSV-1. What medication does the nurse expect the health care provider to order? 1. Idoxuridine 2. Sulfonamide 3. Prednisolone 4. Fluorometholone

1. Idoxuridine Gray, round, raised areas on the conjunctiva along with redness and watery drainage are signs and symptoms of viral conjunctivitis, which is treated with idoxuridine (HerpEX) ointment. Sulfonamide is an antibacterial and is used to treat bacterial conjunctivitis, not viral conjunctivitis. Prednisolone and fluormetholone are corticosteroids, which are contraindicated in the treatment of herpes virus.

The nurse is admitting a patient who is visually impaired to the nursing unit. What measures should the nurse implement to support the patient and prevent injury? Select all that apply. 1. Leave the bed in the low position. 2. Increase the nurse's tone volume. 3. Speak before touching the patient. 4. Tell the patient when leaving the room. 5. Rearrange the furniture after orientation. 6. Leave the door halfway open for the patient.

1. Leave the bed in the low position. 3. Speak before touching the patient. 4. Tell the patient when leaving the room. Leaving the bed in the low position, speaking before touching the patient, and telling the patient when leaving the room will support the patient who is visually impaired and prevent injury. The patient can hear, so speak in a normal tone of voice. The patient has become familiar with the original arrangement, so rearranging could lead to patient injury. The door should either be kept closed or open so that the patient does not run into a partially closed/open door.

Irregularities in which eye structure may result in the visual condition called astigmatism? 1. Lens 2. Pupil 3. Retina 4. Conjunctiva

1. Lens When irregularities in the cornea or lens exist, astigmatism results. Irregularities in the pupil, retina, or conjunctiva do not cause astigmatism.

While assessing the sclera of a patient in an acute care setting, the nurse documents a yellow color (icterus). The nurse reports this finding to the health care provider and anticipates an order to check which diagnostic information? 1. Liver tests 2. Blood pressure 3. Hemoglobin A1c 4. Glomerular filtration rate

1. Liver tests The sclera should be clear white. A yellow color, called icterus, is associated with liver dysfunction, which can be determined by measuring the patient's AST and ALT. Icterus is not associated with hypertension (measured by blood pressure), diabetes (measured by hemoglobin A1c), or kidney dysfunction (measured by glomerular filtration rate).

A patient is receiving treatment with pilocarpine for glaucoma. The licensed practical nurse (LPN) is assessing the patient's vital signs and notes that the pulse has dropped from 80 beats per minute before treatment with pilocarpine to 55 beats per minute after treatment was initiated. Which is the priority action in response to this information by the nurse? 1. Notify the health care provider. 2. Continue to monitor vital signs. 3. Administer atropine as an antidote. 4. Document the information in the patient's chart.

1. Notify the health care provider. The health care provider should be notified of this information immediately because the change in pulse rate is a systemic effect of this medication. Atropine may be administered to correct this effect, but it would not be administered without an order from the health care provider. After notifying the health care provider, the nurse would continue to monitor the patient's vital signs and document the information in the patient's chart.

A laboratory employee has sustained a chemical splash to the right eye and reports to the minor emergency center for care. The health care provider has prescribed immediate eye irrigation. Which is the correct technique for irrigating the eye? 1. Position the patient with the right eye down. 2. Direct the fluid directly over the pupil on the affected eye. 3. Place the irrigating syringe gently onto the sclera of the eye. 4. Direct the fluid into the upper conjunctival sac on the affected eye.

1. Position the patient with the right eye down. The patient should be positioned with the right eye (affected eye) down so that the contaminated fluid does not run into the unaffected eye. The fluid should not be directed over the pupil. The irrigating syringe should not touch the eye. The fluid should be directed into the lower conjunctival sac, from the inner canthus to the outer canthus.

A patient with myopia begins complaining of seeing flashes of light and states, "It seems as if a curtain came down over my eyes." The nurse would suspect that the patient is experiencing which disorder? 1. Retinal detachment 2. Peripheral cataracts 3. Open-angle glaucoma 4. Macular degeneration

1. Retinal detachment Flashes of light and a feeling of a curtain coming down over the eyes are signs and symptoms of retinal detachment. Signs and symptoms of peripheral cataracts consist of the ability to see straight ahead but not to the side. Signs and symptoms of open-angle glaucoma consist of tired eyes, occasional blurred vision, and halos around lights. Signs and symptoms of macular degeneration consist of difficulty reading or doing close work.

A patient is brought to the emergency department with a suspected retinal detachment from an industrial accident. Which finding is most indicative of retinal detachment? 1. Sees flashes of light 2. Has a rock-hard eyeball 3. Has a bloody look in the eye 4. Has yellow exudate present in the eye

1. Sees flashes of light Signs and symptoms of retinal detachment depend on the location and extent of the detachment. Patients may report seeing flashes of light or floaters. Vision may be cloudy. If the area of detachment is large, then vision may be lost completely. Some patients describe the condition as a curtain coming down or across their line of vision. A rock-hard eyeball, a bloody look in the eye, or a yellow exudate present in the eye are not indicative of retinal attachment.

An older adult patient with chronic asthma was recently diagnosed with open-angle glaucoma. What drug order received from the health care provider would the nurse question? 1. Timolol 2. Betaxolol 3. Brimonidine 4. Levobetaxolol

1. Timolol The nurse should question the order of a nonselective beta adrenergic blocker, such as timolol, for the patient who has asthma. Betaxolol is a selective beta adrenergic blocker and is a first-line drug for open-angle glaucoma. Brimonidine is an alpha-2 adrenergic agonist that is used for open-angle glaucoma. Levobetaxolol is a selective beta adrenergic blocker and is a first-line drug for open-angle glaucoma.

Which procedures require the patient to avoid rubbing the eyes? Select all that apply. 1. Tonometry 2. Refractometry 3. Electroretinography 4. Fluorescein angiography 5. Ophthalmologic examination

1. Tonometry 3. Electroretinography The nurse should advise a patient who undergoes tonometry and electroretinography not to rub the eyes for at least 15 minutes after the procedure. This helps to avoid risk for injury to the anesthetized eyes. The nurse should advise patients who have undergone refractometry, fluorescein angiography, and ophthalmologic examinations to wear sunglasses to promote visual acuity.

A patient is scheduled to have a fluorescein angiography. What nursing education should be reinforced to the patient postprocedure? Select all that apply. 1. Urine may be greenish 2. Visual acuity will be increased 3. Patient should wear sunglasses 4. Dye may cause a yellowish skin color 5. Patient will be able to drive himself or herself home

1. Urine may be greenish 3. Patient should wear sunglasses 4. Dye may cause a yellowish skin color With fluorescein angiography, the urine may be green as the dye is eliminated. The dye may cause a yellowish skin color for 6 to 24 hours. The patient is advised to wear sunglasses after the procedure due to the dilation of the pupils. Visual acuity will be decreased because of the pupil dilation. The patient will need someone to drive him or her home as a result of the pupil dilation.

The nurse is preparing to provide preprocedural information for a patient scheduled for a fluorescein angiography. The nurse would include which teaching points? Select all that apply. 1. Urine will appear bright green. 2. The skin may appear yellow for several hours. 3. Miotic drops will be used to constrict the pupil. 4. Intravenous access will be initiated for the procedure. 5. The procedure is performed under general anesthesia.

1. Urine will appear bright green. 2. The skin may appear yellow for several hours. 4. Intravenous access will be initiated for the procedure. The nurse would inform the patient that intravenous access will be initiated for the procedure. The dye used for fluorescein angiography will cause the patient's skin to appear yellow for several hours after the test. As the dye used for fluorescein angiography is excreted, the urine will appear bright green. Mydriatic drops are used during fluorescein angiography to dilate the pupil. The procedure does not involve general anesthesia.

The school nurse is providing information to a group of concerned parents regarding conjunctivitis. The nurse should include information about which possible causes? Select all that apply 1. Viruses 2. Bacteria 3. Herpes zoster 4. Physical injury 5. Adenoviruses

1. Viruses 2. Bacteria 3. Herpes zoster 5. Adenoviruses Bacterial conjunctivitis is commonly called pinkeye. Viral conjunctivitis can be caused by bacteria, herpes simplex virus-1 (HSV-1), herpes zoster virus, or adenoviruses. Physical injury does not cause microbial infection.

If a patient being tested with the Snellen chart reads the 20/30 line with one error, but made three errors on the 20/25 line, the vision would be recorded as what? 1. 20/20 2. 20/30 3. 20/50 4. 20/70

2. 20/30 Visual acuity is commonly tested using the Snellen chart. The Snellen chart has rows of progressively smaller letters. From a distance of 20 feet, the patient is instructed to read down the chart until more than two mistakes are made on a single line. Each eye is tested separately and then together. The lines are numbered 20 over 200, 100, 70, 50, 40, 30, 25, 20, and 15. The findings are reported as the last line the person could read with no more than two errors. That is, if the person read the 20/30 line with one error but made three errors on the 20/25 line, then the vision would be recorded as 20/30 in the eye tested. This means that the person could read at 20 feet what a person with normal vision could read at 30 feet.

A patient comes in to the clinic complaining of inflammation of the eyelids. The nurse suspects that the patient is experiencing which disorder? 1. Stye 2. Chalazion 3. Blepharitis 4. Hordeolum

2. Chalazion A chalazion is an inflammation of the glands of the eyelid. Blepharitis is an inflammation of the hair follicles along the eyelid margin. A hordeolum is a staphylococcal infection of the eyelid margin that originates in a lash follicle. Stye is another name for a hordeolum.

Which part in the eye supplies nourishment to the macula? 1. Sclera 2. Choroid 3. Vitreous humor 4. Aqueous humor

2. Choroid The macula is an area on the retina that does not have blood supply. Therefore, it depends on the choroid for nourishment. The sclera is the outer layer that protects the inner layers of the eye. The vitreous humor helps hold the retina in place. The aqueous humor helps to moisturize and nourish the lens and cornea.

A severely stressed patient is being seen in the clinic. What should the nurse expect to notice upon assessment of the eye? 1. Relaxed iris, dilated pupil 2. Contracted iris, dilated pupil 3. Relaxed iris, constricted pupil 4. Contracted iris, constricted pupil

2. Contracted iris, dilated pupil Severe stress causes the iris to contract, making the pupil dilate or enlarge. The pupil dilates, not constricts, when a patient is severely stressed.

The nurse is participating in a care conference for a resident to be admitted to the long-term care facility. The resident has recently been diagnosed with open-angle glaucoma. Which aspect of care is most likely to be included in the initial plan of care? 1. Intravenous agents to dilate the pupils 2. Drug therapy consisting of beta-blocking agents 3. Drug therapy consisting of anticholinergic agents 4. Radiation treatments to reduce intraocular pressure

2. Drug therapy consisting of beta-blocking agents Open-angle glaucoma is also called chronic glaucoma. Open-angle glaucoma usually is treated first with drug therapy consisting of beta-blocking agents. Anticholinergic agents are not used to treat open-angle glaucoma. Radiation is not usually used to treat glaucoma initially.

A patient who is receiving brimonidine to treat symptoms of glaucoma develops a blood pressure of 176/88 mm Hg and a pulse of 78 beats/min. An hour previously, the patient's blood pressure was 130/73 mm Hg. Which nursing action is appropriate? 1. Notify the pharmacist of the recent vital signs findings. 2. Hold the medication and notify the health care provider. 3. Administer the medication and help the patient try to relax. 4. Ask the health care provider to prescribe anti-anxiety medications.

2. Hold the medication and notify the health care provider. The nurse would hold the medication and notify the health care provider of the patient's vital signs because brimonidine (Alphagan) tends to cause hypertension. After notifying the health care provider, the information can be relayed to the pharmacist and the nurse would continue to monitor the blood pressure. Helping the patient relax and providing anti-anxiety medications may not lower the blood pressure enough to prevent serious patient harm.

A visually impaired patient on the nursing unit is provided with this dinner plate. The nurse can encourage the patient's independence by doing what? 1. Cutting up the meat pastry and feeding it to the patient. 2. Informing the patient that the carrots are at 9 o'clock. 3. Rearranging the items on the tray. 4. Allowing the patient to find the foods himself.

2. Informing the patient that the carrots are at 9 o'clock. Informing the patient that the carrots are at 9 o'clock encourages independence by orienting the patient to the location of foods. The nurse should ask the patient first what assistance is required instead of assuming that help is needed or by feeding the patient. Maintaining a consistent environment enables the patient to be more independent. The nurse should promote independence by informing the patient where the food is on the tray, but not by allowing the patient to find the food himself.

An older adult patient with a cloudy lens is scheduled for keratoplasty. What preoperative medication should the nurse expect to be ordered by the health care provider? 1. Miotic agent 2. Mydriatic agent 3. Systemic antimicrobial agent 4. Topical corticosteroid agent

2. Mydriatic agent A mydriatic agent is used when the lens is cloudy due to age-related changes. This agent allows access to the lens by dilating the pupil. Miotic agent drops are used to constrict the pupil. Systemic antimicrobial agents are not used in the treatment of keratoplasty. Topical corticosteroid agents are used in the postoperative treatment of keratoplasty to reduce inflammation.

The patient is scheduled to undergo pure tone audiometry tests. The LPN is instructing the patient on how the test will be implemented and tells the patient that the initial step in the testing consists of which process? 1. Placing a tuning fork near the patient's ear 2. Placing earphones on the patient and introducing tones 3. Asking the patient to identify when sounds are heard and when they disappear 4. Asking the patient to identify when vibrating sound is heard and when it ceases

2. Placing earphones on the patient and introducing tones The first step in the process would be to place earphones on the patient and introduce tones. Then the patient would be asked to identify when sounds are heard and when they disappear. The patient would also have a tuning fork placed near his or her ear and be asked to identify when vibrations are heard and when they cease.

A patient comes to the emergency department after getting chemicals in the left eye. The nurse plans to irrigate the eye in which order? 1. Place a basin and waterproof pad 2. Put on gloves 3. Cleanse the eyelids and eyelashes. 4. Gently direct fluid from inner to outer canthus. 5. Position patient with the left eye down.

2. Put on gloves. 3. Cleanse the eyelids and eyelashes. 5. Position patient with the left eye down. 1. Place a basin and waterproof pad. 4. Gently direct fluid from inner to outer canthus. When irrigating the eyes, the nurse should wear gloves, then cleanse the eyelids and eyelashes; next, position the patient with the affected eye down; then, place a basin and waterproof pad to collect the fluid; and last gently direct fluid from the inner canthus to the outer canthus.

Which statement is true regarding vision in the older adult? 1. Most older people wear glasses because they have hypoopia. 2. Some older people report floaters moving across the vision field. 3. The amount of fat around the eye increases, raising the eyeball. 4. Tear secretion increases and the cornea becomes more sensitive.

2. Some older people report floaters moving across the vision field. Eye structure and function undergo typical changes with aging. Some elderly people report seeing specks and floaters move across the vision field due to debris in the vitreous humor. Older people's ability to focus becomes impaired, which leads to hyperopia or farsightedness, not hypoopia. The amount of fat in elderly around the eyeball decreases and sinks the eyeball deep into the orbit. Tear secretion in the elderly decreases and the cornea becomes less sensitive as the eyeball sinks deeper into the orbit.

A patient is diagnosed with angle-closure glaucoma in the right eye. Which signs and/or symptoms would the nurse expect to see when assisting with data collection on this patient? Select all that apply. 1. Floaters 2. Sudden, acute pain 3. Halos around lights 4. Nausea and vomiting 5. Headache on the left side 6. Seeing spots or ghost images

2. Sudden, acute pain 3. Halos around lights 4. Nausea and vomiting Sudden, acute pain; halos around lights; and nausea and vomiting are all signs and symptoms of open-angle glaucoma. Headache on the left side is incorrect, as the patient will actually experience a headache on the affected side. Floaters and seeing spots or ghost images are incorrect, as these are signs and symptoms associated with cataracts.

A patient with retinal detachment in the back of the eye undergoes cryotherapy and scleral buckling. The health care provider injects normal saline into the vitreous humor after the surgical procedure. In which position should the nurse expect to place the patient? 1. Prone 2. Supine 3. Semi-Fowler's 4. Trendelenburg

2. Supine The nurse would place the patient in the supine position, because if the detachment is in the back of the eye the saline will travel down rather than up, so the patient would need to stay face up to keep the bubble in place. The patient would need to be in the face down position if air was used instead of saline. The patient would need to be face up, not in the Semi-Fowler's or Trendelenburg position, to keep the bubble in place.

A patient with open-angle glaucoma is not taking medications as prescribed. Which intervention would the nurse expect the health care provider to consider first? 1. Keratoplasty 2. Trabeculoplasty 3. Trabeculectomy 4. Cyclocryotherapy

2. Trabeculoplasty Trabeculoplasty is usually tried first because it can be done under local anesthesia in an outpatient setting. Keratoplasty is a procedure that is performed to replace an unhealthy cornea. Trabeculectomy is not the first surgical intervention to be considered for open-angle glaucoma. Cyclocryotherapy is a last resort if other procedures do not work effectively.

A patient with a history of enucleation is being fitted for a prosthesis. The nurse provides the following patient education on the steps of care for the prosthesis. Place the steps in order of priority. 1. Slip top of prosthesis under orbit 2. Wash hands thoroughly 3. Wash prosthesis under running water 4. Gently depress and pull lower lid down 5. Allow prosthesis to slip out over lower lid 6. Pull lower lid down and slip prosthesis in place 7. Raise upper lid by pressing up against orbit

2. Wash hands thoroughly 4. Gently depress and pull lower lid down 5. Allow prosthesis to slip out over lower lid 3. Wash prosthesis under running water 7. Raise upper lid by pressing up against orbit 1. Slip top of prosthesis under orbit 6. Pull lower lid down and slip prosthesis in place The steps to remove, clean, and reinsert a prosthesis are as follows: wash hands thoroughly; gently depress and pull lower lid down; allow prosthesis to slip out over lower lid; wash prosthesis under running water; raise upper lid by pressing up against orbit; slip top of prosthesis under orbit; and pull lower lid down and slip prosthesis in place.

A patient has returned to the ambulatory surgery postoperative unit after cataract surgery 2 hours ago. Which patient statement warrants immediate notification of the health care provider? 1. "It looks like I've got some clear drainage on the eye patch." 2. "The tape holding my eye shield in place keeps slipping off my forehead." 3. "The pain in my eye is much worse, even after you gave me the pain medication." 4. "This eye patch and shield makes it hard to see, except when I look straight ahead."

3. "The pain in my eye is much worse, even after you gave me the pain medication." Eye pain that increases despite pain medication may indicate increased intraocular pressure. This warrants immediate notification of the health care provider. Clear drainage on the eye patch, tape that slips, and diminished peripheral vision do not warrant immediate notification of the provider.

A patient is scheduled to undergo fluorescein angiography. What is the first step in the testing process? 1. Administer dye intravenously. 2. Take photographs through the pupil. 3. Administer medication to dilate the pupil. 4. Reduce the risk for an allergic reaction with medication.

3. Administer medication to dilate the pupil. Administering medication to dilate the pupil is the first step in the testing process. Other steps in the testing process include administering dye intravenously, taking photographs through the pupil, and reducing the risk for an allergic reaction with medication.

Which membrane covers the anterior sclera of the eye? 1. Retina 2. Choroid 3. Bulbar conjunctiva 4. Palpebral conjunctiva

3. Bulbar conjunctiva The mucous membrane that covers the anterior part of the sclera is the bulbar conjunctiva. The retina is the inner lining of the eyeball. The choroid is the middle layer of the eye that comprises the iris and ciliary muscle. The palpebral conjunctiva covers the eyelids and extends from the inner eyelid margin to the margin of the eye.

A patient's medical record indicates treatment for myopia. The nurse understands this to mean the patient has which visual difficulty? 1. Loss of central vision 2. Blurred or double vision 3. Difficulty seeing far objects 4. Difficulty seeing near objects

3. Difficulty seeing far objects Myopia is the medical term for nearsightedness. In myopia, the lens is situated too far from the retina. Light rays come together to focus in front of the retina. People with myopia have difficulty seeing distant images clearly. Loss of central vision and blurred/double vision are not associated with myopia. Hyperopia is the medical term for farsightedness. People with hyperopia have difficulty with near vision.

After an eye injury, the patient should be monitored for which symptom of retinal detachment? 1. Double vision 2. Central vision loss 3. Flashes of light 4. Peripheral vision loss

3. Flashes of light Signs and symptoms of retinal detachment depend on the location and extent of the detachment. Patients may report seeing flashes of light or floaters. Vision may be cloudy. Double vision, central vision loss, and peripheral vision loss are not symptoms associated with retinal detachment.

A student nurse is preparing to irrigate the eye of a patient. The instructor would allow the student nurse to proceed when the student nurse states that he will direct the flow of the irrigation in which manner? 1. In a temporal to nasal direction 2. Under the upper conjunctival sac 3. From the inner canthus to the outer canthus 4. From the lower conjunctival sac to the upper conjunctival sac

3. From the inner canthus to the outer canthus When irrigating the eye, the flow of solution is directed into the lower conjunctival sac from the inner canthus to the outer canthus; this aids the solution in clearing the eye of debris or chemicals present. Irrigating in a temporal to nasal direction, under the upper conjunctival sac, or from the lower conjunctival sac to the upper conjunctival sac would not allow for optimal cleansing of the eye.

Patients being treated for glaucoma should be warned to avoid which products because of the increase in intraocular pressure? 1. Carbonic anhydrase inhibitors 2. Osmotic diuretics 3. Herbal medications 4. Prostaglandin analogs

3. Herbal medications Caution patients not to take over-the-counter (OTC) products such as herbal medications because they can raise intraocular pressure. Carbonic anhydrase inhibitors, osmotic diuretics, and prostaglandin analogs are used for glaucoma and are not associated with raising intraocular pressure.

A patient is complaining of an extremely dry right eye, while the left eye is normal. The nurse suspects an issue with which structure of the right eye? 1. Sclera 2. Choroid 3. Lacrimal ducts 4. Palpebral conjunctiva

3. Lacrimal ducts The patient is suffering from decreased tear production in the right eye. Lacrimal glands located above the eyes secrete tears into the eyes through lacrimal ducts in the upper eyelids. An obstruction in the right lacrimal duct would lead to decreased tear production in the right eye. The sclera is the tough outer layer of the eyeball. The choroid, or middle layer, of the eyeball makes up the iris and ciliary muscle at the front of the eye. The eyelids are lined with a mucous membrane called the palpebral conjunctiva.

Place the process of vision perception in the correct order of its occurrence. 1. Refraction of light 2. Transmissions to the brain 3. Light entering the refractive media 4. Inverted image on temporal region of retina 5. Synapse with third order neurons

3. Light entering the refractive media 1. Refraction of light 4. Inverted image on temporal region of retina 5. Synapse with third order neurons 2. Transmissions to the brain When light enters the eye, it passes through the aqueous humor, lens and vitreous humor (refractive media), which bend the light (refraction) on to the retina. The reflection of light from image is captured upside down as horizontal and vertical rays. This inverted image falls on the temporal region of the retina. Then the optic nerve carries impulses through the synapse with third-order neurons in the geniculate nucleus of the thalamus. Here, the left optic fields from each eye join to form the left optic tract and the right optic fields of each eye join to form the right optic tract to the brain.

A patient is being treated with an osmotic diuretic in preparation for surgery to treat glaucoma. The LPN suspects that the intravenous (IV) site has been infiltrated. What is the first action by the LPN? 1. Change the IV site. 2. Restart the IV infusion. 3. Notify the charge nurse. 4. Notify the health care provider.

3. Notify the charge nurse. The LPN would initially notify the charge nurse of the need to assess the IV site before any other interventions are implemented. If the charge nurse determines that the site is infiltrated, the IV site would be changed and the IV infusion restarted. It is necessary to notify the health care provider, but the RN must verify the infiltration first.

If a patient describes symptoms of photophobia, the nurse would recommend which intervention? 1. Instilling saline eye drops 2. Patching the eyes bilaterally 3. Wearing darkened sunglasses 4. Staying indoors on sunny days

3. Wearing darkened sunglasses Photophobia is a sensitivity of the eyes to light. Wearing darkened sunglasses will allow the patient to be more comfortable while still allowing exposure to light and vision. Saline drops are not an intervention that would decrease photophobia. Patching the eyes bilaterally would not allow for vision and would impair activities of daily living. Staying indoors on sunny days may help with photophobia but is not always practical.

The nurse is providing discharge instructions to a patient's daughter who will be administering eye drops to the patient following eye surgery. The nurse recognizes that further instruction is required if the daughter makes which comment? 1. "I should wait about 5 minutes between giving different types of eye drops." 2. "I should have the eye medications at room temperature before I give them." 3. "After I give the drop, I should ask Mom to close the eyes and move the eyes around." 4. "I should apply pressure to the inside corner of the eye for 5 minutes after giving the drop."

4. "I should apply pressure to the inside corner of the eye for 5 minutes after giving the drop." The nurse should reeducate the patient's daughter to apply pressure to the inner canthus for 1 minute after administration of the drops to prevent the medication from entering body fluids. The daughter would not need further instruction if she administered the medication at room temperature and asked the patient to close her eyes and move the eyes after the drops are given. No further instruction is necessary if the daughter waits 5 minutes between giving different types of eye medications.

The nurse is caring for a patient with glaucoma. Which drug, if ordered for the patient, would the nurse hold until clarifying the order with the health care provider? 1. Pilocarpine 2. Brimonidine 3. Timolol maleate 4. Atropine sulfate

4. Atropine sulfate Atropine sulfate is an anticholinergic mydriatic drug. Mydriatic medications dilate the pupil and lead to an increase in the intraocular pressure present with glaucoma. Mydriatic medications are contraindicated for use in patients with glaucoma; therefore, the nurse must hold this drug until speaking with the health care provider. Pilocarpine is a cholinergic miotic used in the treatment of glaucoma to facilitate the outflow of aqueous humor. Brimonidine is an adrenergic drug used for the treatment of glaucoma to decrease the formation of aqueous humor. Timolol maleate is a beta blocker and is often the first drug used in the treatment of glaucoma.

A patient is diagnosed with open-angle glaucoma. The health care provider wants to prescribe a drug to help facilitate the outflow of aqueous humor. Which medication would the nurse expect the health care provider to prescribe? 1. Dipivefrin 2. Brimonidine 3. Metipranolol 4. Carbachol

4. Carbachol Carbachol is an example of a cholinergic miotic agent that facilitates the outflow of aqueous humor. Dipivefrin and brimonidine are adrenergic drugs that decrease the formation of aqueous humor. Metipranolol is a beta-blocker that helps decrease the production of aqueous humor.

In the laser in situ keratomileusis (LASIK) procedure, the laser is used to reshape which eye structure? 1. Lens 2. Pupil 3. Retina 4. Cornea

4. Cornea Photorefractive keratectomy (PRK) uses an excimer laser to reshape the cornea for treatment of myopia or hyperopia. For the laser in situ keratomileusis (LASIK) procedure, a thin layer of the cornea is peeled back and the laser is used to reshape the middle layer of the cornea. The lens, pupil, and retina are not involved in this process.

A patient arrives at the minor emergency clinic stating, "A piece of dust has scratched my eye." The nurse would prepare the patient for which type of examination? 1. Computed tomography scan 2. Tonometry 3. Visual field examination 4. Corneal staining

4. Corneal staining Corneal staining involves application of a topical dye to the eye to detect corneal abrasions. The dye permits scratches to be seen more readily. A CT scan, tonometry, and visual field examination would not be the best options for the patient in this situation.

The nurse is assisting with data collection on a patient with hyperthyroidism. The nurse notices which physical change in the eye associated with hyperthyroidism? 1. Retinitis 2. Blepharitis 3. Conjunctivitis 4. Exophthalmos

4. Exophthalmos Exophthalmos is bulging of the eye associated with hyperthyroidism. The other disorders are not associated with hyperthyroidism. Retinitis is inflammation of the retina. Conjunctivitis is inflammation of the conjunctiva. Blepharitis is inflammation of the hair follicles along the eyelid.

A patient comes into the clinic complaining of difficulty reading and doing close work. The nurse suspects that the patient is experiencing which eye disorder? 1. Cataracts 2. Glaucoma 3. Retinal detachment 4. Macular degeneration

4. Macular degeneration Signs and symptoms of macular degeneration consist of difficulty reading and doing close work and loss of central vision. Signs and symptoms of cataracts consist of cloudy vision, seeing spots or ghost images, and floaters. Signs and symptoms of glaucoma consist of blurred vision and halos around lights. Signs and symptoms of retinal detachment consist of seeing flashes of light or floaters.

A patient returned from cataract surgery 2 hours ago and is complaining of severe pain. The nurse administers acetaminophen with codeine (Tylenol with codeine) as prescribed. One hour later, the patient is still complaining of severe pain. What should the nurse do next? 1. Notify the health care provider to get another analgesic prescribed for the patient. 2. Administer another dose of acetaminophen with codeine (Tylenol with codeine). 3. Nothing, inform the patient that the medicine just hasn't absorbed into the system yet. 4. Notify the health care provider, because patient may be experiencing increased intraocular pressure.

4. Notify the health care provider, because patient may be experiencing increased intraocular pressure. Notifying the health care provider due to concern about increased intraocular pressure is the correct action, as severe pain is a sign that the patient may be experiencing hemorrhage or increased intraocular pressure. The patient should not be experiencing severe pain after cataract surgery. Administering another dose of acetaminophen with codeine could overdose the patient, and it would not help with the increased intraocular pressure. Notifying the health care provider to get another analgesic prescribed is an incorrect action, as severe pain is not a normal side effect. The patient needs to be examined by the health care provider for increased intraocular pressure.

During a routine ophthalmic evaluation, which piece of equipment should the nurse have ready for the health care provider to help measure the patient's intraocular pressure? 1. Retinoscope 2. Snellen chart 3. Ophthalmoscope 4. Slit-lamp microscope

4. Slit-lamp microscope Several procedures are used to measure intraocular pressure. The most accurate procedure is called applanation and is performed with a slit-lamp microscope. The retinoscope is used to measure the refractive error of the patient's eyes. Visual acuity is tested with a Snellen chart. The ophthalmoscope allows for visualization of the fundus of the eye.

The nurse is reviewing the laboratory test results on a culture taken from a patient's hordeolum and expects the results to be which organism? 1. Streptococcus 2. Chlamydia trachomatis 3. Neisseria gonorrheae 4. Staphylococcus aureus

4. Staphylococcus aureus Hordeolum, commonly called a stye, is a common acute staphylococcal infection of the eyelid margin and originates in a lash follicle. The nurse would not expect the specimen to culture Streptococcus, Chlamydia trachomatis, or Neisseria gonorrheae.

The nurse is reviewing discharge instructions for a patient who has had a corneal transplant. The nurse should include instructions for the patient to immediately notify the health care provider if which sign of corneal graft rejection develops? 1. Higher pressure in the eye 2. Halos in the vision in the affected eye 3. Increased pressure in the optic nerve 4. The appearance of blood vessels in the cornea

4. The appearance of blood vessels in the cornea Rejection of corneal grafts is not common, but it can happen. When rejection occurs, blood vessels appear in the cornea and the cornea becomes cloudy. Halos and increased pressure are symptoms of glaucoma.

A patient asks the nurse to explain what the health care provider meant when she was told she had 20/70 vision in her right eye. The nurse would provide which explanation? 1. The patient can see letters that are between 20 to 70 millimeters in size. 2. The patient can see clearly within a range of 20 to 70 feet from the eyes. 3. The patient can see at 70 feet what others with normal vision see at a distance of 20 feet. 4. The patient can see at 20 feet what others with normal vision see at a distance of 70 feet.

4. The patient can see at 20 feet what others with normal vision see at a distance of 70 feet. Visual acuity is commonly tested using a Snellen chart. The Snellen chart has rows of progressively smaller letters. From a distance of 20 feet, the patient is instructed to read down the chart until more than two mistakes are made on a single line. If a patient's vision is 20/70, the results indicate that the patient can read at 20 feet what a person with normal vision can read at 70 feet. Visual acuity is not measured in terms of the size of the letters one can see or the range in which a patient can see clearly

The nurse is preparing a patient for a stapedectomy. Which information will the nurse include in the patient's preoperative teaching? 1. Tinnitus is common for weeks after surgery. 2. Change the sterile packing and dressing daily. 3. Hearing will return immediately after surgery. 4. Vertigo and dizziness may occur after surgery.

4. Vertigo and dizziness may occur after surgery. Vertigo is a common occurrence after stapedectomy. Hearing gradually improves after surgery because of postoperative packing and swelling. Tinnitus rarely occurs after stapedectomy. The packing in the ear should not be disturbed. The health care provider removes it approximately 1 week after surgery.