NUR 4135 PrepU Chapter 19
The nurse is admitting a client documented to have papilledema. The nurse recognizes that papilledema is most commonly caused by which condition? Type 2 diabetes Systemic lupus erythematosus Intracranial pressure Viral infection
Intracranial pressure Explanation: The central retinal artery enters the eye through the optic papilla in the center of the optic nerve. An accompanying vein exits the eye along the same path. The entrance and exit of the central retinal artery and vein through the tough scleral tissue at the optic papilla can be compromised by any condition causing persistent increased intracranial pressure. The most common of these conditions are cerebral tumors, subdural hematomas, hydrocephalus, and malignant hypertension. Usually, the thin-walled, low-pressure veins are the first to collapse, with the consequent backup and slowing of arterial blood flow. Under these conditions, capillary permeability increases and leakage of fluid results in edema of the optic papilla, called papilledema.
A client reports being struck in the eye by flying debris falling off a building being demolished. Following fluorescein staining and use of biomicroscope, it is determined the eye has an injury to the Bowman membrane and stromal layer. Which explanation should the nurse provide to the client regarding the extent of this injury?
"Your eye will heal slower with scar formation that impairs the transmission of light to some extent." Explanation: Trauma to the cornea can be extremely painful. Healing will be delayed since the stroma layer is damaged and there is danger of infection. Injuries to the Bowman membrane and the stromal layer heal with scar formation that impairs light transmission.
A client has shingles. What is the best time frame for the initiation of oral and intravenous antiviral drugs after the appearance of a rash to reduce the incidence of ocular complication? 4 days 6 days 3 days 5 days
3 days Explanation: Treatment includes the use of oral and intravenous antiviral drugs. Initiation of treatment within the first 72 hours after the appearance of the rash reduces the incidence of ocular complications but not the postherpetic neuralgia.
A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing: Subacute angle-closure glaucoma Acute-onset wide-angle glaucoma Acute angle-closure glaucoma Primary open-angle glaucoma
Acute angle-closure glaucoma Explanation: The sudden onset of eye pain, blurred vision, and a headache on the affected side indicate acute angle-closure glaucoma, which is an ophthalmic emergency. Subacute angle-closure glaucoma manifests as recurrent short episodes of unilateral pain, conjunctival redness, and blurring of vision associated with halos around lights. Open-angle glaucoma is usually asymptomatic and chronic.
The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located? Posterior segment of the globe Choroid Retina Anterior segment of the globe
Anterior segment of the globe Explanation: The anterior chamber is in the anterior segment of the globe, not the posterior segment of the globe, choroid, or retina.
A young child has been diagnosed with amblyopia. The parents ask the nurse when treatment should be considered. At what age should treatment of children with the potential for development of amblyopia be instituted? Between 6 and 10 years After 18 years Before 6 years Between 10 and 18 years
Before 6 years Explanation: The treatment of children with the potential for development of amblyopia must be instituted well before the age of 6 years to avoid the suppression phenomenon.
Open-angle glaucoma is caused by an abnormality in the trabecular meshwork, which controls the flow of aqueous humor. Where is aqueous humor in a normal eye? Behind the pupil Ocular canal Ductus lacrimalis Canal of Schlemm
Canal of Schlemm Explanation: Primary open-angle glaucoma usually occurs because of an abnormality of the trabecular meshwork that controls the flow of aqueous humor into the canal of Schlemm.
A client has been diagnosed with bilateral cataracts associated with having difficulty seeing clearly. Reviewing the medication history, which drug may be responsible for the development of this condition? Vitamin D Corticosteroids Furosemide Ibuprofen
Corticosteroids Explanation: Cataracts can result from several medications. Corticosteroid drugs have been implicated as causative agents in cataract formation. Both systemic and inhaled corticosteroids have been cited as risk factors. Other drugs include phenothiazines, amiodarone, and strong miotic ophthalmic drugs.
Vision is a special sensory function that incorporates the visual receptor functions of which parts of the eye? Select all that apply. Full functioning of 10 extraocular nerves Distribution of information to the peripheral nervous system Eyeball Retina Optic nerve
Eyeball Optic nerve Retina Explanation: Vision is a special sensory function that incorporates the visual receptor functions of the eyeball, the optic nerve, and optic pathways that carry and distribute sensory information from the optic globe to the central nervous system (CNS) via photoreceptors in the retina, and the primary and visual association cortices that translate the sensory signals into visual images.
The nurse is conducting a vision assessment on a 2-year-old child. The nurse should assess for which visual ability in this child? Identification of shapes Recognizing letters Fixation on an object Recognition of numbers
Fixation on an object Explanation: The best vision assessment for infants and children under 3 years of age is accomplished by determining whether each eye can fixate on an object, maintain fixation, and follow the object. Recognizing letters and shapes and numbers is not appropriate for a 2-year-old.
Adult strabismus is almost always of the paralytic variety. What is a cause of adult strabismus? Huntington disease Graves disease Parkinson disease Addison disease
Graves disease
The nurse is conducting a health promotion class on the prevention of blindness and vision impairment. The nurse determines that participants understand the information when they identify which vision disorder as most likely to have an infectious etiology? Macular degeneration Cataracts Keratitis Glaucoma
Keratitis Explanation: Cataracts, glaucoma, and macular degeneration are not caused by infectious organisms. However, keratitis may be caused by viruses, bacteria, fungi, and amebae.
A student nurse has been assigned to a client in the ambulatory surgery center for a cataract. What is the most common type of cataract? Nuclear Suprascapular Cortical Subscapular
Nuclear Explanation: The most common type of cataract is a nuclear. Less common cataracts affect the cortical, subscapular, and suprascapular areas of the eye.
A client has glaucoma. The nurse is taking a health history and knows that the most common form of glaucoma is which type? Open angle Congenital Infantile Angle closure
Open angle Explanation: Open-angle glaucoma is the most common form of glaucoma, and is usually asymptomatic and chronic, causing progressive damage to the optic nerve and visual field loss unless it is appropriately treated. Angle-closure glaucoma usually occurs as the result of an inherited anatomic defect that causes a shallow anterior chamber. There are several types of childhood glaucoma, including congenital glaucoma that is present at birth and infantile glaucoma that develops during the first 2 to 3 years of life.
Which visual deficit is a clinician justified in attributing to the normal aging process? Strabismus Angle-closure glaucoma Presbyopia Conjunctivitis
Presbyopia Explanation: The term presbyopia refers to a decrease in accommodation that occurs because of aging. Conjunctivitis, strabismus, and angle-closure glaucoma are considered abnormal and pathologic in clients of all ages.
An older adult client comes to the clinic complaining of seeing flashing lights and small spots. The client tells the nurse that this has been going on for over 24 hours but now it is as if there is a dark curtain whenever the client opens the eyes. The client asks the nurse if this means that blindness is imminent. What diagnosis should the nurse suspect? Cataracts Glaucoma Retinal detachment Conjunctivitis
Retinal detachment Explanation: The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur. As the detachment progresses the person perceives a shadow or dark curtain across the visual field.
The nurse is performing an eye assessment on a client who presents with a red eye. The nurse determines that the redness is related to bacterial conjunctivitis based on which additional symptom(s)? Mydriasis and headaches Blurred or iridescent vision Tearing, itching, and burning Cloudy, painful corneas
Tearing, itching, and burning Explanation: Conjunctivitis causes bilateral tearing, itching, burning, foreign body sensation, and morning eyelash crusting and eye redness. Hyperacute conjunctivitis causes conjunctival redness and edema (chemosis), lid swelling and tenderness, and swollen preauricular lymph nodes. Attacks of glaucoma (increased intraocular pressure) are manifested by ocular pain, excruciating headache, blurred or iridescent vision, and corneal edema with hazy cornea, dilated (mydriasis), and fixed pupil; with repeated or prolonged attacks, the eye becomes reddened.
Binocular vision depends on the coordination of how many pairs of extraocular nerves that provide for the conjugate eye movements? Three Two Four One
Three Explanation: Binocular vision depends on the coordination of three pairs of extraocular nerves that provide for the conjugate eye movements, with optical axes of the two eyes maintained parallel with one another as the eyes rotate in their sockets.
The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be: oral diuretics should be administered immediately. laser peripheral iridotomy is performed immediately. administration of topical beta-adrenergic antagonists to lower the pressure. to monitor vision for signs of closed-angle vision.
administration of topical beta-adrenergic antagonists to lower the pressure. Explanation: The elevation in intraocular pressure in persons with open-angle glaucoma is usually treated pharmacologically or, in cases where pharmacologic treatment fails, by increasing aqueous outflow through a surgically created pathway. Medication is generally administered topically.
When pupillary dilation partially compensates for the reduced size of the retinal image by increasing the light entering the pupil, this is a component of which eye adjustment? Contracting the ciliary muscle Narrowing the palpebral opening Cataract development Accommodation
Accommodation Explanation: Accommodation is the process whereby a clear image is maintained as gaze is shifted from far to near objects. During accommodation, pupillary dilation partially compensates for the reduced size of the retinal image by increasing the light entering the pupil. Accommodation requires convergence of the eyes, pupillary constriction, and thickening of the lens through contraction of the ciliary muscle, which is controlled mainly by the parasympathetic fibers of the oculomotor cranial nerve (CN III). A third component of accommodation involves reflex narrowing of the palpebral opening during near vision and widening during far vision.
A client presents with copious amounts of yellow-green drainage, conjunctival redness, and chemosis to the right eye. A culture of the eye drainage reveals S. pneumoniae. The client most likely developed: Allergic conjunctivitis Chronic conjunctivitis Viral conjunctivitis Bacterial conjunctivitis
Bacterial conjunctivitis Explanation: Based on the presenting symptoms and the culture results, this is classic bacterial conjunctivitis. Allergic and chronic conjunctivitis usually involves both eyes.
The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor that fills the anterior and posterior chambers of the eye. What is this disease called? Glaucoma Amblyopia Cataract Retinopathy
Glaucoma Explanation: Glaucoma is a chronic degenerative optic neuropathy characterized by optic disk cupping and visual field loss. It is usually associated with an elevation in intraocular pressure. Amblyopia is lazy eye. Retinopathy is a disorder of the retinal vessels that interrupts blood flow to the visual receptors leading to visual impairment. A cataracts is a lens opacity that interferes with the transmission light to the retina.
The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include: Downward deviation Medial deviation Lateral deviation Upward deviation
Medial deviation Explanation: Disorders of eye movement are described according to the direction of movement. Esotropia refers to medial deviation, exotropia to lateral deviation, hypertropia to upward deviation, hypotropia to downward deviation, and cyclotropia to torsional deviation.
Cortical blindness is the bilateral loss of the primary visual cortex. What is retained in cortical blindness? Red spots seen behind the eyelids Phytosis Myopia Pupillary reflexes
Pupillary reflexes Explanation: Crude analysis of visual stimulation at reflex levels, such as eye- and head-orienting responses to bright moving lights, pupillary reflexes, and blinking at sudden bright lights, may be retained even though vision has been lost.
A client who experiences constant cloudiness of vision, sees floaters, and has an opaque lens is diagnosed with a cataract. The most appropriate treatment would be: daily application of pilocarpine eye drops. wearing bifocal lenses to strengthen vision. patching the affected eye until vision returns. surgical lens replacement to correct vision.
surgical lens replacement to correct vision. Explanation: Although strong bifocal lenses, magnification, appropriate lighting, and visual aids may help, surgery is the only treatment for cataract.
Which of these clients' statements would be most suggestive of retinal detachment? "All of a sudden I got the most intense pain behind my left eye." "I came in today because of this bleeding in the white part of my eye." "This morning I woke up with the worst headache of my life." "I feel like there's a shadow that's blocking my vision."
"I feel like there's a shadow that's blocking my vision." Explanation: The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the field of vision, occur as the vitreous pulls away from the posterior pole of the eye. As detachment progresses, the person perceives a shadow or dark curtain progressing across the visual field. It is not associated with headache or bleeding.
What is ocular muscle imbalance resulting in "lazy eye" called? Hyperopia Presbyopia Amblyopia Myopia
Amblyopia Explanation: Ocular muscle imbalance resulting in "lazy eye" is known as amblyopia. Myopia is the error in refraction resulting from altered focus on an image in front of the retina due to lens thickness. If the anterior-posterior dimension of the eyeball is too short, the image is theoretically focused posterior to (behind) the retina. This is called hyperopia or farsightedness. The term presbyopia refers to a decrease in accommodation that occurs because of aging.
During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which condition? Conjunctivitis Uveitis Arcus senilis Keratitis
Keratitis Explanation: Keratitis, or inflammation of the cornea, can be caused by infections, hypersensitivity reactions, ischemia, trauma, defects in tearing, or trauma.
Impaired function of which eye structure is responsible for blurred vision and loss of fine tuning of focus? Retina Trabecular network Lens Lacrimal gland
Lens Explanation: Impaired function of the lens is responsible for blurred vision and loss of fine tuning of focus. The lacrimal system includes the major lacrimal gland, which produces tears. In open-angle glaucoma, the outflow of aqueous humor is obstructed at the trabecular meshwork. The afferent stimuli for pupillary constriction arise in the ganglionic cells of the retina.
A nurse caring for a client with renal failure and associated malignant hypertension is concerned that the client may suffer partial or total visual loss due to papilledema noted on examination. The nurse realizes that papilledema is: an early sign for the development of glaucoma. indicative of the potential of hypertensive crisis. an early indication of retinopathy and decreased intracranial pressure. a late sign and often indicates severely increased intracranial pressure.
a late sign and often indicates severely increased intracranial pressure. Explanation: Papilledema is a swelling of the optic papilla, which is located in the center of the optic nerve where the retinal artery and vein enter/exit the eye. Swelling in this area, noted on ophthalmic exam, indicates compromise of these vessels with possible damage to the optic nerve fibers. Unfortunately this is usually a late sign, not noticeable until the intracranial pressure is significantly elevated and damage to the optic nerve has already begun. Causes include brain tumors, increased cerebrospinal fluid, malignant hypertension, and subdural hematomas.
An older adult client has been diagnosed with macular degeneration. Which statement by the client best demonstrates an accurate understanding of the new diagnosis? "I suppose this goes to show that I should have controlled my blood pressure better." "I think this is something that I might have caught from my husband." "I suppose that this may be one of the things that happens when you get older." "My friend had this problem and a transplant did wonders for her vision."
"I suppose that this may be one of the things that happens when you get older." Explanation: Although some risk factors have been identified for macular degeneration, most diagnoses are attributed to increased age. The pathogenesis does not involve infection or hypertension, and a corneal transplant is not a recognized treatment modality.
The nursing instructor is teaching a class on diabetes and discusses complications of the disease. The instructor further states that diabetic retinopathy is one of the leading causes of blindness. What does the instructor tell the students are major risk factors for developing diabetic retinopathy? Select all that apply. Chronic hyperglycemia Smoking Hypertension Hypotension Chronic hypoglycemia
Chronic hyperglycemia Hypertension Smoking Explanation: Diabetic retinopathy is one of the leading causes of blindness. Chronic hyperglycemia, hypertension, hypercholesterolemia, and smoking are risk factors for the development and progression of the disorder.
The nurse is conducting a community education class on amblyopia. The nurse determines that the participants understand the concepts when they identify which time period as the time when amblyopia is generally diagnosed? Adolescence After an eye injury Infancy Young adulthood
Infancy Explanation: Amblyopia (i.e., lazy eye) is a decrease in visual acuity resulting from abnormal visual development in infancy and early childhood. There is no known connection between the condition and either injury or diabetes.
An older adult in an assisted care facility with documented presbyopia has lost his or her glasses. The nurse should instruct unlicensed assistive personnel that the client will need assistance with tasks that involve which part of sight? Depth perception Near vision Color distinction Far vision
Near vision Explanation: Presbyopia involves difficulty focusing on near objects. It is common in older adults and is caused by decreased elasticity of the lens and atrophy of the ciliary muscle. The nurse should instruct unlicensed assistive personnel to assist the client with tasks involving near vision. In hyperopia, or farsightedness, the image theoretically falls behind the retina. Disparity between the laterally displaced images seen by the two eyes provides a powerful source to three-dimensional depth perception for objects within a distance of 100 ft (30 m). Color blindness is inherited as an X-linked deficiency of a specific type of retinal photoreceptor.