Patho Ch 19
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: Viral conjunctivitis Allergic conjunctivitis Bacterial conjunctivitis Chronic 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.
A 42-year-old client reports increasing difficulty reading the labels on packages. He states that he has to continually hold it further and further away from his face in order to see the type clearly. Which eye disorder is this client most likely experiencing? The normal decline in retinal function that occurs in adulthood. An age-related change in accommodation. The accumulated effects of ultraviolet light exposure. Undiagnosed diabetic retinopathy.
An age-related change in accommodation. Explanation: The term presbyopia refers to a decrease in accommodation that occurs because of aging. This is unrelated to UV light exposure and diabetes does not normally cause a specific decline in accommodation. Presbyopia is not the result of changes in retinal function.
With aging, progressive inelasticity and thickening of the lens causes which accommodation disorder? Cataracts Hyperopia Astigmatism Presbyopia
Presbyopia Explanation: Presbyopia describes the changes in vision that occur because of aging. No loss of lens fibers occurs, but instead, additional fibers are added to the outermost portion and the lens thickens, the fibers become less elastic, the range of focus or accommodation is diminished, and reading glasses become necessary for near vision. Hyperopia or farsightedness occurs when the anterior-posterior dimension of the eyeball is too short and the image is focused posterior to (behind) the retina. Myopia or nearsightedness occurs when the anterior-posterior dimension of the eyeball is too long and the image is focused anterior to the retina. Astigmatism is non-uniform curvature of the refractive surface, usually caused by a defect in the cornea. Cataracts form with normal aging when the nucleus and the cortex of the lens enlarge as new fibers are formed in the cortical zones; old fibers become more compressed and dehydrated. During the early stages of cataract formation, a yellow pigment and vacuoles accumulate in the lens fibers.
The three layers of the cornea are separated by two important basement membranes. What are characteristics of the Bowman membrane? Select all that apply. Acts as a barrier to infection Opaque scar can form that impairs vision Has a felt-like appearance Regenerates readily after injury
Acts as a barrier to infection Opaque scar can form that impairs vision Explanation: Bowman membrane, which lies between the corneal epithelium and stoma, acts as a barrier to infection. It does not regenerate. If damaged, an opaque scar forms that can impair vision. Descemet membrane, which lies between the corneal endothelium and stroma, has a felt-like appearance and consists of interwoven fibers and pores. Unlike Bowman membrane, it regenerates readily after injury.
The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located? Retina Choroid Anterior segment of the globe Posterior 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 10 and 18 years Between 6 and 10 years Before 6 years After 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.
A group of student nurses is reviewing the anatomy of the eye for an upcoming exam. One of the student nurses asks where the tarsal plate is located. What is the response? Retina Lens Ciliary body Eyelid
Eyelid Explanation: The tarsal plated is located in the eyelid, not the ciliary body, retina, or lens.
A client has been admitted to the stroke unit following a right-side infarct and is suffering from complete homonymous hemianopia. Where would the nurse expect the client's visual field to be absent? In both eyes, on the right quarter In both eyes, on the left half In both eyes, affecting central vision In the right eye, of the right half
In both eyes, on the left half Explanation: A stroke on the right side of the brain affects the left optical tract, producing loss of vision on the left half (hemianopia) of both eyes (homonymous).
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? Infancy Adolescence After an eye injury 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.
The nurse is admitting a client documented to have papilledema. The nurse recognizes that papilledema is most commonly caused by which condition? Systemic lupus erythematosus Viral infection Intracranial pressure Type 2 diabetes
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.
During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which condition? Keratitis Conjunctivitis Arcus senilis Uveitis
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 Lacrimal gland Lens Trabecular network
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 client has been diagnosed with hemianopia. The client asks the nurse what this is describing concerning the eye? Loss of half of the visual field in one eye Blindness in one eye Loss of a quarter of the visual field in one eye Loss of the temporal or peripheral visual fields on both sides
Loss of half of the visual field in one eye Explanation: Blindness in one eye is called anopia. If half of the visual field for one eye is lost, the defect is called hemianopia; if a quarter of the field is lost, it is called quadrantanopia. Loss of the temporal or peripheral visual fields on both sides results in a narrow binocular field, commonly called tunnel vision.
A client who is being treated in the critical care unit is experiencing a slowing of blood flow to the central retinal artery, ultimately resulting in edema of the client's optic papilla. Which assessment would most likely address the etiology of this health problem? Monitoring of the client's intracranial pressure Culture and sensitivity testing of the client's eye exudate Monitoring of the client's mean arterial pressure Palpation for cervical lymphedema
Monitoring of the client's intracranial pressure Explanation: The client is experiencing papilledema, which is most often caused by an increase in ICP. It is noninfectious and is unrelated to systemic blood pressure or lymphedema.
Cortical blindness is the bilateral loss of the primary visual cortex. What is retained in cortical blindness? Phytosis Pupillary reflexes Red spots seen behind the eyelids Myopia
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.
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? Retinal detachment Cataracts Glaucoma 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.
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? Glaucoma Conjunctivitis Cataracts Retinal detachment
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. Reference:
A client has been diagnosed with herpes simplex keratitis. The nurse needs to review proper medication administration for which medication for this client to promote healing? Topical antiviral agents Oral antiviral agents Antihistamines Corticosteroids
Topical antiviral agents Explanation: The treatment of HSV keratitis includes the use of topical antiviral agents to promote healing. Oral antiviral agents (e.g., acyclovir) may be helpful for treatment of severe keratitis and as prophylaxis against recurrence, particularly in persons with compromised immune function. Although corticosteroids may control the damaging inflammatory responses, they do so at the expense of facilitating viral replication. With a few exceptions, their use is contraindicated.
A client has been diagnosed with bacterial conjunctivitis. This type of infection is usually characterized by large amounts of what color drainage? Serous Pink-red Blue-yellow Yellow-green
Yellow-green Explanation: The infection usually is characterized by large amounts of yellow-green drainage. The eyelids are sticky, and there may be excoriation of the lid margins.
A client tells the health care provider he has noticed a recent change in his vision: he can bring distant images into focus, but near images become blurred. The client has most likely developed: nearsightedness. myopia. astigmatism. hyperopia.
hyperopia. Explanation: Hyperopia or farsightedness occurs when the accommodative changes of the lens can bring distant images into focus, but near images become blurred. Persons with myopia or nearsightedness can see close objects without a problem because accommodative changes in their lens bring near objects into focus, but distant objects are blurred. Astigmatism is a refractive defect of the corneal surface.
The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of: amage to the retina leading to vision changes. a breakdown of cells in the macula lutea. the development of degenerative cataracts. imbalance between aqueous production and outflow.
imbalance between aqueous production and outflow. Explanation: Increases in intraocular pressure occur when there is an imbalance between aqueous production and outflow. A cell breakdown in the macula lutea results in macular degeneration. Cataracts may cause blurring of vision but do not alter pressure.
The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as: involuntary eye movements that preserve eye fixation on stable objects in the visual field. unilateral eye movements that preserve eye fixation on unstable objects in the visual field. voluntary eye movements that preserve eye fixation on stable objects in the visual field. fixed eye movements that preserve eye fixation on unstable objects in the visual field.
involuntary eye movements that preserve eye fixation on stable objects in the visual field. Explanation: Nystagmus refers to the involuntary eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. As the body rotates, the vestibuloocular reflexes cause a slow compensatory drifting of eye movement in the opposite direction, thus stabilizing the binocular fixation point.
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: wearing bifocal lenses to strengthen vision. patching the affected eye until vision returns. surgical lens replacement to correct vision. daily application of pilocarpine eye drops.
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.
The nurse is planning education for a client with arcus senilis. Which comments should the nurse include in this education? Select all that apply. It is a common condition. It is associated with hyperlipidemia. It is vital to start treatment immediately. If left untreated, blindness can occur. The edge of the cornea develops a grayish-white film.
t is a common condition. The edge of the cornea develops a grayish-white film. It is associated with hyperlipidemia. Explanation: Arcus senilis is an extremely common, bilateral, benign corneal degeneration. It consists of a grayish-white infiltrate, approximately 2 mm wide, which occurs at the periphery of the cornea. It may represent an extracellular lipid infiltration and commonly is associated with hyperlipidemia, so lipid studies should be done if found in people under the age of 50. Arcus senilis does not produce visual symptoms, and there is no treatment necessary for this finding in older adults.
A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing: Primary open-angle glaucoma Acute-onset wide-angle glaucoma Acute angle-closure glaucoma Subacute angle-closure 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
Vitreous humor occupies the posterior portion of the eyeball. It is an amorphous biologic gel. When liquefaction of the gel occurs, as in aging, what can be seen during head movement? Meshlike structures Red spots Blind spots Floaters
Floaters Explanation: With the loss of gel structure, fine fibers, membranes, and cellular debris develop. When this occurs, floaters (images) can often be noticed because these substances move within the vitreous cavity during head movement. Blind spots, meshlike structures, and red spots are not seen during head movement with a loss of the gel structure of the vitreous humor.
A client has damage to the epithelial layer of the cornea. Which are clinical manifestations that can occur with damage to the epithelial layer of the cornea? Select all that apply. Burning of the eyes Foreign body sensation Reflex lacrimation No pain
Foreign body sensation Burning of the eyes Reflex lacrimation Explanation: Epithelial damage causes discomfort that ranges from a foreign body sensation and burning of the eyes to severe, incapacitating pain. Reflex lacrimation is common.
Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on which factor? The child has to be older than 5 years. Maturity of the visual system at time of onset. The child has to be able to wear contact lenses. The child has to have bilateral congenital cataracts.
Maturity of the visual system at time of onset. Explanation: The reversibility of amblyopia depends on the maturity of the visual system at the time of onset and the duration of the abnormal experience.
The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include: Upward deviation Medial deviation Downward deviation Lateral 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.
A mother brings her toddler to the clinic and tells the nurse that she thinks something is wrong with the baby's eyes. Upon further assessment the nurse notices that the child has upper deviation in movement in only one eye. What diagnosis should the nurse suspect for this child? Strabismus Cataract Glaucoma Amblyopia
Strabismus Explanation: Strabismus, or squint, refers to any abnormality of eye coordination or alignment that results in loss of binocular vision. Amblyopia refers to lazy eye. Glaucoma is a chronic degenerative optic neuropathy. Cataract affects the lens of the eye.
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: a late sign and often indicates severely increased intracranial pressure. indicative of the potential of hypertensive crisis. an early sign for the development of glaucoma. an early indication of retinopathy and decreased 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.
The nurse is performing her morning assessment on a 69-year-old client on a medical-surgical unit. Upon assessing her pupils the nurse notices that they are equal and responsive to light but not to accommodation. The nurse is aware that with aging the lens becomes thicker and its capsule less elastic so she believes this to be the case. When accommodation is diminished in an older person as a result of aging this is referred to as: farsightedness. myopia. hyperopia. presbyopia.
presbyopia. Explanation: The term presbyopia refers to a decrease in accommodation that occurs because of aging. Hyperopia is the same as farsightedness and myopia refers to nearsightedness (when the person can see close objects without problems but distant objects are blurred).
The parents of a 6-month-old child who was born with a blocked tear duct are concerned because their child has been waking up the past few mornings with inflammation in the left eye and yellow, dried secretions preventing eye opening in spite of massaging the tear duct. The nurse would anticipate which of the following? The parents have not been massaging the tear duct. The tear duct needs to be probed immediately. The tear duct will open spontaneously. The child has developed dacryocystitis.
The child has developed dacryocystitis. Explanation: Some babies are born without spontaneous opening of the tear duct(s) before birth, causing the inability of the tears to drain and increasing the risk of infection of the lacrimal sac (dacryocystitis). Signs and symptoms of dacryocystitis include excess secretions in the affected eye, which may cause crusting; excessive tearing; swelling; pain; and tenderness. The initial treatments would include warm compresses to the affected eye, antibiotics, and if appropriate, analgesics. Consideration of surgical probing of the tear duct is reserved for chronic cases of dacryocystitis.
A client seeks medical care when he wrecks his car because of poor eyesight. At the time of admission, his blood glucose level was 390 mg/dL. The client is diagnosed with diabetes (type 2). The ophthalmologist must perform an urgent intravitreal injection. The nurse explains this to the client by stating the doctor will: use a laser to try to seal off any bleeding vessels in your eyeball. remove some of the vitreous from your eye by withdrawing it with a needle/syringe and then strip some of the membranes off your inner eye. just put a couple of drops in each of your eyes. put a needle with syringe into your eyeball and inject some medication to decrease active bleeding.
put a needle with syringe into your eyeball and inject some medication to decrease active bleeding. Explanation: People with type 2 diabetes may have retinopathy as a presenting symptom at the time of diagnosis. Intravitreal injections of anti-VEGF agents are also being used to reduce active neovascularization and vitreous hemorrhage. Other treatment strategies for diabetic retinopathy include laser photocoagulation applied directly to leaking microaneurysms and grid photocoagulation with a checkerboard pattern of laser burns applied to diffuse areas of leakage and thickening. Because laser photocoagulation destroys the proliferating vessels and the ischemic retina, it reduces the stimulus for further neovascularization. Vitrectomy may be used for removing vitreous hemorrhage and severing vitreoretinal membranes that develop.