PrepU ch. 42

A nurse is giving discharge teaching to a client with an eye injury. Which statement about preventing eye injuries should the nurse include?

"Direct all spray nozzles away from your face before spraying." Explanation: Reference:The nurse should instruct the client to direct all spray nozzles away from his face before spraying. The nurse should instruct the client to use a flashlight if checking a car battery at night to decrease the risk of explosion. Safety goggles should be worn at all times in a workshop by everyone; flying debris can cause injuries at any time. The client should never stand next to or in front of a moving lawn mower. Debris can be ejected from the blades and cause injury. Timby, B.K., & Smith, N.E. (2014). Introductory Medical-Surgical Nursing, 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 42: Caring for Clients with Eye Disorders, p. 670. Chapter 42: Caring for Clients with Eye Disorders - Page 670

A client has acute angle-closure glaucoma. The family is concerned that the client may lose sight. The nurse advises that the window in which this problem can progress to permanent sight loss is:

1 to 2 days Explanation: Acute angle-closure glaucoma is an emergency. The nurse refers the client for medical treatment immediately because vision can be permanently lost in 1 to 2 days.

A nurse practitioner examines a patient and documents a best corrected visual acuity (BCVA) ratio in his better eye that qualifies him for government financial assistance based on the definition of legal blindness. What is that ratio?

20/200 Explanation: Legal blindness is a condition of impaired vision in which a person has a BCVA that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20 degrees or less.

The nurse is educating a patient with glaucoma about medications. What medications will the nurse educate the patient about that decrease aqueous production? Select all that apply.

Alpha-adrenergic agonists Carbonic anhydrase inhibitors Beta-blockers Explanation: Many ocular medications are used to treat glaucoma (Table 63-5), including miotics (medications that cause pupillary constriction), beta-blockers, alpha2-agonists (i.e., adrenergic agents), carbonic anhydrase inhibitors, and prostaglandins. Cholinergics (i.e., miotics) increase the outflow of the aqueous humor by affecting ciliary muscle contraction and pupil constriction, allowing flow through a larger opening between the iris and the trabecular meshwork. Alpha2-adrenergic agonists, beta-blockers, and carbonic anhydrase inhibitors decrease aqueous production.

Which feature should a nurse observe during an ophthalmic assessment?

Appearance of the external eye Explanation:During an ophthalmic assessment, the nurse should examine the appearance of the external eye and the pupil responses in the client. A qualified examiner determines internal eye function, visual acuity, and intraocular pressure. Reference: Timby, B.K., & Smith, N.E. (2014). Introductory Medical-Surgical Nursing, 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 42: Caring for Clients with Eye Disorders, p. 669. Chapter 42: Caring for Clients with Eye Disorders - Page 669

A client has just undergone a scleral buckle procedure for a retinal detachment. Which nursing interventions are aimed at reducing the risk for injury related to the surgical procedure? Select all that apply.

Apply a shield over the patched eye at bedtime for at least 3 weeks. Use a dim light in the room after sundown and at bedtime. Explanation: The shield provides additional protection and prevents the client from rubbing or accidentally poking the eye. Total darkness presents safety challenges to the visually compromised client. Minimal light provides a light source and prevents injury. Shower and wash hair carefully. Being cautious with bathing protects the eye from water and chemical irritants and avoids eye injury. Facedown positioning assists in the healing process in that the gas bubble serves as a splint to hold the retina in place.

A client is seen regularly for congenital glaucoma, and on each visit, the nurse reviews general instructions to prevent further complications from this condition. What would be included in that discussion? Select all that apply.

Avoid crying. Limit activities that tire the eyes. Avoid heavy lifting. Explanation: Limiting activities that tire the eyes would be included in the general instructions for a client with congenital glaucoma as would crying and heavy lifting because they increase IOP. Straining at stool can raise IOP and should be included in the general instructions for a client with congenital glaucoma.

A client is being discharged after successful same-day cataract surgery. The nurse instructs the client about permitted activities and which activities to avoid. Which of the following activities would be permitted in the postoperative instructions by the client?

Cooking. Explanation: Cooking will not cause increased ocular pressure. All other activities may increase pressure based on force or leaning or strain. Showering can immerse the eyes in water.

What is the correct advice regarding food for a client who underwent a cataract surgery?

Eat soft, easily chewed foods. Explanation:The nurse should advise clients recovering from cataract surgery to eat soft, easily chewed foods until healing is complete to avoid tearing from excessive facial movements. Reference: Timby, B.K., & Smith, N.E. (2014). Introductory Medical-Surgical Nursing, 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 42: Caring for Clients with Eye Disorders, p. 679. Chapter 42: Caring for Clients with Eye Disorders - Page 679

Which group of medications causes pupillary constriction?

Miotics Explanation:Miotics cause pupillary constriction. Mydriatics cause pupillary dilation. Beta-blockers decrease aqueous humor production. Adrenergic agonists increase aqueous outflow but primarily decrease aqueous production with an action similar to that of beta-blockers and carbonic anhydrase inhibitors. Reference: Timby, B.K., & Smith, N.E. (2014). Introductory Medical-Surgical Nursing, 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 42: Caring for Clients with Eye Disorders, p. 676-677. Chapter 42: Caring for Clients with Eye Disorders - Page 676-677

Which of the following would be an inaccurate clinical manifestation of a retinal detachment?

Pain Explanation: Patient may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do no complain of pain.

A patient presents to an eye clinic with a number of symptoms related to his diminished vision. An initial history leads the nurse practitioner to suspect that the patient has acute angle-closure glaucoma. Which of the following symptoms would apply to this diagnosis? Select all that apply

Severe eye pain Reddening of the eye Sudden onset of visual disturbance Nausea and vomiting Explanation: Gradual loss of peripheral vision, usually in both eyes, and tunnel vision in advanced stages are symptoms of primary open-angle glaucoma.

A client is being treated for glaucoma. What is the rationale for the nurse's instruction to maintain regular bowel habits?

Straining at stool increases intraocular pressure. Explanation: The client should maintain regular bowel habits because straining at stool can raise intraocular pressure (IOP). The other answers are distracters for this question.

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is:

The appearance of tiny, yellow spots in the field of vision. Explanation: Drusen are tiny yellow spots that patients who have dry AMD report.

A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign?

The presence of halos around lights Explanation: Colored halos around lights is a classic symptom of acute-closure glaucoma. Reference:

A client has received a diagnosis of hyperopia and is wondering if there is a physical condition that has caused these vision changes. In explaining hyperopia, what does the nurse indicate is the cause of this client's vision changes?

eyeballs that are shorter than normal Explanation: Hyperopia results when the eyeball is shorter than normal, causing the light rays to focus at a theoretical point behind the retina.

What should the nurse recommend to a client with blepharitis?

frequent washing of the face and hair Explanation: Frequent washing of the face and hair is recommended in a client with blepharitis because seborrhea or excessive oiliness of the skin of the face and scalp is associated with blepharitis. Warm soaks would be included for treatment of a sty. There is no benefit to sleeping with the face parallel to the floor.

A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition?

hyperopia Explanation: Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close.

A client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent:

increased intraocular pressure (IOP). Explanation: Headache and blurred vision are symptoms of increased IOP, such as from glaucoma. Ophthalmic corticosteroids may trigger an episode of acute glaucoma in susceptible clients. Although the effects of some drugs may diminish with continued use, this doesn't happen with ophthalmic corticosteroids. Incorrect ointment application doesn't cause headache or blurred vision. Timby, B.K., & Smith, N.E. (2014). Introductory Medical-Surgical Nursing, 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 42: Caring for Clients with Eye Disorders, p. 675. Chapter 42: Caring for Clients with Eye Disorders - Page 675

Which category of drugs is contraindicated in clients with glaucoma?

mydriatics Explanation: Dilation of the pupil can further obstruct drainage of aqueous fluid, raise IOP, and damage whatever vision remains. Atropine is contraindicated in clients with glaucoma.