CH 21 EAQ Visual Problems

A patient is being provided with discharge instructions after undergoing cataract extraction and intraocular lens implantation. What should the nurse include in the teaching? a. Avoid straining during bowel movements. b. Keep consuming a full-liquid diet for 24 hours. c. Refrain from reading or watching TV for at least 12 hours. d. Keep a patch over the affected eye until the follow-up appointment with the surgeon.

ANS: A After cataract surgery, coughing, bending at the waist, and straining during bowel movements should be avoided because these activities increase intraocular pressure. It is not necessary to maintain dietary restrictions, refrain from reading or watching TV, or wear a patch.

The nurse is caring for a patient suspected of having age-related macular degeneration. What symptoms should the nurse document and report regarding this disorder? a. Blurred, darkened vision b. Itching, burning, and redness c. Sudden, excruciating pain in the eye d. Decreased vision, abnormal color perception

ANS: A Age-related macular degeneration (AMD) is an eye condition that leads to the deterioration of the center of the retina, called the macula, leading to loss of central vision. The patient with AMD has blurred and darkened vision, scotomas, and metamorphopsia. The symptoms of cataract are decreased vision, abnormal color perception, and glare. The symptoms of glaucoma are sudden, excruciating pain in or around the eye. The symptoms of allergic conjunctivitis are itching, burning, and redness.

Which instruction should the nurse give the patient who is prescribed verteporfin for age-related macular degeneration? a. "You should avoid direct exposure to sunlight while on treatment." b. "You can wear clothes with short sleeves after receiving treatment." c. "You should avoid lutein-containing, green, leafy vegetables while on treatment." d. "You should consume vitamin E-containing foods but avoid vitamin C-containing foods after receiving treatment."

ANS: A Age-related macular degeneration is an eye condition that leads to the deterioration of the macula, leading to loss of central vision. Verteporfin is a photosensitizing drug that becomes active when exposed to a low-level laser light wave or sunlight and may cause thermal burns. Therefore the nurse instructs the patient to avoid direct exposure to sunlight. The patient should cover the body completely, rather than wear short sleeves, because any exposure of the skin to sunlight could activate the medication in that area, resulting in a thermal burn. Lutein-containing, green, leafy vegetables do not react with verteporfin. Therefore there is no need of avoiding lutein-containing, green, leafy vegetables. Vitamins C and E are helpful in reducing the risk of age-related macular degeneration.

A patient informs the nurse that allergy symptoms are occurring in the eyes. What symptoms should the nurse ask the patient about when assessing for allergic conjunctivitis? a. Itching b. Photophobia c. Protruding eyeball d. Purulent discharge

ANS: A Allergic conjunctivitis occurs when the conjunctiva becomes swollen or inflamed due to reaction caused by an allergen. The defining symptom of allergic conjunctivitis is itching. Photophobia is the symptom of epidemic keratoconjunctivitis. Protruding eyeball is the symptom of exophthalmos. Purulent discharge is the symptom of corneal ulcer.

The nurse is teaching a patient about managing blepharitis. The most important intervention for the patient with blepharitis is which of these? a. Gently cleaning the lid margins with baby shampoo. b. Monitoring the spread of infection to the opposing eye. c. Regular instillation of artificial tears to the affected eye. d. Teaching the patient and family members good hygiene techniques.

ANS: A Blepharitis is a common chronic bilateral inflammation of the eyelid margins. Emphasize thorough cleaning practices of the skin and scalp. Gentle cleansing of the lid margins with baby shampoo can effectively soften and remove crusting. Blepharitis is not contagious nor does it spread unless conjunctivitis is occurring simultaneously. In this case, antibiotic drops may be used, but not artificial tears. It is not necessary to teach the family good hygiene, unless they are touching the eyelids.

The nurse would refrain from administering a prescribed dose of pilocarpine two drops to both eyes if it was documented that the patient has which comorbidity? a. Secondary glaucoma b. Macular degeneration c. Benign prostatic hypertrophy d. Chronic obstructive pulmonary disease (COPD)

ANS: A Contraindications to the use of pilocarpine include secondary glaucoma, acute iritis, and acute inflammation of the anterior segment of the eye. Benign prostatic hypertrophy, macular degeneration, and COPD are not contraindications to using this medication.

A patient is having a surgical procedure that involves using extreme cold to create an inflammatory response to produce a sealing scar. What procedure will the nurse educate the patient regarding? a. Cryopexy b. Scleral buckling c. Pneumatic retinopexy d. Laser photocoagulation

ANS: A Cryopexy is a procedure used to seal retinal breaks. This procedure involves using extreme cold to create the inflammatory reaction that produces the sealing scar. Scleral buckling is an extraocular surgical procedure that involves indenting the globe so that the pigment epithelium, the choroid, and the sclera move toward the detached retina. It involves suturing a silicone implant against the sclera. Pneumatic retinopexy is the intravitreal injection of a gas to form a temporary bubble in the vitreous that closes retinal breaks and provides apposition of the separated retinal layers. Laser photocoagulation involves using an intense, precisely focused light beam to create an inflammatory reaction.

A patient is diagnosed with epidemic keratoconjunctivitis. How should the nurse help the patient relieve the eye infection? a. Suggest the use of ice packs and dark glasses. b. Discourage the use of mild topical corticosteroids. c. Advise to avoid the use of topical antibiotic ointments. d. Advise to avoid taking any treatment because the condition is self-limiting.

ANS: A Epidemic keratoconjunctivitis is an ocular adenoviral disease. It is spread by direct contact, including sexual activity. Treatment involves the use of ice packs to reduce irritation. Dark glasses are used to reduce photophobia. Treatment should not be avoided in this condition. In severe cases, therapy can include mild topical corticosteroids and topical antibiotic ointment.

A patient reports sudden, severe pain in the eye accompanied by nausea and vomiting. The assessment findings of the patient indicated optic nerve atrophy and peripheral visual field loss. Which drug will the nurse expect to be prescribed by the primary health care provider? a. Betaxolol b. Besifloxacin c. Tropicamide d. Ranibizumab

ANS: A Glaucoma is a group of disorders characterized by increased intraocular pressure and optic nerve atrophy and peripheral visual field loss. The symptoms of glaucoma are pain in or around the eye, nausea, and vomiting. Betaxolol is an antiglaucoma drug that decreases intraocular pressure. Besifloxacin is an antibiotic that is used to treat acute bacterial conjunctivitis. Tropicamide is a cycloplegic that is used to produce pupillary dilation. Ranibizumab is a selective inhibitor of endothelial growth factor that is used to slow vision loss in age-related macular degeneration.

On a home visit to a patient who underwent cataract surgery, the nurse finds that the patient has intense pain in the operated eye. What should be the immediate nursing action? a. Notify the surgeon. b. Administer eyedrops. c. Administer analgesics. d. Apply a cold compress.

ANS: A In the postoperative period after a cataract surgery, the pain is usually mild. However, if the patient complains of intense pain, it should be immediately communicated to the surgeon because it may indicate hemorrhage, infection, or increased intraocular pressure and thus may need prompt intervention. Analgesics can be administered after receiving a surgeon's prescription. Applying a cold compress or administering eye drops may not decrease the pain.

The nurse is discussing glaucoma prevention with a 52-year-old African American patient. Which statement by the patient reflects a correct understanding of glaucoma prevention? a. "I will visit my eye doctor every one to two years." b. "I will wear protective sunglasses while outside." c. "I will take lutein and vitamin E supplements for eye health." d. "There is nothing that can be done to prevent vision loss from glaucoma."

ANS: A Loss of vision as a result of glaucoma is a preventable problem. Teach the patient and the caregiver about the risk of glaucoma and that it increases with age. Stress the importance of early detection and treatment in preventing visual impairment. A comprehensive ophthalmic examination is important in identifying persons with glaucoma or those at risk of developing glaucoma. The current recommendation is for an ophthalmologic examination every two to four years for persons between ages 40 and 64 years, and every one to two years for persons age 65 years or older. African Americans in every age category should have examinations more often because of the increased incidence and more aggressive course of glaucoma in these individuals. Wearing protective sunglasses while outside may help to reduce the development of cataracts, not glaucoma. Lutein and vitamin supplements may be helpful for preventing macular degeneration, not glaucoma.

Which condition is caused by a refractive error in the eye? a. Myopia b. Cataract c. Glaucoma d. Conjunctivitis

ANS: A Myopia is a refractive error of the eye characterized by the ability to see close objects clearly, whereas distant objects appear blurred. A cataract manifests as opacity of the lens, leading to decreased vision. It is not a refractive error. Glaucoma is a group of disorders characterized by increased intraocular pressure; it may lead to permanent blindness. Conjunctivitis is an infection of the conjunctiva caused by bacteria or viruses.

The nurse, who is reinforcing medication teaching before administering the scheduled dose of pilocarpine, would include which statement? a. "You will need someone to drive you home." b. "This medication should be used as needed to reduce eye pain." c. "Eye irritation is to be expected during the first two weeks of use." d. "This medication will help to raise intraocular pressure to a near normal level."

ANS: A Pilocarpine causes blurred vision and difficulty focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Pilocarpine will not reduce eye pain, will not cause eye irritation, and will decrease, not increase, intraocular pressure.

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? a. Absence of pain or pressure b. Blurred vision in the morning c. Seeing colored halos around lights d. Eye pain accompanied with nausea and vomiting

ANS: A Primary open-angle glaucoma is typically symptom free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed. Primary angle-closure glaucoma manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.

The nurse is assessing four patients with visual problems. Which patient does the nurse determine is exhibiting signs of retinal detachment? a. Patient A: "Everything looks like a cobweb to me." b. Patient B: "I am unable to distinguish colors because they have too much glare." c. Patient C: "I am unable to tolerate light and have a sensation of a foreign body in my eyes." d. Patient D: "I have itching and burning sensations in my reddened eyes."

ANS: A Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers. Patients with a detaching retina describe symptoms that include a "cobweb," "hairnet," or ring in the field of vision. Therefore the nurse will expect that Patient A has retinal detachment. For Patient B, abnormal color perception and glares indicate cataracts. Redness, photophobia, and foreign body sensation indicates epidemic keratoconjunctivitis for Patient C. Itching, burning, redness, and tearing indicate allergic conjunctivitis in Patient D.

The nurse is assessing a patient for esotropia. What sign observed by the nurse is clinically significant related to this disorder? a. Eye deviating in b. Eye deviating up c. Eye deviating out d. Eye deviating down

ANS: A Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object. The condition in which one eye deviates in is called esotropia. If the eye deviates up, it is called hypertropia. If the eye deviates out, it is called exotropia. If the eye deviates down, it is called hypotropia.

Which instruction is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? a. Discard all opened or used lens care products. b. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. c. Put all used cosmetics in a plastic bag for one week to kill any bacteria before reusing. d. Disinfect all lens care products with the prescribed antibiotic drops for one week after infection.

ANS: A The patient who wears contact lenses and develops infections should discard all opened or used lens care products and cosmetics to decrease the risk of reinfection from contaminated products. The risk of conjunctivitis is increased with not disinfecting lenses properly, wearing contact lenses too long, or using water or homemade solutions to store and clean lenses.

A patient has a prescription to receive timolol two drops to both eyes every 12 hours. The nurse would withhold the dose and question the prescription if the patient had which condition? a. Asthma b. Urinary retention c. Cluster headaches d. Chronic constipation

ANS: A Timolol is a nonselective beta-adrenergic blocking agent that can cause bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with severe chronic obstructive pulmonary disease (COPD) or asthma. Timolol will not increase urinary retention; that commonly is seen with use of anticholinergics. It will not cause or worsen headaches or constipation.

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. Which surgical procedure will be used to relieve traction on the retina and will the nurse educate the patient? a. Vitrectomy b. Cryotherapy c. Photodynamic therapy d. Ocular coherence tomography

ANS: A Vitrectomy is the surgical removal of the vitreous and is used to relieve traction on the retina caused especially by proliferative diabetic retinopathy. Cryotherapy is a procedure used to seal retinal breaks. Photodynamic therapy is a procedure used to treat age-related macular degeneration. Ocular coherence tomography is used to identify fluid in the central retina; it determines the need for continued intravitreal injections.

A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention? a. Walking behind the patient holding the patient's back b. Describing the environment to the patient while walking c. Helping the patient to sit by placing the patient's hand on the seat of the chair d. Standing slightly in front and to one side of the patient and providing elbow for support

ANS: A While assisting a blind patient using sighted-guide technique, the nurse should walk slightly ahead of the patient, with the patient holding the back of the nurse's arm. This action will help the blind patient to walk easily. The nurse should describe the environment while walking to help orient the patient. The student nurse should help the patient sit by placing one of his or her hands on the seat of the chair. The nurse should stand slightly in front and to one side of the patient and provide an elbow for the patient to hold.

In reinforcing health teaching to a patient diagnosed with primary open-angle glaucoma, the nurse would include which information about the disorder? a. Pressure damage to the optic nerve may occur because of clogged drainage channels. b. The retinal nerve is damaged by an abnormal increase in the production of aqueous humor. c. The pupillary opening is blocked secondary to decreased aqueous humor in the anterior chamber. d. The lens enlarges with normal aging, pushing the iris forward, blocking the outflow of aqueous humor.

ANS: A With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain properly from the eye. This leads to damage to the optic nerve over time. The iris is not affected, the retinal nerve is not damaged, and the aqueous humor builds up because of blockage.

Identify risk factors associated with development of cataracts. Select all that apply. a. Advanced age b. History of diabetes mellitus c. Exposure to ultraviolet light d. Eating a diet high in lutein e. History of eye chronic open-angle glaucoma f. History of prolonged therapy with systemic corticosteroids

ANS: A B C F Risk factors for developing cataracts include advanced age, exposure to ultraviolet light, and conditions in which blood glucose levels are elevated, such as diabetes mellitus, or patients receiving long-term corticosteroid medications. These conditions alter metabolic processes and lead to the lens becoming cloudy and then opaque. A diet high in lutein is thought to decrease the risk of age-related macular degeneration. Patients with chronic glaucoma are not at higher risk for cataracts. However, some patients develop glaucoma after having cataract surgery or having an artificial lens implanted.

A patient is advised to take acetazolamide for chronic glaucoma. What nursing interventions are appropriate to perform when administering acetazolamide? Select all that apply. a. Monitor electrolyte levels. b. Ask if the patient is allergic to sulfa drugs. c. Avoid use if the patient has a history of asthma. d. Caution the patient about decreased visual acuity. e. Avoid use if the patient is on high-dose aspirin therapy.

ANS: A B E Acetazolamide is used to decrease production of aqueous humor. The drug may cause allergic reactions in patients sensitive to sulfa drugs; therefore, the nurse should ask the patient if he or she has a history of allergy to sulfa drugs. The drug has a diuretic effect and requires the nurse to monitor the patient's electrolyte levels. The drug should not be given to people on high-dose aspirin therapy because it can have adverse effects. Visual acuity is not affected with acetazolamide, and the drug is not contraindicated in people with asthma.

The adult child of a patient with macular degeneration asks the nurse how to avoid developing the condition. Which intervention should the nurse include in teaching? Select all that apply. a. Stop smoking or do not start. b. Avoid exposure to ultraviolet light. c. Wash hands before touching face or eyes. d. Wear eye protection while doing yard work. e. Eat green leafy vegetables such as spinach or kale daily.

ANS: A B E Besides aging and family history, risk factors for macular degeneration include cigarette smoking and long-term exposure to ultraviolet light. A diet rich in lutein, found in green leafy vegetables, may reduce the risk of macular degeneration. Hand hygiene prevents infection. Use of eye protection prevents injury.

A patient presenting with an itching, burning sensation and redness in the eye is diagnosed with allergic conjunctivitis. What interventions are most important to ease the symptoms? Select all that apply. a. Administer artificial tears, as prescribed. b. Instruct the patient to wash hands regularly. c. Instruct the patient to avoid the allergen if it is known. d. Administer topical antihistamines and corticosteroids. e. Instruct the patient to use individual or disposable towels.

ANS: A C D Allergic conjunctivitis is caused by exposure to any allergen. If the allergen is known, the patient should be instructed to avoid the allergen as much as possible. Artificial tears can be used to dilute the allergen and wash it from the eye. Topical antihistamines and corticosteroids can be used to further decrease the symptoms. Hand washing and using individual or disposable towels are general measures to prevent the spread of infection, but they are not specific to allergic conjunctivitis.

A nurse provides education to a group of people about eye health care. Which statements by group indicate that the teaching has been understood? Select all that apply. a. "Wash hands regularly to prevent the spread of diseases." b. "Avoid removing contact lenses if there is redness and pain in the eye." c. "Wear sunglasses and ensure proper nutrition to prevent cataract development." d. "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." e. "Regular eye checkups help in early detection of disease and prevent further loss of vision."

ANS: A C D E Proper care of the eye plays a vital role in maintaining eye health. Regular hand washing helps to prevent the spread of disease from one eye to the other. Wearing sunglasses and eating a proper diet help to prevent cataract development and age-related diseases. Wearing eye protection during hazardous work helps to reduce the risk of eye injuries. Regular eye checkups help in the early detection of diseases and prevent further loss of vision. Contact lenses should be removed if there is redness and pain in the eye.

A patient presents with a sty in the left eye. Which nursing actions are appropriate to manage the patient's condition? Select all that apply. a. Teach the patient to perform lid scrubs daily. b. Prepare the patient for surgical removal of the sty. c. Administer appropriate antibiotic ointments or drops, as prescribed. d. Teach the patient to gently cleanse the lid margins with baby shampoo. e. Instruct the patient to apply warm, moist compresses at least four times a day.

ANS: A C E A sty, also called a hordeolum, is caused by a Staphylococcus aureus infection of the sebaceous glands in the lid margin. The infection is manifested as a red, swollen, circumscribed, and acutely tender area. The patient should be instructed to apply warm, moist compresses at least four times a day to decrease the swelling and tenderness. Lid scrubs should be performed daily. Infection should be treated with appropriate antibiotic ointments or drops, as prescribed. Surgical intervention may not be required because a sty may subside with basic interventions. Cleansing with baby shampoo is not required because there are no secretions or crusting.

A patient admitted to the hospital has been taking pilocarpine eye drops at home. What is the desired effect of this medication? Select all that apply. a. Facilitates aqueous humor outflow b. Reverses damage to the optic nerve c. Improves the patient's vision in dim light d. Lessens the amount of pupillary dilation e. Decreases the amount of fluid within the eye

ANS: A D Pilocarpine is a cholinergic (parasympathomimetic) medication used to treat chronic open-angle glaucoma. It causes miosis (pupillary constriction), which improves the flow of the fluid (aqueous humor) within the trabecular meshwork of the eye. This keeps the pressure within the eye low and decreases likelihood of optic nerve damage. Damage to the optic nerve from glaucoma cannot be reversed with treatment. Miotic effects of the medication do not allow for pupil dilation that normally occurs in dim light. Pilocarpine does not decrease the amount of aqueous humor production as do some other medications (beta-adrenergic blockers) used to treat glaucoma.

The patient calls the clinic about a sty that the patient has had for some time on the upper eyelid. The patient says warm moist compresses have been used, but it is no better. What should the nurse tell the patient to do? a. "Go to the pharmacy to get some eye drops." b. "Come in so the ophthalmologist can remove the lesion for you." c. "The health care provider will need to inject it with an antibiotic." d. "Wash the lid margins with baby shampoo to remove the crusting."

ANS: B A chalazion may evolve from a sty, or hordeolum, as it did for this patient. Initial treatment is with warm compresses, but when they are ineffective, the lesion may be surgically removed or injected with corticosteroids. Washing the lid margins with baby shampoo is done with blepharitis.

The nurse is preparing a patient for penetrating keratoplasty. What disorder does the nurse determine the patient is being treated for? a. Retinopathy b. Corneal scars c. Chronic open-angle glaucoma d. Age-related macular degeneration

ANS: B A corneal scar is the chronic inflammation of the corneal stroma. Penetrating keratoplasty is the procedure performed to treat corneal scars. While performing surgery, the ophthalmic surgeon removes the full thickness of the patient's cornea and replaces it with a donor cornea that is sutured into place. Retinopathy is treated by laser photocoagulation. Chronic open-angle glaucoma is treated by argon laser trabeculoplasty. Age-related macular degeneration is treated by photodynamic therapy.

The nurse is reviewing refractive errors of the eye. Which statement does the nurse identify as being true? a. Presbyopia occurs when the eyeball elongates. b. Astigmatism is caused by an irregular corneal curvature. c. Myopia is an inability to accommodate for near objects. d. Hyperopia is an inability to accommodate for objects at a distance.

ANS: B Astigmatism is caused by an irregular corneal curvature. Presbyopia is the loss of accommodation associated with age. As the eye ages, the lens becomes larger, firmer, and less elastic. Myopia (nearsightedness) is an inability to accommodate for objects at a distance. Hyperopia (farsightedness) is an inability to accommodate for near objects.

Which visual problem will the nurse suspect in the patient who has symptoms of itching, irritation, intolerance towards light, with crusts on the lid margins and lashes? a. Cataract b. Blepharitis c. Retinal detachment d. Allergic conjunctivitis

ANS: B Blepharitis is a common chronic bilateral inflammation of the lid margins associated with crusts on the lid margins. Blepharitis is also associated with itching, irritation, and photophobia. Cataract is a clouding of the lens in the eye, which affects vision by abnormal color perception and glaring. Retinal detachment is a separation of the sensory retina and the underlying pigment epithelium. The symptoms of retinal detachment are photopsia and seeing a ring or cobwebs in the field of vision. Allergic conjunctivitis is caused by exposure to an allergen and is associated with itching and swelling.

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, on what should the nurse focus? a. Giving anticipatory guidance about the eventual loss of central vision that will occur b. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision c. Recognizing that eye damage caused by glaucoma can be reversed in the early stages d. Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

ANS: B Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, encourage the patient to remain compliant with drug therapy.

The nurse is assessing four patients with different refractive errors. Which patient will the nurse suspect to have hyperopia? a. Patient A: Inability to accommodate for objects at a distance b. Patient B: Inability to accommodate for near objects c. Patient C: Loss of accommodation which is associated with age d. Irregular corneal curvature

ANS: B Hyperopia, or farsightedness, is an inability to accommodate near objects. It causes the light rays to focus behind the retina and requires the patient to use accommodation to focus the light rays on the retina for near objects; therefore, patient B is suspected to have hyperopia. Myopia or nearsightedness is an inability to accommodate objects at a distance; therefore, Patient A has myopia. Presbyopia is the loss of accommodation associated with age; therefore, Patient C has presbyopia. Astigmatism is caused by an irregular corneal curvature; therefore, Patient D has astigmatism.

A patient is having retinal hemorrhages, anoxic cotton-wool spots, and macular swelling in the eye. What should the nurse closely monitor that is a contributing factor to this disorder? a. Glucose level b. Blood pressure c. Intraocular pressure d. Thyroid hormone levels

ANS: B Hypertensive retinopathy is caused by high blood pressure that creates blockages in retinal blood vessels. The eye examination of a patient with hypertensive retinopathy reveals retinal hemorrhages, anoxic cotton-wool spots, and macular swelling. If the eye examination shows capillary microaneurysms, retinal swelling, and hard exudates, then the nurse will suspect nonproliferative retinopathy and high blood glucose level. Exposure keratitis is seen in patients who cannot close their eyes adequately because of protruding eyeballs, which is caused by increased thyroid hormone. Angle-closure glaucoma occurs because of pupil dilation. When the pupil remains partially dilated long enough, it may result in increased intraocular pressure.

An asthmatic patient is diagnosed with chronic glaucoma. The patient is prescribed timolol (Istalol). In regard to patient safety, what action should the nurse take? a. Explain to patient that carteolol may cause vomiting. b. Do not administer istalol, and notify the health care provider. c. Ask the health care provider to decrease the dose of carteolol. d. Suggest the patient only use carteolol for a short period of time.

ANS: B In an asthmatic patient, administration of timolol should be avoided because it causes bronchospasm. Decreasing the dose and suggesting that the patient only use the medicine for a short period of time do not reduce the risk of bronchospasm. Vomiting is not a side effect of timolol.

Which statement is most appropriate when teaching a patient about timolol eye drops in the treatment of glaucoma? a. "You may feel some palpitations after instilling these eye drops." b. "You may have a temporary headache after instilling these drops." c. "You should withhold this medication if your blood pressure becomes elevated." d. "You should keep your eyes closed for 15 minutes after instilling these eye drops."

ANS: B It is common for patients to have a temporary headache when instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow and blood pressure is more likely to decrease if absorbed systemically. Closing the eyes for 15 minutes after instilling the eye drops is not necessary.

Which part of the eye is inflamed in keratitis? a. Sclera b. Cornea c. Conjunctiva d. Eyelid margins

ANS: B Keratitis is an infection or inflammation of the cornea. Scleritis involves inflammation of the sclera. Inflammation of the conjunctiva is a clinical manifestation of conjunctivitis. Blepharitis is associated with inflammation of the margins of both eyelids.

While examining the eye of a patient, the nurse finds a cone-shaped anterior cornea. Which other finding is associated with this condition? a. Pain b. Blurred vision c. Corneal inflammation d. Abnormal color perception

ANS: B Keratoconus is a noninflammatory eye disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape. The only symptom associated with keratoconus is blurred vision. Pain is a symptom of corneal ulcer. Corneal inflammation is a symptom of keratitis. Abnormal color perception is associated with cataracts.

A patient has severe myopia. Which type of correction is the patient planning to have if the patient tells the nurse, "I can't wait to be able to see after they implant a contact lens over my lens"? a. Photorefractive keratectomy (PRK) b. Phakic intraocular lenses (phakic IOLs) c. Refractive intraocular lens (refractive IOL) d. Laser-assisted in situ keratomileusis (LASIK)

ANS: B Phakic IOL is the implantation of a contact lens in front of the natural lens. PRK is used with low to moderate amounts of myopia; the epithelium is removed, and the laser sculpts the cornea to correct the refractive error. Refractive IOL also is for patients with a high degree of myopia or hyperopia and involves removing the natural lens and implanting an intraocular lens. LASIK surgery is similar to PRK except that the epithelium is replaced after surgery.

Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells? a. Filtration surgery b. Photodynamic therapy c. Laser photocoagulation d. Argon laser trabeculoplasty

ANS: B Photodynamic therapy treats AMD by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells. Filtration surgery is the treatment for chronic open-angle glaucoma but not for AMD. Laser photocoagulation is used for treatment of proliferative retinopathy. Argon laser trabeculoplasty is a noninvasive procedure to lower the intraocular pressure in glaucoma.

In presbyopia the lens of the eye loses flexibility and is unable to accommodate close vision. The nurse recognizes that this condition generally occurs in which group? a. Adolescents and young adults b. Men and women older than 40 c. Men between the ages of 30 and 50 d. Women between the ages of 20 and 40

ANS: B Presbyopia is an age-related change in vision that generally occurs in men and women older than 40 years. Adolescents and young adults are not subject to the condition, and it does not affect one gender exclusively.

While at work a patient has a penetrating eye injury from a foreign object. What action should the occupational health nurse take while awaiting arrival of the emergency response team? a. Place the patient in a flat supine position. b. Stabilize the foreign object within the injury site. c. Instruct the patient to bend over and take deep breaths. d. Continuously irrigate the eye with sterile saline solution.

ANS: B The nurse should stabilize the foreign object penetrating the eye to prevent further damage until the injury can be treated by an emergency medicine specialist and ophthalmologist. The head of the patient should be elevated 45 degrees to prevent excessive pressure within the eye. Bending over is avoided as well. Irrigation of the eye is indicated only if the injury is caused by a chemical exposure.

The nurse has completed patient teaching for a patient who had cataract surgery on the left eye. Which statement by the patient indicates a need for further teaching? a. "I might feel some scratchiness in my left eye." b. "I should notice an improvement in my vision in a few days." c. "I will call my health care provider if I notice white drainage or redness in my left eye." d. "I will call my health care provider if I notice white drainage or redness in my left eye."

ANS: B The patient will notice an improvement in vision after surgery not in a few days. Cataract surgery typically results in little to no pain, but the patient may have some scratchiness in the operative eye. Mild analgesics are usually sufficient to relieve any discomfort, but if the pain is sudden or intense, the patient should notify the health care provider because this may indicate hemorrhage, infection, or increased intraocular pressure (IOP). The patient should be instructed to call the health care provider if redness or drainage occurs in the affected eye. These can be signs of infection.

A patient reports an inability to see near objects. The nurse recalls that which physiologic condition is responsible for this disorder? a. Cornea having irregular curvature b. Light rays focusing behind the retina c. Incoming light rays bending unequally d. Light rays focusing in front of the retina

ANS: B The patient with an inability to see near objects suffers from hyperopia or farsightedness. In this case, the light rays focus behind the retina. Normally the light rays should focus on the retina for near objects. This type of refractive error occurs when the cornea or lens does not have adequate focusing power or when the eyeball is too short. Irregular corneal curvature and incoming light rays bending unequally are associated with astigmatism. Focusing light rays in front of the retina is the sign of myopia.

A nurse administered tropicamide in both eyes of a patient in the preoperative room before cataract surgery. What is the most important nursing intervention for this patient? a. Brighten the room with extra lights. b. Instruct the patient to wear dark glasses. c. Monitor for pulmonary effects of the drug. d. Reassure the patient that the surgery will be uneventful.

ANS: B Tropicamide is a cycloplegic. It dilates the pupil by blocking the effect of acetylcholine on the iris sphincter muscle. It causes photophobia, so the nurse should instruct the patient to wear dark glasses. The nurse should also dim the lights in the room. The drug may also be absorbed systemically; therefore, the nurse should observe the patient for tachycardia and other effects on the central nervous system. Tropicamide does not cause pulmonary side effects.

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? a. "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." b. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." c. "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." d. "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

ANS: B With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This leads to damage to the optic nerve over time. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber.

A patient is using dipivefrin for the treatment of glaucoma. What side effects should the nurse educate the patient to monitor? Select all that apply. a. Depression b. Tachycardia c. Hypertension d. Bronchospasm e. Taste alteration

ANS: B C Dipivefrin is an α-adrenergic agonist and is converted to epinephrine inside the eye. It decreases aqueous humor production and enhances outflow facility. Dipivefrin causes tachycardia and hypertension. Depression and bronchospasm are side effects of the antiglaucoma drug carteolol. Taste alteration is a side effect of carbonic anhydrase inhibitors.

A patient, discharged after eye surgery, is told to avoid activities that will increase intraocular pressure. Which activities should the patient avoid? Select all that apply. a. Eating b. Lifting c. Coughing d. Bending over e. Breathing deeply

ANS: B C D Activities such as coughing, bending over, and lifting increase the pressure within the eye. Eating and breathing deeply do not involve straining or lowering the head, so the pressure within the eye is not increased.

A patient has undergone cataract surgery. What nursing interventions help to prevent postoperative complications? Select all that apply. a. Antiviral medications are given to prevent infections. b. Teach the patient to instill medicine following aseptic techniques. c. Teach the patient about proper hygiene and eye care techniques. d. Ask the patient to discontinue all prescribed medicine two days after surgery. e. Advise the patient to avoid actions that can cause increased intraocular pressure.

ANS: B C E Postoperative care of the eye is essential for proper wound healing. Increased intraocular pressure may break the sutures and increases the risk of complications; therefore, it should be prevented. Proper hygiene and eye care techniques prevent contamination of the wound. Medicines should be instilled in the eye using aseptic techniques to prevent infection. The full course of medicine should be completed to obtain the therapeutic effect. Antibiotic drops, not antiviral medications, are given to prevent infections.

Which symptom occurs initially with retinal detachment? a. Redness of the conjunctiva b. Increased glare with artificial light c. Seeing flashes of light and floaters d. Severe pain when moving the eyes

ANS: C A detached retina involves the separation of the sensory retina from the underlying pigment epithelium. Fluid accumulates in the space and blocks essential nourishment and circulation to retinal cells. Initially symptoms include seeing flashes of light, an increased amount of floaters, or lines in the vision field. If the detachment advances, there is a loss of vision peripherally or centrally, depending where the detachment has occurred. Eye irritation or infection causes redness of the conjunctiva. Increased glare that interferes with visual acuity is noted by patients with cataracts. Inflammation or infection within the eye causes pain with eye movement.

A nurse reviews the medical record for a patient with acute glaucoma for which acetazolamide has been prescribed. The patient has a history of high-dose aspirin therapy. Considering the concomitant use of the medications, the nurse expects what change in medication prescriptions? a. The dose of acetazolamide will be decreased. b. There will be no change in prescriptions of either medication. c. The patient cannot take both medications due to gastric disturbances. d. The patient will be advised to take acetazolamide at a different time than aspirin.

ANS: C Acetazolamide is a carbonic anhydrase inhibitor used in the treatment of glaucoma. The patient is on high-dose aspirin therapy; therefore, acetazolamide is avoided because it increases the risk of gastric disturbances. Decreasing the dose of acetazolamide may not decrease the risk of developing complications. A combination of acetazolamide and aspirin is not recommended because it can cause GI upset. Taking acetazolamide at a different time than aspirin does not prevent drug interactions and should be avoided.

Which statement by the student nurse indicates the need for further teaching regarding age-related macular degeneration (AMD)? a. "AMD is related to retinal aging." b. "Family history is a major risk factor for AMD." c. "People with dark-colored eyes are more at the risk for AMD." d. "Long-term exposure to ultraviolet light is a risk factor for AMD."

ANS: C Age-related macular degeneration is the most common cause of irreversible central vision loss in people above 60 years of age. People with light-colored eyes, not dark-colored eyes, are more at risk for AMD because light eyes have less pigment, which makes them sensitive to light, causing AMD. The student making this statement requires further teaching. AMD is related to retinal aging because changes in astrocytes in retinal aging cause retinal ischemia, which leads to AMD. Genetic factors play a major role in AMD, and family history is a major risk factor for AMD because multiple genetic variants are involved in AMD. Long-term exposure to ultraviolet light is a risk factor for AMD because long-term exposure may cause retinal detachment.

The nurse is performing an eye assessment and determines the pupils are 1 to 2 mm. What medication taken by the patient does the nurse recognize may be causing this symptom? a. Carteolol b. Dipivefrin c. Carbachol d. Latanoprost

ANS: C Carbachol is a cholinergic agent that stimulates iris sphincter contraction and results in miosis. Carteolol is a nonselective beta-adrenergic blocker and decreases intraocular pressure but does not cause miosis. Dipivefrin is a sympathomimetic agent that decreases aqueous humor production but does not cause miosis. Latanoprost is a prostaglandin F2-alpha analog that does not stimulate contraction of the iris sphincter; therefore, it does not cause miosis.

A 68-year-old patient has undergone a total hip replacement and has glaucoma. The nurse forms a nursing diagnosis of disturbed sensory perception related to increased intraocular pressure. The plan of care should focus on which main element? a. Restriction of driving privileges immediately b. Use of occupational and physical therapy for visual deficits c. Encouraging medication compliance to reduce the risk of vision loss d. Managing the pain using oral antiinflammatories and opioids as needed

ANS: C Drug therapy is necessary to prevent the eventual vision loss that accompanies glaucoma. For this reason, the nurse should encourage the patient to remain compliant with drug therapy. Physical therapy will not improve or treat visual deficits. Glaucoma does not cause pain, and unless the vision is severely impaired, driving restrictions are not necessary.

A patient reports ocular pain, photophobia, decreased visual acuity, headaches, corneal edema, and conjunctiva that is reddened and swollen. The nurse recognizes that the patient is most likely experiencing which type of inflammation? a. Scotoma b. Blepharitis c. Endophthalmitis d. Cytomegalovirus retinitis

ANS: C Endophthalmitis is an extensive intraocular inflammation of the vitreous cavity. Ocular pain, photophobia, decreased visual acuity, headaches, reddened, swollen conjunctiva, and corneal edema are the symptoms of endophthalmitis. Blepharitis is a common chronic bilateral inflammation of the lid margins. Cytomegalovirus retinitis is an opportunistic infection that occurs in patients who are immunocompromised. Scotoma is presence of blind spots in the visual field; it is not an infection.

Which extraocular eye disorder will the nurse suspect in the patient demonstrating inflammation of the cornea and exophthalmos? a. Strabismus b. Keratoconus c. Exposure keratitis d. Keratoconjunctivitis sicca

ANS: C Exposure keratitis is an inflammation or infection of the cornea that occurs when the patient has exophthalmos due to thyroid disease or masses behind the globe. Therefore the nurse will suspect exposure keratitis. Strabismus is not associated with inadequately closed eyelids, and there is no inflammation. Instead the patient with strabismus cannot consistently focus the two eyes on same object simultaneously. Keratoconus is a noninflammatory condition in which the patient experiences blurred vision. Keratoconjunctivitis sicca is a condition of dry eyes, particularly seen in older adults and individuals with certain systemic diseases such as scleroderma and systemic lupus erythematosus.

The nurse assesses a patient with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin. What action does the nurse anticipate providing to assist with the relief of discomfort due to this condition? a. Administration of artificial tears b. Insertion of intacs on the cornea c. Application of a warm, moist compress four times a day d. Administration of nonsteroidal antiinflammatory eye drops

ANS: C Hordeolum is an infection of the sebaceous glands in the lid margin. The symptoms of hordeolum are a red, swollen, circumscribed, and acutely tender area near the eye. The only treatment that may be necessary for this patient is to apply warm, moist compresses four times a day, which will decrease the swelling and redness of the eye. Administering artificial tears is the treatment for allergic conjunctivitis to dilute the allergen and wash it away. Insertion of intacs on the cornea is the treatment for keratoconus. Administration of nonsteroidal antiinflammatory eye drops is the treatment given if the patient has inflammation.

A patient asks the nurse, "How does glaucoma damage my eyesight?" What explanation should the nurse provide to the patient? a. Glaucoma leads to detachment of the retina. b. Glaucoma results from chronic eye inflammation. c. Glaucoma results in increased intraocular pressure. d. Glaucoma is caused by decreased blood flow to the retina.

ANS: C In chronic open-angle glaucoma the outflow of aqueous humor is obstructed, leading to increased intraocular pressure. The increased intraocular pressure eventually causes destruction of the nerve fibers of the retina and painless vision loss, beginning in the periphery. Glaucoma does not cause detachment of the retina, result from chronic inflammation, or result from decreased retinal blood flow.

The nurse is caring for a patient with keratitis caused by the herpes simplex virus. What order should the nurse question prior to administering? a. Oral acyclovir b. Trifluridine drops c. Topical corticosteroids d. Topical vidarabine ointment

ANS: C Keratitis is an inflammation or infection of the cornea that can be caused by a variety of microorganisms. Topical corticosteroids are contraindicated in this patient because they may cause deeper ulceration of the cornea on prolonged treatment. Oral acyclovir is an antiviral medication that is effective in the treatment of viral keratitis. Trifluridine drops and topical vidarabine ointment are effective in treating viral keratitis.

A patient has received a prescription for ketoconazole eyedrops. The nurse recognizes that the probable reason for the medication is that the patient is experiencing what? a. Myopia b. Astigmatism c. Acanthamoeba keratitis d. Generalized poor hygiene of the eye

ANS: C Ketoconazole is an antifungal eyedrop that is prescribed for the treatment of Acanthamoeba keratitis because the causative organism is resistant to other drugs. Myopia is an inability to accommodate for objects at a distance; it is not a fungal infection. Astigmatism is caused by an irregular corneal curvature and is not a fungal infection. Ketoconazole is not used for general hygiene of the eye.

A nurse should instruct a patient who had cataract surgery to contact the surgeon if which condition develops? a. Glare b. Itching c. Eye pain d. Blurred vision

ANS: C Pain should not be present after cataract surgery, although there may be slight discomfort that is easily relieved with acetaminophen. The patient should be told that the other symptoms, including glare, itching, and blurred vision, may be present and are expected until healing takes place.

While evaluating a patient the nurse suspects primary open-angle glaucoma if which classic symptom is present? a. Vacillating pupil b. Constant tearing c. Decreased peripheral vision d. Colored halos around lights

ANS: C Primary open-angle glaucoma (POAG) develops slowly and without symptoms. The gradual loss of peripheral vision is one of the diagnostic criteria for primary open-angle glaucoma, which manifests as tunnel vision late in POAG. Vacillating pupils and constant tearing are not directly associated with any form of glaucoma. Colored halos around lights are seen in acute-angle closure glaucoma, which is less common than POAG. Acute-angle closure glaucoma is an ocular emergency requiring immediate intervention because intraocular pressure increases rapidly and may cause optic nerve damage and blindness.

A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. On which treatment option does the nurse educate the patient? a. Filtration surgery b. Photodynamic therapy c. Laser photocoagulation d. Argon laser trabeculoplasty

ANS: C Proliferative retinopathy is a condition associated with the formation of fragile new abnormal blood vessels, which are predisposed to leaks, resulting in severe vision loss. This condition can be treated by laser photocoagulation. Filtration surgery is the treatment for chronic open-angle glaucoma. Photodynamic therapy is the treatment for age-related macular degeneration. Argon laser trabeculoplasty is a noninvasive procedure to lower intraocular pressure in glaucoma.

A patient asks the nurse why the lights are being dimmed prior to the instillation of pupil-dilating eye drops. What is the best response by the nurse? a. To decrease pain b. To prevent anxiety c. To minimize photophobia d. To minimize intraocular pressure

ANS: C Pupil dilation medications enlarge the pupil during eye examinations. After administering pupil dilation medications, patients generally have photophobia. Analgesics are administered to decrease pain. Anxiolytics are given to patients to prevent anxiety. Miotics and oral or intravenous hyperosmotic agents such as glycerin liquid, isosorbide solution, and mannitol solution are useful in lowering the intraocular pressure.

A patient has experienced a sudden decrease in vision. During an eye examination, the patient overhears the primary health care provider mention that the patient has papilledema, and asks the nurse to explain what that is. Which answer by the nurse is correct? a. "Papilledema is caused by irritants and microorganisms." b. "Papilledema is fluid accumulation between two layers within the retina." c. "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." d. "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

ANS: C Sustained, severe hypertension can cause sudden visual loss from swelling of the optic disc and nerve. This condition is known as papilledema. It is not caused by the development of abnormal blood vessels in or around the macula, nor is it caused by microorganisms. Papilledema is not fluid accumulation between two layers within the retina. The development of abnormal blood vessels in or near the macula is known as macular degeneration.

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? a. Apply pressure to each eyeball for a few seconds after administration. b. Have the patient close the eyes and move them back and forth several times. c. Have the patient put pressure on the inner canthus of the eye after administration. d. Have the patient try to blink out excess medication immediately after administration.

ANS: C Systemic absorption can be minimized by applying pressure to the inner canthus of the eye. Applying pressure to each eyeball, having the patient close the eyes and move them back and forth, and having the patient try to blink out excess medication will not minimize systemic effects of the medication.

A patient has sustained an injury to the cornea. The nurse assists the primary health care provider in rinsing the eye with saline solution and then instilling a dye into the conjunctiva of the injured eye. What is the purpose of the dye? a. To disinfect the injured tissue b. To help seal and heal the injured tissue c. To stain the injured tissue so it can more easily be identified d. To bind with foreign particles, allowing them to be rinsed away from injured tissue

ANS: C The injured tissue is susceptible to the dye and will remain stained even after the eye is rinsed with saline. Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects and locate foreign objects in the eye. The dye is not used to disinfect the tissue, seal and heal it, or bind with foreign particles.

A patient left blind as a result of a motor vehicle accident is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? a. Use suitable coping strategies to reduce stress b. Identify patient's strengths and support system c. Verbalize feelings related to visual impairment d. Transition successfully to the sudden vision loss

ANS: C The nurse's priority is to help the patient express feelings about vision loss because the patient is not coping effectively with the situation. Until the patient expresses how he or she feels, the patient will be unable to progress in the rehabilitation process, including using suitable coping strategies to reduce stress, developing strengths and a support system, and transitioning successfully to the sudden vision loss.

The nurse cares for a patient with a detached retina. The patient says, "Before my eye was patched, I saw a lot of spots." The nurse explains that the symptoms are caused by what? a. Contamination of the aqueous humor b. Pieces of the retina floating within the eye c. Blood cells released into the eye by the detached retina d. Spasms of the retinal blood vessels traumatized by the detached retina

ANS: C The spots commonly reported by patients with retinal detachment are blood cells released into the vitreous humor in the detachment. These are also referred to as "floaters." Contamination, retinal fragments, and spasms of the retinal blood vessels are not the cause of floaters in the field of vision of a person with a detached retina.

A patient is discharged to home after cataract surgery. What is the most important instruction the nurse should include in the discharge teaching? a. Restrict activity at home. b. Wear a nighttime eye shield. c. Do not bend, stoop, cough, or lift. d. Wash hands before touching the eye.

ANS: C When teaching postoperative home care for cataract surgery, the nurse should instruct the patient to avoid activities such as bending, stooping, coughing, or lifting because these activities can raise the intraocular pressure, which in turn can adversely affect the newly implanted lens. All other activities are permissible. Wearing a nighttime eye shield is not necessary. Washing hands before touching the eye is a general hygiene practice and not specific to postoperative care.

The nurse is admitting a patient with glaucoma who states that he or she is allergic to all sulfa drugs. Which medication order should the nurse question and immediately report to the primary care provider? a. Carteolol b. Dipivefrin c. Carbachol d. Acetazolamide

ANS: D Acetazolamide is an antiglaucoma drug and a carbonic anhydrase inhibitor that may cause immunologically mediated reactions and result in sulfa-type allergic reactions in patients allergic to sulfa. Carteolol is a nonselective beta blocker and may cause blurred vision, photophobia, and bradycardia. Dipivefrin is sympathomimetic and may cause side effects such as ocular discomfort and redness. Carbachol is an antiglaucoma drug and a cholinergic agent that may cause transient ocular discomfort, headache, and blurred vision.

A patient is diagnosed with bacterial conjunctivitis. The nurse expects what patient symptoms? a. Itching, burning, irritation, and photophobia b. Tearing, redness, photophobia, and foreign body sensation c. Red, swollen, circumscribed, and acutely tender area in the lid margin d. Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

ANS: D Bacterial conjunctivitis manifests as discomfort, pruritus, redness, and a mucopurulent drainage in the eye. It occurs due to unhygienic conditions. The infection is caused by Staphylococcus aureus. It can be treated with antibiotic drops. Itching, burning, irritation, and photophobia are signs of blepharitis. Tearing, redness, photophobia, and foreign body sensation are symptoms of epidemic keratoconjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum.

A patient is prescribed bimatoprost. What nursing intervention would ensure safe administration of the drug? a. Teach the patient to instill three drops three times a day. b. Advise the patient to wash hands with water and then instill the medicine. c. Suggest the patient rinse eyes immediately after instilling the medicine. d. Suggest the patient remove contact lenses 15 minutes before instilling the drops.

ANS: D Bimatoprost is used in the treatment of glaucoma. The patient should be told to remove contact lenses 15 minutes before instilling the eyedrops. Instilling eyedrops with contact lenses on can cause a sensation of a foreign body in the eye. The patient should be instructed to instill one drop per evening in the eye. This is because increasing the dose results in increased brown iris pigmentation, ocular discomfort and redness, dryness, and itching. Instilling the medicine using aseptic techniques prevents infection. Washing eyes immediately after instilling the medicine may affect the therapeutic benefits.

A patient reports, "While I was walking, I got something in my eye." What nursing intervention is most appropriate for a patient with a suspected foreign object in the eye? a. Beginning irrigation with sterile normal saline solution b. Attempting to remove the object without causing further damage to the eye c. Refraining from doing anything until the patient can be seen by an ophthalmologist d. Loosely covering the eye with a sterile patch and referring the patient to emergency care

ANS: D Covering the eye loosely with a sterile patch with referral for emergency care is the safest option for this patient. Eye irrigation and attempting to remove the object are not appropriate in this health care setting. The nurse should never attempt to remove a foreign object from the eye because this could cause further damage. The patient should be seen by the eye specialist, but covering the eye with an eye patch will prevent further trauma and irritation.

While preparing a patient with a visual problem for surgical therapy, the primary health care provider orders the nurse to administer cycloplegics to the patient. What rationale does the nurse identify for this action? a. To prevent anxiety b. To reduce inflammation c. To minimize photophobia d. To block the effect of acetylcholine on ciliary body muscles

ANS: D Cycloplegics are anticholinergic drugs that block the effect of acetylcholine on the ciliary body muscles and produce paralysis of accommodation. Therefore cycloplegics are given in the preoperative phase of surgical therapy to block the effect of acetylcholine on the iris sphincter muscle. Antianxiety drugs are given to the patient to prevent anxiety. Nonsteroidal antiinflammatory drugs are given to reduce inflammation. The patient is advised to wear dark glasses to minimize photophobia.

Which condition involves inflammation of the vitreous cavity? a. Uveitis b. Blepharitis c. Otitis media d. Endophthalmitis

ANS: D Endophthalmitis is intraocular inflammation of the vitreous cavity. Uveitis is inflammation of the uvea. Inflammation of the margins of the eyelids is called blepharitis. Infection of the tympanum, ossicles, and space of the middle ear is called otitis media.

A patient sustained an eye injury, and the nurse assesses blood in the anterior chamber as well as redness of the sclera. What is a priority nursing action for this patient? a. Applying pressure on the eye b. Giving oral fluids to the patient c. Instructing the patient to blow the nose d. Elevating the head of bed to 45 degrees

ANS: D Eye injuries may be caused due to trauma, foreign bodies, chemical burns, or thermal burns and can be a serious threat to vision if not treated appropriately. The assessment findings include pain, photophobia, redness, swelling, and blood in the anterior chamber of the eye. Elevating the head of the patient's bed to 45 degrees helps minimize edema and swelling, thereby preventing the obstruction of vision. The nurse should avoid applying pressure on the eye. Oral fluids and food should not be given to the patient. The patient should be instructed not to blow the nose because it may cause black eyes.

A patient complains of a red, swollen, circumscribed, and acutely tender area in the lid margin. After the medical checkup, it is diagnosed as a hordeolum. The nurse should provide what instructions to help the patient care for the affected eye? a. Advise the patient to not perform lid scrubs for 10 days. b. Suggest wearing glasses to reduce development of the infection. c. Advise to avoid any treatment because the condition is a normal body protective mechanism. d. Suggest applying warm, moist compresses at least four times a day until the condition improves.

ANS: D Hordeolum is an infection caused by the bacteria Staphylococcus aureus. It manifests as a red, swollen, circumscribed, and acutely tender area in the lid margin. Treatment involves applying warm, moist compresses at least four times a day until the condition improves. If it recurs, lid scrubs should be performed daily to aid healing. In addition, appropriate antibiotic ointments or drops are prescribed if required. Wearing glasses may not help in treating hordeolum. It is not a normal body protective mechanism; therefore, treatment should not be deferred.

A patient informs the nurse that he or she is using a homemade saline solution to store contact lenses but is now having irritation and soreness. The nurse assesses inflammation of the cornea. On what medication does the nurse anticipate educating the patient? a. Tropicamide b. Besifloxacin c. Acetazolamide d. Polyhexamethylene biguanide

ANS: D Inflammation of the cornea indicates keratitis. Acanthamoeba keratitis is caused by a parasite that is associated with contact lens wear. Patients who use homemade saline solution are more susceptible to Acanthamoeba contamination. This organism is resistant to most drugs, and polyhexamethylene biguanide is an approved antifungal eye drop. Tropicamide is given during the preoperative phase to produce pupillary dilation. Besifloxacin is beneficial to a patient who has acute bacterial conjunctivitis. Acetazolamide decreases the aqueous humor production and is beneficial to a patient with glaucoma.

A patient with glaucoma is taking timolol drops. What should the nurse include while reinforcing principles of medication administration with the patient? a. The patient will notice an improvement in vision within one month. b. The patient should use these on an as needed basis for eye irritation. c. The patient should maintain a supine position for 30 minutes after the drops are instilled. d. The patient may experience blurred vision after administration of the drops lasting several minutes.

ANS: D It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should be no cause for concern to the patient. This medication should be used on a fixed schedule to reduce intraocular pressure. Glaucoma is asymptomatic and may not result in vision loss. It is not necessary to lie flat following eye drop administration.

An older adult patient tells the nurse, "I feel like there is sand in my eye." Which condition will the nurse suspect? a. Cataract b. Strabismus c. Keratoconus d. Keratoconjunctivitis sicca

ANS: D Keratoconjunctivitis sicca is a dry eye disorder commonly seen in older adults. The patient with keratoconjunctivitis sicca reports irritation and presence of sand in the eye. Cataract is a condition in which there is opacity within the lens and the patient reports decreased vision, abnormal color perception, and glare. Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object and the patient will complain of double vision. Keratoconus is a noninflammatory disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape, and the patient complains of blurred vision.

While assessing a patient with systemic lupus erythematosus (SLE), the nurse observes the patient rubbing the eyes frequently and decreased tear production. What condition should the nurse educate the patient regarding? a. Cataract b. Strabismus c. Keratoconus d. Keratoconjunctivitis sicca

ANS: D Keratoconjunctivitis sicca is a dry eye disorder particularly of older adults and individuals with certain systemic diseases such as scleroderma and systemic lupus erythematosus. The patient has decreased tear secretion because of a decrease in the quality or quantity of the tear film. Cataract is a clouding of the lens in the eye, which affects the vision. The symptoms of cataract are decreased vision, abnormal color perception, and glare. Strabismus is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object and has double vision. Keratoconus is a noninflammatory eye disorder in which the anterior cornea thins and protrudes forward, taking on a cone shape and resulting in blurred vision.

When performing an assessment for a patient with glaucoma, the nurse observes brown iris pigmentation. Which antiglaucoma drug does the nurse determine the patient is taking? a. Carteolol b. Dipivefrin c. Carbachol d. Latanoprost

ANS: D Latanoprost is an antiglaucoma drug that stimulates melanin production in melanocytes and increases the amount of brown pigment in the eye. Carteolol is an antiglaucoma drug that may cause blurred vision, photophobia, and bradycardia. Dipivefrin is an antiglaucoma drug that may cause ocular discomfort and redness in the eye. Carbachol is an antiglaucoma drug that may cause transient ocular discomfort, headache, and blurred vision.

The nurse provides discharge instructions to a patient with glaucoma. Which statement by the patient indicates understanding of the teaching? a. "I'll limit my fluid intake." b. "I'll change positions slowly." c. "I'll use my eye drops until my vision clears." d. "I'll check the labels on my nonprescription drugs."

ANS: D Nonprescription drugs, even caffeine, may increase intraocular pressure, resulting in enough pressure to cause damage. Therefore it is important for the patient to check the contents of all drug labels. Limitation of fluid intake and slow position changes will not affect intraocular pressure. Eye drop medications for glaucoma must be taken as prescribed. Stopping these medications could cause a rebound increase in intraocular pressure.

When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement? a. "Prolonged eye irritation is an expected adverse effect of this medication." b. "This medication will help to raise intraocular pressure to a near normal level." c. "This medication needs to be continued for at least five years after the initial diagnosis." d. "It is important not to do activities requiring visual acuity immediately after administration."

ANS: D Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Prolonged eye irritation is not an expected adverse effect of pilocarpine. Pilocarpine will stimulate iris sphincter contraction. At least five years is not an appropriate amount of time to estimate to the patient.

Which nursing intervention is the highest priority for a patient who has undergone retinal surgery? a. Monitoring the blood pressure b. Preventing fluid volume excess c. Maintaining a darkened environment d. Positioning and activity as preferred by surgeon

ANS: D Postoperatively, the patient may be on bed rest and may require special positioning to maintain proper positioning to maintain proper position of an intravitreal bubble. The level of activity restriction after retinal surgery varies greatly, depending on the patient and surgeon. Monitoring blood pressure and preventing fluid volume excess are not necessarily related to post-retinal surgery care. Maintaining a darkened environment is not necessary and may present a risk for falling.

A patient admitted for a total knee replacement has a history of primary open-angle glaucoma. The nurse expects to see which finding recorded in the history and physical examination report? a. Diplopia b. Frequent falls c. Decreased visual acuity d. Denial of pain or pressure

ANS: D Primary open-angle glaucoma is typically symptom-free, which explains why patients can have significant vision loss before diagnosis unless regular eye examinations are performed. Glaucoma does not result in diplopia or frequent falls.

A patient is diagnosed with strabismus. The nurse expects the patient to exhibit which symptoms? a. Inability to accommodate for near objects b. Discomfort, pruritus, and redness in the eye c. Red, swollen, and acutely tender area in the lid margin d. Inability to focus two eyes simultaneously on the same object

ANS: D Strabismus is a condition affecting eye muscles so that the patient cannot consistently focus both eyes simultaneously on the same object. It is caused if the eye muscles are affected. Hyperopia is a condition in which the patient is unable to see near objects. Discomfort, pruritus, redness, and mucopurulent drainage in the eye are the symptoms of bacterial conjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum.

Prevention of vision loss resulting from chronic open-angle glaucoma is accomplished best by which intervention? a. Tobacco smoking cessation b. Yearly ophthalmic examination c. Eating a diet high in green leafy vegetables and lysine d. Strict adherence to prescribed eye drop medication schedule

ANS: D Strict adherence to prescribed medication regimen to treat glaucoma will keep the intraoptic pressure at safe levels to avoid optic nerve damage. Tobacco cessation is healthy but will not treat glaucoma. Yearly eye examinations are important but will measure only any damage done if the patient does not follow treatment. A diet high in lutein, found in green leafy vegetables, is thought to improve eye health. Lysine is an amino acid that has some antiviral properties.

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing intervention should be the nurse's priority? a. Teach about visual enhancement techniques. b. Teach nutritional strategies to improve vision. c. Assess coping strategies and support systems. d. Assess impact of vision on normal functioning.

ANS: D The most important nursing intervention is to assess the patient's ability to function with the visual impairment. The nurse will use this information to plan nursing care, including assessment of the patient's coping strategies and teaching about vision enhancement techniques and nutrition.

The patient needs, but does not want, a corneal transplant because of difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this? a. If the transplant is done soon after the donor dies, there will not be as much trouble recovering vision. b. The astigmatism the patient is experiencing may be corrected with glasses or rigid contact lenses. c. Increasing the amount of light and using a magnifier to read will be helpful if a transplant is not wanted. d. There are newer procedures in which only the damaged cornea's epithelial layer is replaced, and these procedures have a faster recovery.

ANS: D The new procedures are called Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's membrane endothelial keratoplasty (DMEK). Corneal transplants should be done as soon as possible, but this does not affect the rate of visual recovery. Astigmatism is not experienced with corneal scars and opacities requiring a corneal transplant. Increasing light and magnification helps a person with cataracts to read.

A patient has undergone kidney transplantation surgery and takes immunosuppressant drugs. The patient comes in contact with a person who has chickenpox. The nurse recognizes that the patient is susceptible to which viral ophthalmic infection? a. Blepharitis b. Hordeolum c. Astigmatism d. Herpes zoster ophthalmicus

ANS: D The patient is being treated with immunosuppressant drugs to prevent the rejection of a transplanted kidney. The immunosuppressive drugs tend to decrease the patient's immunity. If the patient comes in contact with a patient with chickenpox, there is the possibility of herpes zoster ophthalmicus infection. It may occur due to reactivation of an endogenous infection. The endogenous infection might have persisted in a latent form after an earlier attack of varicella or by contact with a patient with chickenpox or herpes zoster. It occurs most frequently in older adults and immunosuppressed patients. Blepharitis is a common chronic bilateral inflammation of the lid margins. Hordeolum is an infection of the sebaceous glands in the lid margin. Astigmatism is an eye disorder; it is not a viral infection.

Before administrating timolol eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine? a. Sinusitis b. Migraine headaches c. Chronic urinary tract infection d. Chronic obstructive pulmonary disease (COPD)

ANS: D Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches and does not affect sinusitis or chronic urinary tract infections.

A patient with wet age-related macular degeneration (AMD) has undergone phototherapy with intravenous verteporfin and a cold laser. What is the most important nursing intervention for this patient? a. Instruct the patient to quit smoking. b. Suggest that the patient consider using supplements of vitamins and minerals. c. Advise the patient to eat lots of dark green, leafy vegetables containing lutein. d. Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

ANS: D Verteporfin, used for phototherapy, is a photosensitizing drug. It becomes active in the presence of low-level laser light waves. It can be activated by exposure to sunlight or high-intensity light until it is fully excreted. If activated, it can cause thermal burns in the area. The patient should be instructed to avoid direct sunlight and other intense forms of light for five days after treatment. Taking vitamin and mineral supplements, eating green leafy vegetables high in lutein, and cessation of smoking are measures to decrease the risk of AMD.

A patient has lost an eye after an industrial accident. Which action by the nurse is most appropriate during this time? a. Speak louder when talking to the patient. b. Avoid making eye contact during a conversation. c. Introduce the patient to other visually impaired persons. d. Assist the patient with the same grieving process that is associated with other losses.

ANS: D When the patient has lost visual function or even the entire eye, he or she will grieve the loss. The nurse should help the patient through the grieving process. The patient lost an eye, not an ear, so speaking louder is not necessary. The nurse should still make eye contact with the patient. Introducing the patient to other visually impaired persons is not recommended early in the grieving process.

An elderly patient with a history of bilateral cataracts is admitted to the hospital with pneumonia. What intervention will facilitate the patient's ability to see? Select all that apply. a. Administer prescribed analgesics. b. Patch the eye that has less visual acuity. c. Obtain dark glasses for the patient to wear. d. Increase the amount of light for near vision. e. Obtain teaching materials with enlarged print.

ANS: D E The patient with intact cataracts will see better with the use of increased lighting and magnifiers, including enlarged print. Receiving prescribed analgesics will relieve discomfort. Patching an eye will lessen vision. Wearing dark glasses decreases the patient's visual acuity.