Chapter 20 EAQs

For the patient with severe myopia, which type of correction is scheduled when the patient states, "I can't wait to see after they implant contact lenses over my existing ones"?

Phakic intraocular lenses (phakic IOLs) Rationale 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 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 actions would the nurse implement when using the sighted-guide technique to assist a patient who is blind? Select all that apply.

Describe the environment to the patient while walking. Help the patient to sit by placing the patient's hand on the seat of the chair. Stand slightly in front and to one side of the patient; provide an elbow for support. Rationale 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 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. Although visually impaired patients are at risk for falling, use of a gait belt in a stable environment could be demeaning and is not part of the sighted-guide technique.

Which initial assessment question would the nurse ask when a college student reports to the infirmary complaining of eye pain during finals week?

Do you wear contacts? Rationale College students frequently wear contact lenses and will be up late or all night studying for finals. If the student wears contacts, wearing them while studying, caring for them, and wearing them for an extended period of time should be assessed before looking for a corneal abrasion from extended wear with fluorescein dye. There are no manifestations of allergies, diplopia, or visual changes mentioned.

Which action would be the nurse's priority when noting blood in the anterior chamber of the patient's eye after sustaining an eye injury, as well as redness of the sclera?

Elevate the head of bed to 45 degrees. Rationale Eye injuries may be caused by 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.

When assessing the eye health of a patient reporting an eye irritation, which question would the nurse ask about sleep hygiene?

"How many hours of sleep do you have in 24 hours?" Rationale The health of the eyes depends on various lifestyle factors. One important parameter is sleep. An adequate duration of sleep is required for optimum eye health. Asking how many hours the patient sleeps gives information about the duration of sleep. Bedtime is not an important factor in determining eye health, but duration is important. Position of sleep doesn't affect eye health. Similarly, information about dreams may be used in psychologic and emotional assessment but is not related to eye health.

When obtaining a health history from a patient reporting decreased visual acuity, which relevant sexuality question would the nurse ask?

"Do you use birth control pills?" Rationale Birth control pills have some side effects. Some pills may cause blurred vision, double vision, or floaters in the visual field. Such cases should be immediately reported to the health care practitioner. Eye complaints are not dependent on the number of children or the menstrual period. Similarly, condom use does not affect vision.

Which statement would the nurse include when teaching a patient the pathophysiology of their open-angle glaucoma?

"There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." Rationale 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. It does not lead to retinal nerve damage. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber.

Which additional clinical manifestation would the nurse associate with the patient whose anterior cornea is cone-shaped?

Blurred vision Rationale 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.

Which clinical manifestation would the patient experience when a health care provider identifies smaller and stiffer than normal ciliary muscles during an ophthalmic examination?

Decrease in near vision Rationale Ciliary muscles are the muscles responsible for near vision. If these muscles become smaller or stiffer, the person has difficulty in adjusting near vision. A cataract is a very common age-related disorder. This is formed due to biochemical changes in the lens proteins, which results in clouding of the lens. Changes in perception of colors are not related to the dilator muscle. The diameter of the pupil is regulated by the muscle called the iris. Stiffening or rigidity of the iris causes decreased diameter of pupils. Color perception is carried by cones in the retina. A decrease in the number of cones causes difficulty in perception of colors.

Which condition involves inflammation of the vitreous cavity of the eye?

Endophthalmitis Rationale 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.

Which description would the nurse use to explain the location of blood accumulating from a hemorrhage within the fundus of a patient's eye?

In the retinal background Rationale The fundus is the retinal background. Normally, vascular hemorrhages or exudates are not present in the fundus. The fundus area is not the aqueous humor, between the cornea and the lens, or between the iris and the lens.

Which refractive error describes the vision of a patient for whom nearby objects are clear but objects at a distance are blurred?

Myopia Rationale: The individual with myopia (nearsightedness) can see nearby objects clearly, but objects at a distance appear blurred. The individual with hyperopia (farsightedness) can see distant objects clearly, but close objects appear blurred. Presbyopia is a loss of accommodation, causing an inability to focus on near objects. Astigmatism is an uneven curvature of the cornea, which results in visual distortion.

Which tool would an individual utilize in the physical assessment of the retina and optic nerve?

Opthalmoscope Rationale: An ophthalmoscope is used to examine the retina and optic nerve. A penlight is used to examine pupillary function and reaction to light. Refractometry is a measure of refractive error. This is performed with the patient looking through apertures at a Snellen acuity chart. Ultrasonography determines the correct power of a lens implant before cataract 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?

Photodynamic therapy Rationale 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.

When determining whether a patient has ocular problems, which questions would the nurse ask during the patient's assessment? Select all that apply.

"Does your eye problem hamper your daily activities?" "Have you participated in any activity that may be harmful to your eyes?" Rationale The nurse has to assess the patient's activity in order to assess the severity of the disorder. Assessing occupational hazards may help to understand the possible cause of the eye disorder. Asking the patient if daily activities are disturbed due to eye issues helps in assessing severity. The nurse should ask whether the patient has participated in any harmful activity that may have caused eye damage. Asking how the patient cares for contact lenses helps in understanding how the patient cares for the eyes. Asking how the eye problem makes the patient feel about self helps to explore the patient's psychologic sphere. Asking how much the patient appreciates being able to see only reveals the patient's attitude.

When a patient describes central vision loss, for which test would the nurse provide instructions so macular function changes may be identified?

Amsler grid test Rationale The Amsler grid test is self-administered, and regular testing is necessary to identify any changes in macular function. B-scan ultrasonography is used to diagnose ocular pathologic conditions (e.g., intraocular foreign bodies or tumors, vitreous opacities, retinal detachments). Fluorescein angiography is used to diagnose problems related to the flow of blood through pigment epithelial and retinal vessels. Intraocular pressure testing with a Tono-pen is done to test for glaucoma.

Which potential rationale would the nurse associate with the patient's statement, "I am seeing two of everything"?

An abnormality of the extraocular muscle developed. Rationale The patient's statement, "I see two of everything," indicates that the patient has double vision. This indicates that the patient has diplopia, which is associated with an abnormality of the extraocular muscle. Reduced tear formation will result in dry eyes and a gritty sensation, but not double vision. The presence of inflammation in the cornea results in photophobia. An abnormality in pupil size is associated with central nervous system disorders and is referred to as anisocoria.

When performing an eye assessment, which of the patient's prescribed medications would the nurse associate with the patient's pupil size of 1 to 2 mm?

Carbachol (Miostat) Rationale Carbachol is a cholinergic agent that stimulates iris sphincter contraction and results in miosis. Carteolol is a nonselective β-adrenergic blocker that 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.

Which eye disorder would the nurse associate with the patient scheduled for a penetrating keratoplasty procedure?

Corneal scars Rationale 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.

For which procedure will the nurse provide additional information to the patient who states, "They are going to stick a very cold probe into my eye to produce a scar on my torn retina"?

Cryopexy Rationale 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.

Which assessment finding would the nurse expect to identify in a patient who has ptosis secondary to myasthenia gravis?

Drooping of the upper lid margin in one or both eyes Rationale Ptosis is the term used to describe drooping of the upper lid margin, which may be either unilateral or bilateral. Ptosis can be a result of mechanical causes, such as an eyelid tumor or excess skin, or from myogenic causes, such as myasthenia gravis. Ptosis is not related to redness and swelling of the conjunctiva or lid margin or small, superficial white nodules along the lid margin.

For which clinical manifestation would the nurse teach discharge interventions when a patient's prescription includes alternating patching of one eye at a time for treatment of diplopia?

Dryness in the patched eye Rationale The patient with diplopia (double vision) alternately patches the eye to allow normal vision. The patient will be at increased risk for falls because patching causes impaired stereoscopic (three-dimensional) vision. The patient could fall because of impaired ability to judge distance. Conjunctivitis is redness from infection or inflammation of the conjunctiva, the mucous membrane that covers eyelids and forms a pocket under each eyelid. Dryness is not a usual problem with a patched eye because patching limits exposure to air and the environment. Cataracts occur with the aging process.

Which extraocular eye disorder would the nurse associate with the patient experiencing inflammation of the cornea and exophthalmos?

Exposure keratitis Rationale 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.

Which instructions would the nurse provide the patient scheduled for an Amsler Grid test? Select all that apply.

Hold the test card at a comfortable reading distance. Report any abnormality, such as wavy appearing lines. Focus on the dot located in the center of the card you are holding. Rationale An Amsler Grid test can be carried out by the patient. This test is done to identify any changes in macular function. The correct procedure for an Amsler Grid test is as follows: The patient holds the card at a comfortable reading distance and focuses on a dot present in the center of the chart. The test card is held at the same distance a person holds a book for reading. The person focuses on the center dot and not on the corners. If there is pathology involved, the patient may feel that the lines around the dot are wavy, distorted, or even missing. If the patient finds any abnormality in the surrounding line, he or she should make a note of it and take advice from a primary health care practitioner. The distance of 10 feet is not required for this test. The patient does not focus on the four corners of the card.

When assessing for the presence of allergic conjunctivitis, about which clinical manifestation would the nurse ask the patient?

Itching Rationale 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 a corneal ulcer.

Which condition would the nurse suspect in the older adult patient who states, "I feel like there is sand in my eyes."

Keratoconjunctivitis sicca Rationale Keratoconjunctivitis sicca is a dry eye disorder commonly seen in older adults. The patient with keratoconjunctivitis sicca reports irritation and the feeling of sand in the eye. A 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.

Which condition would the nurse provide additional information for when observing a patient with systemic lupus erythematosus (SLE) frequently rubbing his or her eyes from decreased tear production?

Keratoconjunctivitis sicca Rationale Keratoconjunctivitis sicca is a dry eye disorder particularly of older adults and individuals with certain systemic diseases such as scleroderma and SLE. The patient has decreased tear secretion because of a decrease in the quality or quantity of the tear film. A 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 assisting the health care provider to perform a fluorescein angiography on a patient reporting left eye pain, which nursing intervention has the highest priority?

Monitor for extravasation. Rationale: Fluorescein angiography is when the dye is injected IV into a peripheral vein, followed by serial photographs (over a 10-minute period) of the retina. The dye is toxic to tissue, so it is important to monitor the patient for extravasation at the IV site. Retinal detachment is not a complication of fluorescein. Transient nausea and vomiting may occur, and the patient may experience urine discoloration. However, these are not as high- priority concerns as avoiding contact between the fluorescein and surrounding tissue. Note: Fluorescein dye on an eye strip is used to stain the corneal surface for identification of foreign bodies or abrasions of the corneal surface. This test does not require an IV access.

Which disorder would the nurse associate with a patient who works in the hospital's radiology department and has bilateral small, yellowish spots on the conjunctiva?

Pinguecula Rationale Small, yellowish spots on the medial aspect of the conjunctiva are associated with pinguecula, which occurs as a result of tissue damage related to chronic exposure to ultraviolet light. Because the patient works in the radiology department, the likelihood of exposure to ultraviolet light is high. Pterygium is an abnormality of the cornea that is associated with chronic exposure to sunlight, which manifests as thickened, triangular, pale tissue extending from the inner canthus to the nasal border. Presbyopia is a refractive error that is associated with the loss of near vision. This condition manifests as increased rigidity of the lens, not yellow spots on the conjunctiva. Arcus senilis is an abnormality of the cornea that occurs because of cholesterol deposition in the peripheral cornea and manifests as a milky white and grayish ring around the eye.

Which information would the nurse include when reinforcing the health teachings for a patient diagnosed with primary open-angle glaucoma?

Pressure damage to the optic nerve may occur because of clogged drainage channels. Rationale 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.

During a patient's assessment of pupillary function, which steps would the nurse perform when assessing accommodation? Select all that apply.

Request that the patient focus on the nurse's identified finger. Ask the patient to focus on any distant object within the examination room. Identifies one finger and locates it 3 inches from the patient's nose. Rationale In order to check the accommodation capacity of the patient's eyes, the nurse first asks the patient to focus on a distant object. The patient is then instructed to focus on the nurse's finger, which is placed 3 inches from the patient's nose. The normal response is convergence and constriction of the eyes. A Snellen chart is used for testing visual acuity. The distance of 20 feet, or 6 meters, is maintained while reading a Snellen chart.

Which action would the nurse implement when assessing a patient for corneal light reflex?

Shine a penlight directly on the cornea of each eye. Rationale Corneal light reflex is assessed to determine weakness or imbalance of the extraocular muscles. The procedure is carried out in a dark room. The patient is asked to look straight ahead while a penlight is shined directly on the cornea. The light reflection should be located in the center of both corneas as the patient faces the light source. The patient is asked to follow finger movement when assessing for intact cranial nerves.

When assessing a patient's dilator muscle atrophy of the eye, which clinical manifestation would the nurse expect to identify?

Slow recovery of pupil size after light stimuli Rationale Dilator muscle atrophy or weakness affects the ability of the pupils to contract and relax. As age progresses, this muscle becomes weak. Due to weakness or atrophy, the recovery of pupil size after stimulation by light is delayed. Cataracts are formed due to biochemical changes in the lens proteins, which result in clouding of the lens. Excessive dryness is caused due to reduced production of tears or due to malposition of the eyelids. Changes in perception of colors are not related to the dilator muscle. Color perception is carried by cones in the retina. A decrease in the number of cones causes this problem.

Which test would the nurse perform to assess a patient's near and distance visual acuity?

Snellen chart Rationale The Snellen eye chart is used to test distance and near visual acuity. Ishihara is a test for color vision. Tonometry tests the intraocular pressure. The confrontation visual field test determines whether a patient has a full field of vision without scotomas.

Which abnormal visual system finding would the nurse document when a patient exhibits deviation of eye position in one or more directions?

Strabismus Rationale Strabismus results from overreaction or underreaction of one or more extraocular muscles. Abnormality of extraocular muscle action related to muscle or cranial nerve pathologic conditions results in diplopia (double vision). A cataract is an opacification of the lens due to aging, trauma, diabetes, or long-term systemic corticosteroid use. The patient with exophthalmos may have hyperthyroidism, or intraocular or periorbital tumors. This patient presents with protrusion of the globe beyond its normal position within the bony orbit.

Which interpretation would the nurse associate with the patient's Snellen chart reading of right eye 20/30, left eye 20/40?

The patient has a refractory error consistent with myopia. fDocumentation of Snellen test results includes documenting the eye tested, the distance the vision is tested (20 feet), and the line that the patient is able to read correctly. Patients should wear corrective devices while being tested. Myopia is nearsightedness, the ability to see near objects clearly while distant objects are blurred. The findings of 20/30 and 20/40 are consistent with myopia. Presbyopia is a loss of ability to accommodate and focus on near objects that occurs normally with aging. The Ishihara color test assesses the patient's ability to distinguish color patterns and screens for color blindness. The vision acuity is stronger in the right eye (20/30) than in the left eye (20/40).

Which response would the nurse use when asked why the lights were dimmed prior to instillation of the patient's pupil-dilating eyedrops?

To minimize photophobia Rationale 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 IV hyperosmotic agents such as glycerin liquid, isosorbide solution, and mannitol solution are useful in lowering the intraocular pressure.

Which prescription would the nurse question prior to administering to a patient with keratitis caused by the herpes simplex virus (HSV)?

Topical corticosteroids (Aristocort A) Rationale 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.

The nurse darkens the room, shines a penlight on the cornea, and asks the patient to follow finger movement 10 inches from the patient's nose. For which cranial nerves would the nurse evaluate weakness or paralysis? Select all that apply.

Trochlear nerve Abducens nerve Oculomotor nerve Rationale The examiner is assessing the extraocular muscle function by darkening the room and shining the penlight over the cornea. The trochlear, abducens, and oculomotor nerves are present near the eyeball, and an abnormality of these cranial nerves results in paralysis of the extraocular muscles. The facial nerve helps in the opening and closing movements of the eyelids. The trigeminal nerve helps in the dilation of the iris.

Which action would the nurse implement when performing an eye assessment of a patient's near visual acuity and a Jaeger eye chart is not available?

Use a newspaper or the label on a container. Rationale If the nurse does not have access to a Jaeger eye chart, the nurse can ask the patient to read a newspaper or the label on a container. The findings should be documented as "reads newspaper headline at X inches." Snellen's chart is used for assessing distant vision. The test should not be skipped because an assessment of near vision is important to the patient's overall health. The patient does not need to return on a different day because a near visual acuity assessment can be completed with a newspaper test.

For the patient diagnosed with proliferative diabetic retinopathy, which surgical procedure to relieve traction on the retina will the nurse provide instructions for and schedule?

Vitrectomy Rationale: 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.

Upon request of an ophthalmic checkup, which location would the nurse place the patient when performing a visual acuity assessment using the Snellen chart?

20 feet away Rationale: The distance to be maintained between the patient and the Snellen chart is 20 feet, or 6 meters. This chart is used to check the visual acuity of an individual. Any distance closer or further than the required 20 feet will not provide an accurate assessment of visual acuity.

Which refractive error would the nurse associate with a patient's uneven cornea and complaints of visual distortion?

Astigmatism Rationale Visual distortion that is associated with an uneven cornea indicates that the patient has astigmatism. Myopia is a refractive error in which the patient is not be able to view objects that are far away. Hyperopia is an impairment in vision in which the patient is not be able to see close objects clearly. Presbyopia is the inability to focus on objects that are near, and the condition increases with age. Myopia, hyperopia, and presbyopia are associated with an elongation or shortening of the eyeball, but not an uneven cornea.

During a visual examination, which precipitating factor would the nurse associate with a patient's red, watery eye and inflammation of the conjunctiva?

Bacterial or viral infection Rationale A red, watery eye and inflammation of the conjunctiva are the manifestations of conjunctivitis. It is caused by a bacterial or viral infection. Glaucoma is associated with increased ocular pressure. An increase in intraocular pressure does not cause the eye to become red and watery; rather, it begins with peripheral loss of vision and later results in complete blindness. Intraocular or periorbital tumors cause protrusion of the globe of the eye, called exophthalmos. Inflammation of the anterior uvula tract causes photophobia, or intolerance to light.

Which component of a visual health history includes assessment of a patient's concern about the effect of vision loss on reading?

Cognitive-perceptual problem Rationale A visual deficit that affects a patient's ability to read is an example of a cognitive-perceptual problem. The coping-stress tolerance component explores how a patient is tolerating and coping with changes in vision. A self-perception-self-concept response is related to how a patient feels about himself or herself. Health perception-health management allows the healthcare professional to assess the patient's awareness of his or her visual health and self-care.

The nurse teaches that which part of the eye becomes inflamed for the patient who developed keratitis?

Cornea Rationale 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.

Which instructions would the nurse provide the patient scheduled for refractometry as part of a visual assessment? Select all that apply.

"Please try to hold your head still during the examination." "You may find focusing on near objects for 3 to 4 hours difficult." Rationale The patient may need help to hold the head still during the examination. Pupil dilation makes it difficult to focus on near objects, and dilation may last 3 to 4 hours. The refractometry procedure is painless. Concerns about iodine/contrast media allergy and the possibility of urine color changes occur with fluorescein angiography, not refractometry. (Note: Verify the type of contrast media a facility uses as the newer product does not contain iodine; however, renal impairment will affect clearance of the contrast media.)

Which instruction would the nurse provide the patient who calls the clinic reporting a sty on their upper eyelid for several weeks, and warm moist compresses have not improved the situation?

"Come in so the ophthalmologist can remove the lesion for you." Rationale 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 health care provider may surgically remove the lesion or inject it with corticosteroids. Eyedrops and antibiotics are not measures taken to remove a sty. Washing the lid margins with baby shampoo is done with blepharitis.

When interviewing a patient with a new diagnosis of glaucoma, which question is most relevant to the patient's condition?

"Do you have a history of cardiac or pulmonary disease?" Rationale When collecting a health history for a patient diagnosed with glaucoma, the nurse should ask about cardiac or pulmonary disease. Glaucoma is often treated with beta-adrenergic blockers, which may decrease heart rate, decrease BP, and exacerbate asthma or chronic obstructive pulmonary disease (COPD). Information regarding a visual acuity test, previous surgeries, and a change in lens prescription is gathered as general data but is not specifically related to glaucoma.

Which condition is caused by a refractive error within the eye?

Myopia Rationale: 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.