Chapter 46: Coordinating Care for Patients With Visual Disorders

During a softball game a child was hit in the eye with a bat. What common manifestation should the nurse expect when assessing this patient? 1) Edema 2) Blood-tinged tears 3) Loss of central vision 4) Loss of peripheral vision

1 1 Common manifestations of eye trauma include edema around the eye. 2 Blood-tinged tears are not a common manifestation of eye trauma. 3 Loss of central vision occurs with macular degeneration. 4 Loss of peripheral vision occurs with glaucoma.

A patient seeks treatment for a corneal abrasion that occurred the previous week. What should the nurse expect to be prescribed to reduce this patient's risk of developing a complication? 1) Tetanus vaccination 2) Topical steroid drops 3) Systemic pain medication 4) Topical antihistamine drops

1 1 Tetanus vaccination should be verified and administered if the patient is not considered up-to-date because any open surface of the body can provide a port of entry for Clostridium tetani to enter. 2 Topical steroid drops are not used to treat or prevent a complication from a corneal abrasion. 3 Systemic pain medications may be used for pain caused by a corneal abrasion; however, they will not prevent a complication from developing. 4 Topical antihistamine drops are not used to treat or prevent a complication from a corneal abrasion.

The nurse is evaluating teaching provided to a patient with bacterial conjunctivitis. Which patient statement indicates that additional teaching is required? 1) "I should place my towel in the bathroom." 2) "I should wash my hands frequently during the day." 3) "I should complete all of my prescribed medications." 4) "I should make a follow-up appointment as directed

1 1 Towels should be isolated from other family members to prevent possible transmission to another person. 2 Clean hands are essential to prevent the transmission of conditions from one eye to another or from one person to another; conjunctivitis is considered extremely contagious. 3 Completion of all prescribed medication as ordered is needed to prevent reoccurrence or incomplete healing. Incomplete treatments can lead to an even deeper infection in the eye. 4 It is essential that patients keep follow-up appointments with their practitioner to verify the healing process and to monitor for any possible visual loss

The nurse is planning care for a patient with an astigmatism. What action should the nurse take to reduce this patient's headaches and blurred vision? 1) Encourage to wear corrective lenses while awake 2) Apply cool compresses to the eyes every four to six hours 3) Recommend removing corrective lenses every few hours 4) Instruct to gently massage out eye canthus several times a day

1 1 Wearing corrective lenses while awake will prevent blurred vision and reduce the frequency of headaches. 2 Cool compresses are not identified as treatment for astigmatism. 3 Removing corrective lenses will cause blurred vision and increase the chance of headaches. 4 Massage of the outer canthus is not identified as a treatment for astigmatism.

The nurse suspects that a patient is experiencing a corneal abrasion. What did the nurse assess to come to this conclusion? Select all that apply. 1) Tearing 2) Eye pain 3) Squinting 4) Photophobia 5) Purulent drainage

1,2,3,4 1. The most common clinical manifestations of corneal abrasions include tearing. 2. The most common clinical manifestations of corneal abrasions include eye pain. 3. The most common clinical manifestations of corneal abrasions include squinting. 4. The most common clinical manifestations of corneal abrasions include photophobia. 5. Purulent drainage is a manifestation of bacterial conjunctivitis.

. A patient is diagnosed with viral conjunctivitis. What should the nurse expect to be prescribed for this patient? Select all that apply. 1) Eye lubricants 2) Cold compresses 3) Topical steroid drops 4) Ocular decongestants 5) Topical antihistamine drops

1,2,4 1. The treatment for viral conjunctivitis includes eye lubricants. 2. The treatment for viral conjunctivitis includes cold compresses to the eye for pain relief and decrease in swelling/irritation. 3. The treatment for allergic conjunctivitis includes topical steroid drops instilled directly to the eye to decrease inflammation and block the release of histamine. 4. The treatment for viral conjunctivitis includes ocular decongestants to help reduce swelling and inflammation. 5. The treatment for allergic conjunctivitis includes topically antihistamine drops to decrease itching.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 23. A patient with myopia asks what can be done to correct the disorder. Which procedures should the nurse review with this patient? Select all that apply. 1) LASIK 2) Radical keratotomy 3) Thermal keratoplasty 4) Phakic intraocular lens 5) Photorefractive keratotomy

1,2,4,5 1. LASIK is identified as a treatment for myopia. 2. Radical keratotomy is identified as a treatment for myopia. 3. Thermal keratoplasty is identified as a treatment for hyperopia. 4. Phakic intraocular lens is another form of treatment to correct myopia. This treatment is usually reserved for patients who are unsuitable for LASIK or other vision corrective surgeries. 5. Photorefractive keratotomy is identified as a treatment for myopia.

The nurse is preparing information about cataracts for a community health fair. What should the nurse include about risk factors for the disorder? Select all that apply. 1) Obesity 2) Age over 60 3) Family history 4) Alcohol intake 5) Chronic health problems

1. Obesity may predispose an individual to development of cataracts. 2. Cataracts are more common after age 60 but can occur at any time. 3. Those with family members who had cataracts are more likely to develop them at some point in their life. 4. Alcohol intake is not identified as a risk factor for cataracts. 5. Chronic medical conditions such as diabetes, autoimmune disorders, hypertension, and other eye problems are considered to be at higher risk for cataract development.

A patient comes into the emergency department with manifestations of retinal detachment. What should the nurse do to minimize this patient's eye movements? 1) Provide a sedative 2) Loosely cover both eyes 3) Elevate the head of the bed 45 degrees 4) Apply an eye patch over the affected eye

2 1 A sedative might help with anxiety; however, it will not minimize eye movements. 2 Movement of either eye can exacerbate internal eye injury. Because eyes move together, both eyes must be covered to minimize injury. 3 Elevating the head of the bed helps decrease intraocular pressure; however, this is not a problem with retinal detachment. 4 A single eye patch is not recommended. Both eyes should be covered.

The nurse suspects that a patient has undiagnosed hyperopia. What did the nurse assess to come to this conclusion? 1) Squints, has headaches, and blurred vision 2) Sees distance objects better than those near 3) Sees near objects better than those at a distance 4) Unable to focus on objects held close to the face

2 1 Astigmatism results in visual changes where objects that are near and distant occur blurry. Other clinical manifestations include squinting, headaches, and blurry vision. 2 Hyperopia occurs when a person can see distant objects more clearly than near objects. Blurred vision of near objects is the symptom associated with this disorder. 3 Myopia causes a person to see near objects more clearly than objects at a distance. The result of this distortion is blurred vision for distant objects. 4 Presbyopia, an expected change in vision around midlife, results in the inability to focus on objects held close to the face

A patient contemplating cataract surgery asks if there are any risk factors. How should the nurse respond? 1) Blindness 2) Detached retina 3) Corneal abrasion 4) Macular degeneration

2 1 Cataract removal does not increase the risk of blindness. 2 Cataract removal increases the risk of retinal detachment. 3 Cataract removal is not associated with a corneal abrasion. 4 Cataract removal does not increase the risk of macular degeneration.

A patient is demonstrating signs of a detached retina. What is the reason this occurred? 1) Blood vessels in the eye spasm 2) Inner layers of the retina separate 3) Overgrowth of vessels damages vision 4) Drainage of vitreous humor is blocked

2 1 Retinal detachment is not caused by vessel spasms. 2 Retinal detachment occurs when there is a separation of the inner layers of the retina from the underlying retinal pigment epithelium (RPE; choroid). 3 Retinal detachment is not caused by overgrowth of vessels. 4 Retinal detachment is not caused by blocking the drainage of vitreous humor.

The nurse is visiting the home of a patient recovering from laser trabeculoplasty. Which observation made by the nurse increases this patient's risk of developing a postoperative complication? 1) Takes a daily laxative 2) Picks up a 3-year-old grandchild 3) Washes hands before applying eye drops 4) Applies pressure to the lacrimal duct after applying eye drops

2 1 Straining at a bowel movement is contraindicated and can increase the chance of postoperative bleeding within the eye. A laxative would avoid this potential complication. 2 Lifting heavy objects such as a grandchild increases intraocular pressure, which should be avoided after having this surgery. 3 Washing hands before applying eye drops reduces the risk of a postoperative infection. 4 Applying pressure to the lacrimal duct after applying eye drops reduces the risk of systemic absorption of the medication.

. A patient has been experiencing a gradual loss of central vision. Which tool should the nurse use when assessing this patient? 1) Jaeger card 2) Amsler grid 3) Snellen chart 4) Ishihara chart

2 1 The Jaeger card assesses near vision. 2 The Amsler grid is used to determine if a matrix of black lines appear straight or are wavy, which could indicate macular degeneration. 3 The Snellen chart is used to assess for visual acuity. 4 The Ishihara chart is used to assess color vision.

The nurse is evaluating teaching provided to a patient recovering from eye trauma. Which statement indicates that additional teaching is required? 1) "I have to wear the eye patch." 2) "I can play ball again this weekend." 3) "I need to see the doctor in a few days." 4) "I should call the doctor if my sight changes."

2 1 The patient should be instructed about wearing an eye patch if indicated for the injury. 2 The patient's activity will most likely be restricted until the injury heals and vision is restored. 3 The patient will need to follow up with the health-care provider at regular intervals. 4 The patient should notify the health-care professional with any vision changes during the recovery period.

The nurse notes that a patient is diagnosed with primary open-angle glaucoma. What diagnostic test would have been used to diagnose this health problem? 1) MRI 2) CT scan 3) Tonometry 4) Ultrasound

3 1 An MRI would not detect glaucoma. 2 A CT scan would not detect glaucoma. 3 Tonometry measures the pressures within the eyes and is usually conducted during a routine eye examination. 4 An ultrasound would not detect glaucoma.

It is documented in the medical record that a patient has a rhegmatogenous detached retina. How should this diagnosis be explained to the patient? 1) Eye trauma causes the retinal to detach from the retinal pigment epithelium (RPE). 2) Eye inflammation causes vitreous fluid leaks into the area under the retina. 3) Vitreous fluid moves under the retina and separates the retina from the pigmented cell layer. 4) Scar tissue on the retina causes the retina to separate from the retinal pigment epithelium (RPE).

3 1 Exudative retinal detachment can occur with eye trauma. 2 Exudative retinal detachment can occur with eye inflammation. 3 Rhegmatogenous is the most common form of retinal detachment and occurs when a tear or break in the retina allows vitreous fluid to move under the retina and separate it from the pigmented cell layer that nourishes the retina. 4 Tractional is the least common type of detachment and occurs when scar tissue on the retina's surface contracts and causes the retina to separate from the RPE.``

A patient with macular degeneration is being treated with verteporfin (Visudyne). What should the nurse emphasize in the patient teaching in order to reduce the risk of complications from this treatment? 1) Apply lotion to the skin for two weeks after the treatment 2) Increase the intake of water for three days after the treatment 3) Avoid indoor and outdoor light for five days after treatment 4) Wear sunglasses when going out of doors for one week after treatment

3 1 This treatment does not affect the skin. 2 Increased fluid intake is not required after this treatment. 3 It is important to instruct the patient that he or she must avoid exposing skin/eyes to direct sunlight or bright indoor light for five days after treatment with verteporfin (Visudyne) because the medication is activated by light. 4 The patient should avoid indoor and outdoor bright light for five days. Sunglasses would not be needed since bright light is avoided.

A patient has watery eye discharge affecting both eyes. Which health problem should the nurse suspect this patient is experiencing? 1) Cataracts 2) Eye trauma 3) Conjunctivitis 4) Corneal abrasions

3 1 Watery eye discharge is not a manifestation of cataracts. 2 More information is required before determining if the patient is experiencing eye trauma. 3 Conjunctivitis is described as an inflammation of the conjunctivae of the eye. There are many types of conjunctivitis, and most people in their lifetime will have the unpleasant experience of at least one of them. Diagnosis of conjunctivitis is made on history, clinical presentation, and physical findings. 4 Corneal abrasions may cause eye tearing, but more information is needed to make this clinical determination.

The nurse is preparing a tool about macular degeneration that will be posted during a health fair. Which modifiable risk factors should the nurse include in this tool? Select all that apply. 1) Race 2) Gender 3) Obesity 4) Smoking 5) High blood pressure

3,4,5 1. Nonmodifiable risk factors for macular degeneration include race. 2. Nonmodifiable risk factors for macular degeneration include gender. 3. Modifiable risk factors for macular degeneration include obesity. 4. Modifiable risk factors for macular degeneration include smoking. 5. Modifiable risk factors for macular degeneration include high blood pressure.

A patient is diagnosed with a corneal abrasion. Which diagnostic test was used to confirm this diagnosis? 1) MRI 2) CT scan 3) Ultrasound 4) Fluorescein stain

4 1 An MRI is not used to diagnose a corneal abrasion. 2 A CT scan is not used to diagnose a corneal abrasion. 3 Ultrasound is not used to diagnose a corneal abrasion. 4 Examination for a corneal abrasion includes corneal staining with fluorescein stain, and visualization under a Wood lamp to confirm diagnosis of the abrasion.

The nurse notes that a patient known to the community clinic was unable to recognize the health-care provider. What health problem should the nurse suspect is occurring with this patient? 1) Cataracts 2) Glaucoma 3) Corneal abrasions 4) Macular degeneration

4 1 Cataracts will not cause the patient to be unable to recognize faces. 2 Glaucoma will not cause the patient to be unable to recognize faces. 3 Corneal abrasions will not cause the patient to be unable to recognize faces. 4 Dry macular degeneration causes a gradual blurring of the central vision, and the patient may have difficulty recognizing faces

The nurse is caring for a patient recovering from cataract removal surgery. Which action should the nurse take to reduce intraocular pressure (IOP)? 1) Restrict fluids 2) Position on the operative side 3) Administer mydriatic eye drops 4) Elevate the head of the bed 45 degrees

4 1 Fluids do not need to be restricted after cataract surgery. This does not decrease intraocular pressure. 2 Positioning on the operative side would increase IOP. 3 Mydriatic eye drops dilate the pupil and would be provided preoperatively. These drops do not affect IOP. 4 Elevating the head of the bed 30 to 45 degrees promotes drainage and prevents any increase in IOP.

The nurse suspects that a patient is developing a cataract. What finding did the nurse use to make this clinical decision? 1) Itching of both eyes 2) Tearing of both eyes 3) Redness of the sclera 4) Double vision in one eye

4 1 Itching eyes is not a manifestation of cataracts. 2 Eye tearing is not a manifestation of cataracts. 3 Reddened sclera is not a manifestation of cataracts. 4 Double vision in one eye is a manifestation of cataracts.

During a vision test, the nurse notes that a patient has decreased peripheral vision of both eyes. Which health problem should the nurse suspect that this patient is experiencing? 1) Secondary glaucoma 2) Acute angle glaucoma 3) Normal-tension glaucoma 4) Primary open-angle glaucoma

4 1 Secondary glaucoma usually results from an eye injury, inflammation, tumor, or advanced cases of cataracts, or diabetes. Medications such as steroids, when used chronically, are also noted to cause this type of glaucoma. 2 Acute angle glaucoma is characterized by severe eye pain, nausea and vomiting, sudden onset of visual disturbance (often in low light), blurred vision, halo vision, and reddening of the eye. 3 Normal-tension glaucoma (also referred to as low-tension glaucoma) is a condition where optic nerve damage and vision loss occur despite having a normal IOP between 10 and 21 mm Hg. 4 In primary open-angle glaucoma, clinical manifestations include gradual loss of peripheral vision, usually in both eyes.

While reviewing collected data the nurse notes that a patient has been newly diagnosed with myopia. What information in the patient's history might have contributed to this refractive error? 1) Has 3 children 2) Smokes 1 PPD of cigarettes 3) Raises homegrown tomatoes 4) Worked for 30 years as a tailor

4 1 The number of children does not impact the development of myopia. 2 Smoking is not a risk factor for the development of myopia. 3 Gardening is not a risk factor for the development of myopia. 4 A risk factor for the development of myopia is doing excessive amounts of close work such as tailoring.

The nurse is reviewing teaching provided to a patient with glaucoma. Which patient statement indicates that teaching has been effective? 1) "I should consider surgery to cure this disorder." 2) "I should use the eye drops when my vision blurs." 3) "I should cut down on eating salty and high-fat foods." 4) "I should call my doctor before taking any over-the-counter medications."

4 1 There is no surgery to cure glaucoma. 2 The eye drops should be used as prescribed and not only with blurred vision. 3 Dietary changes will not affect glaucoma. 4 The patient should be instructed to not take any medication, over-the-counter or prescription, without contacting the eye care practitioner first.

A patient is diagnosed with bacterial conjunctivitis. What should the nurse expect to assess in this patient? Select all that apply. 1) Tearing 2) Red sclera 3) Puffy eyelids 4) Purulent eye discharge 5) Matting of the eyelashes

4,5 1. Tearing is associated with allergic conjunctivitis. 2. Red sclera is associated with allergic conjunctivitis. 3. Puffy eyelids are associated with allergic conjunctivitis. 4. Purulent eye discharge is associated with bacterial conjunctivitis. 5. Matting of the eyelashes is associated with bacterial conjunctivitis.