Chapter 58 prepu

"You'll need to use the drops for the rest of your life to control the glaucoma."

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?

Handwashing can prevent the spread of the disease to others.

A 6-year-old is brought to the pediatric clinic for the assessment of redness and discharge from the eye and is diagnosed with viral conjunctivitis. What is the most important information to discuss with the parents and child?

Recommend contrast sensitivity testing measures to determine visual function.

A 68-year-old client reports a change in vision when driving during the night. Which strategies would the nurse recommend to mitigate this problem?

To prevent vision loss

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment?

Constricts pupil

A client asks the nurse why miotic eye solutions were prescribed in the treatment of the client's glaucoma. Which is the best nursing rationale for the use of this medication?

Test the client's visual acuity

A client comes to the clinic for a routine examination. After obtaining the ocular history, which of the following would the nurse do next?

Ishihara

A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness?

Rosenbaum

A client complains to the nurse about having difficulty seeing to read, but reports no difficulty with driving. What test would the nurse prepare for the physician to administer to this client?

Explain the therapeutic effect and expected outcome of the medication.

A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate?

Amsler grid

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client?

demonstrate eyedrop instillation.

A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

Presbyopia

A client has noticed needing to hold printed material at arms length to make the print readable. What is the term used to describe this visual condition?

Hyperopia

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

Hemorrhage

A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?

Cooking

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

A new floater in vision

A client is being discharged home from the ambulatory surgical center after cataract surgery. In reviewing the discharge instructions with the client, the nurse instructs the client to immediately call the office if the client experiences what?

Cones

A client is color blind. The nurse understands that this client has a problem with:

Macular degeneration

A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause?

Elongated eyeballs

A client is examined due to recent vision changes and is diagnosed with myopia. What is the cause of this client's vision change?

The client may experience difficulty seeing in the dark.

A client is prescribed pilocarpine. When preparing the client's teaching plan about this drug, which of the following would the nurse integrate?

Suspect a retinal detachment, alert the health care provider, and prepare for immediate surgical intervention

A client reports an increase in floaters without pain during a routine appointment after cataract surgery. Which is the nurse's priority intervention for this client?

Eyelids

A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included?

Blurred vision

A client who had a corneal transplant a few months ago arrives at the emergency department reporting eye discomfort. When assessing the client, which of the following would lead the nurse to suspect graft failure?

"A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away."

A client who presents for an eye examination is diagnosed as having a visual acuity of 20/40. The client asks the nurse what these numbers specifically mean. What is a correct response by the nurse?

2 to 3 weeks

A client who wears soft contact lenses opts for laser correction surgery. The nurse would instruct the client to discontinue using the contact lenses for which time period before surgery?

increased intraocular pressure (IOP).

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

Improve outflow drainage

A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure?

perimetry test

A client with multiple sclerosis is being seen by a neuro-ophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a:

Irrigating the eye immediately with tap water

A colleague has been splashed in the eye with cleaning solution. Which of the following would be the priority?

Adhere to the medication regimen.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of?

Assess blood urea nitrogen (BUN) and creatinine levels.

A nurse is caring for a client scheduled to have angiography of the right eye in 1 hour. What is the highest priority nursing intervention?

"Direct all spray nozzles away from your face before spraying."

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

"Are you able to raise both eyebrows?"

A nurse is performing an eye examination. Which question would not be included in the examination?

Assuring that the client receives eye care to preserve eye function and prevent further visual loss Assessing and obtaining an accurate baseline of the function and structure of the eyes Explaining the temporary inability to maintain visual focus after mydriatic eye medications

A nurse is working with a client in an optometrist office. What is the role of the nurse with a client who is undergoing an eye examination and tests? Select all that apply.

Ptosis

A nurse notices that a client's left upper eyelid is drooping. The nurse has observed:

A mucopurulent ocular discharge

A patient comes to the clinic with a suspected eye infection. The nurse recognizes that the patient most likely has conjunctivitis, as evidenced by what symptom?

Bright flashing lights Sudden onset of floaters Cobwebs Sensation of a curtain coming across vision of one eye

A patient has been brought to the emergency room after being hit in the head with a baseball. The nurse should be alert to which of the following clinical manifestations of a detached retina? Select all that apply.

A visual field of floating particles A definite area of blank vision Momentary flashes of light

A patient is being seen in the ophthalmology clinic for a suspected detached retina. What clinical manifestations does the nurse recognize as significant for a retinal detachment? Select all that apply.

Visual acuity testing Indirect ophthalmoscopy Slit lamp biomicroscopy Flourescein angiography

A patient is suspected of having retinal detachment. The nurse would expect to prepare the patient for which of the following? Select all that apply.

BUN and creatinine

A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography?

To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.

A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection?

retinal detachment

After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms?

"Astigmatism means that the very front part of the eye is shaped differently than the very front part in most eyes.

An eighth-grade client visits the school nurse and reports having been to an eye doctor who identified an astigmatism and described it as a condition in which the eyeball is not shaped correctly. The client asks the nurse why both eyes look alike in the mirror if this is the case. What is the nurse's best response?

Flashing lights Cobwebs in vision field

An older adult client is admitted with the diagnosis of retinal detachment and is scheduled for laser surgery and scleral buckling procedure. The nurse anticipates which symptom(s) to be exhibited in this client? Select all that apply.

"An implanted lens has replaced the need for corrective glasses."

An older adult client is scheduled for cataract surgery and asks the nurse, "Will I need to wear thick lenses after surgery?" Which is the most appropriate response from the nurse?

Blurred distance vision.

An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by:

Myopia

Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following?

Thinning of the sclera

During a physical assessment, the nurse notes that a client has blue sclera. Which anatomic change will the nurse recognize is the reason for this finding?

Chemosis

Edema of the conjunctiva is termed which of the following?

Avoid heavy lifting for 1 week

Following cataract removal, the client receives discharge instructions from the nurse. Which of the following instructions is most important?

20/200

It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye?

Presbyopia

Nursing students are reviewing information about the causes associated with low vision and blindness. The students demonstrate a need for additional review when they identify which of the following as a common cause in older adults?

Acute angle-closure.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as:

Basal cell carcinoma

Students are reviewing information about orbital and ocular tumors. They demonstrate understanding of the material when they identify which of the following as the most common malignant tumor of the eyelid?

Intraocular pressure 15 mm Hg

The client with chronic open-angle glaucoma is receiving timolol eye drops. Which evaluation finding would indicate to the nurse the treatment is working?

Extraocular muscle function

The nurse asks a client to follow the movement of a pencil up, down, right, left, and both ways diagonally. The nurse is assessing which of the following?

Blurred vision results after application.

The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient?

Macular problems

The nurse is assessing a client using an Amsler Grid. The nurse is assessing for which of the following?

Ophthalmoscope

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification?

Brimonidine (Alphagan-P)

The nurse is caring for an older adult client who is frail in appearance. The client has been diagnosed with glaucoma and will be started on eye drops for the condition. Which medication would cause the nurse to call the health care provider before administering the first dose?

Central vision impairment

The nurse is clearly for an older adult client with macular degeneration has received injections of angiogenesis inhibitors. Which assessment finding would indicate the condition is worsening?

Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye

The nurse is demonstrating how to perform punctual occlusion. Which activities does the nurse perform?

Alpha-adrenergic agonists Carbonic anhydrase inhibitor Beta-blockers

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

The nurse would anticipate the client identifying numbers and shapes.

The nurse is evaluating the client while taking the color vision test. Which response would the nurse anticipate when caring for a client with normal color vision?

Lung

The nurse is explaining metastatic rhabdomyosarcoma to a group of parents with children diagnosed with the disease. The most common site of metastasis in clients diagnosed with rhabdomyosarcoma is the

"This test measures peripheral vision and detects gaps in the visual field."

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer?

Pilocarpine - "Use safety measures in dim lighting." Timolol maleate - "It can cause hypotension." Acetazolamide - "Have your electrolyte levels monitored."

The nurse is preparing to administer medication to a client who has been diagnosed with glaucoma. Which information should the nurse include related to client teaching for each of the identified medications?

Ask the client to demonstrate the instillation of her medications.

The nurse is providing discharge education to an adult client who will begin a regimen of ocular medications for the treatment of glaucoma. How can the nurse best determine if the client is able to self-administer these medications safely and effectively?

Prolonged use of corticosteroids

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder?

"Wash your hands before and after instilling eye drops and do not touch the tip of the bottle."

The nurse is teaching the client to instill eye drops. Which statement is correct?

pulls the tissue near the cheek downward to instill medication.

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client:

Halos and glare

The nurse should monitor for which manifestation in a client who has had LASIK surgery?

>21 mm Hg.

The ophthalmologist tells a patient that he has increased intraocular pressure (IOP). The nurse understands that increased pressure resulting from optic nerve damage is indicated by a reading of:

NSAIDs

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treating inflammatory conditions of the eyes?

Up and backward.

To straighten the ear canal in an adult for examination, the nurse practitioner would grasp the auricle and pull it:

Cycloplegics

What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil?

10 to 20 mm Hg.

When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of:

Sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision:

"My eyelids were stuck together this morning."

Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?

Miotics

Which group of medications causes pupillary constriction?

Bright flashing lights

Which is an accurate clinical manifestation of a retinal detachment?

Pain

Which is not a clinical manifestation of a retinal detachment?

Macular degeneration

Which is the most common cause of visual loss in people older than 60 or 65 years of age?

Glaucoma

Which of the following eye disorders is caused by an elevated intraocular pressure (IOP)?

Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.

Which of the following is an accurate statement regarding refractive surgery?

Eat soft, easily chewed foods

Which of the following is the correct advice regarding food for a patient who underwent a cataract surgery?

Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss

Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests?

Cholinergics

Which of the following medication classifications increases aqueous fluid outflow in the patient with glaucoma?

Beta blockers

Which of the following medications decreases the production of aqueous humor?

Coumadin

Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?

Scleral buckle

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear?

Viral

Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection?

Pain

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

Macula

Which part of the retina is responsible for central vision?

Laser-assisted in situ keratomileusis (LASIK)

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella?

Papilledema

Which term refers to swelling of the optic disc due to increased intracranial pressure?

Hemangioma

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry red in color?

Nuclear

Which type of cataract is caused by central opacity of the lens?