Visual (Glaucoma, cataract, total blindness, AMD, Meniere's, hearing and deafness)

The patient reports to the home health nurse that she is having cloudy vision and seeing spots and halos around lights. Based on these complaints, the nurse makes arrangement to have a medical evaluation for: 1. cataracts. 2. glaucoma. 3. detached retina. 4. macular degeneration.

1 Cataracts are the cause of cloudy vision and seeing spots or halos.

A patient is being discharged after cataract surgery. The nurse evaluates that the patient understands discharge instructions when the patient says, "I should not pick up anything that weighs more than _______ pounds.".

15 lbs

The nurse is admitting a patient with terminal brain cancer who is legally blind in both eyes. When planning care for this patient, which is the priority for the nurse to consider? 1) Nutrition 2) Mobility 3) Communication 4) Hygiene

3

When the 87-year-old resident in a long term care facility keeps the volume on his TV turned up high and sometimes does not respond when spoken to, the nurse assesses deficit associated with the aging process, which is: 1. labyrinthitis. 2. presbyopia. 3. presbycusis. 4. nerve deafness. Logged

3 Presbycusis (normal loss of hearing acuity associated with aging) may begin to appear in middle-aged adults.

Which lifestyle modification should the nurse suggest to the client with Ménière's disease to reduce the frequency or intensity of acute episodes? A. "Stop or reduce cigarette smoking." B. "Avoid aspirin or aspirin-containing drugs." C. "Reduce the amount of saturated fats in your diet." D. "Avoid crowds and people who have upper respiratory infections." Logged

A The vasoconstrictive effects of cigarette smoking reduce endolymph absorption and promote acute episodes of Ménière's disease.

When obtaining a health history from a 49-year-old patient, which patient statement is most important to communicate to the primary health care provider? a. "My eyes are dry now." b. "It is hard for me to see at night." c. "My vision is blurry when I read." d. "I can't see as far over to the side."

ANS: D The decrease in peripheral vision may indicate glaucoma, which is not a normal visual change associated with aging and requires rapid treatment. The other patient statements indicate visual problems (presbyopia, dryness, and lens opacity) that are considered a normal part of aging.

The nurse should instruct the client who has glaucoma to take which action? a. Wear loose-fitting clothing. b. Use eye medications as ordered. c. Wear dark glasses at all times. d. Formulate an exercise plan.

B Drug therapy to reduce intraocular pressure is the usual treatment. Client teaching includes instruction to use eye medications as ordered.

A client is told that he has 20/10 vision when tested on the Snellen chart. How does the nurse explain this finding to the client? a. "You can read at 10 feet what others can read at 20 feet." b. "You can read at 20 feet what others can read at 10 feet." c. "This demonstrates normal vision." d. "You are considered legally blind."

B The "20" is the point at which the client can see from the chart, and the "10" is the point at which a healthy eye can see from the chart. Normal vision is 20/20.

The client who has just had cataract extraction surgery suddenly complains of sharp pain in the eye. The nurse responds by: A) administering pain medication. B) notifying the physician. C) placing an ice pack over the eye. D) removing the dressing to examine the eye.

B) The pain could be secondary to a surgical complication and must be assessed by the physician. Application

A person is considered legally blind when central visual acuity is: a. between 20/70 and 20/200 in the better eye without corrective lenses b. 20/200 or less in either eye without corrective lenses c. 20/200 or less in the better eye with corrective lenses d. absent

C Having a central visual acuity that is 20/200 or less in the better eye with corrective lenses is considered being legally blind.

During an intake physical examination, a patient reports that he has been taking 10 aspirin tablets a day for his arthritis. What question should the nurse ask based on this information? a. "Can you hear high-pitched sounds?" b. "Have you noticed deafness in just one ear?" c. "Do you have ringing in your ears?" d. "Do you experience dizziness when you stand?"

C A ringing in the ears (tinnitus) is an indication of aspirin toxicity. The patient should be advised to stop taking aspirin.

When performing an assessment of the client's pupils, the nurse notes that the client's right pupil appears dilated, with a sluggish pupillary response to light. Which disorder and its re-lated treatment in this client's history would account for this finding? A. Coronary artery disease and beta blockers B. Diabetes mellitus and oral glycemic reducing agents C. Glaucoma and intraocular pressure-reducing eye drops D. Myopia and corrective laser surgery

C Clients with glaucoma who are being treated with eye drops have unequal pupils, especially if only one eye is being treated. The papillary reaction to light also is slowed by the use of eye drops for glaucoma.

A 40-year-old patient has questioned the nurse about being tested for glaucoma. To encourage eye health, the nurse should encourage the patient to have a glaucoma test every: a. year. b. 1 to 2 years. c. 2 to 3 years. d. 3 to 5 years.

C Glaucoma testing should be done every 2 to 3 years for people over age 40.

The nurse providing normal postoperative care to a client who underwent laser trabeculoplasty as part of glaucoma management would a. give food and fluids immediately on arrival. b. instruct the client to lie on the operative side. c. maintain an eye patch and plastic shield in place. d. tell the client to expect eye pain and nausea.

C When the client returns from the operating room, the eye is covered with a patch and a metal or plastic shield for protection. The nurse instructs the client not to lie on the operative side to avoid pressure on the surgical site. When the effects of perioperative sedation have diminished, the client may walk and eat as desired.

The nurse is assessing the client's eyes. Which of the following findings is most consistent with glaucoma? 1. Eyeballs are firm to palpation. 2. Pupils are constricted bilaterally. 3. Central vision is impaired. 4. The client has a history of syphilis.

1 Rationale 1: A client's eyeballs that are firm when palpated may have glaucoma. Rationale 2: Dilated, not constricted, pupils are most often associated with glaucoma. Rationale 3: Impaired central vision is associated with macular degeneration. Rationale 4: Clients who have been infected previously with syphilis may develop a condition called Argyll Robertson pupils. This is when the client's pupils are bilaterally constricted, small, irregular, and nonreactive to light.

An elderly patient is being discharged after having a cataract removed during same-day surgery. The nurse's priority is to assess the patient for which ability? 1. Ability to administer eyedrops postprocedure 2. Ability to read discharge instructions 3. Ability to drive 4. Ability to ambulate safely

1 Rationale 1: The nurse assesses for factors that may interfere with the patient's ability to provide self-care postoperatively. A family member should be included in the teaching as well. Rationale 2: Being able to read discharge instructions is the second most important discharge assessment. Rationale 3: Depth perception may be temporarily impaired after cataract surgery, so the patient should not drive. Rationale 4: Safe ambulation is important but does not have the highest priority.

Glaucoma is the second leading cause of blindness in the United States. The nurse providing health promotion materials should focus information on which issues contributing to that statistic?Select all that apply. 1. Delayed recognition of glaucoma 2. Noncompliance in using eyedrops once diagnosed 3. Lack of understanding of the seriousness of the disorder 4. Difficulty achieving normal pressure readings once glaucoma is established 5. Reluctance to seek treatment due to social stigma of the disease

1,2,3 Rationale 1: Glaucoma is often silent and requires professional assessment for diagnosis. Many people do not realize they have glaucoma. Rationale 2: People diagnosed with glaucoma sometimes do not use eyedrops correctly or consistently once symptoms of glaucoma are controlled. Rationale 3: Many people do not understand how serious glaucoma is and that it can result in blindness. Rationale 4: Glaucoma is easily treated once diagnosed. Rationale 5: There is no social stigma associated with glaucoma.

The nurse providing community education would discuss which techniques to reduce the risk of cataract development? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Smoking cessation 2. Wearing sunglasses 3. Well-balanced diet 4. Maintaining a healthy weight 5. Avoidance of alcohol

1,2,3 Rationale 1: Smoking is a risk factor for the development of cataracts. Rationale 2: Exposure to ultraviolet light increases the risk of cataracts. Rationale 3: A poor diet is a risk factor for the development of cataracts. Rationale 4: Obesity is not a risk factor for cataract development. Rationale 5: Alcohol intake is not associated with cataract development. Logged

To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by a. questioning the patient about blurred vision. b. noting any changes in the patient's visual field. c. asking the patient to rate the pain using a 0 to 10 scale. d. assessing the patient's depth perception when climbing stairs.

ANS: B POAG develops slowly and without symptoms except for a gradual loss of visual fields. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG.

Genetic testing reveals that a client has alteration of CFH and ARMS2 genes, which increases the risk of age-related macular degeneration (AMD). Which health teaching should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "You should make every effort to maintain a normal body weight." 2. "You should arrange your work and living quarters so that dimming vision will not be a safety issue." 3. "You should not smoke cigarettes." 4. "Your diet should be low in fat." 5. "You should take precautions to keep your stress level low."

1,3,4 Rationale 1: Obesity is a risk factor for development of AMD. Rationale 2: While these two gene alterations do increase risk for AMD, it is not inevitable that the client will develop the disease. Rationale 3: The strongest modifiable risk factor for AMD is cigarette smoking. Rationale 4: High-fat diets are associated with increased risk of AMD. Rationale 5: Keeping stress levels low is not protective against development of AMD.

A patient has just returned from surgery for removal of a cataract. Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Position the patient with the head of the bed up at 30 degrees. 2. Have the patient lie on the affected side. 3. Assess the operative eye for drainage. 4. Keep the eye patch in place. 5. Monitor the patient's pain level.

1,3,4,5 Rationale 1: The patient should recline at a 30-degree angle. Rationale 2: The patient should lie on the unaffected side. Rationale 3: The nurse will monitor for drainage from the affected eye. Rationale 4: The patient's eye patch should be kept in place. Rationale 5: A sudden onset of pain may be related to a ruptured vessel.

A patient diagnosed with glaucoma says, "I can't believe this is happening to me and that I can't change it. Everything I do requires that I see well.". Which nursing questions will address the issue reflected in this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "What time is good for you to return to the clinic tomorrow for a recheck?" 2. "Did you bring someone to drive you home?" 3. "Which pharmacy location do you want me to call with your new prescription?" 4. "Is someone staying with you until your vision is clearer?" 5. "Do you want black sunglasses or red ones?"

1,3,5 Rationale 1: This patient is expressing a sense of powerlessness. Letting the patient set the time for the next appointment restores some power. Rationale 2: Requiring someone to drive the patient around may increase this patient's sense of powerlessness. Rationale 3: This patient is expressing a sense of powerlessness. Allowing the patient to determine treatment options, even as simple as choosing the location of the pharmacy, may help to restore some sense of power. Rationale 4: The necessity of having someone "baby-sit" the patient, while necessary, will further diminish the patient's sense of control and power. Rationale 5: Allowing simple choices helps to establish a feeling of control over one's own care, which increases one's sense of power.

During an eye examination, the nurse requests that the client read letters located on the Snellen E chart. The client's vision is determined to be 20/200. Which of the following is true regarding these findings? Standard Text: Select all that apply. 1. The client is legally blind. 2. The client is unable to read from a paper at close range. 3. The client is found to be farsighted. 4. The client is myopic. 5. This is common in clients who are over 45 years old.

1,4 Rationale 1: The client is legally blind. When a client's vision is found to be 20/200, the client is legally blind. Rationale 2: The client is unable to read from a paper at close range. The Snellen E chart assists with determining if the client is able to see items in the distance. Rationale 3: The client is found to be farsighted. Clients who are farsighted are able to see things in the distance. This client is unable to see distant objects. Rationale 4: The client is myopic. Clients who are myopic are unable to see objects in the distance. Rationale 5: This is common in clients who are over 45 years old. Presbyopia is the inability to see items at close range. This condition is more common in people who are over 45 years old.

The nurse has provided discharge instructions to a patient who had cataract surgery. The nurse is satisfied that the patient understands these instructions when the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will ask my wife to tie my shoes for a few days.". 2. "I will wear my eye shield all the time.". 3. "I should expect to see bright flashes of light as my eye heals.". 4. "I will avoid reading at least until my follow-up appointment next week.". 5. "I will sleep on my back or on my nonoperative side.".

1,4,5 Rationale 1: The patient should avoid activities that require bending over at the waist, such as tying the shoes. Rationale 2: The patient should wear the eye shield during sleep but should wear glasses when awake so that the operative eye is being used. Rationale 3: Bright flashes of light are not normal and should be reported. Rationale 4: The patient should avoid reading for some time to minimize strain on the healing eye. Rationale 5: The patient should not sleep on the operative side.

The nurse is caring for a client newly diagnosed with glaucoma. The client is asymptomatic except for the increased intraocular pressure detected during a routine eye examination. When developing a plan of care for this client, which of the following goals should have the highest priority? 1. Stress importance of compliance with glaucoma eyedrops. 2. Assess for fall injuries. 3. Consider home maintenance issues. 4. Discuss risk factors.

1. Stress importance of compliance with glaucoma eyedrops. Rationale: All of the goals should be part of a nursing care plan for a client with glaucoma. However, this client is asymptomatic and has not suffered any vision loss. To prevent vision loss, the importance of client compliance with glaucoma eyedrops to decrease the intraocular pressure should be given the highest priority. Discussion of risk factors is important, but the eyedrops are the most effective method of decreasing the chance of vision loss. Assessing for fall injuries and home maintenance issues are more relevant to clients who already have vision loss.

The nurse considers in planning care for a patient with glaucoma that this disorder is caused by: 1. cloudiness in the lens. 2. an increase in intraocular pressure. 3. failed eye surgery. 4. retinal tears.

2 Glaucoma is caused by an increase in intraocular pressure.

A nurse is working with a patient who experienced the sudden onset of dizziness, nausea, and hearing loss. A diagnosis of Ménière's disease has been made. How should the nurse instruct the patient? 1. Use tranquilizers to help cope with the disease. 2. Avoid tobacco, alcohol, and caffeine. 3. Take OTC medications for the nausea. 4. Stay in bed until symptoms subside.

2 Rationale 1: Tranquilizers, or any medication that may cause vertigo, should be avoided. Rationale 2: Tobacco, alcohol, and caffeine can exacerbate inner ear fluid imbalance. Rationale 3: Ménière's disease requires medical intervention. The patient should not self-medicate. Rationale 4: Bed rest is not required in the treatment of Ménière's disease.

The nurse is teaching a patient about dietary considerations associated with the diagnosis of glaucoma. Which foods should the nurse teach the patient to avoid? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Citrus fruits 2. Cheese 3. White dinner rolls 4. Gas-producing foods such as beans and broccoli 5. Beef

2,3,5 Rationale 1: The patient should eat a variety of fruits and vegetables. Citrus fruits are not eliminated from this diet. Rationale 2: Cheese can be constipating. The patient with glaucoma should avoid becoming constipated as straining at stool increases intraocular pressure. Rationale 3: The patient should avoid products made with white flour. Rationale 4: The patient should increase vegetables such as beans and broccoli. There is no need to avoid gas-producing foods. Rationale 5: Beef can be constipating and should be reduced in the diet of a patient with glaucoma.

Which statement of the student nurse indicates the need for further learning about age-related macular degeneration (AMD)? 1 "AMD is related to retinal aging." 2 "Family history is a major risk factor for AMD." 3 "People with dark-colored eyes are more at the risk for AMD." 4 "Long-term exposure to ultraviolet light is a risk factor for AMD."

3 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 are more at risk for AMD because light eyes have less pigment, which makes them sensitive to light, causing AMD. 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.

A patient has been diagnosed with primary glaucoma. What information would the nurse provide about this condition? 1. It was probably caused by a congenital anomaly in the structure of the eye. 2. Primary glaucoma is not as serious as other forms of glaucoma. 3. The disorder has no relation to other ocular conditions. 4. This condition is the result of conjunctival infections in childhood.

3 Rationale 1: A congenital anomaly is one cause of secondary, not primary, glaucoma. Rationale 2: Glaucoma is always serious and can cause blindness because the increased intraocular pressure can cause optic nerve changes. Rationale 3: Primary glaucoma is not related to other ocular conditions. Rationale 4: Primary glaucoma is not related to any other ocular condition

The nurse is assessing a patient who had cataract surgery several weeks ago. Which patient statement would alert the nurse that the most common complication of cataract surgery is occurring in this patient? 1. "My eye itches at night.". 2. "My vision has not been as clear as I thought it would be.". 3. "I think my cataract is growing back.". 4. "I have pus in the corner of my eye.".

3 Rationale 1: Itching is not the most common complication of cataract surgery. Rationale 2: Numerous complications can result in the vision not being clear. These are not the most common complications. Rationale 3: Posterior capsular opacity is the most common complication of cataract surgery and is evidenced by increasingly blurry vision. The patient may describe this change as the cataract "growing back.". Rationale 4: Infection may occur, resulting in pus formation, but this is not the most common complication of cataract surgery. Logged

When the patient holds his Bible 6 inches from his face and turns his head to read out of the corner of his eyes, the nurse suspects that the patient is developing: 1. cataracts. 2. glaucoma. 3. presbyopia. 4. macular degeneration.

4. The leading cause of new blindness in old age is macular degeneration, which results in loss of central vision.

A client asks the nurse how glaucoma can best be prevented. The nurse's response would include preventive information related to primary open-angle glaucoma, including which of the following? a. Assessment of the optic nerve and tonometry testing should be performed regularly with an annual eye examination. b. Eat a well-balanced diet with adequate amounts of vitamin A and make sure your house has appropriate lighting. c. Exercises that increase blood pressure should be limited, and abrupt temperature changes should be avoided. d. Wear protective eyewear, and do not engage in activity where you are likely to experience blows to the head and neck.

A Because there are no early warning clinical manifestations for glaucoma, it is imperative that regular ophthalmic examinations include tonometry and assessment of the optic head (disc).

Which recommendation does the nurse provide for the client with Ménière's disease who has periodic spells of vertigo? a. "Avoid wearing high-heeled shoes." b. "Put brightly colored rugs on the floor for visibility." c. "Step on a sturdy chair to get items from high shelves." d. "Wait to drive a car until after you have taken your Benadryl."

A Clients with vertigo should wear low-heeled shoes with nonskid soles and tied laces to prevent injury. Brightly colored rugs would not help with safety concerns, especially if the rugs were throw rugs. Clients should use a stepstool with arms to reach items from high shelves, not just a sturdy chair. Diphenhydramine hydrochloride (Benadryl) may cause drowsiness, and clients should not drive after taking it.

The patient is scheduled to have surgery to manage glaucoma. The patient correctly explains that the procedure will: a. increase outflow of aqueous humor. b. reduce amount of vitreous humor. c. widen pupils. d. reduce pain.

A Glaucoma is a condition that causes increased ocular pressure. Surgical management for the condition seeks to provide an increased outflow of aqueous humor.

The client with long-standing primary open-angle glaucoma and loss of 60% of her visual fields is about to undergo surgical treatment to create a new drainage channel for the aqueous humor. Which of the following statements made by the client indicates a lack of understand-ing regarding this treatment? A. "I will probably not regain my total vision again for at least 2 weeks." B. "I will not take any aspirin for the first 2 weeks after surgery." C. "I will wear the eye patch all the time until the doctor says it is okay to stop." D. "I will call the doctor immediately if I have severe eye pain or brow pain."

A Surgery for glaucoma does not correct vision that is lost; it relieves pressure to prevent further loss.

A client with moderate age-related macular degeneration (AMD) asks the nurse about vitamins being advertised for this condition. Which is the best response by the nurse? a. "Certain vitamins seem to delay vision loss in people with macular degeneration." b. "There are no herbs or supplements that can help this condition." c. "There are no research studies that back up those claims." d. "Yes, mega-doses of vitamin B-12 have shown promise in several research studies." Logged

A The client with age-related macular degeneration is threatened with the loss of central vision. Some research findings do show that high-dose antioxidant vitamins (C, E, beta-carotene, and zinc) may delay progression of AMD and vision loss.

A client in seen in the emergency department and is diagnosed as having acute glaucoma. What symptoms could the nurse expect to find in the client's history related to the glaucoma? A) acute eye pain B) loss of peripheral vision C) diplopia D)no symptoms of pain or pressure

A Explanation: Acute glaucoma causes severe eye pain, blurred vision, nausea, vomiting, and halos.

A client has had vision loss because of glaucoma. The nurse identifies the diagnosis: Anticipatory Grieving related to loss of vision. Which interventions does the nurse include in the client's plan of care? (Select all that apply.) a. Allow the client to verbalize feelings. b. Assess causative and contributing factors. c. Examine the need for vocational rehabilitation. d. Help the client explore avenues of support. e. Instruct the client on home safety precautions.

A, B, C, D All interventions are important for the client with significant vision loss; however, home safety precautions relates to the diagnosis Risk for Injury. Anticipatory grieving is an important diagnosis, as clients will most likely need to grieve the loss of normal vision and the need to make compromises and adaptations in daily life.

Postoperative teaching for a person who has had a cataract removed from the left eye would include: (Select all that apply.) a. sleeping on the right side. b. taking a stool softener to avoid straining at stool. c. bending over from the waist; not stooping. d. providing instruction for instilling eye-drops. e. providing instruction on signs of compli-cations.

A, B, D, E The patient should not bend from the waist as the position increases intraocular pressure.

A 42-year-old woman with Ménière's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan? a. Dim the lights in the patient's room. b. Encourage increased oral fluid intake. c. Change the patient's position every 2 hours. d. Keep the head of the bed elevated 30 degrees.

ANS: A A darkened, quiet room will decrease the symptoms of the acute attack of Ménière's disease. Because the patient will be nauseated during an acute attack, fluids are administered IV. Position changes will cause vertigo and nausea. The head of the bed can be positioned for patient comfort.

During the preoperative assessment of the patient scheduled for a right cataract extraction and intraocular lens implantation, it is most important for the nurse to assess a. the visual acuity of the patient's left eye. b. how long the patient has had the cataract. c. for a white pupil in the patient's right eye. d. for a history of reactions to general anesthetics.

ANS: A Because it can take several weeks before the maximum improvement in vision occurs in the right eye, patient safety and independence are determined by the vision in the left eye. A white pupil in the operative eye would not be unusual for a patient scheduled for cataract removal and lens implantation. The length of time that the patient has had the cataract will not affect the perioperative care. Cataract surgery is done using local anesthetics rather than general anesthetics.

Which information will the nurse include for a patient contemplating a cochlear implant? a. Cochlear implants require training in order to receive the full benefit. b. Cochlear implants are not useful for patients with congenital deafness. c. Cochlear implants are most helpful as an early intervention for presbycusis. d. Cochlear implants improve hearing in patients with conductive hearing loss.

ANS: A Extensive rehabilitation is required after cochlear implants in order for patients to receive the maximum benefit. Hearing aids, rather than cochlear implants, are used initially for presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be helpful for conductive loss. They are appropriate for some patients with congenital deafness.

The nurse is providing health promotion teaching to a group of older adults. Which information will the nurse include when teaching about routine glaucoma testing? a. A Tono-pen will be applied to the surface of the eye. b. The test involves reading a Snellen chart from 20 feet. c. Medications will be used to dilate the pupils for the test. d. The examination involves checking the pupil's reaction to light.

ANS: A Glaucoma is caused by an increase in intraocular pressure, which would be measured using the Tono-pen. The other techniques are used in testing for other eye disorders.

The nurse working in the vision and hearing clinic receives telephone calls from several patients who want appointments in the clinic as soon as possible. Which patient should be seen first? a. 71-year-old who has noticed increasing loss of peripheral vision b. 74-year-old who has difficulty seeing well enough to drive at night c. 60-year-old who has difficulty hearing clearly in a noisy environment d. 64-year-old who has decreased hearing and ear "stuffiness" without pain

ANS: A Increasing loss of peripheral vision is characteristic of glaucoma and the patient should be scheduled for an examination as soon as possible. The other patients have symptoms commonly associated with aging: presbycusis, possible cerumen impaction, and impaired night vision.

Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of corticosteroid eye drops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 1 to 2 days after the surgery

ANS: B Antibiotic and corticosteroid eye drops are commonly prescribed after cataract surgery. The patient should be able to administer them using safe technique. Pain is not expected after cataract surgery and opioids will not be needed. Coughing and deep breathing exercises are not needed because a general anesthetic agent is not used. There is no bed rest restriction after cataract surgery.

The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene? a. The nurse leaves the eye shield in place. b. The nurse encourages the patient to cough. c. The nurse elevates the patient's head to 45 degrees. d. The nurse applies corticosteroid drops to the right eye.

ANS: B Because coughing will increase intraocular pressure, patients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a patient after having this surgery.

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider? a. The patient has questions about the ordered eye drops. b. The patient has eye pain rated at a 5 (on a 0 to 10 scale). c. The patient has poor depth perception when wearing an eye patch. d. The patient complains that the vision has not improved very much.

ANS: B Postoperative cataract surgery patients usually experience little or no pain, so pain at a level 5 on a 10-point pain scale may indicate complications such as hemorrhage, infection, or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching but does not indicate that complications of the surgery may be occurring.

Which action will the nurse take when performing ear irrigation for a patient with cerumen impaction? a. Assist the patient to a supine position for the irrigation. b. Fill the irrigation syringe with body-temperature solution. c. Use a sterile applicator to clean the ear canal before irrigating. d. Occlude the ear canal completely with the syringe while irrigating.

ANS: B Solution at body temperature is used for ear irrigation. The patient should be sitting for the procedure. Use of cotton-tipped applicators to clear the ear may result in forcing the cerumen deeper into the ear canal. The ear should not be completely occluded with the syringe.

The nurse is observing a student who is preparing to perform an ear examination for a 30-year-old patient. The nurse will need to intervene if the student a. pulls the auricle of the ear up and posterior. b. chooses a speculum larger than the ear canal. c. stabilizes the hand holding the otoscope on the patient's head. d. stops inserting the otoscope after observing impacted cerumen.

ANS: B The speculum should be smaller than the ear canal so it can be inserted without damage to the external ear canal. The other actions are appropriate when performing an ear examination.

A patient diagnosed with external otitis is being discharged from the emergency department with an ear wick in place. Which statement by the patient indicates a need for further teaching? a. "I will apply the eardrops to the cotton wick in the ear canal." b. "I can use aspirin or acetaminophen (Tylenol) for pain relief." c. "I will clean the ear canal daily with a cotton-tipped applicator." d. "I can use warm compresses to the outside of the ear for comfort."

ANS: C Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other patient statements indicate that the teaching has been successful

A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patient's treatment? a. "I use aspirin when I have a sinus headache." b. "I have had frequent episodes of conjunctivitis." c. "I take metoprolol (Lopressor) daily for angina." d. "I have not had an eye examination for 10 years."

ANS: C It is important to note whether the patient takes any -adrenergic blockers because this classification of medications is also used to treat glaucoma, and there may be an increase in adverse effects. The use of aspirin does not increase intraocular pressure and is safe for patients with glaucoma. Although older patients should have yearly eye examinations, the treatment for this patient will not be affected by the 10-year gap in eye care. Conjunctivitis does not increase the risk for glaucoma.

The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient for many years. During the initial assessment of the patient, it is most important for the nurse to a. obtain more information about the cause of the patient's vision loss. b. obtain information from the spouse about the patient's special needs. c. make eye contact with the patient and ask about any need for assistance. d. perform an evaluation of the patient's visual acuity using a Snellen chart.

ANS: C Making eye contact with a partially sighted patient allows the patient to hear the nurse more easily and allows the nurse to assess the patient's facial expressions. The patient (rather than the spouse) should be asked about any need for assistance. The information about the cause of the vision loss and assessment of the patient's visual acuity are not priorities during the initial assessment.

The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is most important to report to the health care provider at this time? a. The patient has had blurred vision for 3 years. b. The patient has not eaten anything for 8 hours. c. The patient takes 2 antihypertensive medications. d. The patient gets nauseated with general anesthesia.

ANS: C Mydriatic medications used for pupil dilation are sympathetic nervous system stimulants and may increase heart rate and blood pressure. Using punctal occlusion when administering the mydriatic and monitoring of blood pressure are indicated for this patient. Blurred vision is an expected finding with cataracts. Patients are expected to be NPO for 6 to 8 hours before the surgical procedure. Cataract extraction and intraocular lens implantation are done using local anesthesia.

The nurse recording health histories in the outpatient clinic would plan a focused hearing assessment for adult patients taking which medication? a. Atenolol (Tenormin) taken to prevent angina b. Acetaminophen (Tylenol) taken frequently for headaches c. Ibuprofen (Advil) taken for 20 years to treat osteoarthritis d. Albuterol (Proventil) taken since childhood to treat asthma

ANS: C Nonsteroidal antiinflammatory drugs (NSAIDs) are potentially ototoxic. Acetaminophen, atenolol, and albuterol are not associated with hearing loss.

Which action should the nurse take when providing patient teaching to a 76-year-old with mild presbycusis? a. Use patient education handouts rather than discussion. b. Use a higher-pitched tone of voice to provide instructions. c. Ask for permission to turn off the television before teaching d. Wait until family members have left before initiating teaching.

ANS: C Normal changes with aging make it more difficult for older patients to filter out unwanted sounds, so a quiet environment should be used for teaching. Loss of sensitivity for high-pitched tones is lost with presbycusis. Because the patient has mild presbycusis, the nurse should use both discussion and handouts. There is no need to wait until family members have left to provide patient teaching

When the nurse is taking a health history of a new patient at the ear clinic, the patient states, "I have to sleep with the television on." Which follow-up question is most appropriate to obtain more information about possible hearing problems? a. "Do you grind your teeth at night?" b. "What time do you usually fall asleep?" c. "Have you noticed ringing in your ears?" d. "Are you ever dizzy when you are lying down?"

ANS: C Patients with tinnitus may use masking techniques, such as playing a radio, to block out the ringing in the ears. The responses "Do you grind your teeth at night?" and "Are you ever dizzy when you are lying down?" would be used to obtain information about other ear problems, such as vestibular disorders and referred temporomandibular joint (TMJ) pain. The response "What time do you usually fall asleep?" would not be helpful in assessing problems with the patient's ears.

The charge nurse must intervene immediately if observing a nurse who is caring for a patient with vestibular disease a. speaking slowly to the patient. b. facing the patient directly when speaking. c. encouraging the patient to ambulate independently. d. administering Rinne and Weber tests to the patient.

ANS: C Vestibular disease affects balance, so the nurse should monitor the patient during activities that require balance. The other actions might be used for patients with hearing disorders.

The nurse in the eye clinic is examining a 67-year-old patient who says "I see small spots that move around in front of my eyes." Which action will the nurse take first? a. Immediately have the ophthalmologist evaluate the patient. b. Explain that spots and "floaters" are a normal part of aging. c. Inform the patient that these spots may indicate retinal damage. d. Use an ophthalmoscope to examine the posterior eye chambers.

ANS: D Although "floaters" are usually caused by vitreous liquefaction and are common in aging patients, they can be caused by hemorrhage into the vitreous humor or by retinal tears, so the nurse's first action will be to examine the retina and posterior chamber. Although the ophthalmologist will examine the patient, the presence of spots or floaters in a 65-year-old is not an emergency. The spots may indicate retinal damage, but the nurse should assess the eye further before discussing this with the patient.

In reviewing a 55-year-old patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a. visual acuity. b. pupil reaction. c. color perception. d. peripheral vision.

ANS: D The patient's increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma

A 72-year-old patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective? a. "I will need to use bright lights to read for at least the next week." b. "I will use drops to keep my pupils dilated until my appointment." c. "I will not use facial lotions near my eyes during the recovery period." d. "I will cover up with long-sleeved shirts and pants for the next 5 days."

ANS: D The photosensitizing drug used for photodynamic therapy is activated by exposure to bright light and can cause burns in areas exposed to light for 5 days after the treatment. There are no restrictions on the use of facial lotions, medications to keep the pupils dilated would not be appropriate, and bright lights would increase the risk for damage caused by the treatment.

Which teaching point should the nurse plan to include when caring for a patient whose vision is corrected to 20/200? a. How to access audio books b. How to use a white cane safely c. Where Braille instruction is available d. Where to obtain specialized magnifiers

ANS: D Various types of magnifiers can enhance the remaining vision enough to allow the performance of many tasks and activities of daily living (ADLs). Audio books, Braille instruction, and canes usually are reserved for patients with no functional vision.

A nurse is teaching a patient with glaucoma how to administer eyedrops to achieve maximum absorption. Where should the nurse teach the patient to instill the eyedrops? A) Conjunctival sac B) Pupil C) Sclera D) Vitreous humor

Ans: A Feedback: The nurse should instill the eyedrops into the conjunctival sac, where absorption can best take place. The pupil permits light to enter the eye. The sclera maintains the eye's shape and size. The vitreous humor maintains the retina's placement and the shape of the eye.

A patient who is legally blind is being admitted to the hospital. The patient informs the nurse that she needs to have her guide dog present during her hospitalization. What is the nurse's best response to the patient? A) "Arrangements can be made for your guide dog to be at the hospital with you during your stay." B) "I will need to check with the care team before that decision can be made." C) "Because of infection control, your guide dog will likely not be allowed to stay in your room during your hospitalization." D) "Your guide dog can stay with you during your hospitalization, but he will need to stay in a cage or crate that you will need to provide."

Ans: A Feedback: If patients usually use service animals to assist them with ADLs, it is necessary to make arrangements for the accommodation of these animals. The patient should be moved to a private room, and a cage would prevent the service dog from freely assisting the patient, so it is not necessary.

You are the clinic nurse doing a preoperative assessment on a patient who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the patient's medical history, you note that this patient had a kidney transplant 8 years ago. The patient is taking immunosuppressive drugs. What is this patient at increased risk for when having surgery? A) Rejection of the transplanted organ B) Rejection of the implanted lens C) Infection D) Adrenal storm

Ans: C Feedback: The mildest symptoms or slightest temperature elevation must be investigated. Because patients who are immunosuppressed are highly susceptible to infection, great care is taken to ensure strict asepsis. Options A and B are incorrect; this patient is taking immunosuppressive drugs so the transplanted organ and the implanted lens should not be at risk because of the surgery. Option D is incorrect because immunosuppressive drugs will not cause an adrenal storm.

The nurse is planning care for an older adult client diagnosed with age-related macular degeneration (AMD). Which prescriptions does the nurse anticipate for this client? Select all that apply. A) Laser surgery B) Eye patches C) Antioxidants D) Eye drops E) Zinc

Answer: C, E High-dose antioxidants and zinc are the treatments for early dry macular degeneration. Laser surgery is used to treat wet macular degeneration. Eye drops and eye patches may be used after laser surgery but are not part of the initial treatment for the disorder.

A client has Ménière's disease. Which question by the nurse would elicit the most pertinent information related to client safety? a. "Are your attacks at certain times of the day?" b. "Do your attacks come on without warning?" c. "How long does each attack last?" d. "What seems to bring on your attacks?"

B Ménière's disease triggers attacks of vertigo that present safety concerns for the client. While all the questions elicit useful information, knowing that a client has no warning before becoming dizzy would lead the nurse to advise that the client not drive, swim, climb ladders or scaffolds, or do other activities where a sudden onset of dizziness would present an increased risk of injury.

To help reduce the nausea and vomiting experienced by a patient with Ménière's disease, the nurse would caution the patient to avoid: a. drinking coffee. b. moving the head or eyes suddenly. c. bending over at the waist. d. facing backward in a moving vehicle.

B Rapid movement of the head and/or eyes can increase the nausea and vomiting in a patient with Ménière's disease.

For which client does the nurse suspect secondary open-angle glaucoma? A. 38-year-old client who has sudden poor light perception and reduced vision bilaterally when coming indoors after spending 2 hours snow skiing on a sunny day B. 78-year-old client who has a decreased sense of peripheral vision on the fourth postoperative day after cataract surgery with lens replacement C. 48-year-old client who has sudden brow pain and reduced vision on one side when coming out of a dark theater into the sunlight D. 68-year-old client who has noticed decreased peripheral vision in both eyes during the past year

B Secondary open-angle glaucoma results from another condition that interferes with the drainage of aqueous humor. Eye surgery is a common cause of secondary open-angle glaucoma.

Severe vertigo, tinnitus, and progressive hearing loss are characteristic of: a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse.

B The classic triad of Ménière disease is vertigo, tinnitus, and progressive hearing loss.

The 75-year-old client tells his nurse that this is the first time he will have had his intraocular pressure measured and that he only came because his daughter insisted. He also says that he is afraid the test will hurt and that he might find out he has glaucoma and will go blind. What is the nurse's best response? A. "The test is painless because you will receive a sedative. If you have glaucoma, the correct glasses or contact lenses can prevent blindness." B. "The test is quick and painless because a local anesthetic is used. Early detection of glaucoma allows medications and other procedures to prevent blindness." C. "The test does cause a little pain, but it is over very quickly. This test, however, does not determine whether or not you have glaucoma or are at risk for glauco-ma." D. "The test causes some pain and tearing, but you can have your daughter present to hold your hand. It is unlikely that you have glaucoma because no one in your family has it."

B The different ways to measure intraocular pressure are performed with the eye anesthetized so that there is no pain. Glaucoma is caused by a persistent increase in intraocular pressure. When discovered early and managed appropriately, blindness can be avoided.

At a home visit for a client who had cataract surgery 3 days ago, a nurse observes creamy, white, dry, crusty drainage on the client's operative eyelid and lashes. What is the nurse's best action? A. Obtain a specimen of the drainage for culture. B. Cleanse away the drainage and apply the prescribed drops. C. Contact the physician for an antibiotic order. D. Arrange for the client to be seen by the ophthalmologist today.

B White, dry, crusty drainage on the eyelid and lashes after cataract surgery is normal.

A nurse in an outpatient surgical setting is assessing a client scheduled for cataract removal. The nurse would expect to find that the client has (Select all that apply) a. a shadow across the visual field. b. better vision in low light. c. blurred vision, photophobia, and glare. d. nausea and vomiting, worse with eye movements. e. sudden onset of acute eye pain.

B, C A cataract is an opacity of the lens. Classic manifestations are blurred or double vision, photophobia, and glare. Clients usually see better in low light. A shadow across the visual field is characteristic of retinal detachment. Nausea and vomiting, and acute eye pain often accompany acute angle-closure glaucoma, although the nausea may or may not be worse with eye movement.

The nurse reviews the classic symptoms of a cataract, which are: (Select all that apply.) a. nystagmus. b. troubled by glare. c. increased myopia. d. color distortion.

B, C, D, E A cataract is opacity of the lens that produces an effect similar to one a person would get when looking through a sheet of falling water. A cataract causes a blurring of vision because the lens, which is normally transparent, becomes cloudy and opaque. Nystagmus is not a symptom of a cataract. All other options are classic symptoms of a person with a developing cataract.

An important primary prevention activity the nurse could teach a community group for vision is (Select all that apply) a. having an annual ophthalmologic examination. b. keeping blood pressure under control. c. taking medication for glaucoma as prescribed. d. wearing safety goggles and sunglasses.

B, D Primary prevention attempts to prevent disease processes before they start. Maintaining normal blood pressure can prevent hypertension-related eye problems. Wearing safety goggles and sunglasses can prevent eye injury. An annual eye exam is secondary prevention and taking glaucoma medications would be tertiary prevention.

What is the priority nursing diagnosis for the client with Ménière's disease during an acute attack? A. Acute Pain related to presence of inflammation B. Risk for Aspiration related to excessive vomiting C. Risk for Injury related to impaired sense of balance D. Deficient Knowledge of prevention measures

C During an acute episode, clients with Ménière's disease experience an altered perception of bal-ance and are at risk for falling. In addition, many clients have nausea and vomiting, which are distressing but do not increase the risk for aspiration. Pain is not associated with Ménière's dis-ease. Teaching preventive techniques is not appropriate during an acute attack.

The nurse talking with a client with open-angle glaucoma would instruct the client to make a behavior change based on the statement a. "I take an aspirin a day to prevent any problems with clotting." b. "I usually drink at least 8 to 10 glasses of water a day." c. "Now that the allergy season is here, I take antihistamines on a regular basis." d. "I like to eat hot, spicy foods."

C Many over-the-counter (OTC) medications, including antihistamines, can dilate the pupil, putting the client at risk for angle-closure glaucoma.

The client is using an ophthalmic beta-blocking agent for the treatment of glaucoma. Which of the following actions should the nurse teach the client to prevent orthostatic hypotension? A. "Change positions slowly." B. "Take your pulse rate at least four times daily." C. "Apply pressure to the inside corner of your eye when putting the drops into the eye." D. "Be sure to lie down for at least 10 minutes after putting the drops into your eyes."

C Nasal punctal occlusion during eye drop instillation keeps the drug in contact with the eye struc-tures longer and decreases systemic absorption and side effects.

The nurse would consider that discharge teaching for a client after cataract surgery was not effective when the client states "I will a. avoid lifting more than 5 pounds for a while." b. only experience mild pain." c. sleep on the side they operated on." d. wear my eye shield to protect my eye."

C The postsurgical cataract client should wear eye shields, avoid lifting more than 5 pounds until cleared by the ophthalmologist, and should only experience mild pain, for which acetaminophen (Tylenol) should be effective. These clients should avoid sleeping on the operated side.

The client, a 78-year-old woman who has a mature cataract in the right eye, tells her nurse, "Now I have lost the sight in my right eye because I waited too long for treatment." What is the nurse's best response? A. "Yes, this type of blindness could have been prevented by earlier treatment." B. "It is fortunate that you came for treatment in time to save the sight of your left eye." C. "Nothing you could have done would have made any difference at all in the sight you have lost." D. "The result of surgery on your right eye will be just as good now as it would have been a year ago."

D Although sight is increasingly impaired as a cataract matures, no other damage is done to the eye by waiting. The removal of the cataract will result in improved vision regardless of how long the cataract has been present.

The client who is being discharged after cataract surgery is a nursing home resident. For what activities should the nurse instruct this client to use an eye shield? A. The client should have the eye shield in place 24 hours a day for the first 2 weeks after surgery. B. The client should have the eye shield in place when engaging in activities that require bending. C. An eye shield is not needed, because this client is not in an environment where protection is needed. D. An eye shield should be applied when the client is ready for bed.

D An eye shield after cataract surgery is usually considered a safety intervention.

Which statement made by a client after cataract surgery indicates the need for further teaching regarding activities that can increase intraocular pressure? A. "I will avoid wearing tight shirt collars and ties." B. "I will take stool softeners daily to prevent having to strain." C. "I will try not to sneeze, cough, or blow my nose for the next 2 weeks." D. "I will place items from high shelves on low shelves to avoid having my arms above my head."

D Arm position does not influence intraocular pressure.

Which subjective clinical manifestation alerts the nurse to the possible presence of a cataract? A. Loss of central vision B. Loss of peripheral vision C. Dull aching in the eye and brow areas D. Blurred vision and reduced color perception

D As the lens becomes opaque and less able to refract light appropriately, the client experiences blurred vision and a reduced ability to distinguish among different colors.

The client complains of eye pain and has nausea 2 hours after cataract surgery on the left eye. What is the nurse's priority intervention? A. Document the manifestations as the only action. B. Administer the prescribed antiemetic. C. Position the client on the right side. D. Notify the physician.

D Eye pain accompanied by nausea and vomiting is an indication of increased intraocular pressure and/or hemorrhage. This clinical manifestation requires immediate attention from the ophthal-mologist.

The nurse is teaching a client about home care after cataract surgery. Which statement indicates that the client requires further teaching? a. "I am glad that I don't need an eye patch after the surgery." b. "I will try a cool compress to decrease the swelling around the operated eye." c. "Dark sunglasses will be necessary when I am in the sun." d. "Pain, nausea, and vomiting are normal after this surgery."

D Eye pain accompanied by nausea and vomiting is an indication of increased intraocular pressure and/or hemorrhage. This is an emergent situation and the surgeon must be contacted by the client. The other responses are correct. The client will not need an eye patch, cool compresses will decrease the slight swelling, and dark glasses are necessary outdoors until the pupil responds to sunlight.

The nurse caring for a frail 72-year-old client recently diagnosed with Ménière's disease would know that the nursing diagnosis frequently associated with this problem that is the priority for the client is a. Deficient Knowledge. b. Ineffective Health Maintenance. c. Risk for Impaired Skin Integrity. d. Risk for Injury.

D Ménière's disease causes vertigo and balance problems; thus the client is at risk for injury, particularly because the client is frail.

The nurse is caring for a client with Ménière's disease. What does the nurse recommend to the client to reduce the symptoms of vertigo? a. "Take salt and potassium supplements daily." b. "Drink at least eight glasses of water every day." c. "Blow your nose hard when dizziness first begins." d. "When dizziness begins, lie down and keep your head still."

D Vertigo is a sense of whirling or turning in space, disturbing the sense of balance and inducing nausea and/or vomiting. Restricting head motions can help reduce the disturbances induced by vertigo. Excessive endolymph fluid can cause symptoms of Ménière's disease, so the nurse should not encourage extra fluid intake. Sodium will encourage water retention, which can ex-acerbate symptoms. The client should not blow his or her nose forcefully because this can cause damage to the ear.

A 45-year-old client is admitted complaining of vertigo, hearing loss, unilateral aural fullness, and tinnitus. Based on the client's age and symptoms, the nurse feels the client is suffering from: 1. Meniere's disease. 2. Bell's palsy. 3. Otosclerosis. 4. Anosmia.

Meniere's disease. Rationale: Meniere's disease is a dysfunction of the labyrinth, with symptoms of vertigo, hearing loss, unilateral aural fullness, and tinnitus. It is most common between the ages of 30 and 60. Bell's palsy is an inflammation of the seventh cranial nerve that results in asymmetric facial movements. Otosclerosis is a familial disorder in which irregular ossification occurs in the stapes of the middle ear, causing conductive deafness, sensorineural hearing loss, and tinnitus. Anosmia is the complete loss of smell.

A patient with a gradual onset of cataracts tells the nurse, "I can't understand how this happened. I take good care of my eyes." The nurse's response is based on the knowledge that: A) Cataracts are not statistically connected to advancing age. B) Years of exposure to ultraviolet light are a risk factor for cataracts. C) Corticosteroids taken for several months can inhibit cataract formation. D) Uncontrolled hypertension is associated with cataracts in older adult patients.

b