CH 42

For which diseases or conditions will the nurse monitor clients carefully because they can adversely affect eyes and vision? Select all that apply.

B. Pregnancy C. Diabetes D. Hypertension F. Thyroid problems

Which issue will the nurse consider a priority when caring for a client with cataracts and impaired vision?

B. Safety

Which signs and symptoms will the nurse instruct the client and family to immediately report to the eye health care provider after cataract surgery? Select all that apply.

B. Sharp sudden pain in the eye C. Bleeding or increased discharge from the eye D. Flashes of light or floating shapes seen in the eye E. Decreased vision in the eye that had surgery F. Green or yellow, thick drainage from the eye

Primary angle-closure glaucoma (PACG)

A form of glaucoma that can have a sudden onset and is an emergency; it is characterized by a forward displacement of the iris, which presses against the cornea and closes the chamber angle, suddenly preventing outflow of aqueous humor. Also called closed-angle glaucoma, narrow-angle glaucoma, or acute glaucoma.

How does the nurse expect a decreased ability of the iris and pupil to dilate to affect an older client's vision?

B. Increased difficulty with vision in dark environments

Which client statement affirms that nurse teaching about instillation of multiple different eye drops has been effective? Select all that apply.

A. "A schedule will help me remember when to instill the eyedrops." B. "If I have trouble instilling the drops, there are devices that can be helpful." C. "I can label the eye drops by color to help me easily distinguish which one is which." D. "I will not touch the droppers to my eyes as this can cause contamination and infection."

What is the appropriate nursing response when a 66-year-old healthy client asks how often a visit to the eye care provider is recommended?

A. "Every 1 to 2 years if you have no eye problems."

Which patient does the nurse identify at highest risk for development of dry age-related macular degeneration (AMD)?

A. 65-year old client with diabetes

When the nurse is instilling ophthalmic drops in a client's eyes, which steps are included in the correct procedure? Select all that apply.

A. Check the eyedrop name, strength, expiration date, color, and clarity. B. Wash hands and remove the cap from the bottle. D. Gently pull the lower lid down against the client's cheek, forming a small pocket. E. Hold the eyedrop bottle (with the cap off) like a pencil, with the tip pointing down. F. Without touching any part of the eye or lid with the tip of the bottle, gently squeeze and release the prescribed number of drops into the pocket. G. Gently release the lower lid and tell the client to close the eye gently. H. Gently blot away any excess drug or tears with a tissue. I. Ask the client to keep eyes closed for about 1 minute.

Which age-related changes in eyes and vision will the nurse expect for an older adult client? Select all that apply.

A. Cornea flattens which blurs vision B. Ocular muscle strength is decreased C. Decreased discrimination among colors green, blue, and violet D. Tear production is decreased resulting in dry eyes F. Eyes appear sunken

What will the nurse teach the client to prevent harm postoperatively after keratoplasty (corneal transplant)? Select all that apply.

A. Do not use an ice pack on the eye. C. Avoid jogging and any other activity that promotes rapid or jerky head motions for several weeks after surgery. E. Report the presence of purulent discharge immediately to the surgeon. F. Examine the eye daily for the presence of infection or graft rejection.

How frequently will the nurse recommend a basic eye examination for a 50-year-old African-American client?

A. Every 2 to 4 years

What finding does the nurse anticipate when assessing a client with a new diagnosis of glaucoma?

A. Gradual loss of visual fields

Which supplement will the nurse recommend to a client who wishes to enhance eye health?

A. Lutein

Which interprofessional collaboration will the nurse seek to assist a client diagnosed with glaucoma to cope who expresses anxiety over the possibility of sight loss?

A. Mental health professional

Which error in refraction does the nurse recognize when a client reports difficulty seeing objects at a distance?

A. Myopia

Which assessment findings will the nurse consider normal when assessing a client's eyes? Select all that apply.

A. Nystagmus in the lateral gaze B. Presbyopia in a 35-year-old client C. Yellow sclera with small pigmented dots in a dark-skinned person

Which symptoms will the nurse teach the client who just had surgery to correct a retinal detachment to immediately report to the eye care provider? Select all that apply.

A. Pain in the affected eye* B. Pus in the affected eye* C. Decreased visual acuity*

Which assessment data does the nurse anticipate when a client presents to the emergency department reporting the sensation of a foreign body in the eye that started 30 minutes prior? Select all that apply.

A. Photophobia B. Blurred vision C. Pain D. Tearing

Which priority topics would the nurse teach the client and family for postoperative care after cataract surgery? Select all that apply.

A. Proper instillation of antibiotic and steroid ointments B. Remind the client that mild eye itching and "bloodshot appearance" is normal D. Use acetaminophen or aspirin for mild discomfort E. Report yellow or green drainage to the eye health care provider immediately F. Final best vision will not occur until 4 to 6 weeks after surgery

Which predisposing factors will the nurse ask about when taking a history of a client at risk for cataracts? Select all that apply.

A. Recent or past trauma to the eyes B. Presence of diabetes or hypertension D. Family history of cataracts E. Prolonged use of corticosteroids or beta blockers

With which specific interprofessional team member, would the nurse collaborate to manage a client's dry, age-related macular degeneration for which there is no cure?

A. Registered dietitian nutritionist

Which statements about vision testing of a client by the nurse are accurate? Select all that apply.

A. The Snellen eye chart measures distance vision. B. The light perception test determines if a client is unable to identify the presence or absence of light. D. Visual field testing determines the degree of a client's peripheral vision. E. Color vision is usually tested using Ishihara color plates. F. The six cardinal positions of gaze are used to assess muscle function.

Which priority instruction does the nurse teach a client with glaucoma who is prescribed eyedrops to decrease intraocular pressure (IOP)?

B. Perform punctal occlusion after using eyedrops for glaucoma therapy.

nystagmus

An involuntary and rapid twitching of the eyeball

Which assessment does the nurse use to determine if a client documentation will include PERRLA?

B. Assess size, shape, and reactivity of pupils.

To avoid harm after a scleral buckling procedure for retinal detachment, which instruction does the nurse provide the client?

B. Avoid reading, writing, and work that requires close vision in the first week after surgery.

Which finding does the nurse expect to see when examining a client with a mature cataract using an ophthalmoscope?

B. Bluish-white pupil

Which signs and symptoms will the nurse expect when a client is in the early stage of cataract development? Select all that apply.

B. Decreased color perception D. Blurred vision

Which first sign will the nurse expect when evaluating a client for primary open-angle glaucoma (POAG)?

B. Gradual loss of visual fields

What is the nurse's best response when a young athletic client who suffered a traumatic eye injury with enucleation states, "What's the point of learning about how to take care of this empty hole in my face?"

C. "You seem frustrated. Tell me about how this accident will affect your life."

What is the next management action the nurse expects when a client with glaucoma does not respond to prescribed eyedrops with a decrease in intraocular pressure (IOP)?

C. A laser trabeculoplasty

For which client situation will the nurse contact the eye health care provider immediately?

C. Client scheduled for MRI whose eye was injured by a piece of metal

When the medial rectus muscle is not functioning correctly, which eye movement will the nurse note the client has difficulty with?

C. Gazing in toward the nose

Which sign or symptom does the nurse expect when a client has early retinitis pigmentosa (RP)?

C. Night blindness

Which instruction will the nurse teach a client with bilateral eye infections and two bottles of the same antibiotic solution are prescribed?

C. Obtain both bottles and label one for the right eye and the other for the left eye.

keratoplasty

Corneal transplant. The surgical removal of diseased corneal tissue and replacement with tissue from a human donor cornea.

Which cranial nerve is the nurse assessing when asking a client to open and close the eyelids?

D. Cranial nerve VII (facial)

Which activities will the nurse instruct a client receiving discharge teaching after cataract surgery are acceptable?

D. Meal preparation and washing dishes are acceptable activities.

What priority information would the nurse include when documenting a client's intraocular pressure (IOP)?

D. Type and time of IOP measurement

Which specific priority teaching for eye protection will the nurse provide for a client who spends a great deal of time in the sun?

D. Use sunglasses that filter UV light when outdoors.

Which activity will the nurse expect a client with myopia to have difficulty with when he or she has forgotten to bring glasses to the hospital?

D. Watching the television

primary open-angle glaucoma (POAG)

The most common form of primary glaucoma; characterized by reduced outflow of aqueous humor through the chamber angle. Because the fluid cannot leave the eye at the same rate it is produced, intraocular pressure gradually increases.

glaucoma

a condition in the eye that occurs with increased pressure and resulting hypoxia of photoreceptors and their synapsing nerve fibers

cataract

a lens opacity that distorts the image projected onto the retina

arcus senilus

an opaque, bluish-white ring within the outer edge of the cornea

keratoconus

degeneration of the cornea

hyperopia

farsightedness

keratitis

inflammation of the cornea

myopia

nearsightedness

photophobia

sensitivity to light

enucleation

surgical removal of the entire eyeball