Ch 44 Assessing and Caring for Clients with Eye and Visual Disorders

8. The client has a disorder that causes the lens or its capsule to lose its transparency or become opaque. The nurse is aware that the client has which of the following conditions? a. cataract b. chalazion c. glaucoma d. keratitis

ANS: A A cataract occurs when the lens or its capsule loses its transparency; it becomes cloudy, and visual impairment results. Cataracts are usually associated with aging. Treatment is surgical removal of the lens and implantation of an intraocular lens when significant visual loss has occurred. Most eye surgery is performed under local anesthesia on an outpatient basis. The client must have a driver available to provide transportation home.

9. The client asks the nurse "What is the most common cause of cataracts?" The BEST response by the nurse would be: a. "Cataracts occur as a result of aging." b. "Cataracts occur as a result of congenital defects." c. "Cataracts occur as a result of systemic diseases characterized by metabolic problems." d. "Cataracts occur as a result of uveitis."

ANS: A A cataract occurs when the lens or its capsule loses its transparency; it becomes cloudy, and visual impairment results. Cataracts are usually associated with aging. Treatment is surgical removal of the lens and implantation of an intraocular lens when significant visual loss has occurred. Most eye surgery is performed under local anesthesia on an outpatient basis. The client must have a driver available to provide transportation home.

20. The client is experiencing a cyst of the meibomian glands. The nurse is aware that the client is experiencing a: a. chalazion b. benign ocular tumor c. ciliary body d. sty

ANS: A A chalazion is a cyst of the meibomian glands.

25. How are refractory disorders MOST commonly corrected? a. corrective lenses b. ocular muscle training c. laser photocoagulation d. radial keratotomy

ANS: A Refractive errors, the incorrect bending of light rays to focus on the retina, result in changes in visual acuity. This is corrected by prescription lenses or contact lenses, which bend the light rays correctly on the retina.

24. In which refractive disorder do the refractive surfaces of the eye have unequal curvatures that create visual distortion? a. astigmatism b. hyperopia c. myopia d. strabismus

ANS: A Refractive errors, the incorrect bending of light rays to focus on the retina, result in changes in visual acuity. When the refractive surfaces of the eye have unequal curvatures that create visual distortion, it is considered astigmatism. This is corrected by prescription lenses or contact lenses, which bend the light rays correctly on the retina.

1. What is the name of the outer coat of the eyeball composed posteriorly of the sclera and anteriorly of the transparent cornea? a. fibrous tunic b. nervous tunic c. orbital tunic d. vascular tunic

ANS: A The eye is the sensory receptor of the visual system that transduces light from the environment into electrical impulses, which the optic nerve then transmits to the brain to be interpreted as vision. The fibrous tunic is the outer coat of the eyeball composed posteriorly of the sclera and anteriorly of the transparent cornea.

4. Which receptors within the nervous tunic allow color vision? a. cones b. fovea c. macula lutea d. rods

ANS: A The two types of receptors are rods, for vision in dim light, and cones, for daytime or color vision.

1. A nurse has just taken a position in an ophthalmologist's office and she will be screening client's for glaucoma. Which of the following are important for the nurse to know as risk factors for glaucoma? (Select all that apply.) a. elevated intraocular pressure b. any person over 60 years of age c. ethnic background d. nutritional history e. familial history f. individuals with farsightedness g. prolonged use of anti-inflammatories

ANS: A, B, C, E The risk factors for glaucoma include: elevated intraocular pressure, any individual over 60 years of age, ethnic background, familial history with possible genetic link, history of diabetes and hypothyroidism, eye conditions - retinal detachment, eye tumors, eye inflammations; individuals with nearsightedness, and extensive use of corticosteroids.

2. The client is diagnosed with retinal detachment. Which of the following would NOT allow the surgeon to be able to visualize the retinal tear? (Select all that apply.) a. scleral buckling b. retinal scarring c. jaundice d. vitreous cloudiness e. absence of vitreous

ANS: A, B, D Factors that would not allow the surgeon to be able to visualize the retinal tear include scleral buckling, retinal scarring, and vitreous cloudiness. Sections of the vitreous are removed to allow visualization.

23. In which refractive disorder is the refractive system weak or the eyeball flattened, causing vision beyond 20 feet to be normal but poor at close range? a. astigmatism b. hyperopia c. myopia d. strabismus

ANS: B Refractive errors, the incorrect bending of light rays to focus on the retina, result in changes in visual acuity. When the eyeball is flattened, causing vision beyond 20 feet to be normal but poor at close range, it is considered hyperopia. This is corrected by prescription lenses or contact lenses, which bend the light rays correctly on the retina.

11. A client with cataracts has a nursing diagnosis of Risk for injury related to difficulty in processing visual images and altered depth perception. The MOST appropriate goal for this diagnosis is that the client will: a. accept wearing glasses or contact lenses b. avoid activities associated with increased potential for injury c. demonstrate improved ability to process visual stimuli and communicate visual limitations d. discuss the impact of vision loss on lifestyle

ANS: B A cataract occurs when the lens or its capsule loses its transparency; it becomes cloudy and visual impairment results. Cataracts are usually associated with aging. Treatment is surgical removal of the lens and implantation of an intraocular lens when significant visual loss has occurred.

7. The client is seeing a specialist who is a medical doctor specializing in the diagnosis and medical and surgical treatment of diseases of the eye, visual disorders, and eye injuries. The nurse explains that the client will be seeing an: a. oculist b. ophthalmologist c. optometrist d. otolaryngologist

ANS: B An ophthalmologist is a medical doctor who specializes in the diagnosis and medical and surgical treatment of diseases of the eye, visual disorders, and eye injuries.

15. 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.

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

3. The innermost "tunic" of the eye is also called the: a. sclera b. retina c. orbit d. iris

ANS: B The innermost tunic of the eye is the retina which translates light waves into neural impulses.

2. The nurse is caring for an infant with brown eyes and recalls that which portion of the vascular tunic is responsible for the color of the eye? a. cornea b. iris c. retina d. sclera

ANS: B The portion of the vascular tunic that contains the pigment responsible for the color of the eye is the iris.

21. Which intervention is essential when caring for a client who has conjunctivitis of bacterial origin? a. Wear gloves when assisting the client with personal care. b. Discard linens after use by the client. c. Perform proper hand hygiene by the nurse and client. d. Remove all possible allergens (such as flowers) from the client care area.

ANS: C Conjunctivitis is an inflammation of the conjunctiva resulting from invasion by bacterial, viral, or rickettsial organisms, and causing pain and redness. When caused by bacterial organisms, nursing interventions should include performing proper hand hygiene by the nurse and client to prevent transmission.

14. The main objective of the medical management of glaucoma is to: a. correct visual abnormalities b. prevent postsurgical infection c. reduce intraocular pressure d. relieve pain

ANS: C Drug therapy to reduce intraocular pressure is the usual treatment. Surgery to facilitate drainage of the aqueous humor may be necessary.

27. 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

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

12. The client is diagnosed with a disorder that is characterized by an abnormally high pressure of fluid within the eyeball. The nurse is aware that this condition is: a. cataracts b. chalazion c. glaucoma d. keratitis

ANS: C In glaucoma, the aqueous humor accumulates and compresses the lens into the vitreous humor, putting pressure on the neurons of the retina. Continuous pressure over time destroys the neurons and causes blindness.

18. When caring for a client, the nurse notes inflammation of the cornea associated with irritation or allergies. Which of the following would the nurse suspect is associated with irritation or allergies? a. chalazion b. glaucoma c. keratitis d. conjunctivitis

ANS: C Infections of the eye include keratitis, sty, chalazion, and conjunctivitis. An antibiotic ointment or solution is generally prescribed. Proper hand-washing is extremely important in avoiding the occurrence or spread of these infections.

28. The loss of central vision interferes with the client's ability to: a. walk b. perform activities of daily living (ADLs ) c. read and write d. recognize colors

ANS: C Macular degeneration is the atrophy or deterioration of the macula (the point on the retina where the light rays meet). The client loses central vision; that is, there is a dark hole in the center of vision, making it difficult for the client to read and write. This is usually associated with aging. The client moves the head slightly to use peripheral vision to see.

26. When a person has experienced a chemical exposure or burn to the conjunctiva or cornea, which action should be taken immediately? a. Apply an eye patch to the affected eye. b. Administer fluorescein drops to the affected eye. c. Perform lavage on the eye with tap water. d. Neutralize the chemical.

ANS: C Priority care for the chemical exposure or burn to the conjunctiva or cornea requires immediate lavage on the eye with tap water. Injury to the eye requires immediate attention by an ophthalmologist.

22. In which refractive disorder is the eyeball elongated, causing normal near vision but poor distant vision? a. astigmatism b. hyperopia c. myopia d. strabismus

ANS: C Refractive errors, the incorrect bending of light rays to focus on the retina, result in changes in visual acuity. When the eyeball is elongated, causing normal near vision but poor distant vision, it is considered myopia. This is corrected by prescription lenses or contact lenses, which bend the light rays correctly on the retina.

6. The nurse is aware that the proper name of the "blind spot," which lacks photoreceptors and does not detect light focused on it, is the: a. fovea b. macula lutea c. optic disk d. retina

ANS: C The optic disk, or "blind spot," lacks photoreceptors and does not detect light focused on it.

10. The nurse anticipates treatment for cataracts to be: a. administration of medications that enhance pupillary constriction b. cryotherapy c. iridectomy d. surgical removal of the lens

ANS: D A cataract occurs when the lens or its capsule loses its transparency; it becomes cloudy, and visual impairment results. Cataracts are usually associated with aging. Treatment is surgical removal of the lens and implantation of an intraocular lens when significant visual loss has occurred. Most eye surgery is performed under local anesthesia on an outpatient basis. The client must have a driver available to provide transportation home.

19. The client is experiencing a pustular inflammation of the eyelash follicle or sebaceous gland on the lid margin that is commonly caused by staphylococcal organisms. The nurse explains to the client that this is: a. a chalazion b. conjunctivitis c. keratitis d. a sty

ANS: D A sty is a pustular inflammation of the eyelash follicle or sebaceous gland on the lid margin that is commonly caused by staphylococcal organisms.

13. Which statement about open-angle glaucoma is TRUE? a. The gradual rise in intraocular pressure causes rapid loss of vision. b. It is usually unilateral. c. The condition is seldom painful. d. It is the most prevalent form of glaucoma.

ANS: D Open-angle glaucoma is the most common type of glaucoma characterized by a gradual rise in intraocular pressure, slow, progressive loss of peripheral vision, a loss of central vision, and eventually blindness.

17. Which treatment may be used for surgical correction of a retinal detachment? a. cryotherapy b. electrodiathermy c. laser photocoagulation d. scleral buckling

ANS: D Retinal detachment is a separation of the retina from the choroid. If the detachment is complete, the result is total loss of vision. It is a painless condition. Several procedures can be used to create an inflammatory reaction that reattaches the retina to the choroid, one of which is scleral buckling.

16. A client tells the nurse about experiencing sudden flashes of light, blurred vision, and floating spots. The nurse should recommend that the client seek evaluation by a health care provider for which condition? a. cataracts b. glaucoma c. keratitis d. retinal detachment

ANS: D Retinal detachment is a separation of the retina from the choroid. If the detachment is complete, the result is total loss of vision. It is a painless condition. Several procedures can be used to create an inflammatory reaction that reattaches the retina to the choroid.

5. The nurse notes that which type of receptor increases in density toward the periphery of the retina and allows vision in dim light? a. cones b. fovea c. macula lutea d. rods

ANS: D The two types of receptors are: rods for vision in dim light, and cones for daytime or color vision.