Chapter 47

The nurse is caring for four clients. Which has the highest risk for development of age-related macular degeneration (AMD)?

a. 25 year old, 70 inches tall, with fracture of the right femur. b. 38 year old, 71 inches tall, who has just given birth to a healthy baby. c. 45 year old, 67 inches tall, who is a vegetarian. d. 57 year old, 60 inches tall, with HTN. d.

How long should you wait in between eye drops if using more than one type of medication for glaucoma?

a. 3-4 minutes b. 20-25 minutes c. 5-10 minutes d. 15 minutes c. to prevent washing out or diluting another drug.

What are the late s/s of open-angle glaucoma?

a. gradual loss of visual fields b. mild eye aching or headaches c. seeing halos around lights d. losing peripheral vision e. decreased visual sensory perception that does not improve with glasses. c, d, e. The other options are early signs.

What are some refractive errors?

a. myopia b. hyperopia c. presbyopia, astigmatism. d. near-sighted with partial blindness e. far-sighted with full blindness a, b, c. a is near-sighted, b is far-sighted, c is age related loss of elasticity and inability to focus on an image.

What is dry age-related macular degeneration (AMD)?

a. no tear production b. gradual blockage of retinal capillaries, allowing retinal cells in the macula to become ischemic and necrotic. c. decreased vision, increased reddening of the eye, pain in the visual field. d. Vision loss related to environmental, sex, and age related factors b.

How do we treat cataracts?

a. nothing can be done b. surgery c. wear sunglasses d. all of the above b

Is it true that open-angle glaucoma affects only one eye?

a. true b. false b. it normally affects both eyes and has no s/s in the early stages

After recovery, the nurse provides postoperative teaching for the patient. Which statement by the patient indicates a need for further teaching?

A."I will wear dark sunglasses." B."Aspirin will help decrease discomfort." C."My daughter will help me if I need to lift something." D."My surgeon needs to know if I am experiencing reduced vision." b Aspirin should be avoided. Wearing dark sunglasses to protect the eye from light, avoiding lifting, and reporting reduction in vision are all accurate statements and do not require correction.

What priority teaching will the nurse provide to a patient who has received a corneal transplant?

A.Keep the eye moist. B.Watch the eye for signs of infection. C.Avoiding straining to have a bowel movement. D.Keep the eye covered for the first 24 hours postoperatively. c The patient should avoid activities that increase intraocular pressure (IOP) because they can interfere with corneal graft take. Activities such as straining to have a bowel movement, sneezing, coughing, vomiting, and bending over should be avoided. Other postoperative considerations include keeping the eye moist and covered with a protective eye patch, and daily assessment for signs of bleeding, infection, or graft rejection.

After seeing the ophthalmologist, the patient is scheduled for cataract surgery. What preoperative teaching should the nurse provide?

A.Remind him that immediately after surgery he will have his best vision. B.Tell him that after surgery he will no longer need to wear eyeglasses for reading. C.Instruct him that after surgery, different types of eye drops will be prescribed for 2 to 4 weeks. D.Caution him to avoid wearing dark glasses because the retina needs a direct source of light for best vision. c

Which postoperative outcome would the nurse anticipate for a patient who has undergone surgery for cataract removal?

A.Yellowish drainage and photophobia B.Mild itching and bloodshot appearance C.Pain early after surgery accompanied by nausea and vomiting D.Change in visual acuity accompanied by tearing and redness b Mild itching and bloodshot appearance are considered to be normal postoperative outcomes for this patient. Pain early after surgery may indicate increased intraocular pressure or hemorrhage. Change in visual acuity accompanied by tearing and redness and any yellowish drainage and photophobia can be signs of infection.

A 78-year-old patient tells the nurse that over the past 18 months he has noticed a decrease in visual acuity in his left eye. He states that he initially thought he had smudges on his eyeglasses, but when the cloudiness in his vision continued to develop, he saw his doctor who referred him to an ophthalmologist. Upon assessment, it was determined that he has a large cataract that requires surgical removal. The patient asks the nurse why the cataract only affected his left eye. What is the nurse's best response?

Both eyes may have cataracts, but the rate of progression in each eye is usually different.

The nurse is teaching a client who must instill multiple types of eyedrops before cataract surgery. Which client statement requires FURTHER teaching?

a. "I will make a schedule for inserting the eyedrops." b. "Touching the dropper to my eye could cause contamination and infection." c. If I cant remember when to take which drops, I'll just take them all at once." d. If I have trouble instilling the drops, I will have my spouse put them in for me." c.

What are some common causes of cataracts? (SATA).

a. age b. caused by trauma c. obesity d. sun exposure e. diabetes a, b, d, e

What assessment questions will we ask patients with suspected cataracts? (SATA).

a. ask about recent or past trauma to the eye. b. ask what their favorite activity is. c. ask if they have been exposed to any radioactive materials. d. any prolonged use of corticosteroids, beta blockers, or miotic drugs e. ask if they have pain in their eyes f. family hx or intraocular diseases a, c, d, f

What are the early signs of cataracts? (SATA).

a. blurred vision b. decreased color perception c. smudged eyeglasses feeling d. pain e. double vision b, c. The others are late signs of cataracts. Need regular eye exams.

The nurse is caring for a client who reports slow onset of a gradual loss of vision in the center of both eyes. The client describes vision as "foggy" and reports concerns of ongoing HA from "trying to concentrate to see." What condition does the nurse anticipate?

a. cataract b. glaucoma c. conjuntivitis d. retinal detachment b

Define cataracts.

a. decrease in IOP b. cloudy and blurring of the lens c. red-streaked sclera d. clear lens with pink streaks b

What is glaucoma characterized by?

a. decreased IOP b. increased IOP c. too much sugar in the urine d. too little protein in the blood b

How does macular degeneration occur?

a. deterioration of the macula (area of central vision). b. increased IOP c. Blurred or obstructed vision d. cornea can permanently lose its shape, become scarred, or cloudy. a. B is glaucoma, C. is cataracts, and D. is corneal opacities

A client is being discharged after surgery to correct a retinal detachment. Which symptoms will the nurse teach the client to immediately report to the eye doctor? (SATA).

a. purulent discharge in the affected eye. b. fever of 102 c. pupil that constricts in response to light. d. improved visual acuity. e. pain in the eye. a, b, e

What are the risk factors of AMD?

a. smokers, HTN, female and short-statured, fx, and long-term poor diet. b. non-smokers, CAD, males, and diet high in fats. c. High blood pressure, low o2, high RR, and low temp. d. All of the above a

What are some things to remember when caring for a patient with reduced vision?

a. speak loud and clear b. always knock and announce and introduce yourself. c. stand to the patient's side so they can see you peripherally. d. orient the patient to the environment e. remove clutter on the floor f. ask the patient their preferences on aid that they need such as help toileting, eating, or walking. b, d, e, f. Do not have problems hearing and standing in the peripheral visual field is for pts with macular degeneration.