NU272 Visual Impairment
A patient has just received carbachol (Miostat). Which statement indicates the patient understands the nurse's teaching about this medication?
"I should expect the medication to decrease pressure in my eye." Explanation: The medication is for glaucoma and should decrease pressure in the eye. The medication does not work on headaches and does not suppress the immune system, nor is it given by injection.
An older adult client is scheduled for outpatient cataract surgery. While taking a presurgery history, which statement by the client correlates to the manifestations of cataracts, thereby verifying the client has received information about the condition? "I have blurred vision in both my eyes and my vision is distorted." "I feel like I have a buildup of pressure in my eyeball." "I had intense eye pain coupled with photosensitivity." "One of my eyes has redness and purulent drainage."
"I have blurred vision in both my eyes and my vision is distorted." Explanation: Age-related cataracts, which are the most common type, are characterized by increasingly blurred vision and visual distortion. Symptoms of conjunctivitis include a foreign body sensation, a scratching or burning sensation, itching, and photophobia or light sensitivity. Severe pain suggests corneal rather than conjunctival disease. A discharge, or exudate, may be present. It is usually watery when the conjunctivitis is caused by allergy, a foreign body, or viral infection and it is usually mucopurulent (mucus mixed with pus) in the presence of bacterial or fungal infection. Trauma that causes abrasions of the cornea can be extremely painful. Glaucoma is a chronic, pressure-induced degenerative neuropathy that produces changes in the optic nerve and visual field loss.
The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided? "It's an overgrowth of retinal blood vessels." "This can be genetic or acquired." "The liquid inside the eye can't drain." "This is caused by silver nitrate."
"It's an overgrowth of retinal blood vessels." Explanation: The pathophysiology of ROP is one of injury to the developing blood vessels and tissues of the retina, and the healing process of regrowth or overgrowth of retinal vessels. Cataracts may be caused by genetics or may be acquired after birth. The inability of the aqueous humor to drain from the eye is a result of glaucoma. Silver nitrate 1% is an antibacterial prophylaxis that may cause conjunctivitis.
The nurse admits a client to the emergency department who has been referred by the eye clinic. Which condition is an emergency where the nurse should refer the client for medical treatment immediately? Acute angle-closure glaucoma Hordeolum Blepharitis Chalazion
Acute angle-closure glaucoma Explanation: Acute angle-closure glaucoma is an emergency where the nurse should refer the client for medical treatment immediately because vision may be permanently lost in 1 to 2 days. Treatment of a chalazion is not necessary if the cyst is small and does not interfere with vision. Occurrence of a hordeolum or blepharitis is not an emergency and may be treated with warm soaks or frequent washing of the eye.
A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat glaucoma. The nurse notes that the client's pilocarpine solution is cloudy. What should the nurse do first? Watch the client or a family member administer the drug to determine possible contamination sources. Advise the client to discard the drug because it may have undergone chemical changes or become contaminated. Advise the client to keep the container closed tightly and protected from light. Advise the client to obtain a fresh container of pilocarpine solution to avoid omitting ordered doses.
Advise the client to discard the drug because it may have undergone chemical changes or become contaminated. Explanation: A cloudy solution indicates that the drug has changed chemically or has become contaminated. Therefore, the nurse first should advise the client to discard the drug. Advising the client to obtain a fresh container of pilocarpine, watching the client or a family member administer the drug, and advising the client to keep the container closed tightly and protected from light are all appropriate actions to take after telling the client to discard the solution.
A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy? Stimulation of sphincters in her infant An increase in bronchial secretions in her infant An increase in airway resistance in her infant Cholinergic stimulation in her infant
Cholinergic stimulation in her infant Explanation: The therapy for closed-angle glaucoma should be continuously assessed for cholinergic stimulation in the patient's infant. If such stimulation occurs, the drug should be discontinued immediately. The assessment for cholinergic stimulation would include assessing for an increase in the airway resistance, bronchial secretions, and stimulation of sphincters; these are all cholinergic effects. It would not be advisable to assess only one of these factors. Therefore, assessing for cholinergic stimulation is the best answer.Glaucoma Explanation: In glaucoma, there is an abnormally high IOP. Cataracts occur when there is a clouding of the lens. Hyperopia is farsightedness. Myopia is nearsightedness.
A client has been diagnosed with bilateral cataracts associated with having difficulty seeing clearly. Reviewing the medication history, which drug may be responsible for the development of this condition? Ibuprofen Furosemide Corticosteroids Vitamin D
Corticosteroids Explanation: Cataracts can result from several medications. Corticosteroid drugs have been implicated as causative agents in cataract formation. Both systemic and inhaled corticosteroids have been cited as risk factors. Other drugs include phenothiazines, amiodarone, and strong miotic ophthalmic drugs.
A college junior calls his mother, a nurse, reporting "not being able to see." When questioned further, he describes the following: "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which condition and have the teenager go to the emergency department immediately? Glaucoma Retinal detachment Macular degeneration Strabismus
Retinal detachment Explanation: The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur as the vitreous pulls away from the posterior pole of the eye. As detachment progresses, the person perceives a shadow or dark curtain progressing across the visual field.
An older adult client comes to the clinic complaining of seeing flashing lights and small spots. The client tells the nurse that this has been going on for over 24 hours but now it is as if there is a dark curtain whenever the client opens the eyes. The client asks the nurse if this means that blindness is imminent. What diagnosis should the nurse suspect? Conjunctivitis Glaucoma Cataracts Retinal detachment
Retinal detachment Explanation: The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur. As the detachment progresses the person perceives a shadow or dark curtain across the visual field.
Altered sensory reception is a category of occurrences that can lead to sensory deprivation. Which scenario describes an example of altered sensory reception? A 35-year-old man was diagnosed and is being treated for tuberculosis. He has been in an isolation room for 1 week and is starting to get anxious. An 87-year-old woman is losing her eyesight. She is not able to leave her assisted living apartment without help. She is becoming more and more confused. A 2-month-old spends much of her day in a crib. Her mother suffers from postpartum depression and is not able to interact with the child except to change her diaper and feed her. The 2-month-old cries most of the day. A man has multiple sclerosis, a degenerative neuromuscular disease. Up until 1 year ago he was a very social person. Now, he is bedridden and cannot get out to see his friends. This dramatic change in his environment, from stimulating to asocial, is causing him to feel depressed.
The 87-year-old is experiencing altered sensory reception because her progressive blindness is limiting her visual cues. The other clients are experiencing sensory deprivation because they are immersed in deprived environments.
The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be: oral diuretics should be administered immediately. laser peripheral iridotomy is performed immediately. administration of topical beta-adrenergic antagonists to lower the pressure. to monitor vision for signs of closed-angle vision.
administration of topical beta-adrenergic antagonists to lower the pressure. Explanation: The elevation in intraocular pressure in persons with open-angle glaucoma is usually treated pharmacologically or, in cases where pharmacologic treatment fails, by increasing aqueous outflow through a surgically created pathway. Medication is generally administered topically.
A client is color blind. The nurse understands that this client has a problem with: aqueous humor. lens. cones. rods.
cones. Explanation: Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can't discriminate color. The lens is responsible for focusing images. Aqueous humor is a clear watery fluid and isn't involved with color perception.
A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should: teach about intraocular lens cleaning. provide instructions on eye patching. assess the client's visual acuity. demonstrate eyedrop instillation.
demonstrate eyedrop instillation. Explanation: Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma.
During a physical exam, the nurse practitioner notes that the client's optic disk is very pale with a larger size/depth of the optic cup. At this point, the NP is thinking that the client may have: retinal tear. glaucoma. macular degeneration. diabetes retinopathy.
glaucoma. Explanation: The normal optic disk has a central depression called the optic cup. With progressive atrophy of axons caused by increased intraocular pressure, pallor of the optic disk develops, and the size and depth of the optic cup increases. Diabetes retinopathy, macular degeneration, and retinal tear do not have these clinical manifestations.
Atropine sulfate is contraindicated as a preoperative medication for which client? A client with: diabetes. pyelonephritis. glaucoma. chronic obstructive pulmonary disease (COPD).
glaucoma. Explanation: Atropine is contraindicated in clients with glaucoma because it increases intraocular pressure. It is not contraindicated in clients with diabetes, pyelonephritis, or COPD.
When obtaining the health history from a client with retinal detachment, a nurse expects the client to report: headaches, nausea, and redness of the eyes. light flashes and floaters in front of the eye. a recent driving accident while changing lanes. frequent episodes of double vision.
light flashes and floaters in front of the eye. Explanation: The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea, and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts.
When obtaining the health history from a client with retinal detachment, a nurse expects the client to report frequent episodes of double vision. a recent driving accident while changing lanes. headaches, nausea, and redness of the eyes. light flashes and floaters in front of the eye.
light flashes and floaters in front of the eye. Explanation: The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea, and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts. Remediation:
A client has been diagnosed with open-angle glaucoma during a routine eye exam. The client has been prescribed a topical β-adrenergic antagonist. Client teaching about how this drug works should include which of the following statements? β-adrenergic antagonists: exert their effects by increasing the effects of acetylcholine, thereby increasing aqueous outflow through contraction of the ciliary muscle and pupillary constriction. reduce the secretion of aqueous humor. lower intraocular pressure by decreasing aqueous humor production. cause an early decrease in production of aqueous humor by constricting the vessels supplying the ciliary body.
lower intraocular pressure by decreasing aqueous humor production. Explanation: Topical β-adrenergic antagonists, which are thought to lower intraocular pressure by decreasing aqueous humor production, are usually the drugs of first choice. The α-adrenergic agonists cause an early decrease in production of aqueous humor by constricting the vessels supplying the ciliary body. Carbonic anhydrase inhibitors reduce the secretion of aqueous humor. Cholinergic drugs exert their effects by increasing the effects of acetylcholine (a postganglionic neurotransmitter in the parasympathetic nervous system) and increase aqueous outflow through contraction of the ciliary muscle and pupillary constriction.
Vitreous humor occupies the posterior portion of the eyeball. It is an amorphous biologic gel. When liquefaction of the gel occurs, as in aging, what can be seen during head movement? Blind spots Meshlike structures Floaters Red spots
Floaters Explanation: With the loss of gel structure, fine fibers, membranes, and cellular debris develop. When this occurs, floaters (images) can often be noticed because these substances move within the vitreous cavity during head movement. Blind spots, meshlike structures, and red spots are not seen during head movement with a loss of the gel structure of the vitreous humor.
The parents of a blind child are reporting to the nurse that they have noticed their child rocking and bouncing repetitively. The nurse can best explain those behaviors by stating: "Unfortunately there is nothing that can be done to stop him." "That's normal, all blind children do that." "Your child will never make friends acting like that!" "Those behaviors are called blindisms and may indicate your child is trying to communicate with you."
"Those behaviors are called blindisms and may indicate your child is trying to communicate with you." Explanation: Blind children may develop self-stimulatory actions to compensate for the lack of visual stimulation, called blindisms. Examples include pressing, rocking, spinning, bouncing, and head banging. They may indicate an effort to communicate but could also interfere with the child's socialization. Parents can be worked with to develop strategies for the development of alternative behaviors that might be helpful for the child.
It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye? 20/150 20/100 20/50 20/200
20/200 Explanation: Legal blindness is a condition of impaired vision in which a person has best corrected visual acuity that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20 degrees or less (Prevent Blindness America, 2012).
A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage? 0 to 5 mm Hg 6 to 10 mm Hg 11 to 20 mm Hg 21 mm Hg or higher
21 mm Hg or higher Explanation: Intraocular pressure of greater than 21 mm Hg is a sign of primary open-angle glaucoma.
A client presents to the clinic complaining, "I have something in my eye." When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed: Acute glaucoma Retinal detachment Conjunctivitis Corneal edema
Conjunctivitis Explanation: Conjunctivitis causes bilateral tearing, itching, burning, foreign body sensation, and morning eyelash crusting and eye redness. The primary symptom of retinal detachment is painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the field of vision, are early symptoms. Attacks of glaucoma (increased intraocular pressure) are manifested by ocular pain, excruciating headache, blurred or iridescent vision, and corneal edema with hazy cornea, dilated (mydriasis), and fixed pupil; with repeated or prolonged attacks, the eye becomes reddened. With corneal edema, the cornea appears dull, uneven, and hazy; visual acuity decreases; and iridescent vision (i.e., rainbows around lights) occurs.
A 15-year-old child with type 1 diabetes asks nurse about the potential to "lose sight." Which response would be the most appropriate? Reassure the client that only type 2 diabetes is a risk factor for blindness. Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels. Tell the client to expect that eyesight loss will likely begin gradually by the age of 25. Tell the client there is about a 50% chance of suffering some diabetes-related sight loss by the age of 50
Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels. Explanation: The types of microvascular complications that occur in diabetes mellitus can include neuropathy, retinopathy, nephropathy, and disorders of gastrointestinal motility. In the United States, diabetes is a leading cause of vision loss and blindness as well as chronic kidney disease. Pregnancy, puberty, and cataract surgery can accelerate these changes.
A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate? Administer the medication immediately. Refer the patient to the emergency department. Explain the therapeutic effect and expected outcome of the medication. Talk with the doctor about switching to a different glaucoma medication.
Explain the therapeutic effect and expected outcome of the medication. Explanation: The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.
From which direction should a nurse approach a client who is blind in the right eye? From the right side of the client From directly in front of the client From directly behind the client From the left side of the client
From the left side of the client Explanation: The nurse should approach the client from the left side so that the client can be aware of the nurse's approach. Likewise, personal items should be placed on the client's left side so that he can see them easily.
The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor that fills the anterior and posterior chambers of the eye. What is this disease called? Cataract Retinopathy Glaucoma Amblyopia
Glaucoma Explanation: Glaucoma is a chronic degenerative optic neuropathy characterized by optic disk cupping and visual field loss. It is usually associated with an elevation in intraocular pressure. Amblyopia is lazy eye. Retinopathy is a disorder of the retinal vessels that interrupts blood flow to the visual receptors leading to visual impairment. A cataracts is a lens opacity that interferes with the transmission light to the retina.
The nurse is caring for an older adult client that recently lost total vision in both eyes due to macular degeneration. Which interventions will the nurse add to the client's plan of care to assist with the with vision loss? Choose all that apply. Clear the room of clutter and do not rearrange furnishings. Acknowledge presence when entering the room. Hold tightly to the client's arm during ambulation. Speak in a louder tone than usual. Orient to sounds in the immediate environment. Inform the client when the nurse is leaving the room
Inform the client when the nurse is leaving the room Acknowledge presence when entering the room. Clear the room of clutter and do not rearrange furnishings. Orient to sounds in the immediate environment. Explanation: When communicating with clients with reduced vision, the nurse should follow these guidelines: acknowledge presence in the client's room, identify oneself by name, speak in a normal tone of voice, remember that the blind person is unable to pick up most nonverbal cues during communication, explain the reason for touching the person before doing so, keep the call light or bell within easy reach of the person and place the bed in the lowest position, orient the person to sounds in the environment, orient the person to the arrangement of the room and its furnishings, clear pathways for the person and do not rearrange furnishings and clarify this fact with housekeeping personnel, assist with ambulation by walking slightly ahead of the person, allowing the person to grasp nurse's arm, stay in the person's field of vision if she has partial or reduced peripheral vision, provide diversions using other senses, and indicate to the person when the conversation has ended and leaving the room.
An older adult in an assisted care facility with documented presbyopia has lost his or her glasses. The nurse should instruct unlicensed assistive personnel that the client will need assistance with tasks that involve which part of sight? Near vision Depth perception Color distinction Far vision
Near vision Explanation: Presbyopia involves difficulty focusing on near objects. It is common in older adults and is caused by decreased elasticity of the lens and atrophy of the ciliary muscle. The nurse should instruct unlicensed assistive personnel to assist the client with tasks involving near vision. In hyperopia, or farsightedness, the image theoretically falls behind the retina. Disparity between the laterally displaced images seen by the two eyes provides a powerful source to three-dimensional depth perception for objects within a distance of 100 ft (30 m). Color blindness is inherited as an X-linked deficiency of a specific type of retinal photoreceptor.
The spouse of a blind client calls the nurse practitioner to ask what is causing the client such a difficult time sleeping and what can be done. What might the client be suffering from, and which would be the most accurate response? Chronic insomnia; use bright light therapy prior to sleep. Obstructive sleep apnea; administer melatonin daily. Free-running sleep disorder; get a prescription for a sleep aid. Non-24 hour sleep-wake syndrome; regulate wake and sleep times.
Non-24 hour sleep-wake syndrome; regulate wake and sleep times. Explanation: Sleep-wake cycle disturbance is a circadian rhythm disorder and is a common problem for people who are blind. This disturbance is classified as free-running sleep disorder (FRSD) or non-24 hour sleep-wake syndrome. Treatments include regulating the sleep-wake times, bright light therapy, and melatonin.
A legally blind client is in pre-op area prior to an appendectomy. What steps does the nurse take to effectively communicate with this client ? Sit near the client to provide reassurance of the strange surroundings. Notify the client prior to touching the client. Inform the client that the nurse will be working nearby. Make direct eye contact with the client when communicating.
Notify the client prior to touching the client. Explanation: The nurse should announce upon arrival the bedside every time because many voices sound similar. The nurse should use the client's name initially so the client knows the nurse is communicating with the client directly. The nurse should speak before touching the client as not to startle the client. The nurse should notify the client when approaching and leaving the bedside each time. Orient the client to their surroundings using verbal descriptions and directions such as left, or right.
A client has glaucoma. The nurse is taking a health history and knows that the most common form of glaucoma is which type? Infantile Congenital Angle closure Open angle
Open angle Explanation: Open-angle glaucoma is the most common form of glaucoma, and is usually asymptomatic and chronic, causing progressive damage to the optic nerve and visual field loss unless it is appropriately treated. Angle-closure glaucoma usually occurs as the result of an inherited anatomic defect that causes a shallow anterior chamber. There are several types of childhood glaucoma, including congenital glaucoma that is present at birth and infantile glaucoma that develops during the first 2 to 3 years of li
There are four major types of ophthalmic procedures to complete a glaucoma examination. If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for: Gonioscopy. Perimetry. Tonometry. Ophthalmoscopy.
Ophthalmoscopy. Explanation: Four major types of examinations are used in glaucoma evaluation, diagnosis, and management: tonometry to measure the IOP, ophthalmoscopy to inspect the optic nerve, gonioscopy to examine the filtration angle of the anterior chamber, and perimetry to assess the visual fields.
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? Glaucoma Presbycusis Cataract Presbyopia
Presbyopia Explanation: Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.
A client who is legally blind must undergo a colonoscopy. The nurse is helping the healthcare provider obtain informed consent. When obtaining informed consent from a client who is visually impaired, the nurse should take which step? Make sure the client's family is present when the consent form is signed. Document on the consent form that the client is unable to sign the consent because of being legally blind. Contact the client's nearest relative to obtain consent. Read the consent form to the client and ask if there are any questions.
Read the consent form to the client and ask if there are any questions. Explanation: The nurse should read the consent form to the client and make sure that the client understands all the information. The healthcare provider should answer any questions the client has before the consent form is signed. The client's family doesn't need to be present, and there is no need to contact the client's closest relative. A client who is legally blind may sign the consent form.
The nurse is conducting an assessment of an elderly client who is blind. What would the nurse expect to be present in the client's medical history? systemic lupus erythematosus cancer diabetes mellitus cerebrovascular accident
diabetes mellitus Explanation: Type 2 diabetes is very prevalent, especially in the elderly. Diabetic retinopathy is the primary cause of blindness through destruction of retinal blood vessels. The other conditions, while they may be associated with blindness, are not common causes of blindness.
The nurse is caring for a client who has been diagnosed with both Parkinson's disease and narrow-angle glaucoma. What medication should cause the nurse concern? gabapentin phenytoin levodopa amantadine
levodopa Explanation: Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. The other listed medications are not necessarily contraindicated.
After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms? angle-closure glaucoma chalazion eye trauma retinal detachment
retinal detachment Explanation: A detached retina is associated with a hole or tear in the retina caused by stretching or degenerative changes. Retinal detachment may follow a sudden blow, penetrating injury, or eye surgery.
A client who experiences constant cloudiness of vision, sees floaters, and has an opaque lens is diagnosed with a cataract. The most appropriate treatment would be: wearing bifocal lenses to strengthen vision. surgical lens replacement to correct vision. patching the affected eye until vision returns. daily application of pilocarpine eye drops.
surgical lens replacement to correct vision. Explanation: Although strong bifocal lenses, magnification, appropriate lighting, and visual aids may help, surgery is the only treatment for cataract.