143 Module 9 - Eye Problems (PRACTICE QUESTION)

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is: A. Reporting that a straight line appears crooked. B. The abrupt onset of symptoms. C. Reporting that letters in words appear broken. D. The appearance of tiny, yellow spots in the field of vision.

The test bank says "D" is the correct answer, but I don't think the patient can see the drusen spots in their field of vision. I think "A" is a better answer, because it references the Amsler grid test.

A family member of a client diagnosed with macular degeneration asked the nurse about ways to prevent the disease. Which of these options should the nurse include? Select all that apply. A) Do not smoke B) Eat a healthy diet C) Take ARED vitamins D) Sustain a healthy weight E) Keep blood pressure under control

A, B, C, D, E. Macular degeneration can be prevented or slowed if the client catches the problem early. Regular scheduled eye exams are essential; the client should not smoke; eat a healthy diet; take the ARED vitamins; sustain a healthy weight; and keep blood pressure and any other diseases under control. Macular degeneration is age-related. Smoking does increase the client's risk for developing macular degeneration. Clients who smoke will likely develop the disease around 10 years sooner than others who never smoked a cigarette or used tobacco. Eating a healthy diet high in green leafy veggies, orange and yellow fruits, whole grains and fish are recommended.Sustaining a healthy weight is important because obesity contributes to developing macular degeneration. Take Age-Related Eye Disease (AREDS) vitamins. AREDS formulation may decrease the possibility of developing the disease. Vitamin A is essential for retinal pigment cells and vitamins C and E function as antioxidants. Blood pressure and other disease processes should be controlled to prevent this disease. It is important to exercise routinely. Wear sunglasses and hats when out in the sun to protect the eyes.

A novice nurse asks the emergency room nurse how to know if a client has closed-angle glaucoma. Which symptoms are most associated with closed angle glaucoma? Select all that apply. A) Nausea and vomiting B) Gradual onset eye pain C) Sudden headache D) Unilateral facial droop E) Central vision loss

A, C. Closed-angle glaucoma is sudden onset of intraocular pressure that occurs when there is closure or blockage of drainage between the iris and cornea causing pressure to build up in the eye where fluid has accumulated and cannot circulate throughout the eye. The trabecular network becomes obstructed and damaged. Symptoms may include nausea, vomiting, sudden headache, extreme eye pain, and blurred vision. Closed-angle glaucoma is like closing a door suddenly with your fingers inside. The client may see halos surrounding lights. Symptoms are sudden and severe and a medical emergency, so the health care provider (HCP) should be notified immediately.

Which type of glaucoma presents an ocular emergency? A. Acute angle-closure glaucoma B. Normal tension glaucoma C. Chronic open-angle glaucoma D. Ocular hypertension

A. Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added at a later time.

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client? A. Amsler grid B. Slit lamp C. Visual field D. Ishihara polychromatic plates

A. Clients with macular problems are tested with an Amsler grid. It is made up of a geometric grid of identical squares with a central fixation point. The examiner instructs the client to stare at the central fixation spot on the grid and report if they see any distortion of the squares. Clients with macular problems may say some of the squares are faded or wavy. An Ishihara polychromatic plate, visual field, or slit lamp test will not diagnose macular degeneration.

An independent client with bilateral macular degeneration is preparing to eat lunch. Where should the nurse place the client's food tray? A) Place the client's tray to the periphery of his visual field B) Place the client's tray in the center of his visual field C) Place the client's tray to the center right of his visual field D) Place the client's tray to the center left of his visual field

A. Macular degeneration is caused by damage to the center of the retina called the macula. Clients may experience blurred central vision and the inability to see small details while reading. A client with bilateral macular degeneration who is independent should have the food tray placed to the periphery of his visual field. Central vision is blurred so the client should not have anything placed in his central vision. The nurse should stand and talk to the client on his peripheral side of his visual field.

A nurse is teaching a client with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the client to perform what action? A. Instill the medication in the conjunctival sac. B. Maintain a supine position for 10 minutes after administration. C. Keep the eyes closed for 1 to 2 minutes after administration. D. Apply the medication evenly to the sclera

ANS: A Rationale: Eye drops should be instilled into the conjunctival sac, where absorption can best take place, rather than distributed over the sclera. It is unnecessary to keep the eyes closed or to maintain a supine position after administration.

The nurse is admitting a 55-year-old client diagnosed with a left eye retinal detachment. While assessing this client, what characteristic symptom would the nurse expect to find? A. Flashing lights in the visual field B. Sudden eye pain C. Loss of color vision D. Colored halos around lights

ANS: A Rationale: Flashing lights in the visual field is a common symptom of retinal detachment.Clients may also report spots or floaters or the sensation of a curtain being pulled across the eye. Retinal detachment is not associated with eye pain, loss of color vision, colored halos around lights.

The nurse should recognize the greatest risk for the development of blindness in which of the following clients? A. A 58-year-old Caucasian woman with macular degeneration B. A 28-year-old Caucasian man with astigmatism C. A 58-year-old black woman with hyperopia D. A 28-year-old black man with myopia

ANS: A Rationale: The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. The 58-year-old Caucasian woman with macular degeneration has the greatest risk for the development of blindness related to her age and the presence of macular degeneration. Individuals with hyperopia, astigmatism, and myopia are not in a risk category for blindness.

The nurse on the medical-surgical unit is reviewing discharge instructions with a client who has a history of glaucoma. The nurse should anticipate the use of what medications? A. Potassium-sparing diuretics B. Cholinergics C. Antibiotics D. Loop diuretics

ANS: B Rationale: Cholinergics are used in the treatment of glaucoma. The action of this medication is to increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis and opening the trabecular meshwork. Diuretics and antibiotics are not used in the management of glaucoma.

A client has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the client should be kept in a prone position until otherwise ordered. What should the nurse do? A. Clarify the order with the surgeon. B. Follow the order because this bed position is correct. C. Reposition the client after the first dressing change. D. Ask the client to lie in a semi-Fowler position.

ANS: B Rationale: For care of the client after surgical retina detachment repair, postoperative positioning of the client is critical because the injected bubble must float into a position overlying the area of detachment, providing consistent pressure to reattach the sensory retina. The client must maintain a prone position that would allow the gas bubble to actas a tamponade for the retinal break. Clients and family members should be made aware of these special needs beforehand so that the client can be made as comfortable as possible. It would be inappropriate to deviate from this order and there is no obvious need to confirm the order.

A client has been diagnosed with glaucoma and the nurse is preparing health education regarding the client's medication regimen. The client states that eagerness to beat this disease and looks forward to the time that the client will no longer require medication. How should the nurse best respond? A. You have a great attitude. This will likely shorten the amount of time that you need medications. B. In fact, glaucoma usually requires lifelong treatment with medications. C. Most people are treated until their intraocular pressure goes below 50 mm Hg. D. You can likely expect a minimum of 6 months of treatment.

ANS: B Rationale: Glaucoma requires lifelong pharmacologic treatment. Normal intraocular pressure is between 10 and 21 mm Hg.

When administering a client's eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal? A. Ensure that the client is well hydrated at all times. B. Encourage self-administration of eye drops. C. Occlude the puncta after applying the medication. D. Position the client supine before administering eye drops.

ANS: C Rationale: Absorption of eye drops by the nasolacrimal duct is undesirable because of the potential systemic side effects of ocular medications. To diminish systemic absorption and minimize the side effects, it is important to occlude the puncta. Self-administration,supine positioning, and adequate hydration do not prevent this adverse effect.

The nurse is assessing a new adult client. What characteristic of this client's status should the nurse identify as increasing the client's risk for glaucoma? A. The client uses over-the-counter NSAIDs. B. The client has a history of stroke. C. The client has diabetes. D. The client has Asian ancestry.

ANS: C Rationale: Diabetes is a risk factor for glaucoma, but Asian ancestry, NSAIDs, and stroke are not risk factors for the disease.

A client has informed the home health nurse that he/she has recently noticed distortions when looking at the Amsler grid that is mounted on the refrigerator. What is the nurse's most appropriate action? A. Reassure the client that this is an age-related change in vision. B. Arrange for the client to have his/her visual acuity assessed. C. Arrange for the client to be assessed for macular degeneration. D. Facilitate tonometry testing.

ANS: C Rationale: The Amsler grid is a test often used for clients with macular problems, such as macular degeneration. Distortions would not be attributed to age-related changes and there is no direct need for testing of intraocular pressure or visual acuity.

An older adult client has been diagnosed with macular degeneration and the nurse is assessing for changes in visual acuity since last visit. When assessing the client for recent changes in visual acuity, the client states that the lines on an Amsler grid as being distorted. What is the nurse's most appropriate response? A. Ask if the client has been using OTC vasoconstrictors. B. Instruct the client to repeat the test at different times of the day when at home. C. Arrange for the client to visit an ophthalmologist . D. Encourage the client to adhere to prescribed drug regimen.

ANS: C Rationale: With a change in the client's perception of the grid, the client should notify the ophthalmologist immediately and should arrange to be seen promptly. This is a priority over encouraging drug adherence, even though this is also important. Vasoconstrictors Are not a likely cause of this change and repeating the test at different times is not relevant.

The nurse is administering eye drops to a client with glaucoma. After instilling the client's first medication, how long should the nurse wait before instilling the client's second medication into the same eye? A. 30 seconds B. 1 minute C. 3 minutes D. 5 minutes

ANS: D Rationale: A 5-minute interval between successive eye drop administrations allows for adequate drug retention and absorption. Any time frame less than 5 minutes will not allow adequate absorption.

A client with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education? A. Risk factors for postoperative cytomegalovirus (CMV) B. Compensating for vision loss for the next several weeks C. Nonpharmacologic pain management strategies D. Signs and symptoms of increased intraocular pressure

ANS: D Rationale: Clients must be educated about the signs and symptoms of complications,particularly of increasing IOP and postoperative infection. CMV is not a typical complication and the client should not expect vision loss. Vitreoretinal procedures are not associated with high levels of pain.

The public health nurse is addressing eye health and vision protection during an educational event. What statement by a participant best demonstrates an understanding of threats to vision? A. I'm planning to avoid exposure to direct sunlight on my next vacation. B. I've never exercised regularly, but I'm going to start working out at the gym daily. C. I'm planning to talk with my pharmacist to review my current medications. D. I'm certainly going to keep a close eye on my blood pressure from now on.

ANS: D Rationale: Hypertension is a major cause of vision loss, exceeding the significance of inactivity, sunlight, and adverse effects of medications.

A client is ready to be discharged home after a cataract extraction with intraocular lens implant and the nurse is reviewing signs and symptoms that need to be reported to the ophthalmologist immediately. Which of the client's statements best demonstrates an adequate understanding? A. I need to call the doctor if I get nauseated. B. I need to call the doctor if I have a light morning discharge. C. I need to call the doctor if I get a scratchy feeling. D. I need to call the doctor if I see flashing lights.

ANS: D Rationale: Postoperatively, the client who has undergone cataract extraction with intraocular lens implant should report new floaters in vision, flashing lights, decrease invision, pain, or increase in redness to the ophthalmologist. Slight morning discharge and scratchy feeling can be expected for a few days. Blurring of vision may be experienced for several days to weeks.

A client is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this client's care? A. Antioxidant supplements, vitamin C and E, beta-carotene, and selenium B. Eyeglasses or magnifying lenses C. Corticosteroid eye drops D. Surgical intervention

ANS: D Rationale: Surgery is the treatment option of choice when the client's functional and visual status is compromised. No nonsurgical (medications, eye drops, eyeglasses)treatment cures cataracts or prevents age-related cataracts. Studies recently have found no benefit from antioxidant supplements, vitamins C and E, beta-carotene, or selenium.Corticosteroid eye drops are prescribed for use after cataract surgery; however, they increase the risk for cataracts if used long-term or in high doses. Eyeglasses and magnification may improve vision in the client with early stages of cataracts, but have limitations for the client with impaired functioning.

Which intervention will the registered nurse (RN) educate the mother to implement in the care of her child diagnosed with conjunctivitis? Select all that apply. A) Clean the eye from the outer to inner canthus four times daily B) Apply warm or cool compresses to the eye for comfort as needed C) Correct technique for eye drop instillation and frequency D) Importance of handwashing before and after instilling eye drops E) Clean the eye from the inner to outer canthus four times daily

B, C, D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. For this reason it is imperative that strict hand washing be implemented before and after instilling eye drops. It is equally important to avoid touching the eye drop dispenser to the eye and implement the correct administration technique. Warm or cool compresses applied frequently throughout the day can reduce discomfort. Cleansing the eye from clean to dirty (inner to outer canthus) can help prevent the spread of the infection.

While providing care for a 12-year old child diagnosed with conjunctivitis, which clinical manifestation will the registered nurse (RN) anticipate assessing? Select all that apply. A) Report of excessive blinking of the affected eye B) Redness of the conjunctiva of the affected eye C) Report of itchiness of the affected eye D) Purulent discharge from the affected eye E) Report of crustiness of the affected eye after sleeping

B, C, D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. The clinical manifestations may vary depending upon the cause of the infection. The generalized presentation includes erythema, pruritus, edema, and purulent drainage from the affected eye. There is also a development of cutaneous crust on the outer aspect of the eye after prolonged eye closing.

A nurse is assessing a client who was diagnosed with macular degeneration. Which of these symptoms would the nurse expect the client would be experiencing? Select all that apply. A) Clear central vision B) Blurred central vision C) Blurred peripheral vision D) Inability to see small details E) Clarity of precise details when reading

B, D. Macular degeneration is caused by damage to the center of the retina called the macula. The macula maintains the sharpest vision. Clients may experience blurred central vision and the inability to see small details while reading. Blurred peripheral vision may be caused by glaucoma. Clear vision and clarity of precise details when reading is the goal for all clients. Blood vessels may leak fluid and blood into the client's retina causing distorted vision. Straight line may appear wavy. The client may experience blind spots and central vision loss. The bleeding blood vessels cause a scar to form causing permanent central vision loss. No cause exists for macular degeneration, but thought to be caused by heredity plus environmental factors such as diet, smoking, and obesity.

A client with bacterial conjunctivitis is prescribed erythromycin ophthalmic solution. The first time the client places the drops in the eye the drop burns, itches, and the eye becomes more red, increased photosensitivity and swelling. When the client reports this occurrence to the nurse, what is the appropriate response? A) Use the drops every other day B) Stoop using the drops C) This is expected. Continue using the drops. D) You will not be able to place many drops in that eye.

B. Allergic reaction to ophthalmic drops should be reported. The medication should be discontinued until the health care provider (HCP) is contacted and likely, a different antibiotic class of drops prescribed. Localized allergic reaction to an antibiotic has symptoms including increased pain, burning, itching, increased redness, photosensitivity, and swelling. Since ophthalmic drops can absorb into the system, a systemic reaction could occur, including rash to even anaphylactic symptoms of airway obstruction.

The client asks the nurse, Why is open-angle glaucoma considered the silent stealer of vision? Which response by the nurse explains this condition correctly? A) Open angle glaucoma causes gradual central vision loss. It often goes unnoticed until it becomes severe. B) Open angle glaucoma causes gradual peripheral vision loss. It often goes unnoticed until it is severe. C) Open angle glaucoma causes a cloud blur, which is so insidious, the client often just attributes it to dirty glasses. D) Open angle glaucoma has no warning. Suddenly, there is vision loss with severe pain in the eye and head.

B. Open-angle glaucoma occurs when the pathway of drainage between the cornea and the iris stays open, yet the trabecular network is partly blocked. Eye pressure builds up causing damage to the client's optic nerve. The most common type of glaucoma is open-angle glaucoma. Open-angle glaucoma causes gradual peripheral vision loss. It often goes unnoticed until it is severe. Other symptoms may include mild eye pain and tunnel vision. The client gradually loses peripheral vision. Gradual central vision loss is a symptom of cataracts.

Which action by the nurse will most impact the effectiveness of the client's ophthalmic solution prescribed to prevent infection post cataract surgery? A) Teaching the client to wash their hands prior to using the ophthalmic solution B) Teaching the client how to place the solution in the eye C) Teaching the client to wear the eyepatch during sleeping hours D) Teaching the client the importance of returning for the follow up visit

B. Ophthalmic drops need to be properly instilled to be effective. This is especially important when antibiotics and intraocular pressure lowering drops are prescribed. Permanent vision loss and systemic infection can occur if the prescribed medication is not properly placed in the eye. Proper placement techniques with return demonstration is important. The nurse's role in teaching how to instill eye drops can not be overemphasized.

A nurse is obtaining a history from a new client with glaucoma. The client indicates having read about the diagnosis and understanding that this type of glaucoma is due to the degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the aqueous humor. The loss of absorption will lead to an increased resistance, and thus a chronic, painless buildup of pressure in the eye. Which type of glaucoma has the client described? A. secondary B. open angle C. angle closure D. congenital

B. The client described open-angle glaucoma. This type of glaucoma develops painlessly, and visual changes occur slowly. As the IOP rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve.

The nurse recognizes the following as marker(s) of medication effectiveness in glaucoma control except: A. Visual field B. Opacity of the lens C. Lowering intraocular pressure to the target pressure D. Stable appearance of the optic nerve head

B. The main markers of the efficacy of the medication in glaucoma control are lowering of the intraocular pressure to the target pressure, stable appearance of the optic nerve head, and the visual field. Opacity of the lens relates to cataract formation.

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear? A. Phacoemulsification B. Scleral buckle C. Pneumatic retinopexy D. Pars plana vitrectomy

B. The scleral buckle is a procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. The other surgeries do not use this type of procedure.

Which question is most important for the nurse to ask the client before beginning timolol ophthalmic drops? A) Have you taken timolol before? B) Do you have a history of heart problems? C) Do you have a history of migraine headaches? D) Did you receive the flu vaccine?

B. Timolol is a beta-blocker that decreases the pressure of the eyes. The nurse should inquire about the client's history of heart problems because adverse side effects of timolol may include bradycardia, orthostatic hypotension, heart conduction problems, and syncope. Timolol should be avoided in asthma and chronic obstructive pulmonary disease clients due to timolol causing bronchospasms. Timolol is used to treat open-angle glaucoma. Severe allergic reactions to timolol may include a rash, face/tongue/throat swelling, difficulty breathing, and severe dizziness.

The registered nurse (RN) will educate the mother of a 5-year old son as to which issue can result in conjunctivitis? Select all that apply. A) Excessive shampoo getting in his eyes during bathing B) Excessive rubbing of the eyes in his sleep C) Environmental allergies affecting the eye D) Bacterial infection affecting the eye E) Viral infection affecting the eye

C, D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. This infection can be related to viral or bacterial infection, as well as allergic agents, such as pollen.

Postoperative health teaching for a patient who has had an intraocular lens implant is a vital nursing responsibility. Which of the following statements applies to this situation? Select all that apply. A. Avoid lying on the side of the affected eye for 72 hours. B. Avoid shampooing your hair for 48 hours. C. Wipe the closed eye from the inner canthus outward. D. Do not lift, pull, or push objects heavier than 15 pounds. E. Avoid bending the head forward for an extended time.

C, D, E. Hair shampooing may resume in 24 hours, if done cautiously. It is only necessary to avoid lying on the side of the affected eye for the first night after surgery. Refer to Box 49-7 in the text.

A client is prescribed timolol ophthalmic drops to decrease the intraocular eye pressure associated with glaucoma. Which comorbidity should the nurse notify the health care provider about? Select all that apply. A) Cataracts B) Diabetes C) Asthma D) Heart failure E) Bradycardia

C, D, E. Timolol ophthalmic drops are utilized to decrease the elevated intraocular eye pressure of a person with glaucoma. can easily enter the bloodstream and impose a systemic effect on the body. When beta blocker medications enter the body systemically, they lower the heart rate, blood pressure, and can narrow the bronchioles. This can cause a negative outcome if a client has asthma, severe COPD, severe heart failure, bradycardia, and other serious heart conditions (e.g., 2nd and 3rd degree heart block).

An older adult client is admitted with the diagnosis of retinal detachment and is scheduled for laser surgery and scleral buckling procedure. The nurse anticipates which symptom(s) to be exhibited in this client? Select all that apply. A. Complete loss of vision in both eyes B. Arcus senilis C. Cobwebs in vision field D. Flashing lights E. Loss of central vision F. Eye pain

C, D. Many clients with detached retina experience a sensation of a curtain or veil lowering over vision field, flashing of lights, floaters, cobwebs, or spots. Complete vision loss can occur in the affected eye. Loss of central vision, eye pain, and arcus senilis is not indicated in this disorder.

The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma? A. Diminished acuity B. Pain associated with a purulent discharge C. The presence of halos around lights D. A significant loss of central vision

C. Glaucoma is often called the silent thief of sight because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or halos around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.

The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform? A. Applies gentle pressure to the upper eyelid to keep the lid open while telling the client to gaze upward B. Holds down the lower lid of the eye by applying pressure on the eyeball and the cheekbone C. Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye D. Applies firm pressure to the upper and lower eyelids at the outer edges to keep eyelids in approximation

C. Punctal occlusion is done by applying gentle pressure to the inner canthus of each eye for 1 to 2 minutes immediately after eye drops are instilled. The nurse does not apply pressure to the eyeball when administering medications. The lower eyelid is held down to expose the conjunctival sac. The other action described will not aid in the retention or absorption of medication.

While providing home care instructions to the mother of a child diagnosed with allergic conjunctivitis, the registered nurse (RN) anticipates the healthcare provider to prescribe which drug therapy? Select all that apply. A) Sulfacetamide B) Fluoroquinolone C) Erythromycin D) Corticosteroid E) Antihistamine

D, E. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms. This is a highly contagious infection that can affect one or both eyes. The selected drug therapy will be dependent upon the type of conjunctivitis. In the presence of a bacterial infection, the drug therapy can include sulfacetamide or fluoroquinolone. In the presence of an infection related to allergies, the drug therapy can include steroids and antihistamines.

Several residents of a long-term care facility have developed signs and symptoms of viral conjunctivitis. What is the most appropriate action of the nurse who oversees care in the facility? A. Arrange for the administration of prophylactic antibiotics to unaffected residents. B. Instill normal saline into the eyes of affected residents two to three times daily. C. Swab the conjunctiva of unaffected residents for culture and sensitivity testing. D. Isolate affected residents from residents who have not developed conjunctivitis.

D.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as: A. Chronic open-angle. B. Chronic angle-closure. C. Normal tension. D. Acute angle-closure.

D. Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain.

A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure? A. Restore vision B. To relieve pain C. Reverse optic nerve damage D. Improve outflow drainage

D. Laser iridotomy or standard iridotomy is a surgical procedure that provides additional outlet drainage of aqueous humor. This is done to lower the IOP as quickly as possible since permanent vision loss can occur in 1 to 2 days. Once optic nerve damage occurs, it cannot be reversed, and vision is not restored. Pain that occurs with rising IOP will be controlled once pressure is lowered through improved outflow drainage.

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification? A. Amsler grid B. Retinoscope C. Tonometer D. Ophthalmoscope

D. The nurse is correct to provide an ophthalmoscope to the surgeon for examination of the optic disc. A retinoscope is used to determine errors in refraction. A tonometer measures intraocular pressure. An Amsler grid tests for problems with the macula.

Which of these client symptoms should the nurse report immediately to the health care provider (HCP)? A) Gradual central vision changes B) Gradual peripheral vision blur C) Sudden onset of watering eyes D) Sudden onset of extreme eye pain

D. The nurse should report the sudden onset of extreme eye pain immediately to the health care provider (HCP). This is a sign of closed-angle glaucoma and is a medical emergency. Closed-angle glaucoma is sudden onset of intraocular pressure that occurs when there is closure or blockage of drainage between the iris and cornea causing pressure to build up in the eye where fluid has accumulated and cannot circulate throughout the eye. The trabecular network becomes obstructed and damaged. Symptoms may include nausea, vomiting, sudden headache, extreme eye pain, and blurred vision. Closed-angle glaucoma is like closing a door suddenly with your fingers inside. The client may see halos surrounding lights. Symptoms are sudden and severe and a medical emergency, so the health care provider (HCP) should be notified immediately.

What explanation will the registered nurse (RN) implement to best explain conjunctivitis to the mother of a 5 year old diagnosed with this infection? A) Conjunctivitis is the inflammation of the conjunctiva of the eye. B) Conjunctivitis is irritation of the sclera and conjunctiva of the eye. C) Conjunctivitis is distortion of the covering of the eyelid and eyeball. D) Conjunctivitis is swelling of the lining of the inner eyelid and eyeball.

D. This answer is correct because the explanation conjunctivitis is swelling of the lining of the inner eyelid and eyeball is the best explanation for the RN to provide to the mother. Conjunctivitis is an inflammation or erythema of the conjunctiva of the eye. The conjunctiva is a thin membrane covering of the inner eyelid and sclera of the eye. This is a common eye infection because the conjunctiva is ongoingly exposed to environmental microorganisms.

An ophthalmologist is working with a client who believes his macular degeneration has progressed. Which diagnostic test might be implemented to confirm progression diagnosis? A) Visual acuity test B) Tonometry C) Autofluorescence D) Amsler grid

D. When an ophthalmologist suspects progression of macular degeneration, the health care provider (HCP) might conduct an amsler grid test. An Amsler grid test checks the client's eyes to detect lines that might look distorted or wavy and to assess for areas of the client's visual field that may be missing. The grid should be taped at the client's eye level so the client has consistent non-glaring light. This grid can help the health care provider (HCP) detect progression of dry AMD to wet AMD early while the disease is still treatable. The grid appears to look like graph paper and has a small dot at the center of the graph. Dry AMD is when the eye blood vessels don't drain or leak. Wet AMD is the worst type of AMD and is caused by eye growth of irregular blood vessels that leak into the retinal center or the macular. The bleeding and leaking of blood vessels creates permanent loss of vision.