Ch.63 Assessment and Management of Patients with Eye and Vision Disorders

The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient?

Blurred vision results after application.

Which medication classification increases aqueous fluid outflow in the client with glaucoma?

Cholinergics

A nurse is performing an eye examination. Which question would not be included in the examination?

"Are you able to raise both eyebrows?"

The nurse is teaching the client to instill eye drops. Which statement is correct?

"Wash your hands before and after instilling eye drops and do not touch the tip of the bottle."

An 8th grade boy comes to the school nurse and tells the nurse that he had an eye exam the day before. He says the eye doctor told him he had astigmatism and that meant his eyeball wasn't shaped right. The boy is concerned because he says he went home and looked in the mirror and both eyes looked just alike. What is the school nurse's best response?

"Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes."

Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse?

"It means corrective lenses are required."

Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?

"My eyelids were stuck together this morning."

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse?

"Prescriptions of this medication are generally not given because it can cause corneal problems."

The nurse is instructing a nursing student when a new client comes to the eye clinic. The client explains that he thinks he has a corneal abrasion. The nurse should explain what to the student nurse?

"To detect corneal abrasions, a slit lamp is used."

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?

"You'll need to use the drops for the rest of your life to control the glaucoma."

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?

20/200

When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following?

20/50-3

A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal?

25 mm Hg

The ophthalmologist tells a patient that he has increased intraocular pressure (IOP). The nurse understands that increased pressure resulting from optic nerve damage is indicated by a reading of:

>21 mm Hg.

Which type of glaucoma presents an ocular emergency?

Acute angle-closure glaucoma

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of?

Adhere to the medication regimen.

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?

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.

Which term refers to the absence of the natural lens?

Aphakia

The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform?

Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye

A nurse is caring for a client scheduled to have angiography of the right eye in 1 hour. What is the highest priority nursing intervention?

Assess blood urea nitrogen (BUN) and creatinine levels.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important?

Avoid any activity that can increase intraocular pressure.

A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography?

BUN and creatinine Prior to the angiography, the patient's blood urea nitrogen (BUN) and creatinine should be checked to ensure that the kidneys will excrete the contrast agent

A client is color blind. The nurse understands that this client has a problem with:

Cones

Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?

Coumadin Withhold this to reduce the risk for retrobulbar hemorrhage

During a routine physical examination, the nurse practitioner notes that a 72-year-old patient has a significant loss of ability to discriminate words. The patient also states that he has noticed that he has trouble hearing high-frequency sounds. The nurse suspects that the patient has an age-related change in his ears known as:

Degeneration of the organ of Corti.

Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests?

Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss

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?

Explain the therapeutic effect and expected outcome of the medication.

The nurse is providing care to a client who has been admitted to the hospital for treatment of an infection. The client is visually impaired. Which of the following would be most appropriate for the nurse to do when interacting with the client?

Face the client when speaking directly to him.

The nurse should monitor for which manifestation in a client who has had LASIK surgery?

Halos and glare

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry red in color?

Hemangioma

A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?

Hemorrhage

The nurse is obtaining a visual history from a client who has noted an increase in glare and changes in color perception. Which assessment would the nurse anticipate to confirm a definitive diagnosis?

Identification of opacities on the lens

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?

Improve outflow drainage

A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness?

Ishihara

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer?

Laser-assisted stromal in situ keratomileusis (LASIK)

A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing:

Loss of accommodative power in the lens.

A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication?

Lowering intraocular pressure to target pressure

Which group of medications causes pupillary constriction?

Miotics

During an intial assessment, the nurse notes a symptom of a mild case of bacterial conjunctivitis and documents in the electronic medical record that the client is displaying which of the following ?

Mucopurulent ocular discharge

Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following?

Myopia

During a routine eye examination, a patient complains that she is unable to read road signs at a distance when driving her car. What should the patient be assessed for?

Myopia

To avoid the side effects of corticosteroids, which medication classification is used as an alternative in treating inflammatory conditions of the eyes?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A nurse practitioner is assessing a patient who is experiencing changes in her vision. The nurse performs the following steps. Place them in the order in which the nurse would complete them. Use all options.

Obtain an ocular history Test visual acuity Examine the external eye Perform direct ophthalmoscopy

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?

Ophthalmoscope

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:

Ophthalmoscopy. 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.

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal?

Retinal Angiography

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?

Scleral buckle

A nurse is assessing a pediatric client in a public health clinic. The parent states that the client has been sneezing and rubbing the eyes. The nurses observes the client's eyes and documents objective symptoms of watery and red eyes. When reporting to the physician the assessment findings, which word is appropriate?

Signs and symptoms of conjunctivitis

Which of the following occurs when there is deviation from perfect ocular alignment?

Strabismus

When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is:

The presence of halos around lights.

A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection?

To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.

Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection?

Viral

A client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent:

increased intraocular pressure (IOP).

A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition?

hyperopia

Which would be an advanced stage finding in a client with wet macular degeneration?

inability to see images by looking at them directly

A client has noticed needing to hold printed material at arms length to make the print readable. What is the term used to describe this visual condition?

presbyopia

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client:

pulls the tissue near the cheek downward to instill medication.

When the client tells the nurse that his vision is 20/200 and then asks what that means, the nurse informs the client that a person with 20/200 vision

sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

A client is having a routine eye examination. The procedure being performed is done by using an instrument to indent or flatten the surface of the eye. This is known as ________ and it is routinely done to test for ________.

tonometry; intraocular pressure