Eye Diseases
A woman was working in her garden. She accidentally sprayed insecticide into her right eye. She calls the emergency department, frantic and screaming for help. The nurse should instruct the woman to take which immediate action? 1. Irrigate the eyes with water. 2. Come to the emergency department. 3. Call the primary health care provider (PHCP). 4. Irrigate the eyes with diluted hydrogen peroxide.
Answer: 1 Rationale: In this type of accident, the client is instructed to irrigate the eyes immediately with running water for at least 20 minutes, or until the emergency medical services personnel arrive. In the emergency department, the cleansing agent of choice is usually normal saline. Calling the PHCP and going to the emergency department delays necessary intervention. Hydrogen peroxide is never placed in the eyes. Test-Taking Strategy: Note the strategic word, immediate. Focus on the type of injury and eliminate options 2 and 3 because they delay necessary intervention. Next, eliminate option 4 because hydrogen peroxide is never placed in the eyes.
During the early postoperative period, a client who has undergone a cataract extraction complains of nausea and severe eye pain over the operative site. What should be the initial nursing action? 1. Call the surgeon. 2. Reassure the client that this is normal. 3. Turn the client onto her or his operative side. 4. Administer the prescribed pain medication and antiemetic.
Answer: 1 Rationale: Severe pain or pain accompanied by nausea following a cataract extraction is an indicator of increased intraocular pressure and should be reported to the surgeon immediately. Options 2, 3, and 4 are inappropriate actions. Test-Taking Strategy: Note the strategic word, initial, and the word severe. Eliminate option 2 because this is not a normal condition. The client should not be turned to the operative side; therefore, eliminate option 3. From the remaining options, focusing on the strategic word will direct you to the correct option.
The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which intervention should be initiated immediately? 1. Apply ice to the affected eye. 2. Irrigate the eye with cool water. 3. Notify the primary health care provider (PHCP). 4. Accompany the client to the emergency department.
Answer: 1 Rationale: Treatment for a contusion begins at the time of injury. Ice is applied immediately. The client then should be seen by a PHCP and receive a thorough eye examination to rule out the presence of other eye injuries. Test-Taking Strategy: Focus on the strategic word, immediately. Recalling the principles related to initial treatment of injuries and noting the type of injury sustained will direct you to the correct option.
The nurse is preparing to test the visual acuity of a client, using a Snellen chart. Which identifies the accurate procedure for this visual acuity test? 1. The right eye is tested, followed by the left eye, and then both eyes are tested. 2. Both eyes are assessed together, followed by an assessment of the right eye and then the left eye. 3. The client is asked to stand at a distance of 40 feet (12 meters) from the chart and to read the largest line on the chart. 4. The client is asked to stand at a distance of 40 feet (12 meters) from the chart and to read the line that can be read 200 feet (60 meters) away by an individual with unimpaired vision.
Answer: 1 Rationale: Visual acuity is assessed in 1 eye at a time, and then in both eyes together, with the client comfortably standing or sitting. The right eye is tested with the left eye covered; then the left eye is tested with the right eye covered. Both eyes are then tested together. Visual acuity is measured with or without corrective lenses, and the client stands at a distance of 20 feet (6 meters) from the chart. Test-Taking Strategy: Remember that normal visual acuity as measured by a Snellen chart is 20/20 vision. This should assist in eliminating options 3 and 4, because they are comparable or alike in that they indicate standing at a distance of 40 feet (12 meters). From the remaining options, remember that it is best and most accurate to test each eye separately and then test both eyes together.
The nurse is caring for a client following enucleation to treat an ocular tumor and notes the presence of bright red drainage on the dressing. Which action should the nurse take at this time? 1. Document the finding. 2. Continue to monitor the drainage. 3. Notify the primary health care provider (PHCP). 4. Mark the drainage on the dressing and monitor for any increase in bleeding.
Answer: 3 Rationale: If the nurse notes the presence of bright red drainage on the dressing, it must be reported to the PHCP, because this indicates hemorrhage. Options 1, 2, and 4 are inappropriate at this time. Test-Taking Strategy: Determine if an abnormality exists. Note the words, bright red. Since an abnormality does exist, eliminate options that state to document and continue to monitor because an action is needed.
The nurse is preparing a teaching plan for a client who had a cataract extraction with intraocular implantation. Which home care measures should the nurse include in the plan? Select all that apply. 1. Avoid activities that require bending over. 2. Contact the surgeon if eye scratchiness occurs. 3. Take acetaminophen for minor eye discomfort. 4. Expect episodes of sudden severe pain in the eye. 5. Place an eye shield on the surgical eye at bedtime. 6. Contact the surgeon if a decrease in visual acuity occurs.
Answer: 1, 3, 5, 6 Rationale: Following eye surgery, some scratchiness and mild eye discomfort may occur in the operative eye and usually is relieved by mild analgesics. If the eye pain becomes severe, the client should notify the surgeon, because this may indicate hemorrhage, infection, or increased intraocular pressure (IOP). The nurse also would instruct the client to notify the surgeon of increased purulent drainage, increased redness, or any decrease in visual acuity. The client is instructed to place an eye shield over the operative eye at bedtime to protect the eye from injury during sleep and to avoid activities that increase IOP, such as bending over. Test-Taking Strategy: Focus on the subject, postoperative care following eye surgery. Recalling that the eye needs to be protected and that increased IOP is a concern will assist in determining the home care measures to be included in the plan.
A client arrives in the emergency department with a penetrating eye injury from wood chips that occurred while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye. What is the initial nursing action? 1. Apply an eye patch. 2. Perform visual acuity tests. 3. Irrigate the eye with sterile saline. 4. Remove the piece of wood using a sterile eye clamp.
Answer: 2 Rationale: If the eye injury is the result of a penetrating object, the object may be noted protruding from the eye. This object must never be removed except by the ophthalmologist, because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the cornea. Test-Taking Strategy: Note the strategic word, initial, and note the word penetrating. This should indicate that a laceration has occurred and that interventions are directed at preventing further disruption of the integrity of the eye. The only option that will prevent further disruption is to assess visual acuity.
Tonometry is performed on a client with a suspected diagnosis of glaucoma. The nurse looks at the documented test results and notes an intraocular pressure (IOP) value of 23. What should be the nurse's initial action? 1. Apply normal saline drops. 2. Note the time of day the test was done. 3. Contact the primary health care provider (PHCP). 4. Instruct the client to sleep with the head of the bed flat.
Answer: 2 Rationale: Tonometry is a method of measuring intraocular fluid pressure. Pressures between 10 and 21 mm Hg are considered within the normal range. However, IOP is slightly higher in the morning. Therefore, the initial action is to check the time the test was performed. Normal saline drops are not a specific treatment for glaucoma. It is not necessary to contact the PHCP as an initial action. Flat positions may increase the pressure. Test-Taking Strategy: Focus on the subject, normal IOP, and note the strategic word, initial. Remember that normal IOP is between 10 and 21 mm Hg and the pressure may be higher in the morning.
A client's vision is tested with a Snellen chart. The results of the tests are documented as 20/60. What action should the nurse implement based on this finding? 1. Provide the client with materials on legal blindness. 2. Instruct the client that he or she may need glasses when driving. 3. Inform the client of where he or she can purchase a white cane with a red tip. 4. Inform the client that it is best to sit near the back of the room when attending lectures.
Answer: 2 Rationale: Vision that is 20/20 is normal—that is, the client is able to read from 20 feet (6 meters) what a person with normal vision can read from 20 feet (6 meters). A client with a visual acuity of 20/60 can only read at a distance of 20 feet (6 meters) what a person with normal vision can read at 60 feet (18 meters). With this vision, the client may need glasses while driving in order to read signs and to see far ahead. The client should be instructed to sit in the front of the room for lectures to aid in visualization. This is not considered to be legal blindness. Test-Taking Strategy: Focus on the subject, interpreting a Snellen chart result. Note the test result, 20/60, and recall the associated interventions for this result. Also, eliminate options 1 and 3, as they are comparable or alike, implying that the test results indicate blindness.
The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care? 1. Avoid overuse of the eyes. 2. Decrease the amount of salt in the diet. 3. Eye medications will need to be administered for life. 4. Decrease fluid intake to control the intraocular pressure.
Answer: 3 Rationale: The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of her or his life. Options 1, 2, and 4 are not accurate instructions. Test-Taking Strategy: Focus on the subject, client teaching for glaucoma. Recalling that medications are an integral component of the treatment plan will assist in directing you to the correct option.
The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which sign or symptom is associated with this eye problem? 1. Total loss of vision 2. Pain in the affected eye 3. A yellow discoloration of the sclera 4. A sense of a curtain falling across the field of vision
Answer: 4 Rationale: A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is falling across the field of vision. No pain is associated with detachment of the retina. Options 1 and 3 are not characteristics of this problem. A retinal detachment is an ophthalmic emergency, and even more so if visual acuity is still normal. Test-Taking Strategy: Focus on the subject, manifestations of retinal detachment. Thinking about the pathophysiology associated with this problem will direct you to the correct option.
The nurse is performing an assessment on a client with a suspected diagnosis of cataract. Which clinical manifestation should the nurse expect to note in the early stages of cataract formation? 1. Diplopia 2. Eye pain 3. Floating spots 4. Blurred vision
Answer: 4 Rationale: A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception. Options 1, 2, and 3 are not characteristics of a cataract. Test-Taking Strategy: Note the strategic word, early. Remember the pathophysiology related to cataract development. As a cataract develops, the lens of the eye becomes opaque. This description will assist in directing you to the correct option.
A patient with bilateral cataracts is scheduled for an extracapsular cataract extraction with an intraocular lens implantation of one eye. What should be done by the nurse preoperatively? a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance. b. Inform the patient that the operative eye will need to be patched for 3 to 4 days postoperatively. c. Assure the patient that vision in the operative eye will be improved to near normal on the first postoperative day. d. Teach the patient routine coughing and deep-breathing techniques to use postoperatively to prevent respiratory complications.
Answer: a Assessment of the visual acuity in the patient's unoperated eye enables the nurse to determine how visually compromised the patient may be while the operative eye is patched and healing and to plan for assistance until vision improves. The patch on the operative eye is usually removed within 24 hours and although vision in the eye may be good, it is not unusual for visual acuity to be reduced immediately after surgery. Activities that are thought to increase intraocular pressure, such as bending, coughing, and Valsalva maneuver, are restricted postoperatively.
Which characteristics of glaucoma are associated with only primary angle-closure glaucoma (PACG)? (select all that apply) a. Caused by lens blocking papillary opening b. Treated with trabeculoplasty or trabeculectomy c. Causes loss of central vision with corneal edema d. Treated with β-adrenergic blockers such as betaxolol (Betoptic) e. Causes sudden, severe eye pain associated with nausea and vomiting f. Treated with hyperosmotic oral and IV fluids to lower intraocular pressure
Answer: a, c, e, f. The other answers are associated with primaryopen-angle glaucoma (POAG).
When teaching the patient about the new diagnosis of glaucoma, which characteristics of glaucoma are associated with only primary open-angle glaucoma (POAG)? select all that apply. a. Gradual loss of peripheral vision b. Treated with iridotomy or iridectomy c. Causes loss of central vision with corneal edema d. May be caused by increased production of aqueous humore. Treated with cholinergic agents such as pilocarpine (Pilocar)f. Resistance to aqueous outflow through trabecular meshwork
Answer: a, d, f The other answers are associated with primary angle closure glaucoma (PACG).
What nursing action is most important for the patient with age-related macular degeneration(AMD)? a. Teach the patient how to use topical eyedrops for treatment of AMD. b. Emphasize the use of vision enhancement techniques to improve what vision is present. c. Encourage the patient to undergo laser treatment to slow the deposit of extracellular debris. d. Explain that nothing can be done to save the patient's vision because there is no treatment for AMD.
Answer: b The patient with AMD can benefit from low-vision aids despite increasing loss of vision and it is important to promote a positive outlook by not giving patients the impression that "nothing can be done" for them.Laser treatment may help a few patients with choroidal neovascularization and photodynamic therapy is indicated for a small percentage of patients with wet AMD but there is no treatment for the increasing deposit of extracellular debris in the retina.
A 60-year old patient is being prepared for outpatient cataract surgery. When obtaining admission data from the patient, what would the nurse expect to find in the patient's history? a. A painless, sudden, severe loss of vision b. Blurred vision, colored halos around lights, and eye pain c. A gradual loss of vision with abnormal color perception and glare d. Light flashes, floaters, and a "cobweb" in the field of vision with loss of central or peripheral vision
Answer: c The lens opacity of cataracts causes a decrease in vision, abnormal color perception, and glare. Blurred vision, halos around lights, and eye pain are characteristic of glaucoma.Light flashes, floaters, and "cobwebs" or "hairnets" in the field of vision followed by a painless, sudden loss of vision are characteristic of detached retina
A patient with wet AMD is treated with photodynamic therapy. What does the nurse instruct the patient to do after the procedure? a. Maintain the head in an upright position for 24 hours. b. Avoid blowing the nose or causing jerking movements of the head. c. Completely cover all the skin to avoid a thermal burn from sunlight. d. Expect to experience blind spots where the laser has caused retinal damage.
Answer: c Verteporfin, the dye used with photodynamic therapy to destroy abnormal blood vessels, is a photosensitizing drug that can be activated by exposure to sunlight or other high-intensity light. Patients must cover all of their skin to avoid thermal burns when exposed to sunlight. Blind spots occur with laser photocoagulation used for dry AMD. Head movements and position are not of concern following this procedure.
What is an important health promotion nursing intervention related to glaucoma? a. Teaching individuals at risk for glaucoma about early signs and symptoms of the disease b. Preparing patients with glaucoma for lifestyle changes necessary to adapt to eventual blindness c. Promoting regular measurements of intraocular pressure for early detection and treatment of glaucoma d. Informing patients that glaucoma is curable if eye medications are administered before visual impairment has occurred
Answer: c Because glaucoma develops slowly and without symptoms, it is important that intraocular pressure be evaluated every 2 to 4 years in persons between the ages of 40 and 64 and every 1 to 2 years in those over 65 years old. More frequent measurement of intraocular pressure should be done in a patient with a family history of glaucoma, African American patients, and a patient with diabetes or cardiovascular disease. The disease is chronic but vision impairment is preventable in most cases with treatment.
A patient with early cataracts tells the nurse that he is afraid cataract surgery may cause permanent visual damage. What should the nurse teach the patient? a. The cataracts will only worsen with time and should be removed as early as possible to prevent blindness. b. Cataract surgery is very safe, and with the implantation of an intraocular lens, the need for glasses will be eliminated. c. Progression of the cataracts can be prevented by avoidance of ultraviolet (UV) light and good dietary management. d. Vision enhancement techniques may improve vision until surgery becomes an acceptable way to maintain desired activities.
Answer: d Although cataracts do become worse with time, surgical extraction is considered an elective procedure and is usually performed when the patient decides that he or she wants or needs to see better for his or her lifestyle. There are no known measures to prevent cataract development or progression. Surgical extraction is safe but the patient will still need glasses for near vision and for any residual refractive error of the implanted lens.
